Pengaruh Self-Management Education Terhadap Pemberdayaan Pasien Penyakit Paru Obstruksi Kronik (PPOK) di RSUD Wangaya Denpasar
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Published:
Jun 19, 2017
Keywords:
Self Management Education, Pemberdayaan, Gejala PPOK
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Abstract
PPOK merupakan penyebab utama morbiditas dan mortalitas kronik di seluruh dunia. Tahun 2020 PPOK diprediksi sebagai penyebab kematian keempat di dunia. Pemberdayaa pasien untuk berpartisipasi aktif dibutuhkan dalam penanganan pasien PPOK. Akan tetapi, pemberdayaan pasien PPOK dalam mengelola penyakitnya masih rendah. Self management education merupakan salah satu intervensi untuk meningkatan pemberdayaan pasien. Tujuan penelitian ini untuk mengetahui pengaruh self management education terhadap pemberdayaan pasien PPOK. Penelitian ini menggunakan rancangan quasy experiment dengan pendekatan pre test and post test control group design. Pengambilan sampel dengan teknik consecutive sampling yaitu sebesar 36 orang yang terdiri dari 18 kelompok perlakuan yang mendapatkan self management education melalui media booklet dan 18 kelompok kontrol yang mendapat prosedur edukasi yang berlaku di ruangan. Sampel diambil dari populasi pasien PPOK di Poliklinik paru RSUD Wangaya yang memenuhi kriteria inklusi. Data yang diambil meliputi karakteristik responden, pengetahuan, sikap, tindakan, kemampuan mengambil keputusan, self efficacy dan gejala PPOK. Data dikumpulkan dengan mengunakan kuesioner dan dianalisis menggunakan uji Paired t test, dan Mann whitney U test. Hasil uji statistik Mann Whitney U test menunjukkan ada perbedaan komponen pemberdayaan (pengetahuan, sikap, tindakan, kemampuan mengambil keputusan dan self efficacy) antara kelompok perlakuan dan kontrol dengan p=<0,0001, sedangkan untuk gejala PPOK tidak terdapat perbedaan dengan p=0,713. Self management education efektif meningkatkan pemberdayaan pasien PPOK, tetapi belum efektif menurunkan gejala PPOK. Penelitian di tempat yang berbeda dengan responden yang lebih homogen dan waktu pengamatan yang lebih panjang perlu dikembangkan untuk penelitian selanjutnya
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Putra, P. W. K. (2017). Pengaruh Self-Management Education Terhadap Pemberdayaan Pasien Penyakit Paru Obstruksi Kronik (PPOK) di RSUD Wangaya Denpasar. Journal Center of Research Publication in Midwifery and Nursing, 1(1). https://doi.org/10.36474/caring.v1i1.16
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References
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Anderson, R. M., (2014). Patient Empowerment, BMC Health Services Research. 18(7), 943–949.
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Barnett, M., (2012). End of life issues in the management of COPD. Journal of Community Nursing, 26(3), 4.
Barr. et al., (2015). Assessment of Patient Empowerment - A Systematic Review of Measures. Plos One, 10(5), e0126553.
Bentsen, SB., et al., (2010). Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation--an exploratory study. Patient Educations. 81(1):5-13. http://www.ncbi.nlm.nih.gov/pubmed/20356 diaskes tanggal 22 Mei 2016.
Blackler, et al., (2007). Managing Chronic Obstructive Pulmonary Disease. London; John Wilet & Sons.
Bourbeau, Jean. (2002). Comprehensive Management of Chronic Obstructive Pulmonary Disease. London ; BC Decker Inc
Bourbeau, J., & Saad, N., (2013). Integrated care model with self-management in chronic obstructive pulmonary disease: From family physicians to specialists. Chronic Respiratory Disease, 10(2), 99–105.
Bravo, P., et al., (2015). Conceptualising patient empowerment: a mixed methods study. BMC Health Services Research, 15(1), 252.
Cosgrove, D., Macmahon, J., Bourbeau, J., Bradley, J. M., & O’Neill, B. (2013). Facilitating education in pulmonary rehabilitation using the living well with COPD programme for pulmonary rehabilitation: a process evaluation. BMC Pulmonary Medicine, 13(1), 50.
