Construction of a patient health management patient journey map based on health action process approach theory for patients with chronic obstructive pulmonary disease

Abstract

Background

Self-management ability for patients with chronic obstructive pulmonary disease (COPD) in China urgently needs to be strengthened. The Health Action Process Approach (HAPA) promotes health-oriented behaviour change by tailoring interventions to each stage of the individual’s disease. This approach has been applied across a wide range of fields. However, its application among patients with COPD remains relatively limited.

Objective

To construct a patient health management journey map based on the HAPA theory.

Methods

Using the HAPA theory as a framework, a patient health management patient journey map was developed through literature review, reference to standardised guidelines, phenomenological research and expert consultation.

Results

From the literature review, 12 relevant articles were included to form the preliminary framework. Semi-structured interviews with 5 respiratory medical staff identified the core stages of the patient journey. In a separate subsequent process, the 8 experts selected for consultation had an average work experience of 19.13 ± 3.27 years. Education levels included 2 with a bachelor’s degree and 6 with a master’s degree or above; professional titles included 3 associate senior doctors, 3 senior doctors and 2 intermediate doctors; and research specialties included 5 in respiratory medicine and 3 in internal medicine nursing. As for the consultation involvement, 3 experts participated once and 5 experts participated twice or more. The familiarity coefficient with consultation content was 0.851, the judgment basis coefficient was 0.916 and the authority coefficient of the experts was 0.889. The coordination of expert opinions was measured by Kendall’s W and was 0.429 (χ² = 42.452, P < 0.001). Finally, a proof-of-concept test with 5 patients refined the patient journey map’s usability by simplifying terminology and adjusting adherence strategies.

Discussion

The patient health management journey map constructed in this study, based on the HAPA theory, is scientific, comprehensive and usable, covering key stages such as disease diagnosis, acute exacerbation management, stable period maintenance and rehabilitation support. It provides patients with comprehensive scientific guidance and promotes the establishment of healthy behaviours.

Keywords

health action process approach theory chronic obstructive pulmonary disease nursing self-management patient journey map

1. Introduction

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable respiratory disease characterised primarily by persistent, progressive and irreversible airflow limitation.¹ This disease is notable for its large patient population and high mortality rate, treatment costs and readmission rates, and it is the third leading cause of death worldwide.² The prevalence of COPD is expected to continue rising due to worsening air pollution, the ageing population in China, increasing numbers of smokers and unhealthy lifestyles and habits.³ Its prevalence has reached 13.7% among patients over 40 years old⁴ and 35.5% among those over 70 years old.⁵

In clinical practice, the treatment of COPD involves a combination of pharmacological and non-pharmacological approaches.⁶ However, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) points out that patient self-management is key to successfully controlling the disease. Good self-management by patients can reduce readmission and mortality rates and improve quality of life.^6,7

Most patients with COPD have poor self-management behaviours and abilities,⁸ especially in terms of adherence to respiratory management behaviours such as taking medication, performing respiratory muscle exercises and using home oxygen therapy.⁹ Globally, healthcare systems face substantial barriers to optimal COPD care, including service fragmentation and suboptimal primary care involvement.¹⁰ Within this broader international context, most communities in China face numerous challenges in COPD management. These include low rates of early screening and diagnosis, the lack of necessary medical equipment, shortages of medications, inadequate treatment measures and insufficient diagnostic and treatment skills of physicians.¹¹

The self-management ability of patients with COPD, both worldwide and in China, urgently needs to be strengthened. Research has shown that interventions based on theoretical foundations require patients to master disease knowledge and, more importantly, commit to behavioural change.¹² However, most patients have not yet entered the action stage of maintaining healthy behaviours.¹³ The action stage represents the period where individuals translate their formed intentions into specific, sustainable health behaviours through self-regulatory processes. Health behaviours are behaviours that patients undertake to maintain or improve their health to prevent disease progression. Therefore, it is important to identify a theory that can transform the behavioural intentions of patients with COPD into effective actions.

