Barriers and enablers to pulmonary rehabilitation in low- and middle-income countries: a qualitative study of healthcare professionals

Abstract

Low- and middle-income countries bear a disproportionately high burden of global morbidity and mortality caused by chronic respiratory diseases. Pulmonary rehabilitation is recommended as a core intervention in the management of people with chronic respiratory diseases. However, the intervention remains poorly accessed/utilised globally, especially in low- and middle-income countries. This qualitative study explored barriers and enablers to pulmonary rehabilitation in low- and middle-income countries from the perspective of healthcare professionals with pulmonary rehabilitation experience in these settings. Online-based semi-structured in-depth interviews with healthcare professionals were undertaken to data saturation, exploring lived barriers and enablers to pulmonary rehabilitation in their low- or middle-income country. Anonymised Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. A total of seven healthcare professionals from seven low- and middle-income countries representing Africa, Asia, and South America, were interviewed. They included five physiotherapists (four females), one family physician (male), and one pulmonologist (female). Themes for barriers to pulmonary rehabilitation included limited resources, low awareness, Coronavirus Disease 2019, and patient access-related costs. Themes for enablers included local adaptation, motivated patients, Coronavirus Disease 2019 (which spanned both enablers and barriers), better awareness/recognition, provision of PR training, and resource support. Successful implementation of these enablers will require engagement with multiple stakeholders. The findings of this study are a necessary step towards developing strategies that can overcome the existing pulmonary rehabilitation evidence-practice gap in low- and middle-income countries and alleviating the burden of chronic respiratory diseases in these countries.

Towards a framework for the scale-up of rehabilitation for patients with non-communicable disease in low-resource settings

“…A global audit of cardiac rehabilitation programs revealed that in only 40% of LMIC such rehabilitation services are available; roughly translating to one cardiac rehabilitation spot available for every 66 patients with ischaemic heart disease. (6,8) However, this gap in the availability of cardiac rehabilitation specifically, is illustrative for a broader need for rehabilitation type services in general, including rehabilitation for lung health, (10) access to assistive technology, (11) cardiometabolic disease, and others. (12,13) To address these needs, a concerted effort is needed to scale-up access to rehabilitation services (Figure 1).…”