Currie, Graeme P. (2009). The fact Chronic Obstructive Pulmonary Disease. New York: Oxford University Pres.
Delgado-Passler, P., & McCaffrey, R. (2006). The influences of postdischarge management by nurse practitioners on hospital readmission for heart failure. Journal of the American Academy of Nurse Practitioners, 18, 154–160.
Dowson, C. A., Kuijer, R. G., Town, I. G., & Mulder, R. T. (2010). Impact of panic disorder upon self-management educational goals in chronic obstructive pulmonary disease? Chronic Respiratory Disease, 7(2), 83–90.
Effing, T., van der Palen, J., & Frith, P. (2014). Education in COPD self-management: only part of the game. Respirology, 19(2), 151–152.
Effing, T. W., et al., (2012). Self-management programmes for COPD: Moving forward. Chronic Respiratory Disease, 9(1), 27–35.
Efraimsson, E. Ö., Hillervik, C., & Ehrenberg, A. (2008). Effects of COPD self-care management education at a nurse-led primary health care clinic. Scandinavian Journal of Caring Sciences, 22(5), 178–185.
Emme, C., et al., (2012). Danish version of “The COPD self-efficacy scale”: translation and psychometric properties. Scandinavian Journal of Caring Sciences, 26(3), 615–623
Fotoukian, Z., et al., (2014). Concept analysis of empowerment in old people with chronic diseases using a hybrid model. Asian Nursing Research, 8(2), 118–127.
GOLD. (2015). Global Srategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease.
GOLD. (2014). Global Srategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease.
Hernandez P, et al., (2009). Living with chronic obstructive pulmonary disease : A survey of patients ’ knowledge and attitudes. Respir Med. 2009;103(7):1004-1012.
Howard, C., & Dupont, S. (2014). “The COPD breathlessness manual”: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. Npj Primary Care Respiratory Medicine, 24(August), 14076.
Hurley, J., et al., (2012). Meta-analysis of self-management education for patients with chronic obstructive pulmonary disease. Southwest Journal of Pulmonary & Critical Care, 4, 194–202.
Kadir. (2015). Statistika Terapan Konsep, Contoh dan Analisis Data dengan program SPSS/Lisrel dalam penelitian. Jakarta; Rajawali Pers
Kementerian Kesehatan RI. (2012). Buletin jendela data dan informasi kesehatan : Penyakit Tidak Menular. Jakarta; Kemenkes RI.
Kementerian Kesehatan Republik Indonesia. (2013). Laporan Hasil Riset Kesehatan Dasar Indonesia (Riskesdas). Jakarta; Kemenkes RI.
Kim, S. H., & Youn, C. H.,(2015). Efficacy of Chronic Disease Self-management Program in Older Korean Adults with Low and High Health Literacy. Asian Nursing Research, 9(1), 42–46.
Lenz, E & Lillie, M., (2002). Self-Efficacy in Nursing; research and measurement perspectives. New York: Springer Publishing Company.
Li, J.-M., et al., (2014). Transitional care for patients with chronic obstructive pulmonary disease. International Journal of Nursing Sciences, 1(2), 157–164.
Marcinkho, S. (2008). The wellness planner: Testing an intervention designed to increase empowerment and improve quality of life in individuals with mental illness. University of Manitoba (Canada)). ProQuest Dissertations and Theses, , n/a. Retrieved from http://search.proquest.com/docview/304402398?accountid=17242
McGEOCH, G., et al., (2006). Self‐management plans in the primary care of patients with chronic obstructive pulmonary disease. Respirology, 11, 611–618.
Ministry of Health. (2014). Self-management Support for people with long-term conditions, (November), 1–7.
Monteagudo, M., et al., (2013). Factors associated with changes in quality of life of COPD patients: a prospective study in primary care. Respiratory Medicine, 107(10), 1589–97.
Monteagudo, M., et al., (2013). Effect of health professional education on outcomes of chronic obstructive pulmonary disease in primary care: a non-randomized clinical trial. Respirology., 18, 718–727.
Murphy, K., et al., (2011). A cluster randomised controlled trial evaluating the effectiveness of a structured pulmonary rehabilitation education programme for improving the health status of people with chronic obstructive pulmonary disease (COPD): The PRINCE Study protocol. BMC Pulmonary Medicine, 11(1), 4.
