Chronic Obstructive Pulmonary Disease (COPD) is one of the health problems that occurs throughout the world; this disease can occur in both developed and developing countries. COPD is an irreversible condition in which the airways narrow, airflow obstruction increases, and the lungs lose their elasticity. The World Health Organization (WHO) in 2022 stated that chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the world. Based on data from the Global Burden Diseases 2019 Diseases and Injuries Collaborators, it shows that COPD sufferers in the world have 209 incidents per 100,000 population with 3.2 million deaths
Increasing the severity of COPD will have an impact on the patient's quality of life. Patients with very severe severity are 5.44 times more likely to experience poor quality of life than patients with mild severity
The perception of illness in COPD patients is very important because if the patient has a bad perception of their illness, it will affect the patient's quality of life. Quality of life is a person's expectation of their life related to the reality they are facing. The perception of illness is one of the psychological dimensions of quality of life that can be influenced by physical and spiritual aspects. The physical aspects that will be seen in this study are general health status and nutritional status, while the spiritual aspect is assessed based on spiritual well-being. Spiritual well-being is a source of strength that increases a person's self-confidence and ability to overcome life's problems well. Spiritual health is a form of a person's effort in building an intimate relationship with God, which is the basis of belief or faith in his life. Every time someone responds positively to the teachings, values, or provisions of religious law, he also radiates good spiritual well-being. Well-maintained spiritual well-being will enable COPD patients, from mild to severe, to respond positively to every event, incident, or experience in their life. Even though someone is facing a difficult situation, a bad experience, or an unwanted incident that befalls them, with good spiritual well-being, sufferers will still have optimism, self-confidence, and hope for a better future
The physical aspects that will be seen in this study are health status and nutritional status. Health status is a measure of how people perceive their health and is considered a good global assessment of a person's well-being
Nutritional status is an important factor in the course of the disease in COPD patients. People with COPD usually have low nutritional status. Low nutritional status in COPD patients occurs due to decreased food intake. In addition, low nutritional status occurs because when breathing, patients require high energy, resulting in reduced calories and protein in the body
The referral hospital for respiratory diseases in the Special Region of Yogyakarta is the Respira Yogyakarta Hospital. The Respira Yogyakarta Lung Hospital has the task of providing comprehensive health services, especially lung and respiratory tract health. Based on the results of a preliminary study at the Respira Lung Hospital in Yogyakarta, data on the incidence of COPD was obtained; namely, in 2020 the number of inpatients from January to December was 298 people. Meanwhile, in 2021 the number of patients from January to December was 27,797 outpatient visits.
Based on the fact that COPD is a chronic disease with irreversible symptoms, patients need to have a good perception of illness in order to improve their motivation and quality of life. From the explanation above, the researcher will see the spiritual well-being, health status, and nutritional status and their relation with the perception of illness of COPD patients at the Respira Hospital in Yogyakarta.
The method that is used in this study is descriptive correlation research with a cross-sectional approach to see the relationship between spiritual well-being, health status, and nutritional status with the perception of illness in COPD patients at Respira Hospital Yogyakarta. This research has been tested ethically based on the Ethical Clearance number 01/KEPK/I/2024 from the Yogyakarta Respira Lung Hospital and has obtained a research permit with a reply letter number 500.10.3.1/10.
The population used by the researcher was COPD patients at the Respira Yogyakarta polyclinic, with 100 respondents calculated based on the Slovin formula. Researchers prescribed the sample criteria: COPD as the primary diagnosis by medical record, no comorbidities, severity of COPD in GOLD 2-GOLD 4, no memory or mental disorders, and no other accompanying illnesses that could affect nutritional status. Exclusion criteria are for patients with dyspnea who refused to participate in research. The sampling technique was accidental sampling with a non-random technique that is taken accidentally until the quota is fulfilled.
The variables of this study are spiritual well-being, health status, nutritional status, and illness perception. Other variables that will be studied in this research are age and gender, which can influence the perception of illness and health status. The variable of illness perception in this study was measured using a translation of the Revised Illness Perception Questionnaire (IPQ-R). IPQ-R has been proven to be a valid and reliable scale for determining illness perception in COPD patients with an r value of 0.7 and a Cronbach alpha coefficient of 0.755
This study has a confidence level of 95% with α < 0.05. The principal analysis stage includes univariate analysis to see descriptive statistical data for each variable and non-parametric independent difference test statistics using Mann-Whitney. The Mann-Whitney test is to see the relationship between spirituality, well-being variables, health status, nutritional status, and the perception of illness variable.
