Acceptability of pulmonary rehabilitation in Malawi - a qualitative study

Fanuel Meckson Bickton; Talumba Mankhokwe; Beatrice Chavula; Emily Chitedze; Martha Manda; Cashon Fombe; Martha Mitengo; Langsfield Mwahimba; Moses Isiagi; Richard N van Zyl-Smit; Susan Hanekom; Martin Heine; Harriet Shannon; Jamie Rylance; Enock Chisati; Stephen B Gordon; Felix Limbani

doi:10.1136/bmjresp-2024-002547

Acceptability of pulmonary rehabilitation in Malawi - a qualitative study

Fanuel Meckson Bickton^*
, Talumba Mankhokwe
, Beatrice Chavula
, Emily Chitedze
, Martha Manda
, Cashon Fombe
, Martha Mitengo
, Langsfield Mwahimba
, Moses Isiagi
, Richard N van Zyl-Smit
, Susan Hanekom
, Martin Heine
, Harriet Shannon
, Jamie Rylance
, Enock Chisati
, Stephen B Gordon
, Felix Limbani

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with chronic respiratory diseases (CRDs), but its acceptability in Malawi was unknown.

OBJECTIVES: To explore patients' acceptability of PR at Queen Elizabeth Central Hospital, Blantyre, Malawi.

METHODS: This was a pre-post cohort study where participants were offered a two times per week hospital-based PR programme for 6 weeks, consisting of endurance and strengthening exercises. Following programme completion, face-to-face semistructured in-depth interviews with the participants were conducted. Interview transcripts were thematically analysed using a deductive approach.

RESULTS: 10 adults (five females and five males) out of 14 invited (~70% uptake) participated in the PR programme and subsequent in-depth interviews. Five key themes emerged: (1) debilitating symptom experience of CRD prior to PR; (2) positive impact of PR on living with CRD; (3) contextual programme design improved participants' experience with PR; (4) one size does not fit all and (5) challenges and opportunities for home-based PR. Participants reported experiencing improvements in physical, psychological and social health associated with PR programme participation. The provision of transport was considered a key facilitator for PR programme completion. Realising the gained PR benefits, participants were willing to continue exercising at their homes.

CONCLUSION: The PR programme 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 NUMBER: Prospective; 27 August 2021; ISRCTN13836793.

Original language	English
Article number	e002547
Number of pages	10
Journal	BMJ open respiratory research
Volume	12
Issue number	1
DOIs	https://doi.org/10.1136/bmjresp-2024-002547
Publication status	Published - 22 May 2025

Keywords

Adult
Aged
Chronic Disease
Exercise Therapy/methods
Female
Humans
Malawi
Male
Middle Aged
Patient Acceptance of Health Care/statistics & numerical data
Qualitative Research

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Acceptability of pulmonary rehabilitation in Malawi: a qualitative studyFinal published version, 278 KBLicence: CC BY

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Bickton, F. M., Mankhokwe, T., Chavula, B., Chitedze, E., Manda, M., Fombe, C., Mitengo, M., Mwahimba, L., Isiagi, M., van Zyl-Smit, R. N., Hanekom, S., Heine, M., Shannon, H., Rylance, J., Chisati, E., Gordon, S. B., & Limbani, F. (2025). Acceptability of pulmonary rehabilitation in Malawi - a qualitative study. BMJ open respiratory research, 12(1), Article e002547. https://doi.org/10.1136/bmjresp-2024-002547

@article{98d321de12bb487587bdfe936f2c6e01,

title = "Acceptability of pulmonary rehabilitation in Malawi - a qualitative study",

abstract = "BACKGROUND: Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with chronic respiratory diseases (CRDs), but its acceptability in Malawi was unknown.OBJECTIVES: To explore patients' acceptability of PR at Queen Elizabeth Central Hospital, Blantyre, Malawi.METHODS: This was a pre-post cohort study where participants were offered a two times per week hospital-based PR programme for 6 weeks, consisting of endurance and strengthening exercises. Following programme completion, face-to-face semistructured in-depth interviews with the participants were conducted. Interview transcripts were thematically analysed using a deductive approach.RESULTS: 10 adults (five females and five males) out of 14 invited (\textasciitilde{}70\% uptake) participated in the PR programme and subsequent in-depth interviews. Five key themes emerged: (1) debilitating symptom experience of CRD prior to PR; (2) positive impact of PR on living with CRD; (3) contextual programme design improved participants' experience with PR; (4) one size does not fit all and (5) challenges and opportunities for home-based PR. Participants reported experiencing improvements in physical, psychological and social health associated with PR programme participation. The provision of transport was considered a key facilitator for PR programme completion. Realising the gained PR benefits, participants were willing to continue exercising at their homes.CONCLUSION: The PR programme 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 NUMBER: Prospective; 27 August 2021; ISRCTN13836793.",

keywords = "Adult, Aged, Chronic Disease, Exercise Therapy/methods, Female, Humans, Malawi, Male, Middle Aged, Patient Acceptance of Health Care/statistics \& numerical data, Qualitative Research",

