Development of an educational intervention to reduce the burden of adult chronic lung disease in rural India: Inputs from a qualitative study.

Biswajit Paul,Liz Grant,John Norrie,Harish Nair,Rita Isaac,Aziz Sheikh,Muthathal S,Hemalatha R,Paul Jebaraj,David Weller,Deepa Das,Hilary Pinnock,Vijayaprasad Gopichandran

doi:10.1371/journal.pone.0254534

Abstract

BackgroundChronic respiratory diseases (CRDs) are major causes of mortality and morbidity worldwide with a substantial burden of the disease being borne by the low and middle income countries (LMICs). Interventions to change health behaviour which aim to improve the quality of life and reduce disease burden due to CRD require knowledge of the problem and factors influencing such behaviour. Our study sought to appreciate the lived experiences of people with CRD, their understanding of the disease and its risk factors, and usual practice of health behaviour in a rural low-literate community in southern India.MethodsQualitative data were collected between September and December 2018 through eight focus group discussions (FGDs), five in-depth interviews and four key-informant interviews from patients and community members. Community engagement was undertaken prior to the study and all interviews and discussions were recorded with permission. Inductive coding was used to thematically analyse the results.ResultsMajor themes included understanding of chronic lung disease, health behaviours, lived experiences with the disease and social norms, attitudes and other factors influencing health behaviour.DiscussionPoor understanding of CRDs and their risk factors affect health seeking behaviour and/or health practices. Stigma associated with the disease and related health behaviours (e.g. inhaler use) creates emotional challenges and mental health problems, besides influencing health behaviour. However barriers can be circumvented by increasing community awareness; communication and connection with the community through community based health care providers can turn challenges into opportunities for better health care.

Highlights

Chronic respiratory diseases (CRD) constitute a major and escalating challenge to public health in low-and middle-income countries (LMICs) because of their high prevalence and severity—and limited awareness of the risk factors and treatment options in the population, especially in the rural, low-health-literate communities [1,2,3]
focus group discussions (FGDs) were conducted among the patients with CRDs, in-depth interviews (IDIs) with the care-givers and key informant interviews (KIIs) were with key community members
Our study confirms that CRD-related attitudes and behaviours are influenced by knowledge and awareness–and by a range of financial, social and other constraints

Summary

Background

Chronic respiratory diseases (CRDs) are major causes of mortality and morbidity worldwide with a substantial burden of the disease being borne by the low and middle income countries (LMICs). Interventions to change health behaviour which aim to improve the quality of life and reduce disease burden due to CRD require knowledge of the problem and factors influencing such behaviour. Our study sought to appreciate the lived experiences of people with CRD, their understanding of the disease and its risk factors, and usual practice of health behaviour in a rural low-literate community in southern India. Data Availability Statement: The de-identified data can be accessed at the open access data repository of University of Edinburgh known as Edinburgh DataShare available at https://datashare.ed.ac.uk. Qualitative study to inform intervention development for behaviour change in adults with chronic lung disease in rural India, 2018 [text].

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