Identifying self-care needs of patients with chronic obstructive pulmonary disease to design a mobile phone application-based self-care program

Abstract

BACKGROUND:

Self-care programs based on mobile phone applications facilitate the management and control of chronic obstructive pulmonary disease (COPD), and identifying self-care needs is necessary for designing such programs. This study aims to identify the needs of COPD patients to design a self-care program based on a mobile phone application.

MATERIALS AND METHODS:

In this multi-method study, the self-care needs of COPD patients were identified with two approaches: literature review and quantitative content analysis. Articles were extracted through a comprehensive review of studies from the past 10 years. Self-care needs were identified via semi-structured interviews with 18 participants.

RESULTS:

In the literature review, out of 1,671 articles retrieved, 27 were selected by removing duplicate and unrelated articles. In the qualitative research, three categories of educational needs were identified: the maintenance of psycho-emotional health, physical health, and effective communication and support. After combining the extracted needs, the patients’ self-care requirements were categorized into three areas: physical health, enhancement and promotion of psycho-emotional well-being, and effective communication and connection with healthcare professionals, family, friends, and community.

CONCLUSION:

The needs identified in the present study were divided into three groups: the need to improve and enhance psycho-emotional status; the need to improve physical status; and the need to establish effective communication with healthcare professionals, family members, and community; which can be used in designing a self-care program based on a mobile application.

Introduction

Chronic obstructive pulmonary disease (COPD) is a leading cause of death globally, predicted to be the fourth leading cause of death by 2040.[1] This disease is characterized by persistent respiratory symptoms and chronic airflow limitation[2]; however, it also has systemic metabolic, musculoskeletal, hematological, and cardiovascular implications.[1] Because of the high prevalence of the disease, the disability associated with COPD significantly reduces the quality of life, creating both social and economic burdens.[3] Although COPD is not curable, both pharmaceutical and non-pharmaceutical interventions are essential based on the severity of symptoms. Among the non-pharmacological methods, self-care programs can slow disease progression and help manage and control the disease.[4] Although the management of this disease is difficult and complex due to its heterogeneous status, symptom burden, fluctuating symptoms, and continuous hospitalizations, self-care interventions can encourage people to engage in the behaviors they need to successfully manage the disease.[5] Self-care requires the active role of patients in symptom management, treatment, and psychological, social, and lifestyle changes, ultimately improving quality of life and health outcomes.[6]

To achieve an optimal self-care plan, it is essential to identify the needs of patients, including the training and learning skills necessary for self-monitoring, symptom awareness, and lifestyle modifications.[7] Adapting educational programs to the needs of each patient can improve learning results. Research indicates that patient-driven interventions are more effective than those designed with external input on learning needs.[8] Consequently, further research is necessary to understand patients’ needs from their perspective.[9] Recognizing the needs of patients and implementing self-care programs can significantly enhance patient autonomy while simultaneously reducing rates of hospitalization, alleviating symptoms, and decreasing associated costs,[10] while Insufficient knowledge of the patient’s needs and barriers to self-care programs, along with a lack of time, skills, and motivation among patients, may hinder the successful implementation of self-care programs at the bedside.[11] With advancements in technology, there are emerging methods to enhance self-care behaviors among patients, particularly through the application of communication and information technology. Given the widespread availability and popularity of smartphones, a mobile phone-based self-care approach could provide an innovative means to motivate patients. This strategy encourages individuals to take responsibility for their health by addressing high-risk behaviors. Additionally, it helps mitigate the fatigue associated with regular clinic visits, ultimately saving time for both patients and healthcare providers.[12] Recent studies have demonstrated the advantageous effects of mobile phone-based self-care interventions.[13,14] The World Health Organization (WHO) has recommended using mobile applications and telemedicine tailored to patients’ needs to enhance treatment outcomes and care for those with COPD.[15] Some research has demonstrated that the active participation of beneficiaries in the development of new technologies, coupled with a focus on addressing their specific needs, significantly reduces resistance and enhances the overall acceptance of these technologies.[16] Meanwhile, patients in Iran remain engaged with conventional methods of treatment and care. This study aimed to identify the needs of patients with COPD to design and implement a self-care program using a mobile phone application.