Notoatmodjo, S. (2007). Promosi kesehatan & ilmu perilaku, Jakarta, Rineka Cipta
Notoatmodjo, S. (2010). Ilmu perilaku kesehatan, Jakarta, Rineka Cipta
Notoatmodjo, S. 2010)\. Metodologi Penlitian kesehatan, Jakarta, Rineka Cipta
Nursalam. 2008. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Pedoman Skripsi Tesis dan instrument penelitian keperawatan. Jakarta: Salemba Medika
Nursalam. 2014. Metodologi Penelitian Ilmu Keperawatan. Edisi 3. Jakarta: Salemba Medika
Patel, N., et al., 2015. Chronic Obstructive Pulmonary Disease Patients’ Experiences of an Enhanced Self-Management Model of Care. Qualitative Health Research. http://doi.org/10.1177/1049732315573013
Pearson, M., et al., (2007). Patient self-management support programs: an evaluation. Agency for Healthcare Research and Quality, (08), 282–285.
Potter, P., A., & Perry, A.G. (2009). Fundamental Keperawatan.Edisi 7 buku 1 & 2. Jakarta: Salemba Medika
Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and self-management. Health Expectations, 17(3), 303–310.
Rini, Ika S. (2011). hubungan antara efikasi diri dengan kualitas hidup pasien penyakit paru obstruksi kronik dalam konteks asuhan keperawatan di RS Paru Batu dan RSU Dr Saiful Anwar Malang Jawa Timur. Tesis. universitas Indonesia. Tidak dipublikasikan.
Rogers, E. S., Ralph, R. O., & Salzer, M. S. (2010). Validating the empowerment scale with a multisite sample of consumers of mental health services. Psychiatric Services, 61(9), 933–936.
Sari, N., & Osman, M. (2015). The effects of patient education programs on medication use among asthma and COPD patients: a propensity score matching with a difference-in-difference regression approach. BMC Health Services Research, 15(1), 332.
Sastroasmoro, S & Ismael, S. (2010). Dasar- dasar metodologi penelitian klinis, edisi 3, Jakarta; Sagung Seto.
Sidhu, et al., (2015). Patient self-management in primary care patients with mild COPD - protocol of a randomised controlled trial of telephone health coaching. BMC Pulmonary Medicine, 15(1), 16.
Simons-morton, BG.,McLeroy, K., Wendel, M., (2012). Behavior Theory in Health Promotion Practice and Research. Wall Streat Burlington USA; Jones & Bartleet Learning.
Small, N., et al., (2013). Patient empowerment in long-term conditions: development and preliminary testing of a new measure. BMC Health Services Research, 13(1), 263.
Smeltzer,S.,C. & Bare, G. (2008). Brunner & Suddarth’s Textbook of Medical Surgical Nursing. Philadelpia: Lippincott.
Smeltzer, S.C., et al., (2010). Brunner & Suddarth’s Textbook of Medical Surgical Nursing. Philadelpia: Lippincott.
Smilkstein, R., (2011). We’re born to learn: using the brain’s natural learning process to create today’s curriculum second edition. California: Corwin.
Spalding. (2004). Preoperative education ; empowering patients with confidence. International Journal Rehabilitation. N(4); 147-153
Stoilkova, A., Janssen, D, & Wouters, E. F. M., (2013). Educational programmes in COPD management interventions: A systematic review. Respiratory Medicine, 107(11), 1637–1650.
Trappenburg, et al., (2011). How do COPD patients respond to exacerbations? BMC Pulmonary Medicine, 11(1), 43.
Turner, A., et al., (2015). An evaluation of a self-management program for patients with long-term conditions. Patient Education and Counseling, 98(2), 213–9.
Turner, A., Anderson, J., Wallace, L., & Kennedy-Williams, P. (2014. Evaluation of a self-management programme for patients with chronic obstructive pulmonary disease. Chronic Respiratory Disease, 11(3), 163–172.
Valero, C., et al., (2009). Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD): Information and health education feedback for improving clinical monitoring and quality-of-life. BMC Public Health, 9(1), 442.
White, R., et al., (2006). Bristol COPD Knowledge Questionnaire (BCKQ): testing what we teach patients about COPD. Chronic Respiratory Disease, 3(3), 123–131.
