Supporting engagement with pulmonary rehabilitation amongst people from minority ethnicities in the UK: A theoretically informed behavioural analysis

Background: Despite strong evidence supporting Pulmonary Rehabilitation (PR) for Chronic Obstructive Pulmonary Disease (COPD), many patients choose not to attend. Uptake is particularly low among people with COPD from UK minoritised ethnic groups. Limited data exist on their perspectives of PR. We aimed to identify factors influencing PR engagement, to inform development of appropriate interventions. Methods: We conducted focus groups and semi-structured interviews with UK COPD patients, carers and community leaders of Black Caribbean, Black African and Bangladeshi heritage (n=16). Topic guides were structured around the Capability (C), Opportunity (O) and Motivation (M) model of behaviour (COM-B). A combined deductive and inductive thematic analysis identified key influences on PR uptake, which were mapped to potential interventions using the Behaviour Change Wheel (BCW). Results: Influences on PR uptake included limited knowledge of COPD causes and the benefits of PR and exercise (C), low confidence in their ability to exercise (M), and logistical barriers such as being unable to use public transport because of breathlessness (O). Bangladeshi participants wanted PR to reflect cultural values, including women-only sessions, prayer-time accommodation, language support, and community-based venues (O). Participants across the ethnicities sampled also reported limited trust in health services (O). Conclusion: Uptake of PR can be enabled by improving knowledge, engaging families and carers, shifting beliefs about PR’s value, and addressing logistical barriers. Culturally focused strategies included involving trusted community figures, tailoring PR classes to reflect cultural values, and raising awareness at the grassroots level. Clinical trial number: Not applicable