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 patients' experiences 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 anonymized and thematically analyzed 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) 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. Realizing 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.