Understanding Quality of Life in COPD Through Photovoice

Published in the International Journal of Qualitative Studies on Health and Well-Being in December 2025, this qualitative study highlights that the lived burden of COPD extends beyond physical symptoms. Using a photovoice methodology, the authors explore how people living with COPD experience their condition in daily life, revealing psychological and social dimensions that are often under-recognized or difficult to surface within routine clinical care.

Eight adults with established COPD, predominantly White British women aged between 60 and 77 years, contributed a total of 67 photographs depicting how the condition shapes their everyday environments and activities. Most patients had lived with a COPD diagnosis for several years and reported multiple physical comorbidities. Each participant then completed an hour-long interview to explain the meaning and context of each image and how it reflected the impact of COPD on their quality of life. Three interconnected themes emerged:

• Self-criticism and shame
• Social interactions and relationships
• Strategies for wellbeing and managing the impacts of COPD.

Across all themes, breathlessness functioned as the central organizing experience.

Shame, Self-Criticism, and the Hidden Work of Concealment

Shame and self-criticism were particularly prominent. Many patients described actively concealing breathlessness from colleagues, family members, and strangers by, for example, taking public transport instead of walking short distances, stopping to “admire” scenery to disguise the need for rest, or avoiding social situations altogether. These behaviors appeared to extend beyond symptom management, reflecting efforts to protect dignity and pre-COPD identity.

Shame was often linked to internalized stigma and beliefs that COPD was self-inflicted, particularly in narratives shaped by smoking-related histories. For clinicians, this may help explain why some patients under-report symptoms or disengage from care when they anticipate judgment.

When Support Helps and When It Harms

The second theme highlights the complexity of social support. While friends and family were generally described as caring and helpful, support could also feel over-protective or identity-threatening. Well-intentioned offers to slow down or stop sometimes reinforced patients’ awareness of loss and dependence. Mobility aids, such as wheelchairs, improved access and participation but could simultaneously increase feelings of marginalization by altering how others interacted with the patient.

These findings suggest that support may undermine autonomy and negatively affect confidence and emotional wellbeing, even when physical needs are addressed.

Everyday Strategies to Preserve Meaning and Independence

The third theme focused on coping strategies for managing quality of life. Patients described problem-focused approaches as important for maintaining independence and emotional wellbeing. These included gentle walking on flat ground, gardening, meaningful routines, and practical home adaptations. Activities that limited physical exertion but provided purpose and connection, particularly with nature, were also valued by patients.

As symptoms progressed, patients described strategies becoming less effective for managing emotional distress, highlighting an unmet need in later-stage care for patients with COPD.

What These Insights Mean for Clinical Care

Based on these findings, effective COPD management should extend beyond symptom control to address emotional and interpersonal dimensions. A compassionate, non-judgmental clinical approach may foster more open disclosure with patients. Lastly, integrating psychological support and explicitly addressing patients’ experiences of independence, dignity, and social support could help improve quality of life alongside standard medical care.

Reference:
Grimwood S, Baraniak A, Faghy MA, Sharpe E. Using a photovoice methodology to explore the impacts of living with COPD on quality of life. Int J Qual Stud Health Well-being. 2026;21(1):2608197. doi:10.1080/17482631.2025.2608197