Optimising Pulmonary Rehabilitation Implementation in Malaysia: Tailored strategies for Improved Referral, uptake and delivery in patients with Chronic Respiratory Diseases

Research Question: Can tailored strategies focusing on challenges in referral, uptake and delivery, address the underutilisation of Pulmonary Rehabilitation (PR) for Chronic Respiratory Diseases (CRDs) in Malaysia? Background: Globally, 545 million people are affected by CRDs, disproportionately affecting Low- and Middle-Income Countries. Malaysia, grappling with a substantial burden of CRDs, especially Chronic Obstructive Pulmonary Disease, incurs high healthcare costs. Despite recognised benefits, PR services remain underutilised. Building on the NIHR Global Health Research Unit on Respiratory Health (RESPIRE) home-based model during the COVID-19 pandemic, our research aims to develop strategies to enhance PR implementation. Methodology: We aim to develop and test strategies for PR implementation in Malaysia: 1. Mapping existing PR Services in Malaysia: Assessing their structure and identifying potential barriers through a survey of healthcare facilities. 2. Qualitative research with patients, healthcare providers (HCPs), and managers: Exploring perspectives on PR referral and uptake through focus groups and interviews. 3. Mapping causal pathways: Identifying socio-ecological factors influencing awareness, demand, referral, uptake, and completion of PR. 4. Developing an implementation strategy: Creating culturally tailored strategies based on findings through an iterative design process involving stakeholder feedback. 5. Feasibility study: Testing the implementation strategy in two diverse sites through a mixed-method feasibility study to assess its potential impact on enhancing PR access and uptake in Malaysia. Questions to Discuss: 1. What tailored strategies should we consider to address the under-utilization of pulmonary rehab? 2. Which facets of PR services we should explore during our mapping exercise? 3. What insights emerge from qualitative research with patients, HCPs, managers, policy makers and researchers on PR referral and uptake, informing effective strategy development?