Innovative strategies for sustaining Stakeholder Engagement in Respiratory Health Research: Lessons from Malaysia's RESPIRE initiative amidst the COVID-19 Pandemic

Aim: The primary aim was to sustain impactful stakeholder engagement in a global health research program during the COVID-19 pandemic. Context: RESPIRE, funded by the National Institute of Health and Care Research, tested low-cost interventions to enhance respiratory health in Asia. Over five years (2017-2022), 52 studies across Bangladesh, India, Malaysia, and Pakistan aimed to map respiratory disease burdens and explore interventions, underpinned by a systematic approach to community, provider and policy engagement. However, the COVID-19 pandemic disrupted RESPIRE's research and planned in-person engagements. Intervention: In Malaysia, the RESPIRE team conducted in-person interactive workshops for patients and primary care providers to design a self-management app for asthma. Primary healthcare providers and school stakeholders were engaged through Zoom meetings. A unique virtual run for asthma was organised, fostering a virtual community. During an online workshop, children with asthma and their parents co-developed an interactive and informational comic book. Strategy for Change: The hybrid strategy involved leveraging online platforms for training, intervention design and public awareness raising despite physical limitations imposed by the pandemic. Implementing this strategy required risk mitigation, resources, and budgetary flexibility. Impact: Stakeholder participation was sustained despite the pandemic. Providers continued to build their clinical and teaching capacity; patients stayed involved in the research. The novel virtual asthma run engaged significant numbers (760 participants) and offered a platform for sharing stories, fostering a sense of community. Lessons Learned: Adaptability and creativity are required to sustain stakeholder engagement during public health emergencies. Online platforms served as an important mode to maintain and enhance collaboration with stakeholders. However, online engagement was only possible because of trust and relationship building conducted in the pre-pandemic phase. These lessons can be adapted and used to navigate challenges amid unforeseen disruptions in other settings.