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

BackgroundCommunity-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. ObjectivesTo 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. MethodsFourteen 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. ResultsTen 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) experiences of living with a CRD before PR, (2) experiences of living with a CRD after PR, (3) feedback on the conduct of the completed PR program, (4) suggestions to improve a future PR program, and (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. ConclusionThe 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 RegistrationProspective; 27/08/2021; ISRCTN13836793