The goal of this clinical trial is to evaluate whether a behavior change intervention, delivered through a shared medical appointment (SMA) model, can improve self-management behaviors and health outcomes among community-based patients with chronic obstructive pulmonary disease (COPD). The main questions it aims to answer are:

i) Can a BCW-based intervention strategy that integrates shared medical appointments increase COPD patients' self-management behaviors? ii) Does this strategy relate to reduced acute exacerbations, slower lung function decline, and improved health-related quality of life?

Researchers will compare the shared medical appointment group and the usual care group to see if integrating SMA improves behavioral and clinical outcomes.

Participants will i) Take part in group-based shared medical appointments once every two months for a total of three sessions over six months, led by a general practitioner, involving structured medical consultation, behavioral guidance, and peer interaction.

ii) Receive behavioral intervention based on the Behavior Change Wheel (BCW) framework, targeting modifiable factors influencing self-management behaviors.

iii) Complete questionnaires and assessments at baseline and 6-month follow-up to evaluate changes in behavior, symptoms, and quality of life.

The study uses a three-stage mixed methods design:

i) Stage 1 involves longitudinal qualitative interviews and co-design with patients and clinicians to develop the intervention strategy.

ii) Stage 2 is a pilot study to test the feasibility and acceptable for up-coming cluster randomized controlled trial.

iii)Stage 3 is a cluster randomized controlled trial to evaluate the effectiveness and mechanisms of the intervention.

Chronic obstructive pulmonary disease (COPD) affects nearly 100 million patients in China, with poor self-management behaviors contributing to frequent exacerbations and increased disease burden. Despite inclusion in national basic public health services, limited healthcare resources hinder effective COPD management. Shared medical appointments (SMAs) offer a promising solution by providing group-based clinical care and behavioral interventions. This study aims to develop and evaluate a behavioral intervention strategy incorporating SMAs for community-based COPD self-management.

This multi-stage mixed methods study comprises three phases. Stage 1 uses patient-provider co-design and longitudinal qualitative research methods to analyze self-management behavioral factors based on the Behavior Change Wheel theory and develop the SMA-COPD intervention. Stage 2 conducts a feasibility study to assess intervention acceptability and research procedures. Stage 3 implements a cluster randomized controlled trial across 20 community health centers, recruiting 280 COPD patients (14 per cluster, 140 per arm). The intervention group receives three monthly SMA sessions, while controls receive routine care. Primary outcomes include COPD self-management behaviors, inhaler medication adherence, and health-related quality of life. Secondary outcomes include inhaler technique, lung function, physical activity capacity, and number of acute exacerbations. Data collection occurs at baseline and 6 months post-intervention, with additional assessments at 6 months post-intervention completion. The study follows the RE-AIM framework to evaluate reach, effectiveness, adoption, implementation, and maintenance.

Inclusion Criteria:

• Meets the diagnostic criteria for Chronic Obstructive Pulmonary Disease (COPD) according to the GOLD 2024 guidelines.
• Diagnosed with COPD within the past year, or has had fewer than two outpatient visits for COPD management in the past year.
• Resides in the community under the jurisdiction of the respective community health service centre.
• Aged 40 to 80 years.
• Has full cognitive and behavioural capacity and is able to clearly express personal will.
• No plans for long-term travel in the next six months.
• Has provided written informed consent and voluntarily agreed to participate in the study.

Exclusion Criteria:

• Has severe complications or other serious diseases.
• Has limited physical activity due to comorbidities or complications.
• Is currently participating in another clinical trial.
• Is unsuitable for participation by the study investigators.

The data that support the publication will be shared with the publication.

When the data analysis completed and the related paper published, the IPD and supporting information will be available for 3 years.

IPD and supporting documents (e.g., study protocol, statistical analysis plan) will be available to qualified researchers upon reasonable request, subject to approval by the study steering committee.

Accessible Data: De-identified IPD, including demographics, clinical outcomes, and behavioral intervention records, will be shared.

Access Process: Requests should be submitted via email to the corresponding author, with a detailed research proposal and ethical approval proof. Data will be transferred through secure platforms after signing a data use agreement.

This is a single-blind study. Due to the nature of the intervention, participants, care providers, and investigators will be aware of group assignments. However, outcome assessors and data analysts will be blinded to participant group allocation to minimize the risk of bias during data evaluation and interpretation.