The study was conducted at the Respira Lung Hospital in Yogyakarta from December 2023 to January 2024. The results of the study obtained the following demographic data:
Univariate Analysis
| Description | Frequency | Percentage (%) | |
|---|---|---|---|
| Gender | Male | 61 | 61 |
| Female | 39 | 39 | |
| Ages | 12-25 | 1 | 1 |
| 26-45 | 4 | 4 | |
| 45-54 | 17 | 17 | |
| 55-65 | 39 | 39 | |
| 66-74 | 29 | 29 | |
| 75-90 | 10 | 10 | |
| Spirituality Well-Being | High | 75 | 75 |
| Moderate | 25 | 25 | |
| Healthy Status | Very Good | 6 | 6% |
| Good | 16 | 16% | |
| Average | 63 | 63% | |
| Bad | 15 | 15% | |
| Very Bad | 0 | 0% | |
| Nutritional Status | Normal | 65 | 65 |
| Risk of Malnutrition | 32 | 32 | |
| Malnutrition | 3 | 3 | |
| Perception of Illness | Very high | 0 | 0 |
| High | 15 | 15 | |
| Moderate | 85 | 85 | |
| Low | 0 | 0 | |
| Very low | 0 | 0 | |
| Total | 100 | 100 |
Based on healthy status, it shows that out of 100 respondents, 63 (63%) respondents showed moderate results, followed by 16 (16%) respondents with good results, 15 (15%) respondents with bad results, and 6 (6%) respondents with very good results on the CAT questionnaire to measure health status.
Based on nutritional status, it was found that there were 65 (65%) respondents with normal nutritional status, 32 (32%) respondents who were at risk of malnutrition, and 3 (3%) respondents who experienced malnutrition or poor nutrition.
Based on perception of illness, it can be seen that the majority have a moderate perception of illness, as many as 85 (85%) respondents, while a small portion have a high perception of illness, as many as 15 (15%) respondents at the Yogyakarta Respira Lung Hospital.
Bivariate tests were conducted to see the relationship between the variables Spirituality, Well-Being, Health Status, and Nutritional Status on Illness Perception in COPD. The results shown as the table below :
Bivariate Test Results
| Variabel | p-value |
|---|---|
| S | 0.257 |
| Healthy Status | 0.72 |
| Nutritional Status | 0.28 |
The majority of respondents were male. The results of this study are in line with Astriani's (2020) study involving 30 COPD respondents at Buleleng District Hospital, which showed that the majority (73.3%) of respondents with COPD were male
Based on age, 78 (78%) respondents were over 55 years old. The results of this study are in accordance with Apriani's (2023) study involving 18 respondents at Al Ihsan Hospital, West Java Province. The results showed that respondents with a diagnosis of COPD were found to be more at the age of >40 years, with the highest prevalence at the age of >65 years at 61%
The results of the study showed that 75 (75%) respondents were in the high spiritual well-being category. This study is in line with the study conducted by Wiyahya (2022) involving 71 respondents, the results obtained were 48 (67.6%) respondents with high spiritual well-being, 19 (26.8%) respondents with moderate spiritual well-being, and 4 (5.6%) respondents with low spiritual well-being. Fulfillment of spiritual well-being is recognized to have a positive impact, such as helping patients accept their condition when they are sick and have a more positive outlook on life. Fulfillment of spiritual well-being also gives a person strength in thinking and acting. In addition, it can provide more enthusiasm to live life and establish relationships with God, others, and the surrounding environment. When spiritual well-being is fulfilled, a person tends to find purpose, meaning, strength, and guidance in their life journey. Spiritual well-being is an important factor for patients who undergo routine check-ups. Conversely, the impact of unfulfilled spiritual well-being can cause significant problems, such as anxiety, loss of inspiration, uncertainty, sadness, lack of acceptance of love, and other signs such as restlessness, crying, difficulty sleeping, and feelings of hopelessness. Therefore, attention to the spiritual well-being of COPD patients becomes a crucial aspect in their care.