Materials and Methods

There is a limited history of self-care applications for COPD in Iran. Most of these applications are primarily focused on their interactive features rather than addressing the specific needs of patients. However, there are a few exceptions that successfully incorporate both scientific content and user feedback into their design.[17] In the present study, the design of a self-care application for COPD patients is based on the identified needs of the patients through a simultaneous qualitative and quantitative approach. The more the application’s features and structure are tailored to the needs of the target audience, the greater its usability and acceptability.

The conceptual framework for the design of this study was adapted from Peffers et al.[18] approach, one of the most widely cited conceptual frameworks for conducting research in design science. The framework implementation steps include:

1. Problem identification

2. Objectives of a solution

3. Design and development (of a product)

4. Demonstration

5. Evaluation

6. Communication.

This multi-method study was conducted at the Shahid Sayad Shirazi Hospital, a major referral hospital associated with Golestan University of Medical Sciences in Gorgan, northeastern Iran. The self-care needs of patients with COPD were extracted in the following two ways:

1. Determining the self-care needs of patients with COPD through a literature review

   To determine the self-care needs of patients with COPD, a goal-oriented method based on subject syntax was used. To achieve this, a list of keywords with MeSH terms related to self-care needs assessment in patients with COPD was created, followed by a comprehensive review of relevant studies and documents in scientific databases. Documents in English published in the last decade were retrieved from databases such as Web of Science, PubMed, ProQuest, Google Scholar, and Scopus using the following keywords: chronic obstructive pulmonary disease, COPD AND self-management, self-care AND needs, and preferences. Articles in Persian were obtained from SID, IranDoc, and Magiran databases. The retrieved articles were entered into Endnote, and duplicate entries were removed. The title and abstract of the articles were reviewed and related articles were identified. Then, the full text of the identified studies was extracted based on the following inclusion criteria: any articles in either English or Persian related to the self-care needs of patients with COPD, the availability of the full text, and being published between October 2003 and October 2023. Initially, 1,671 articles were identified through the searches. After a thorough review based on the inclusion criteria and the removal of duplicates, the full texts of 25 articles were retrieved [Figure 1]

2. Explaining the self-care needs of patients with COPD

   To explain the self-care needs of COPD patients, a quantitative content analysis approach was used. Inclusion criteria included patients diagnosed with COPD by a physician, a willingness to participate in the study, and a sufficient clinical condition to take part as determined by the treating physician. Patients suffering from other chronic respiratory diseases such as lung cancer, asthma, etc., were excluded. Data were collected through semi-structured in-depth interviews that began with a general, open-ended question: “Can you describe a typical day living with the disease?” Follow-up questions included: “How do you take care of yourself?” “What kind of care do you require?” “What needs are your top priorities?” and “How much have you been able to manage the disease through self-care?” To further enrich the data, findings from the literature review were used in designing the interview questions. During the interviews, probing questions such as “Can you explain more?” and “What do you mean?” were used. At the beginning of each interview, after self-introduction, the researcher explained the study objectives and obtained consent from all participants. Permission was also obtained to record the interviews and all ethical considerations were observed. All interviews were transcribed verbatim and in order within the first 24 hours. Sampling continued until data saturation i.e., no new analysis unit was obtained, and data saturation was reached with 18 participants. The interviews were conducted from November 2023 to April 2024. The interviews lasted an average of 40 min, depending on the patient’s condition and sometimes due to their inability to speak because of breathing difficulties.

Figure 1.

Selection of articles on self-care needs of patients with COPD from scientific

Data analysis was conducted using a quantitative content analysis approach. The text from the interviewees’ statements was divided and counted based on the length of the sentences. This analysis helped determine the extent to which different areas of need were addressed in the responses of each interviewee. In each interview, the frequency of the main themes was counted. After identifying the self-care needs of COPD patients through the literature review and quantitative content analysis, these needs were organized according to the key goals of the self-care interventions, leading to a clear determination of the final self-care needs of the patients.