The German psychologist Schwarzer, drawing on and referencing Bandura’s self-efficacy theory, proposed the Health Action Process Approach (HAPA). Compared with traditional health behaviour models, the HAPA was specifically selected for this study because it effectively addresses the intention–behaviour gap – a primary barrier in COPD self-management. It uniquely recognises that patients with an intention to change require different volitional strategies, such as action and coping planning, from those who lack intention. This theory integrates health-related models and suggests that a series of psychological and social factors trigger changes in health behaviours. Individuals go through different stages in the process of changing behaviour, and the tasks and difficulties faced vary for each stage. Therefore, implementing different interventions according to the individual’s stage can promote the shift from intention towards health behaviour.¹⁴ This theory divides the behaviour process into three stages – pre-intention stage, intention stage and action stage – and addresses the gap between intention and behaviour. Although the HAPA has been applied in various fields, its application in patients with COPD remains limited.

The health of patients with COPD must be managed during multiple disease stages, including acute exacerbation, the stable phase and rehabilitation. Patients’ health management needs are increased by the long course of the disease, frequent transitions between care settings and complex coordination among personnel.

Currently, health management for patients with COPD in many countries, including China, is hospital-centred, primarily led by doctors and has low community participation, limiting its scope and effectiveness. Therefore, this study aims to construct a patient health management journey map based on the HAPA theory. While existing qualitative studies have extensively explored the patient illness experience, journey mapping provides distinct information by visualising the complex interactions between patients and the healthcare system over time. With this patient journey map, medical institutions can systematically identify gaps in service delivery, as well as accurately identify weak points in patients’ disease awareness, behaviour change and treatment adherence, providing a structural framework to design targeted health education content and care strategies. By integrating established clinical priorities into this visual framework, the map illustrates how interventions should be tailored: in the early stage of the disease, the focus is on strengthening patients’ understanding of the pathophysiological mechanisms of COPD, risk factors and preventive measures; during the stable phase, the emphasis is on cultivating patients’ self-monitoring skills and their ability to recognise acute exacerbations; during the acute exacerbation phase, the importance of seeking timely medical care and standardised treatment is stressed.

2. Research methods

This study employed a multi-phase approach to construct and refine a COPD health management journey map. The developmental process consisted of three interconnected components: (1) a comprehensive literature review, which established the theoretical foundation and identified existing evidence for the initial framework; (2) stakeholder co-production and validity testing, which integrated semi-structured interviews with healthcare professionals (stakeholders) to provide real-world clinical insights into patient behaviours, psychological states and needs to construct the core stages of the patient journey map, followed by an expert consultation panel to evaluate and modify the preliminary draft to ensure its scientific validity and clinical relevance; and (4) a proof-of-concept test with patients with COPD to verify usability and optimise the final version of the patient journey map based on user feedback. The literature review and semi-structured interviews were conducted specifically as foundational work for this study and have not been published or presented elsewhere.

The overall methodological framework, data collection process, multi-source data synthesis and systematic integration of the HAPA theory are visually summarised in Figure 1.

2.1. Establishment of a research team

A research project team was formed, consisting of one chief physician of the respiratory department, one head nurse of the respiratory department, two senior nurses and three nurses. Members of the research team were responsible for literature retrieval, data collection, expert consultation, construction of a patient health management journey map and preliminary clinical application. They were also responsible for quality control and supervision throughout the research process, ensuring the scientific validity of the research design and the standardisation of its implementation. All participants involved in this study (research team members, experts and patients) were from this hospital and had signed informed consent forms.

2.2. Literature review

A search was conducted of Chinese and English databases, with a search period from the inception of the databases until 20 March 2025. Chinese databases included China National Knowledge Infrastructure, China Biomedical Literature Database, Wanfang Database and VIP Information Resources System; English databases included PubMed, Web of Science, Cochrane Library, Cumulated Index in Nursing and Allied Health Literature, ScienceDirect and Excerpta Medica Database. Search terms were developed based on the research topic and included ‘Chronic Obstructive Pulmonary Disease/COPD’, ‘Health Management/Patient Journey Map/Integrated Care’ and ‘Acute Exacerbation/Stable Phase/Rehabilitation Phase’. Searches were conducted using a combination of subject terms and free-text terms, and specific search strategies were formulated according to the characteristics of different databases, providing both theoretical support and practical reference for the construction of a patient health management journey map.