Wong, S., et al.,, (2014). Unmet needs of patients with chronic obstructive pulmonary disease (COPD): a qualitative study on patients and doctors. BMC Family Practice, 15(1), 67.
World Health Organization. (2007). Global Surveillance Prevention and Control of Chronic Respiratory Disease, a comprehensive approach. Jenewa. Switzerland.
World Health Organization. (2012). noncommunicable disease. Jenewa. Switerland. http://www.euro.who.int /en/ health-topics / noncommunicable diseases /pages /news /news / 2012 /4 /empowering-patients Diakses tgl 18 Mei 2016
http://www.euro.who.int/en/media-centre/events/events/2012/04/first-european-conference -on- patient- empowerment- living-with-chronic-disease diakses tanggal 18 Mei 2016.
World Health Organization. (2014). Global status report on noncommunicable disease 2014. Jenewa. Switzerland.
Alligood, M.R & Tomey, A.M., (2006). Nursing Theory : utilization & application. Missouri; Mosby Inc.
Alsayed, S., Elnagar, K., & Mousa, E., (2014). Influence of 7 weeks self management education on the BAI and 6MWD of COPD stable patients. Egyptian Journal of Chest Diseases and Tuberculosis, 63(3), 603–609.
Anderson, R. M., (2014). Patient Empowerment, BMC Health Services Research. 18(7), 943–949.
Barnes. et al., (2013). Chronic obstructive pulmonary disease and exacerbations: patient insights from the global Hidden Depths of COPD survey. BMC Pulmonary Medicine, 13, 54.
Barnett, M., (2012). End of life issues in the management of COPD. Journal of Community Nursing, 26(3), 4.
Barr. et al., (2015). Assessment of Patient Empowerment - A Systematic Review of Measures. Plos One, 10(5), e0126553.
Bentsen, SB., et al., (2010). Self-efficacy as a predictor of improvement in health status and overall quality of life in pulmonary rehabilitation--an exploratory study. Patient Educations. 81(1):5-13. http://www.ncbi.nlm.nih.gov/pubmed/20356 diaskes tanggal 22 Mei 2016.
Blackler, et al., (2007). Managing Chronic Obstructive Pulmonary Disease. London; John Wilet & Sons.
Bourbeau, Jean. (2002). Comprehensive Management of Chronic Obstructive Pulmonary Disease. London ; BC Decker Inc
Bourbeau, J., & Saad, N., (2013). Integrated care model with self-management in chronic obstructive pulmonary disease: From family physicians to specialists. Chronic Respiratory Disease, 10(2), 99–105.
Bravo, P., et al., (2015). Conceptualising patient empowerment: a mixed methods study. BMC Health Services Research, 15(1), 252.
Cosgrove, D., Macmahon, J., Bourbeau, J., Bradley, J. M., & O’Neill, B. (2013). Facilitating education in pulmonary rehabilitation using the living well with COPD programme for pulmonary rehabilitation: a process evaluation. BMC Pulmonary Medicine, 13(1), 50.
Currie, Graeme P. (2009). The fact Chronic Obstructive Pulmonary Disease. New York: Oxford University Pres.
Delgado-Passler, P., & McCaffrey, R. (2006). The influences of postdischarge management by nurse practitioners on hospital readmission for heart failure. Journal of the American Academy of Nurse Practitioners, 18, 154–160.
Dowson, C. A., Kuijer, R. G., Town, I. G., & Mulder, R. T. (2010). Impact of panic disorder upon self-management educational goals in chronic obstructive pulmonary disease? Chronic Respiratory Disease, 7(2), 83–90.
Effing, T., van der Palen, J., & Frith, P. (2014). Education in COPD self-management: only part of the game. Respirology, 19(2), 151–152.
Effing, T. W., et al., (2012). Self-management programmes for COPD: Moving forward. Chronic Respiratory Disease, 9(1), 27–35.
Efraimsson, E. Ö., Hillervik, C., & Ehrenberg, A. (2008). Effects of COPD self-care management education at a nurse-led primary health care clinic. Scandinavian Journal of Caring Sciences, 22(5), 178–185.
Emme, C., et al., (2012). Danish version of “The COPD self-efficacy scale”: translation and psychometric properties. Scandinavian Journal of Caring Sciences, 26(3), 615–623
Fotoukian, Z., et al., (2014). Concept analysis of empowerment in old people with chronic diseases using a hybrid model. Asian Nursing Research, 8(2), 118–127.
