Perspectives of Patients With Chronic Respiratory Diseases and Medical Professionals on Pulmonary Rehabilitation in Pune, India: Qualitative Analysis (Preprint)

Abstract

BACKGROUND Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality globally and in India. Access to non-pharmacological options, such as Pulmonary Rehabilitation (PR), are however limited. OBJECTIVE The current study explored the perceptions, experiences, needs and challenges of individuals living with CRDs and the potential of and need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR. METHODS In-depth qualitative semi-structured interviews were conducted among 20 individuals diagnosed with CRDs and nine medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the two participant groups. RESULTS The individuals living with CRDs considered lifestyle choices (smoking and drinking), lack of physical activity, mental stress and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and lack of physical strength consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice for was an inhaler. Most of them believed that yoga and exercise were good self-management strategies and some were performing yoga postures and breathing exercises as advised by friends or family members, or learnt from a televised programme or on YouTube videos. None of them identified with the term ‘Pulmonary Rehabilitation’, but many were aware of the exercise component and its benefits. Despite being naïve to smartphone technology or having difficulty reading, most of them were very enthusiastic to enroll for an application-based remotely delivered digital PR programme. The medical practitioners were however reluctant to depend on a PR programme delivered entirely online. They recommended that individuals living with CRDs be supported by their family to use technology with some time spent with a medical professional during programme. CONCLUSIONS Individuals suffering with CRDs in India are currently managing their disease with ‘non-guided’ strategies, but are eager to improve and would benefit from a ‘guided’ PR programme to ‘feel better’. A home-based’ PR programme, with delivery facilitated by digital solutions would be welcomed by patients and healthcare professionals involved in their care, as it reduces the need for travel, specialist equipment and setup. For the Indian context, including yoga in a PR programme could be a way of making PR ‘culturally congruent’ and more successful. The digital PR intervention should be flexible to individual patient needs and should be complimented with physical sessions and a feedback mechanism for both the practitioners as well as the patients for better uptake and adherence.