The inclusion criteria were formulated in accordance with the PICO framework as follows: (1) Population: patients with COPD; (2) Intervention: programs with a primary focus on patient self-management; (3) Comparison: routine care or any comparison group inherent to the selected empirical study designs; and (4) Outcome: intervention effectiveness regarding self-management abilities and health behaviours. Additionally, regarding study design and language, the study type was a randomised controlled trial or quasi-experimental study (these designs were chosen because they provide the highest level of empirical evidence regarding intervention effectiveness), and the language was Chinese or English. The exclusion criteria were as follows: (1) duplicate literature, (2) literature with incomplete information preventing full-text access, (3) low-quality literature (cited fewer than 5 times or no citations in the past 5 years, non-core journal, sample size not indicated or references including non-academic sources) and (4) reviews, systematic evaluations and status investigations.

The literature screening process was conducted independently and in a blinded manner by two members of the research team. They initially evaluated the titles and abstracts and then conducted a comprehensive full-text review based on the pre-defined inclusion and exclusion criteria. Any discrepancies or disagreements between the two reviewers during the sifting process were resolved through discussion and consensus with a third senior researcher. Finally, a formal quality assessment of the included articles was performed using the Joanna Briggs Institute critical appraisal tools, ensuring that all final selected studies met the rigorous methodological standards required for constructing the patient journey map (Supplemental Table 1).

2.3. Stakeholder Co-production:Semi-Structured Iiterviews

This study adopted a purposive sampling method, selecting respiratory medical staff who play a core role in COPD health management as interview participants. The specific interview background and outline are shown in Supplementary Materials. The interview sample size was determined by the point at which information saturation was achieved. The purposive sampling inclusion criteria for medical staff were as follows: (1) nursing managers must have held the position of head nurse for no less than 5 years, possess extensive experience in COPD health management and be willing to participate in interviews; (2) clinical nurses must have at least 5 years of respiratory nursing experience, hold the title of senior nurse or above, have sufficient understanding of the patient health management journey map and be willing to participate in interviews. The data collection and analytic strategies were theoretically driven by the HAPA framework. During data collection, the semi-structured interview guide was specifically designed to elicit information relating not only to clinical symptoms but also to HAPA constructs. Questions targeted patients’ risk perception, outcome expectancies and self-efficacy (relevant to the pre-intentional and intentional stages) as well as their action planning, coping planning and barriers to action (relevant to the action stage). For the analytic strategy, the HAPA served as a deductive coding framework. Qualitative data from the transcripts were categorised and analysed based on whether the patients’ reported behaviours and psychological needs fell into the pre-intentional, intentional or action phases.

An interview outline was developed based on the literature review and group discussions. Three dimensions in the trajectory of disease progression – clinical behaviour, psychological state and health needs – were considered to categorise patients with COPD according to the following core stages from the onset of symptoms to stable management: disease diagnosis, acute exacerbation, stable phase, rehabilitation phase, long-term follow-up, home adaptation period (30 days), follow-up visits and home rehabilitation period (>30 days). Identifying these core stages provided the structural framework for the interview guide, ensuring that the qualitative data collection covered the entirety of the patient experience.

Before the interview, the researchers provided a detailed explanation of the interview’s purpose and conducted the interview in a quiet environment. The interview process focused on the research topics, with the entire session being recorded and keywords marked. Each interviewee spent 30–45 minutes in the interview. After the interview, the research team organised and analysed the content, extracted key information and provided practical evidence for the construction of a patient health management journey map.

The research team transcribed the recordings within 24 hours of each interview and analysed them using Colaizzi’s seven-step method: repeatedly reading the interview content, extracting and analysing important information, coding and summarising relevant content, categorising similar views into themes, providing detailed descriptions and relating them to the research participants and finally returning the results to the interviewees for verification, with themes further refined through categorical analysis.