The results of the study showed that there was no relationship between Spirituality Well-Being with the perception of illness. This shows that the results of the study are not the same as the study by
Spiritual well-being is part of spirituality that represents an individual's perception of life and the comfort of faith in God. Patients with COPD make spirituality an important resource when facing life situations. Spirituality plays an important role in overcoming illness, so that it can improve a person's quality of life. By looking at the values and beliefs held by each patient, spiritual health can provide a deeper meaning for patients to become better individuals
Fulfillment of spiritual well-being can make someone accept their condition when they are sick and have a better outlook on life. Fulfillment of spiritual well-being gives a person the strength to think and act. Fulfillment of spiritual well-being also gives a person more enthusiasm in living life and establishing relationships with God, other people, and the environment. When spiritual well-being is fulfilled, a person will find purpose, meaning, strength, and guidance in their life journey
In some situations, patients need a long time to achieve spiritual well-being. Although there is no definite information regarding the time required to achieve a high level of spiritual well-being, in crisis conditions such as being diagnosed with a chronic, terminal, or life-threatening illness, a person tends to draw closer to God and try to find meaning in the illness they are suffering from. In this condition, religious beliefs and practices, such as praying or performing worship at a mosque or church, become tools to achieve spiritual well-being
Based on the calculation of the research results, the highest score obtained was the statement of the respondent's belief regarding God's love and concern for the respondent's life. The total score of this statement was 533. On average, respondents answered by agreeing and believing that God always loves and cares about the respondent's life, especially with the illness that the respondent is currently suffering from. The researcher analyzed that respondents could feel interpersonal support both with other people and God. Support from other people and God is very important for someone who has a chronic illness. With support and encouragement, it can encourage them to continue living and recover from their illness.
The result of the research calculation that got the second highest score was the statement of the respondent's belief regarding a meaningful personal relationship between the respondent and God. The total score of this statement was 523. On average, respondents answered by agreeing and strongly believing that the respondent had a meaningful personal relationship with God. The researcher has analyzed that respondents feel a meaningful relationship with God through prayer, which then contributes to the emergence of hope and strength in dealing with their illness. The increase in spiritual well-being occurs because respondents believe that they have a deep personal relationship with God. This finding is in line with what was expressed by
The results of the study showed that 63 (63%) respondents had moderate health status. The results above are in line with the research of
The results of processing each CAT questionnaire question that got the highest score first were questions about shortness of breath when climbing stairs, with a total score of 238. COPD patients tend to have shortness of breath during activities, especially those that require excess energy, such as climbing stairs or walking on uphill roads, because there is airway obstruction, which causes expiratory airflow to decrease; air is trapped in the alveoli, causing air trapping; the lungs get bigger and reduce lung elastic recoil, which ultimately causes shortness of breath during activities
The results of the bivariate analysis showed that there was no relationship between health status and the perception of COPD patients with a p-value of 0.72 (p > 0.05). Good health status will change a person's behavior to be good by always maintaining their own health. The results of previous studies stated that health status is said to be good if the use of health services is carried out actively and health monitoring is carried out well
The results of the study also showed that the patient always coughed (total score 222). One of the signs and symptoms of COPD is a productive cough, which usually occurs in the morning due to an increase in the amount of thick mucus (sputum), which causes ciliary function to be disrupted, making it difficult to clear mucus (sputum) in the airways. Sputum is a mucus secretion produced by the lungs, bronchi, and trachea
Respondents with malnutrition and risk of malnutrition amounted to 35 (35%). In theory, according to
The results of the study also showed that nutritional status had no relationship with the perception of COPD patients, with a p-value of 0.28 (p > 0.05). As we know, malnutrition often occurs in patients with respiratory system disorders. If the nutritional condition is not good (lacking/poor), the body's immune reaction will decrease, which means the body's ability to defend itself against infection attacks also decreases. Malnutrition that occurs in the body of COPD sufferers, one of which is an increase in energy needs. Increased effort in breathing and a systemic inflammatory reaction process are triggers for increased energy in the body of COPD patients
Based on the calculation of the research results, it was found that the first lowest value was the question about whether respondents consumed protein intake such as dairy products (milk, cheese, and yogurt) per day, nuts, eggs per week, or meat, fish, or poultry every day. The total score for this question is 36. The average respondent consumes protein intake from nuts and eggs per week, which is 53 (53%) out of 100 (100%) respondents. Researchers analyzed that protein is important for COPD patients. Protein functions to build and maintain body tissue. Other functions of protein as a former of essential body bonds include hormones, enzymes, and antibodies, as well as transporting nutrients and regulating water or fluid balance. If the source of carbohydrate energy in food is insufficient for the body, then protein is used to meet energy needs. So if dietary carbohydrates are sufficient, protein will be used as a building substance. Protein produces antibodies to fight infection. If COPD patients lose protein intake, it can reduce nutritional status due to the reduced ability of the lungs to fight infection.
