Self-efficacy

Participants reported behavioural changes including assertively declining requests, restructuring routines, setting priorities, and using the ABC model. Self-efficacy gains were among the most consistently reported outcomes of PHP participation. Learning to adjust exercise around symptom fluctuations built lasting self-efficacy, leaving patients feeling equipped to continue independently. Facilitators also gained confidence in group facilitation through training and progressive responsibility. Mastery experiences have been empirically linked to better treatment adherence and improved health status in COPD. Harmonica practice prompted an unexpected expansion into lifelong learning, including reading music notation and exploring audiobooks and podcasts. Mastering harmonica playing provided immediate, tangible evidence of breathing control, translating into increased self-management confidence. Patients who maintained exercise applied self-monitoring skills—particularly heart rate monitoring and symptom-based adjustments—to self-directed training after the programme. Participants continued to use the ABC model after the programme ended. Concrete progress markers such as learning a ne…