2.4. Validity testing and development of a health management patient journey map for patients with chronic obstructive pulmonary disease

A patient health management journey map is a visual tool used to systematically present the interactions between patients and the healthcare system at different stages of a disease. Using a visual step diagram, it comprehensively describes the stages and experiences a patient goes through from the onset of symptoms to disease treatment or management. A patient journey map aims to optimise diagnosis and management strategies, enhance doctor–patient interactions, promote patient-centred medical activities and evaluate patient experiences within a complex healthcare system.¹⁵ Researchers can select the appropriate type of patient journey map for their research goals and requirements to achieve precise and personalised health management.

No participants chose to withdraw part way through the semi-structured interview process. Based on the literature review and qualitative research results, a preliminary draft of the COPD health management journey map was developed. The patient journey map was then revised and refined through expert panel discussions and pre-test feedback to create the final version. Crucially, the HAPA directly informed the structural development of the patient journey map. Instead of merely mapping the chronological clinical timeline (e.g. stable phase and acute exacerbation), the three core HAPA stages (pre-intention, intention and action) were overlaid as the primary vertical dimensions of the patient journey map. This theoretical integration ensured that every touchpoint, pain point and corresponding medical intervention identified in the patient journey map was systematically matched to the patients’ specific psychological and behavioural change stage, thereby translating the HAPA from a conceptual model into a practical visual tool.

Eight experts from relevant fields, who were not members of the research team, were invited to participate in a hybrid online and offline expert panel meeting. The draft of the patient journey map and related theoretical materials were provided to the expert team in advance, allowing the participants to identify any potential conflicts of interest.

The inclusion criteria for experts were as follows: (1) experts in respiratory medicine or chronic disease management; (2) professional titles of associate senior or above, with more than 10 years of experience in the relevant field; (3) familiarity with COPD health management-related content; and (4) voluntary participation in the consultation.

The expert meeting was chaired by the researchers, who reported on the background and objectives of the research and the process of constructing the patient journey map. The meeting focused on the following topics: (1) the scientific validity of the patient journey map, (2) clarity of content, (3) feasibility of implementation and (4) modifications and improvements of specific details, including key node design, intervention steps and outcome evaluation methods.

The meeting was recorded and documented, and the recordings were transcribed and summarised. The meeting conclusion criteria were as follows: ≥75% of experts had to agree on the proposed plan, and the opposition rate had to be ≤20%.

Based on expert suggestions, the research team discussed and revised the patient journey map, making modifications, deletions or additions to entries to ensure its scientific validity and practicality.

2.5. Proof-of-Concept

Finally, five patients with COPD meeting specific inclusion criteria were recruited to participate in a proof-of-concept test to verify the usability of the patient journey map (patient characteristics are detailed in Supplemental Table 2). Based on their feedback, further optimisations were made to form the final version of the patient health management journey map. The inclusion criteria were as follows: (1) the patient was clinically diagnosed with COPD according to established guidelines¹; (2) the patient had sufficient cognitive and communication abilities, including the capacity to read and write; (3) the patient or their primary caregiver was proficient in using WeChat; and (4) the patient participated voluntarily with full knowledge of the study. The exclusion criteria were as follows: (1) the presence of other severe pulmonary diseases (e.g. lung cancer, severe pneumonia or tuberculosis) or concurrent major organ failure (heart, liver or kidney); (2) extreme lack of cooperation or geographical distance making communication difficult; and (3) current or previous participation in similar research studies.

According to the established inclusion and exclusion criteria, five patients with COPD meeting the criteria were selected from this hospital for a proof-of-concept test before the formal intervention to ensure the scientific validity and feasibility of the intervention programme. This proof-of-concept test involved a trial walkthrough where patients were required to engage with the proposed health education content and action plans derived from the draft patient health management journey map. Qualitative data regarding their comprehension, willingness to communicate and perceived barriers to adherence were collected through direct observation and immediate feedback discussions, and subsequently analyzed to identify implementation barriers.