Ethical considerations

The present study received approval from the ethics committee of the Golestan University of Medical Sciences under the number IR.GOUMS.REC.1402.036. Ethical principles including respect for the participants, willingness or unwillingness to participate in the study, the right to withdraw, and confidentiality of information were observed. The participants were accompanied by family members during the interviews, and their general condition was continuously monitored.

Results

The findings of the literature review section were the result of an analysis of 25 articles, mainly quantitative and qualitative studies, from 2003 to 2023 [Table 1]. The results indicated that self-care interventions are beneficial in helping individuals with COPD adapt to changing symptoms and make informed decisions regarding the management of their chronic condition.[19]

Table 1.

The extracted articles related to the self-care needs of COPD patients from the literature review

Order		Author /publication year		Study type		Self-care needs
1		Hang Ding et al., 2019[20]		Clinical trial		- Correct use of medicines - Lifestyle modification - Avoiding risk factors - Monitoring symptoms and taking timely action
2		Hanna Sandelowsky et al., 2019[21]		Cross-sectional		- Diet - Exercise - Information about the disease - How to take medication and quit smoking
3		Stalia SL Wong et al., 2014[22]		Qualitative		- Lack of knowledge about the disease - Physical and psychosocial complications caused by disease symptoms - Not knowing the correct self-care plan
4		Marc Miravitlles et al., 2023[23]		Review		- Smoking cessation and assessment of environmental exposures - Pulmonary rehabilitation with physical activity and nutritional care, oxygen therapy
5		Ainee Khan et al., 2017[24]		Cohort		- Taking medications - Quit smoking - Vaccination - Sports activity - Necessary knowledge about the disease and exacerbation of symptoms
6		Josette Askratni et al., 2018[25]		Documentary and interventional analysis		- Medication management - Nutrition - Smoking cessation - Physical activity - Activity program - Education about the disease communication
7		Manbinder S Sidhu et al., 2015[26]		Clinical trial		- Rapid access to treatments during exacerbation of symptoms - Breathing techniques - Exercise - Dietary programs and stress management - Smoking cessation
8		McCabe C et al., 2017[27]		Review		Educational and motivational information about: - Exercise - Smoking cessation - Diet - Symptom management
9		Lenferink A et al., 2017[28]		Review		Action plan Educating patients for a quicker diagnosis of symptoms. Expediting the initiation of appropriate treatment and controlling symptoms of disease exacerbation
10		Ad A Kaptein et al., 2014[29]		Review		- Medication management - Symptom management - Management of psychological consequences - Lifestyle adjustment - Use of social support - Effective communication
11		YJG Korpershoek et al., 2016[30]		Exploratory cross-sectional		- Management of symptoms and prevention of complications - Medication - Exercise and diet - Breathing technique and contact with health professionals
12		Carole Gardener et al., 2018[31]		Review		- Knowledge of the disease - Symptom management and medication use - Healthy lifestyle - Management of emotions - Living positively with illness and thinking about the future - Anxiety and depression - Functional and financial support - Communication with family and friends, social life, and entertainment - Independence - Services
13		Jonina Sigurgeirsdottir et al., 2019[32]		Qualitative		- Quitting smoking - Anxiety management - Information about the disease - Healthy lifestyle - Periodic checkup and visit - The need for good support, entertainment, and maintaining social relationships - Coping with shortness of breath: constant feeling of suffocation and lack of energy
14		Ana Cravo et al., 2022[19]		Review		- Monitoring symptoms, quick diagnosis, and timely action - Medication use - Vaccination - Smoking cessation - Healthy diet and physical activity
15		Lindsay Apps et al., 2013[33]		Combinational		- Promoting physical activity - Smoking cessation - Managing social interactions - Managing medications - Enabling patients to recognize and respond to symptoms
16		Lian Hong Wang et al., 2020[34]		Clinical trial		- Information about the disease - Breathing techniques - Medication and use of inhalers - Coughing technique - Non-pharmaceutical strategies for symptom management - Appropriate exercise - Quitting smoking and oxygen therapy if needed
17		Argyroula Kalaitzaki et al., 2023[35]		Cross-sectional		- Teaching breathing exercises - Appropriate exercise program - Treatment of shortness of breath - Maintaining weight - Maintaining hope and optimism - Increased fluid intake
18		Heleen Westland et al., 2022[36]		Delphi method		- Taking medicines - Coughing technique to clear the airway - Calling a doctor - Teaching breathing exercises and the use of oxygen - Nutrition tips and increasing appetite - Controlling shortness of breath - Fever management - Fatigue relief training
19		Mobina Bahador et al., 2023[37]		Clinical trial		- Pulmonary rehabilitation - Relaxation - Breathing exercises to improve lung capacity
20		Mahnaz Ilkhani et al., 2023[38]		Review		- Adhering to a proper diet - How to comply with the prescribed medication regimen - Daily activity, exercise, and physical activity - Eliminating harmful habits such as smoking - Counseling and communicating with friends, family, social support - Methods of using oxygen devices and inhalers
21		Omidi et al., 2015[39]		Semi-experimental		- Information about the disease Diet and daily activity - Drug regimen - Physical activity and elimination of harmful habits such as smoking - Family and non-family support - Use of oxygen device and inhaler
22		Abedi et al., 2012[40]		Descriptive-correlational		- Examination and control of disease symptoms - Acceptance of treatment regimen - Maintaining a healthy lifestyle - Disease control - Daily functioning, emotions and social relationships
23		Hannele Siltanen et al., 2020[41]		Descriptive - cross-sectional		- Management of exacerbation of symptoms - Diet - Fatigue - Stress and anxiety - Sexual needs - Palliative care
24		Deborah Morrison et al., 2017[11]		Review		- Self-monitoring of symptoms and timely identification of worsening of symptoms, and timely action - Adherence to treatments - Quitting smoking and avoiding stimulants - Periodic visits - Improving lifestyle (exercise, diet, and stress reduction)
25		Schrijver et al., 2022[5]		Review		- Correct use of drugs (adherence to drug regimen and inhalation technique) - Increasing the level of physical activity - Smoking cessation - Management of shortness of breath - Use of energy conservation techniques - Avoiding aggravating factors such as pollution and cigarette smoke - Using stress management strategies