author = "Bickton, \{Fanuel Meckson\} and Talumba Mankhokwe and Beatrice Chavula and Emily Chitedze and Martha Manda and Cashon Fombe and Martha Mitengo and Langsfield Mwahimba and Moses Isiagi and \{van Zyl-Smit\}, \{Richard N\} and Susan Hanekom and Martin Heine and Harriet Shannon and Jamie Rylance and Enock Chisati and Gordon, \{Stephen B\} and Felix Limbani",

year = "2025",

month = may,

day = "22",

doi = "10.1136/bmjresp-2024-002547",

language = "English",

volume = "12",

journal = "BMJ open respiratory research",

publisher = "BMJ Publishing Group",

number = "1",

}

Bickton, FM, Mankhokwe, T, Chavula, B, Chitedze, E, Manda, M, Fombe, C, Mitengo, M, Mwahimba, L, Isiagi, M, van Zyl-Smit, RN, Hanekom, S, Heine, M, Shannon, H, Rylance, J, Chisati, E, Gordon, SB & Limbani, F 2025, 'Acceptability of pulmonary rehabilitation in Malawi - a qualitative study', BMJ open respiratory research, vol. 12, no. 1, e002547. https://doi.org/10.1136/bmjresp-2024-002547

TY - JOUR

T1 - Acceptability of pulmonary rehabilitation in Malawi - a qualitative study

AU - Bickton, Fanuel Meckson

AU - Mankhokwe, Talumba

AU - Chavula, Beatrice

AU - Chitedze, Emily

AU - Manda, Martha

AU - Fombe, Cashon

AU - Mitengo, Martha

AU - Mwahimba, Langsfield

AU - Isiagi, Moses

AU - van Zyl-Smit, Richard N

AU - Hanekom, Susan

AU - Heine, Martin

AU - Shannon, Harriet

AU - Rylance, Jamie

AU - Chisati, Enock

AU - Gordon, Stephen B

AU - Limbani, Felix

PY - 2025/5/22

Y1 - 2025/5/22

N2 - BACKGROUND: Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with chronic respiratory diseases (CRDs), but its acceptability in Malawi was unknown.OBJECTIVES: To explore patients' acceptability of PR at Queen Elizabeth Central Hospital, Blantyre, Malawi.METHODS: This was a pre-post cohort study where participants were offered a two times per week hospital-based PR programme for 6 weeks, consisting of endurance and strengthening exercises. Following programme completion, face-to-face semistructured in-depth interviews with the participants were conducted. Interview transcripts were thematically analysed using a deductive approach.RESULTS: 10 adults (five females and five males) out of 14 invited (~70% uptake) participated in the PR programme and subsequent in-depth interviews. Five key themes emerged: (1) debilitating symptom experience of CRD prior to PR; (2) positive impact of PR on living with CRD; (3) contextual programme design improved participants' experience with PR; (4) one size does not fit all and (5) challenges and opportunities for home-based PR. Participants reported experiencing improvements in physical, psychological and social health associated with PR programme participation. The provision of transport was considered a key facilitator for PR programme completion. Realising the gained PR benefits, participants were willing to continue exercising at their homes.CONCLUSION: The PR programme 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 NUMBER: Prospective; 27 August 2021; ISRCTN13836793.

AB - BACKGROUND: Pulmonary rehabilitation (PR) is an effective non-pharmacological intervention for people with chronic respiratory diseases (CRDs), but its acceptability in Malawi was unknown.OBJECTIVES: To explore patients' acceptability of PR at Queen Elizabeth Central Hospital, Blantyre, Malawi.METHODS: This was a pre-post cohort study where participants were offered a two times per week hospital-based PR programme for 6 weeks, consisting of endurance and strengthening exercises. Following programme completion, face-to-face semistructured in-depth interviews with the participants were conducted. Interview transcripts were thematically analysed using a deductive approach.RESULTS: 10 adults (five females and five males) out of 14 invited (~70% uptake) participated in the PR programme and subsequent in-depth interviews. Five key themes emerged: (1) debilitating symptom experience of CRD prior to PR; (2) positive impact of PR on living with CRD; (3) contextual programme design improved participants' experience with PR; (4) one size does not fit all and (5) challenges and opportunities for home-based PR. Participants reported experiencing improvements in physical, psychological and social health associated with PR programme participation. The provision of transport was considered a key facilitator for PR programme completion. Realising the gained PR benefits, participants were willing to continue exercising at their homes.CONCLUSION: The PR programme 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 NUMBER: Prospective; 27 August 2021; ISRCTN13836793.

KW - Adult

KW - Aged

KW - Chronic Disease

KW - Exercise Therapy/methods

KW - Female

KW - Humans

KW - Malawi

KW - Male

KW - Middle Aged

KW - Patient Acceptance of Health Care/statistics & numerical data

KW - Qualitative Research

U2 - 10.1136/bmjresp-2024-002547

DO - 10.1136/bmjresp-2024-002547

M3 - Article

C2 - 40404184

VL - 12

JO - BMJ open respiratory research

JF - BMJ open respiratory research

IS - 1

M1 - e002547

ER -

Acceptability of pulmonary rehabilitation in Malawi - a qualitative study

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