3. Results

3.1. Literature study results

A total of 2,031 relevant articles were retrieved. After removing duplicates using EndNote software (Clarivate, Philadelphia, PA, USA), 1,498 articles remained. By reading the titles and abstracts, 1,443 articles that did not meet the criteria were excluded. The full texts of the remaining 55 articles were obtained and thoroughly reviewed. Based on the inclusion and exclusion criteria, 12 articles were finally included, consisting of 4 Chinese and 8 English articles. The authors, countries, sample sizes, forms and durations of interventions, intervention implementers and outcomes of the included studies were summarised. Details are presented in Table 1.

Table 1.

Literature summary.

Author	Country	Sample size	Form of intervention	Intervention time	Intervention implementer	Result
WatsonPB et al.	NewZealand	56	Self-Management Manual, Action Plan	6 months	Advanced nurse, general practitioner	Improvement in the patient’s quality of life and self-management abilities
SidhuMS et al.	UnitedKingdom	556	Phone Guidance	7 weeks	Nurses, researchers, research assistants, doctors	Prevent disease progression, promote behavior change in patients, and strengthen self-management skills
PoureslamiI et al.	Canada	100	Videos, manuals, face-to-face conversations	3 months	Clinicians, role players	Self-efficacy improved, and self-management of disease behaviors significantly improved.
DingH et al.	Australia	100	Application	3 months	Researcher, Nurse, and Doctor Website Guide	Improve patient adherence and self-management skills
PARKSK	South Korea	42	Educational and exercise courses, smartphones, text messages	3 months	Researchers, nurses, exercise specialists, pulmonologists	Improving self-management behaviors and physical activity
SetoE et al.	Canada	156	Remote monitoring system	3 months	Researchers, clinicians	Provide patients with self-management and clinical decision support
BenzoR et al.	United States	215	Health guidance, motivational interviewing	6 months	Respiratory therapist, nurse	Improve self-management skills and enhance outcomes
WaltersJ et al.	Australia	182	Phone Guidance	3 months	Community Nurse, Health Mentor	Improved self-management and coping skills
Wang XY et al.	China	136	Healthcare provider app, patient app, push videos	6 months	Nurse, doctor, respiratory therapist, psychological counselor, health manager	Improve patients’ treatment adherence, quality of life, and self-management abilities
Sun YQ	China	110	Telephone follow-up, discussion meetings, group education	6 months	Researchers, nurses, respiratory therapists	Establish and maintain healthy behaviors, and improve self-management skills
Fen M et al.	China	86	One-on-one conversations, WeChat group, phone calls, and home visits	6 months	Respiratory Specialist Nurse	Effectively improved self-management skills and capabilities
Zhao CL	China	120	Intensive classroom teaching and face-to-face discussions	6 months	Researchers, charge nurses, respiratory physicians, psychiatrists	Improved self-management skills and reduced disease symptoms

Through synthesis of the included articles, three key themes emerged that directly informed the subsequent patient journey map design: (1) the effectiveness of structured action plans and motivational interviewing in promoting behaviour change and improving adherence, (2) the central role of self-efficacy in sustaining physical activity and self-management behaviours and (3) the value of continuous clinical support through remote monitoring systems and mobile applications. These evidence-based themes provided the foundational rationale for integrating wearable remote monitoring, personalised rehabilitation plans and digital follow-up platforms into our final HAPA-based patient journey map.

3.2. Draft of the health management journey map for patients with chronic obstructive pulmonary disease

The draft of the patient journey map is shown in Figure 2. It directly addresses the core challenges in current COPD management, such as fragmented health management processes, insufficient early warning for acute exacerbations, low rehabilitation adherence due to patients’ fear of exercise and lack of psychosocial support in long-term follow-up. The solution innovatively integrates wearable remote monitoring tools, such as fitness bracelet trackers, to monitor patients’ physiological parameters in real-time through smart devices, enabling early warning and immediate intervention. At the same time, personalised and progressive rehabilitation training plans and psychological counselling modules were designed to target common exercise-related fears and anxiety or depressive emotions in patients. Additionally, a long-term follow-up mechanism linking hospitals, communities and families was established through a digital platform to ensure continuity of management services.