The definitions of self-care programs have evolved significantly over time. Currently, approaches classified as needs-based self-care interventions are characterized by considerable heterogeneity. These interventions can range from the straightforward provision of information to more complex strategies encompassing multiple components.[42] Therefore, in 2016, a group of international experts agreed that a structured self-care intervention tailored to the needs of COPD patients is essential to enhance patient motivation and involvement while supporting the adoption of healthy behaviors and the development of critical management skills.[5] In the current study, the needs of patients with COPD were categorized into three main groups based on the key objectives of self-care interventions: 1. the need to improve physical health, 2. the need to enhance psycho-emotional well-being, and 3. the need for effective communication with healthcare professionals, family, friends, and the community [Table 2].

Table 2.

Classification of the needs of COPD patients based on the literature review according to key self-care goals

Column		Class		Subclass
1		The need to improve the psycho-emotional state		sleeping habits
				Stress and emotion management
				Anxiety and Depression Management
				Management of physical and psychosocial effects caused by symptoms of the disease
				Living positively with illness and thinking about the future
2		The need to promote physical health		Self-monitoring of symptoms and timely identification of symptom exacerbations and timely action (Action plan for acute exacerbations)
				Compliance and adherence to medication
				Increasing knowledge about the disease
				Quitting smoking and avoiding stimulants
				Nutrition and physical activity
				Sexual activity
				Breathing and inhalation techniques
				Pulmonary rehabilitation
				Oxygen therapy
				Vaccination
3		The need for effective communication and connection with health professionals, family, friends, and the community		Periodic checks for physical health
				Using social support
				Establishing communication with the treatment team
				Financial support
				Effective communication with family and friends
				Services

Based on the qualitative approach, the patient’s needs were extracted and classified into three categories: maintaining mental-emotional health, maintaining physical health, and effective communication and support [Table 3].