A high-protein diet is one way that can be used to meet the protein needs of the bodies of COPD patients. Examples of foods that can be used for a high-protein diet are nuts, peas, and processed bean products such as tempeh and tofu. In addition, foods such as meat, fish, chicken, eggs, and dairy products such as milk, cheese, and yogurt are also examples of high-protein diets for COPD patients. If the nutritional intake of COPD patients is sufficient, then there is no risk of weight loss that will result in malnutrition. A good and nutritious diet is important for someone with COPD to support the lungs while working. Adequate nutrition in the body of COPD patients is needed to provide energy when breathing
Based on research using the MNA questionnaire, the results of the research calculation that had the lowest value were questions about whether respondents took more than 3 prescription drugs per day, with a total score of 56. On average, respondents did not take more than 3 prescription drugs per day, namely 56 (56%) out of 100 (100%) respondents. Most of them only use suction devices for shortness of breath. Some COPD drugs can affect the nutritional needs of COPD sufferers because they remove too much potassium from the body. One of the drugs that is often given to COPD patients is a diuretic
The results of the MUAC calculation have a low value of 72. Protein intake affects LILA in COPD patients. Protein functions to build and maintain body tissue. Nutritional status greatly affects the growth and development of body organs;poor nutritional status will result in organ function not functioning properly. So that the physiological and anatomical development of the respiratory tract will affect the strength and mass of the respiratory muscles to pump oxygen throughout the body not optimally, control the respiratory rate, and body immunity. In COPD patients, breathing requires high energy, resulting in a lack of protein and calories, which results in decreased nutritional status
Most of the respondents (85%) have a moderate perception of illness. This study is in accordance with
Based on the results of this study, the second-highest score is the question about respondents having lung disease for the rest of their lives. The total score for this question is 419. As many as 83.8% of respondents disagree with this statement because respondents feel confident that their COPD can be cured with routine treatment. While, in theory, COPD is a chronic disease that cannot be completely cured
The results of the study also showed that 84% of respondents stated that there was a support system that could help the patient's condition. Respondents stated that the support system came from family and closest friends. The role of the family has a very large impact on providing support for clients undergoing treatment and care, which usually requires months of treatment, so if no one provides support either physically or psychologically, the client cannot undergo treatment to completion
Based on the results of the study, it was also found that 55% of respondents felt worried about their illness. Worry in COPD patients can increase the work of the parasympathetic nervous system, causing systemic effects such as physical limitations, decreased lung function, and increased risk of exacerbations
The limitation of the study is in the measurement of nutritional status. Ideally, the nutritional status is also evaluated by the results of a nutritional panel laboratory that measured micronutrient levels of minerals such as Zn, Se, Mn, Cu, Fe, and Co in the blood. This study implies the importance of more in-depth assessment to measure the independent variables and the involvement of families as research subjects.
This study showed that there is no relationship between spiritual well-being and perception of illness, no relationship between health status and perception of illness, and also no relationship between nutritional status and perception of illness in COPD patients. The perception of pain in COPD patients can be influenced by variables other than the independent variables studied.
This study gives recommendations to improve family support in caring for COPD patients, providing a diet to meet the nutritional needs of COPD patients, the need for peer groups among fellow COPD patients to improve spiritual well-being, health status, and nutritional status, and improve the perception of illness in COPD patients.
The author would like to thank the Head of the Panti Rapih Yogyakarta Health Sciences and all employees at the Respira Hospital polyclinic for their support for this research.
Author 1 contributed to the proposal preparation, research permit, ethical testing, data collection, data presentation, and discussion. Author 2 contributed to data presentation, discussion, and writing references. Author 3 contributed to data processing.
This research has been tested ethically based on the Ethical Clearance number: 01/KEPK/I/2024 from the Yogyakarta Respira Lung Hospital and has obtained a research permit with a reply letter number 500.10.3.1/10. Informed consent was obtained from all individual participants included in the study.
This study received no external funding.
The authors hereby declare that there's no conflict of interest in this study, either to any institutions or individuals
The data that support the findings of this study are not publicly available due to privacy or ethical restrictions.
This study was not registered.