3.3. Overview of consultation experts

The selected experts from the research institute have an average professional experience of 19.13 ± 3.27 years. Regarding their education, 2 experts held a bachelor’s degree and 6 held a master’s degree or higher. Their professional titles included 3 associate senior, 3 senior and 2 intermediate levels. In terms of research areas, 5 experts specialised in respiratory medicine and 3 specialised in internal medicine nursing. Finally, 3 experts had participated in 1 previous inquiry and 5 had participated 2 or more times (see Supplemental Table 3).

3.4. Expert enthusiasm and authority level

The familiarity coefficient of the consultation content was 0.851, the judgment basis coefficient of the consultation was 0.916 and the authority coefficient of the consulting experts was 0.889.¹⁶

3.5. Expert consultation results

Based on the opinions and suggestions from the expert meeting, the draft of the intervention programme was revised. The specific modifications are detailed in Table 2.

Table 2.

Expert revision comments.

Expert opinion	Modify content
1. The ‘emotions’ section is of little significance and unclear in meaning; it is recommended to delete it.	Accept and adopt the experts’ suggestions to delete the ‘Emotions’ section.
2. In the drafted initial intervention plan, the ‘location’ section does not need to be listed separately.	Accept and adopt the experts’ advice to delete the ‘Location’ section.
3. When formulating an action plan, invite family members to participate and supervise its implementation.	Accept and adopt the experts’ advice to include family members when formulating the action plan.
4. When the patient is in the action stage, use material or spiritual rewards to strengthen their determination to follow through with the plan.	Accept and adopt the experts’ advice to give patients rewards and boost their confidence.

3.6. Proof-of-Concept

During the proof-of-concept walkthrough, suggestions and opinions from the patients were recorded. The analysis of this feedback revealed three main issues: patients struggled to understand professional medical terminology, their adherence in various aspects was not ideal and their willingness to express thoughts was relatively low. Based on these results, the intervention programme was continuously adjusted – such as by minimising the use of professional terminology in favour of simple, easy-to-understand language and modifying communication strategies to better ensure patient compliance – resulting in a finalised intervention programme for the patient health management journey map. The revisions and adjustments after the proof-of-concept test are shown in Table 3.

Table 3.

Modifications from the proof-of-concept test.

Problems occurred	Revision plan
1. Patients do not understand professional terminology.	During the intervention process, try to minimize the use of professional terminology
2. Patients’ adherence in various aspects is not ideal.	and use more simple, easy-to-understand language.
3. When communicating with patients, their willingness to express thoughts and use language is not strong.	In order to better ensure patient compliance during the intervention,

3.7. Formation of the final intervention programme

Through the aforementioned expert meetings and revisions based on the proof-of-concept, the draft intervention programme was refined, ultimately resulting in the final intervention programme as shown in Figure 3.

4. Discussion

Patient self-management can, to some extent, help patients with chronic diseases control their condition.^17,18 This study, based on the HAPA theory, proposes a patient health management journey map that is designed to enhance the understanding of patients’ disease management needs and provide a structured framework to support patients’ self-management behaviours and abilities. A patient journey map is useful for various reasons. First, when healthcare providers and patients jointly develop action plans, patient participation in disease treatment is increased. Second, when patients have higher self-efficacy, their self-management abilities and levels are improved.¹⁹ The selection of the HAPA framework over other traditional health behaviour models was a deliberate methodological decision. Traditional continuum models, such as the Theory of Planned Behaviour or the Health Belief Model, primarily focus on the motivational phase, identifying factors that predict behavioural intention. However, they frequently fail to explain how to translate that intention into sustained action, leading to a well-documented intention–behaviour gap in chronic disease management. By functioning as a stage model, the HAPA overcomes this critical limitation. It explicitly separates the motivational phase from the volitional phase, emphasising that forming an intention is only the first step. For patients with COPD, the translation of intention into complex behaviours (e.g. long-term pulmonary rehabilitation) requires specific volitional self-regulatory strategies, namely action planning (when, where and how to act) and coping planning (how to anticipate and overcome barriers). Therefore, the HAPA provides a superior, actionable framework for designing stage-matched interventions that not only motivate patients but also equip them with the tools to sustain behavioural changes. In this study, the HAPA theory-based patient health management journey map implements interventions at various stages, focusing on strengthening, maintaining and restoring patients’ self-efficacy. It enhances communication and interaction between patients and healthcare providers, thereby further improving disease awareness and management.

