Beliefs, Perceptions, and Behaviors Regarding Chronic Lung Disease in Kyrgyzstan: A Mixed-method FRESHAIR Study

IntroductionChronic lung disease (CLD) represents a substantial health burden in low- and middle-income countries (LMICs). However, in-depth CLD studies in Kyrgyzstan, where CLD is highly prevalent, remain scarce. ObjectivesTo explore in Kyrgyzstan (1) beliefs, perceptions and behaviors regarding CLD among community members (CMs), (2) relations between illness perceptions, demographics, behaviors and setting (highlands vs. lowlands), and (3) illness perception profiles across subgroups. MethodsQualitative data were gathered through semi-structured interviews and focus groups and analyzed using a Framework Method. Quantitative data were collected via questionnaires including the brief Illness Perception Questionnaire (B-IPQ), measures of smoking, indoor heating and cooking, and help-seeking behaviors. Univariable and multivariable linear regression analysis and latent class analysis (LCA) were conducted. Triangulation integrated qualitative and quantitative findings. ResultsWe included 8 interviews, 13 focus groups, and 420 questionnaires. CMs held misperception about CLD and its causes, continued smoking despite perceived harms and prevention efforts, used risk fuels with limited ventilation, and delayed help-seeking. CMs obtained a mean B-IPQ score of 23.4 (SD 2.1), with longer duration of education, lowland setting, and being unemployed significantly associated with higher B-IPQ scores (p<0.05). LCA identified 2 subgroups: highlanders were more likely to be in class 1 whereas lowlanders in class 2 ({chi}2=5.95, p=0.01). ConclusionMisbeliefs and misperceptions about CLD, smoking, household risk behaviors, and delayed help-seeking were prevalent in Kyrgyz CMs. Longer education, being unemployed and living in the lowlands were associated with more negative illness perceptions. Two distinct subgroups based on B-IPQ profiles were identified: one with more negative perceptions in the consequence, symptoms, concern and emotion, while the other perceived more negatively in the timeline, treatment and understanding. Targeted education in CLD, smoking cessation support should be provided for the public to improve the awareness, prevention, and care of CLD in Kyrgyzstan. Summary boxO_ST_ABSWhat is already known in this topicC_ST_ABSCLD poses a large burden in Kyrgyzstan and other LMICs. Interventions to address non-communicable diseases in Kyrgyzstan appear to be ineffective. What this study addsO_LIMisconceptions about CLD, prevalent smoking, household risk behaviors, delayed help-seeking were evident in Kyrgyzstan, shaped by socioeconomic, cultural and policy-related factors. C_LIO_LIInfrastructure issues, affordability, accessibility to clean energy and healthcare service, weak enforcement for tobacco control and antibiotics use were barriers to CLD prevention and care. C_LIO_LILonger education, being unemployed and living in the lowlands were associated with more negative illness perceptions, with distinct B-IPQ profiles in different subgroups. C_LI How this study might affect research, practice or policyO_LIFuture studies should explore the social and cultural factors contributing to CLD misperceptions in depth and assess the effectiveness of educational interventions to improve disease understanding and help-seeking. C_LIO_LIBehavior change techniques should be integrated into tailored health interventions to ensure better effectiveness in improving CLD awareness and promoting behavioral change. C_LIO_LIPolicymakers should prioritize smoking cessation programs, enforce stronger tobacco control measures, and invest in clean energy infrastructure and equitable healthcare access. C_LI