Table 3.

Frequency distribution of subcategories and categories formed by patients’ expressed needs in the qualitative section

Class		Subclass		Frequency (%)
Maintaining psycho-emotional health		The need for training on energy conservation strategies		10 (55.5)
		The need to learn stress control strategies		16 (88.8)
		The need for sleep and wakefulness health education		6 (33.3)
		The need for constant motivation		1 (5.5)
Maintaining physical health		The need for education about the disease		13 (72.2)
		The need to recognize and avoid risk factors		18 (100)
		The need for regular and correct use of medications		18 (100)
		The need for effective coughing technique training		7 (38.8)
		The need for smoking cessation training		11 (61.1)
		The need to learn the actions required in critical situations		18 (100)
		The need for education about nutritional principles		17 (94.4)
		The need to learn physical activity and be encouraged and motivated to perform		17 (94.4)
		The need to learn pursed lip breathing		8 (44.4)
		The need for daily symptom control training		15 (83.3)
		The need to learn the importance of vaccination		7 (38.8)
		The need for training on how to use oxygen		13 (72.2)
		The need for reminders (medication and activities)		4 (22.2)
		The need for pulmonary exercise (pulmonary rehabilitation) training		9 (50)
		The need to receive training on prevention of symptom exacerbation and taking the necessary measures		1 (5.5)
		The need to be educated on disease awareness and lifestyle with the disease		15 (83.3)
Effective communication and support		The need to communicate with peer groups		1 (5.5)
		The need for financial support		7 (5.27)
		The need to communicate with others		9 (50)
		The need to support patients		1 (5.5)
		The need for regular doctor visits 1-5.5		1 (5.5)
		The need for family support		11 (61.1)

Combining the findings of the two phases of the study led to the formation of patients’ needs in the form of three categories: the need to improve and enhance mental and emotional status, the need to improve physical health, and the need for effective communication and continuity with healthcare professionals, family members, friends, and the community [Table 4].

Table 4.

Integrated categories and subcategories derived from the literature review and interviews based on the key self-care goals

Column		Group		Subgroup
1		The need to improve the psycho-emotional state		Stress, anxiety, and depression management training
				Sleep and wakefulness health education
				Training for energy conservation and motivation strategies
2		The need to promote physical health		Raise awareness about the disease
				Self-monitoring of symptoms, identification of symptom exacerbation, and timely action in critical situations
				Continuous adherence and correct use of medications
				Training to recognize and avoid risk factors such as smoking and environmental pollution
				Teaching effective breathing and coughing techniques, pulmonary rehabilitation, and oxygen therapy
				The need for education and familiarization with the lifestyle of the disease (education about sexual activity, nutrition, physical activity, and vaccination)
3		The need for effective communication and connection with health professionals, family, friends, and the community		Periodic and regular visits and communication with the treatment team
				Benefiting from peer group support
				Effective communication and support from family and friends
				Services and financial support

Discussion

In the current study, the self-care needs of patients with COPD were determined utilizing two methodologies: a comprehensive literature review and a quantitative content analysis. Based on the main goals of self-care interventions, the identified needs were categorized into three groups: improving psycho-emotional well-being, enhancing physical health, and fostering effective communication and connection with health professionals, family, friends, and community. Alwashmi et al.[43] argue that health interventions using such applications should be tailored to patients’ needs to enhance their self-management abilities. O’Connell et al.[9] also considered the same approach for designing applications to facilitate self-care behavior. Utilizing digital teaching aids, such as applications, instead of traditional methods like lectures, has significantly increased people’s enthusiasm and motivation to learn, resulting in higher levels of knowledge.[44] However, Korpershoek et al.[45] argued that providing medical advice and self-care processes using mobile devices may pose safety risks because of significant variability among patients and their respective symptoms.

