A Qualitative Exploration of Patients’ Experiences of Living with Chronic Respiratory Diseases before and after Participating in a Pulmonary Rehabilitation Program at a Tertiary Hospital in Malawi, and Their Suggestions to Improve a Future Program

Background Community-based surveys suggest a substantial burden of chronic respiratory diseases (CRDs) in the Malawian population, causing significant morbidity and loss of economic productivity. Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with CRDs, but there is limited data on its feasibility and acceptability in Malawi. Objectives To explore the experiences of patients with CRDs before and after participating in a PR program at Queen Elizabeth Central Hospital (QECH), Blantyre, Malawi, and their suggestions to improve a future program. Methods Fourteen adult patients (eight females and six males) presenting with functionally limiting CRDs to QECH were invited to participate in a six-week PR program. Following program completion, face-to-face semi-structured in-depth interviews with the participants were conducted. Interviews were audio-recorded and transcribed verbatim. The transcripts were anonymised and thematically analysed using a deductive approach. Results Ten adults (five females and five males) participated in the PR program. Their documented CRD diagnoses included chronic obstructive pulmonary disease (COPD), asthma, post-tuberculosis lung disease, and bronchiectasis. Five key themes emerged: ([1][1]) experiences of living with a CRD before PR, ([2][2]) experiences of living with a CRD after PR, ([3][3]) feedback on the conduct of the completed PR program, ([4][4]) suggestions to improve a future PR program, and ([5][5]) program continuation/maintenance at home. Participants reported experiencing improvements in physical, psychological, and social health associated with PR program participation. The provision of transport was considered a key facilitator for PR program completion. Realising the gained PR benefits, participants were willing to continue exercising at their homes, albeit with potential barriers including a lack of equipment. Conclusion The PR program improved the participants’ perceived health status and was well-accepted. Addressing barriers related to transport facilitated immediate implementation while providing a challenge for the scaling and sustainability of PR beyond the project duration. These findings support the drive for shifting chronic care, including rehabilitation, towards primary care and community. Trial Registration Prospective; 27/08/2021; ISRCTN13836793 ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial ISRCTN13836793 ### Clinical Protocols ### Funding Statement This work was supported by the National Institute for Health Research (NIHR) (using the UK Official Development Assistance (ODA) Funding) and Wellcome [221465/Z/20/Z] under the NIHR-Wellcome Partnership for Global Health Research. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval for this study was obtained from the College of Medicine Research and Ethics Committee (COMREC), protocol number P.07/19/2752. Participants signed consent forms after willingly agreeing to participate in the study based on study information provided by the investigators. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Raw data produced in the present study are available upon reasonable request to the authors. [1]: #ref-1 [2]: #ref-2 [3]: #ref-3 [4]: #ref-4 [5]: #ref-5