GOLD. (2015). Global Srategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease.
GOLD. (2014). Global Srategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease.
Hernandez P, et al., (2009). Living with chronic obstructive pulmonary disease : A survey of patients ’ knowledge and attitudes. Respir Med. 2009;103(7):1004-1012.
Howard, C., & Dupont, S. (2014). “The COPD breathlessness manual”: a randomised controlled trial to test a cognitive-behavioural manual versus information booklets on health service use, mood and health status, in patients with chronic obstructive pulmonary disease. Npj Primary Care Respiratory Medicine, 24(August), 14076.
Hurley, J., et al., (2012). Meta-analysis of self-management education for patients with chronic obstructive pulmonary disease. Southwest Journal of Pulmonary & Critical Care, 4, 194–202.
Kadir. (2015). Statistika Terapan Konsep, Contoh dan Analisis Data dengan program SPSS/Lisrel dalam penelitian. Jakarta; Rajawali Pers
Kementerian Kesehatan RI. (2012). Buletin jendela data dan informasi kesehatan : Penyakit Tidak Menular. Jakarta; Kemenkes RI.
Kementerian Kesehatan Republik Indonesia. (2013). Laporan Hasil Riset Kesehatan Dasar Indonesia (Riskesdas). Jakarta; Kemenkes RI.
Kim, S. H., & Youn, C. H.,(2015). Efficacy of Chronic Disease Self-management Program in Older Korean Adults with Low and High Health Literacy. Asian Nursing Research, 9(1), 42–46.
Lenz, E & Lillie, M., (2002). Self-Efficacy in Nursing; research and measurement perspectives. New York: Springer Publishing Company.
Li, J.-M., et al., (2014). Transitional care for patients with chronic obstructive pulmonary disease. International Journal of Nursing Sciences, 1(2), 157–164.
Marcinkho, S. (2008). The wellness planner: Testing an intervention designed to increase empowerment and improve quality of life in individuals with mental illness. University of Manitoba (Canada)). ProQuest Dissertations and Theses, , n/a. Retrieved from http://search.proquest.com/docview/304402398?accountid=17242
McGEOCH, G., et al., (2006). Self‐management plans in the primary care of patients with chronic obstructive pulmonary disease. Respirology, 11, 611–618.
Ministry of Health. (2014). Self-management Support for people with long-term conditions, (November), 1–7.
Monteagudo, M., et al., (2013). Factors associated with changes in quality of life of COPD patients: a prospective study in primary care. Respiratory Medicine, 107(10), 1589–97.
Monteagudo, M., et al., (2013). Effect of health professional education on outcomes of chronic obstructive pulmonary disease in primary care: a non-randomized clinical trial. Respirology., 18, 718–727.
Murphy, K., et al., (2011). A cluster randomised controlled trial evaluating the effectiveness of a structured pulmonary rehabilitation education programme for improving the health status of people with chronic obstructive pulmonary disease (COPD): The PRINCE Study protocol. BMC Pulmonary Medicine, 11(1), 4.
Notoatmodjo, S. (2007). Promosi kesehatan & ilmu perilaku, Jakarta, Rineka Cipta
Notoatmodjo, S. (2010). Ilmu perilaku kesehatan, Jakarta, Rineka Cipta
Notoatmodjo, S. 2010)\. Metodologi Penlitian kesehatan, Jakarta, Rineka Cipta
Nursalam. 2008. Konsep dan Penerapan Metodologi Penelitian Ilmu Keperawatan. Pedoman Skripsi Tesis dan instrument penelitian keperawatan. Jakarta: Salemba Medika
Nursalam. 2014. Metodologi Penelitian Ilmu Keperawatan. Edisi 3. Jakarta: Salemba Medika
Patel, N., et al., 2015. Chronic Obstructive Pulmonary Disease Patients’ Experiences of an Enhanced Self-Management Model of Care. Qualitative Health Research. http://doi.org/10.1177/1049732315573013
Pearson, M., et al., (2007). Patient self-management support programs: an evaluation. Agency for Healthcare Research and Quality, (08), 282–285.