The HAPA theory is an important theory of behaviour change. The theory categorises individual health behaviours of patients with COPD into three stages: the pre-intentional stage, the intentional stage and the action stage. In the pre-intentional stage, nurses provide disease education and share rehabilitation cases for patients and their families to promote the formation of behavioural intentions in patients. In the intentional stage, personalised action plans and coping strategies for difficulties are developed jointly with patients, thereby translating their behavioural intentions into concrete actions. In the action stage, researchers and family members jointly supervise patients to ensure they adhere to their actions. When patients’ health behaviours are disrupted, methods and social support are provided to handle interruptions. Extensive data studies have shown that individual health behaviours can be effectively predicted by the HAPA theory, promoting patients’ transition to the stage of healthy behaviour.^20,21

The patient health management journey map originated in the field of service design, with the core ideal of optimising service processes through in-depth analysis of user needs and experiences. With the popularisation of the patient-centred approach, medical institutions and health management organisations now use patient journey maps in clinical practice, service optimisation and chronic disease management.^22,23 The visual framework provided by patient journey maps facilitates the efficient allocation of medical resources and provides a scientific basis for the comprehensive management of patients with chronic diseases. Foreign researchers often use qualitative research methods such as observation, interviews and thematic analysis to collect and analyse data to construct and depict patient journey maps, thereby gaining an in-depth understanding of patients’ disease management experiences. In view of this, this study constructs a health management patient journey map for patients with COPD covering key stages such as disease diagnosis, acute exacerbation management, stable period maintenance and rehabilitation support. During the acute exacerbation period, the focus is on optimising emergency care and inpatient management processes; during the stable period, the emphasis is on enhancing patients’ self-management abilities and community support; and during the rehabilitation period, attention is given to lung function recovery and psychosocial support. The application of patient journey maps must be adapted to the characteristics of China’s healthcare environment, integrating multidisciplinary resources and promoting seamless coordination between hospitals and communities to achieve comprehensive, systematic and personalised health management for patients with COPD.

This study has certain limitations. For example, it did not explore the long-term effects of a patient health management journey map based on the HAPA theory for patients with COPD, and it is hoped that future clinical trials will observe the long-term outcomes for patients.

5. Conclusion

In summary, the construction of a patient health management journey map based on the HAPA theory in this study provides a systematic visual framework for healthcare providers to comprehensively understand the complex needs and barriers patients with COPD face at different disease stages. Rather than a finalised clinical intervention, it serves as a foundational tool to design targeted, stage-specific support strategies that assist in the establishment of healthy behaviours. Future large-scale, longitudinal clinical trials are necessary to evaluate the long-term effectiveness of this patient journey map in improving actual self-management outcomes.

Supplemental material

Supplemental material - Construction of a patient health management patient journey map based on health action process approach theory for patients with chronic obstructive pulmonary disease

Supplemental material for Construction of a patient health management patient journey map based on health action process approach theory for patients with chronic obstructive pulmonary disease by Shengxi Chen, Yinlong Li, Yan Zhang, Xinxin Chen, Panpan Zhang, Yuqin Cheng in Chronic Respiratory Disease.

Footnotes

ORCID iD

Yuqin Cheng

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Zhejiang Provincial Science and Technology Program for Traditional Chinese Medicine. (NO. 2022ZB136, NO. 2025ZL040, NO. 2025ZL285).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

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