Self-management support using mHealth in patients with COPD: From promise to proof

Worldwide, Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic diseases and currently the fourth leading cause of mortality. The natural course of this progressive disease is interrupted by periods of symptom deterioration called exacerbations. Exacerbations accelerate the decline in lung function, negatively affect the quality of life, and lead to increased mortality and high socio-economic costs. Self-management is widely recognized to be important to reduce this negative impact on both patients and society. Patients are nowadays expected to have an active role and to take responsibility in decisions affecting their chronic disease. Thus far, patients with COPD do not always respond to self-management interventions. There is a need for more comprehensive, dynamic and individualized strategies to improve exacerbation-related selfmanagement behavior. The use of mobile health (mHealth) has potential to engage patients in managing their own health, to provide tailored support in developing self-management skills over time and to change health behaviors. The aim of this thesis was twofold. In part one, we aimed to generate a better understanding of self-management behavior of patients with COPD and explore whether the use of mHealth is promising to enhance exacerbation-related selfmanagement. In part two, we aimed to develop an evidence-driven, attractive and usable mHealth intervention to enhance exacerbation-related self-management in patients with COPD. This resulted in the Copilot app, a mobile app for patients with COPD that targets early detection of exacerbations and performing prompt actions. In part two, we described the development of the Copilot app in detail. During the development, proof for the Copilot app was collected by stepwise scientific underpinning of the working mechanism and usability of the app. Finally, the feasibility of the Copilot app in the daily practice of health care providers was evaluated