Potter, P., A., & Perry, A.G. (2009). Fundamental Keperawatan.Edisi 7 buku 1 & 2. Jakarta: Salemba Medika
Pulvirenti, M., McMillan, J., & Lawn, S. (2014). Empowerment, patient centred care and self-management. Health Expectations, 17(3), 303–310.
Rini, Ika S. (2011). hubungan antara efikasi diri dengan kualitas hidup pasien penyakit paru obstruksi kronik dalam konteks asuhan keperawatan di RS Paru Batu dan RSU Dr Saiful Anwar Malang Jawa Timur. Tesis. universitas Indonesia. Tidak dipublikasikan.
Rogers, E. S., Ralph, R. O., & Salzer, M. S. (2010). Validating the empowerment scale with a multisite sample of consumers of mental health services. Psychiatric Services, 61(9), 933–936.
Sari, N., & Osman, M. (2015). The effects of patient education programs on medication use among asthma and COPD patients: a propensity score matching with a difference-in-difference regression approach. BMC Health Services Research, 15(1), 332.
Sastroasmoro, S & Ismael, S. (2010). Dasar- dasar metodologi penelitian klinis, edisi 3, Jakarta; Sagung Seto.
Sidhu, et al., (2015). Patient self-management in primary care patients with mild COPD - protocol of a randomised controlled trial of telephone health coaching. BMC Pulmonary Medicine, 15(1), 16.
Simons-morton, BG.,McLeroy, K., Wendel, M., (2012). Behavior Theory in Health Promotion Practice and Research. Wall Streat Burlington USA; Jones & Bartleet Learning.
Small, N., et al., (2013). Patient empowerment in long-term conditions: development and preliminary testing of a new measure. BMC Health Services Research, 13(1), 263.
Smeltzer,S.,C. & Bare, G. (2008). Brunner & Suddarth’s Textbook of Medical Surgical Nursing. Philadelpia: Lippincott.
Smeltzer, S.C., et al., (2010). Brunner & Suddarth’s Textbook of Medical Surgical Nursing. Philadelpia: Lippincott.
Smilkstein, R., (2011). We’re born to learn: using the brain’s natural learning process to create today’s curriculum second edition. California: Corwin.
Spalding. (2004). Preoperative education ; empowering patients with confidence. International Journal Rehabilitation. N(4); 147-153
Stoilkova, A., Janssen, D, & Wouters, E. F. M., (2013). Educational programmes in COPD management interventions: A systematic review. Respiratory Medicine, 107(11), 1637–1650.
Trappenburg, et al., (2011). How do COPD patients respond to exacerbations? BMC Pulmonary Medicine, 11(1), 43.
Turner, A., et al., (2015). An evaluation of a self-management program for patients with long-term conditions. Patient Education and Counseling, 98(2), 213–9.
Turner, A., Anderson, J., Wallace, L., & Kennedy-Williams, P. (2014. Evaluation of a self-management programme for patients with chronic obstructive pulmonary disease. Chronic Respiratory Disease, 11(3), 163–172.
Valero, C., et al., (2009). Evaluation of a combined strategy directed towards health-care professionals and patients with chronic obstructive pulmonary disease (COPD): Information and health education feedback for improving clinical monitoring and quality-of-life. BMC Public Health, 9(1), 442.
White, R., et al., (2006). Bristol COPD Knowledge Questionnaire (BCKQ): testing what we teach patients about COPD. Chronic Respiratory Disease, 3(3), 123–131.
Wong, S., et al.,, (2014). Unmet needs of patients with chronic obstructive pulmonary disease (COPD): a qualitative study on patients and doctors. BMC Family Practice, 15(1), 67.
World Health Organization. (2007). Global Surveillance Prevention and Control of Chronic Respiratory Disease, a comprehensive approach. Jenewa. Switzerland.
World Health Organization. (2012). noncommunicable disease. Jenewa. Switerland. http://www.euro.who.int /en/ health-topics / noncommunicable diseases /pages /news /news / 2012 /4 /empowering-patients Diakses tgl 18 Mei 2016
http://www.euro.who.int/en/media-centre/events/events/2012/04/first-european-conference -on- patient- empowerment- living-with-chronic-disease diakses tanggal 18 Mei 2016.
World Health Organization. (2014). Global status report on noncommunicable disease 2014. Jenewa. Switzerland.