The first main group of identified needs of COPD patients, in the present study, was the need to improve the psycho-emotional state and the subgroups of stress, anxiety, and depression management training, sleep and wakefulness health training, and training on ways to conserve energy and create motivation. In the subgroup focused on anxiety and depression management training, patients emphasized the need to address both anxiety and depression. A previous study also showed that COPD patients often experience mental health problems that have a great impact on the prognosis of the disease.[46] In another study, more than half of COPD patients experienced depression and anxiety simultaneously, which were effectively reduced by some interventions such as self-care training programs.[47] A study conducted by Kelly et al.[48] indicated that psychological therapies, such as cognitive behavioral therapy (CBT), can be potential treatments for patients with COPD. However, research suggests that the beneficial effects of psychological treatment for anxiety and depression in COPD patients are limited on their own. Therefore, studies have reported that combining psychological treatment with interventions focused on physical activity, lifestyle changes, and self-management support may help improve outcomes for these patients. In our study, we found that COPD patients reported a need for training on sleep and wakefulness health, experiencing low quality of sleep along with loss of energy and motivation. The poor quality of sleep and wakefulness is affected by increased disease recurrence and symptom onset during sleep, as well as a greater need for emergency care.[49] It has been emphasized that training in energy conservation techniques can effectively assist patients in preserving the energy expended during daily activities.[50]

Another main group of identified needs was to improve physical health incorporating the subgroup of increasing awareness about the disease, self-monitoring of symptoms, continuous adherence to medication, avoiding risk factors, and teaching breathing techniques and familiarity with lifestyle with the disease. There was a significant need for heightened awareness among our subjects, as many individuals remain unfamiliar with the name of their condition. Similarly, a study by Wong et al.[22] conducted in Malaysia reported that one unmet need of patients was a lack of knowledge about COPD. A significant number of patients diagnosed with COPD remain unaware of the critical importance of adhering to prescribed medications and implementing necessary precautions related to their condition. Consequently, enhancing awareness about their illness is essential for the prevention of frequent exacerbations and associated complications.[51] However, a study conducted by Sigurgeirsdottir et al.[32] showed that many participants used the Internet as a source of education. This inconsistency may be attributed to several factors prevalent in developing countries such as Iran, including low literacy rates, limited access to internet services, insufficient knowledge and skills required for effective online search, and a pervasive lack of trust in information available in cyberspace.

The necessity for management and self-monitoring of symptoms, along with prompt intervention by individuals with COPD, remains critically important. This necessity is believed to facilitate the development of essential skills and enhance self-care behaviors among patients.[9] Previous studies have highlighted that medication adherence is a common challenge among COPD patients, with estimates indicating that 30% to 50% of prescribed medications are not taken as directed.[52] In this regard, Janjua et al.[53] also stressed that interventions to improve adherence should encompass educational initiatives alongside motivational or behavioral components. Various factors may contribute to non-adherence, including inhalation technique errors, smoking, coexisting health conditions, insufficient patient awareness, economic constraints, and differing levels of education, and effectively addressing these issues presents significant challenges.[54] In our study, many patients failed to recognize smoking as a risk factor, believing it was solely linked to lung cancer, which highlights the need for education on risk factors like smoking and environmental pollution. Consistent with our findings, previous research indicated that training to identify risk factors is critical for implementing targeted prevention and intervention strategies.[55] Breathing exercises such as breathing technique training, effective coughing, and oxygen therapy were among the other needs of patients in this group. Breathing exercises in COPD patients including diaphragmatic and pursed-lip breathing and oxygen therapy can be incorporated into the self-care plan of COPD patients.[56] The necessity of teaching oxygen therapy and breathing exercises in self-care programs was highlighted in a similar study,[57] while Ubolnuar et al.’s[58] research indicated that the positive effects of these exercises remain a topic of debate.

The need for training related to disease management included education on sexual activity, physical activity, nutrition, and vaccination, among other essential areas. Research indicates that over two-thirds of COPD patients, irrespective of gender, often do not report sexual dissatisfaction because of the shame that prevents them from voicing these concerns.[59] Factors such as ethnicity, culture, beliefs, veiling, and patient modesty are significant barriers to discussing sexual issues in Iran.[60]

Teaching proper nutrition and encouraging physical activity are essential for maintaining health and energy. Research indicates that 30%–60% of hospitalized patients with Chronic Obstructive Pulmonary Disease (COPD) experience malnutrition. This malnutrition can lead to decreased lung function, increased hospitalizations, and lower activity tolerance, which ultimately impacts quality of life and raises mortality rates.[23] Numerous patients lack awareness regarding the critical importance of vaccination. In the study conducted by Ambrosino and Bertella, the flu vaccine was found to be effective in preventing readmission. Some evidence suggests that pneumococcal vaccines may protect against COPD complications.[61]

The third major group of identified needs for COPD patients in this study was effective communication and connection. This included interactions with health professionals, family, friends, and the community. Key subgroups of this need were highlighted, such as the importance of regular visitations, ongoing communication with the treatment team, and access to support from peer groups. Additionally, patients emphasized the need for strong communication and support from family and friends, as well as services and financial assistance. Effective communication between care providers and patients enhances decision-making and self-management, forming the foundation of quality care.[62] However, a previous study highlighted the lack of effective communication between patients and their treatment team, with the most significant need being communication with family members.[63] The findings of our study indicate that patients with COPD benefit significantly from support provided by peer groups and the shared experiences of other patients, which contribute to improved disease management. According to Fan et al.,[64] despite feeling the need for social support, COPD patients always suffer from insufficient social support, which could be resolved by peer support programs. In another study, although benefiting from peer group support in the self-care program did not positively affect the quality of life, it led to fewer COPD-related incidents during the intervention period.[65] The patients also reported that the loss of energy and physical strength contributed to feelings of hopelessness regarding their potential isolation during exacerbations of symptoms. This concern indicates the critical need for effective communication and support from family and friends, as it significantly affects their long-term independence. The absence of effective symptom management significantly restricts these patients, leading to increased isolation and a heightened need for assistance in their daily activities.[66] Furthermore, the limited engagement in recreational and social pursuits accelerates disease progression and adversely impacts overall quality of life.[51] Another identified need of COPD patients was financial support and services. A study showed that access to welfare benefits increases patients’ ability to live in the best possible way.[31] Living with a chronic illness often requires access to information about services and facilities that patients require in times of need.

Limitations and recommendations

One of the limitations of the present study was the inability to access the full text of some articles published in the databases that were inaccessible in Iran based on the policies of the relevant ministry. In addition, considering that the use of the application by patients requires an evaluation of its effectiveness, compliance, and ease of use by patients, it is recommended to continue interventional and effectiveness studies in this regard. Herein, we identified the comprehensive needs of patients for designing a self-care program based on a mobile application using two methods, which brought some degrees of innovation compared to previous cases.

Conclusion

The needs identified in the present study were divided into three groups: the need to improve and enhance psycho-emotional status; the need to improve physical status; and the need to establish effective communication with healthcare professionals, family members, and the community. Awareness of these needs can serve as a valuable resource for managers and policymakers engaged in health policy formulation and the development of strategic initiatives aimed at enhancing mental health, medical care services, and the overall well-being of the community.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

• COPD: Chronic obstructive pulmonary disease

• WHO: World Health Organization

• CBT: Cognitive Behavioural Therapy.

Author’s contributions

AH: Writing original draft; investigation. MO: Review and editing. HK: Supervision; investigation. MK: Validation. SK: Writing; review and editing; supervision.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

This study was derived from a doctoral dissertation of nursing that will be financially supported by the Deputy of Research and Technology, Golestan University of Medical Sciences, Iran.