BREATHLEssness in INDIA (BREATHE-INDIA): realist review to develop explanatory programme theory about breathlessness self-management in India.

IF 3.1 3区 医学 Q1 PRIMARY HEALTH CARE NPJ Primary Care Respiratory Medicine Pub Date : 2025-03-13 DOI:10.1038/s41533-025-00420-2
Joseph Clark, Naveen Salins, Mithili Sherigar, Siân Williams, Mark Pearson, Seema Rajesh Rao, Anna Spathis, Rajani Bhat, David C Currow, Kirsty Fraser, Srinagesh Simha, Miriam J Johnson
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Abstract

Breathlessness is highly prevalent in low and middle-income countries (LMICs). Low-cost, non-drug, breathlessness self-management interventions are effective in high-income countries. However, health beliefs influence acceptability and have not been explored in LMIC settings. Review with stakeholder engagement to co-develop explanatory programme theories for whom, if, and how breathlessness self-management might work in community settings in India. Iterative and systematic searches identified peer-reviewed articles, policy and media, and expert-identified sources. Data were extracted in terms of contribution to theory (high, medium, low), and theories developed with stakeholder groups (doctors, nurses and allied professionals, people with lived experiences, lay health workers) and an International Steering Group (RAMESES guidelines (PROSPERO42022375768)). One hundred and four data sources and 11 stakeholder workshops produced 8 initial programme theories and 3 consolidated programme theories. (1) Context: breathlessness is common due to illness, environment, and lifestyle. Cultural beliefs shape misunderstandings about breathlessness; hereditary, part of aging, linked to asthma. It is stigmatised and poorly understood as a treatable issue. People often use rest, incense, or tea, while avoiding physical activity due to fear of worsening breathlessness. Trusted voices, such as healthcare workers and community members, can help address misconceptions with clear, simple messages. (2) Breathlessness intervention applicability: nonpharmacological interventions can work across different contexts when they address unhelpful beliefs and behaviours. Introducing concepts like "too much rest leads to deconditioning" aligns with cultural norms while promoting beneficial behavioural changes, such as gradual physical activity. Acknowledging breathlessness as a medical issue is key to improving patient and family well-being. (3) Implementation: community-based healthcare workers are trusted but need simple, low-cost resources/skills integrated into existing training. Education should focus on managing acute episodes and daily breathlessness, reducing fear, and encouraging behavioural change. Evidence-based tools are vital to gain support from policymakers and expand implementation. Breathlessness management in India must integrate symptom management alongside public health and disease treatment strategies. Self-management interventions can be implemented in an LMIC setting. However, our novel methods indicate that understanding the context for implementation is essential so that unhelpful health beliefs can be addressed at the point of intervention delivery.

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来源期刊
NPJ Primary Care Respiratory Medicine
NPJ Primary Care Respiratory Medicine PRIMARY HEALTH CARE-RESPIRATORY SYSTEM
CiteScore
5.50
自引率
6.50%
发文量
49
审稿时长
10 weeks
期刊介绍: npj Primary Care Respiratory Medicine is an open access, online-only, multidisciplinary journal dedicated to publishing high-quality research in all areas of the primary care management of respiratory and respiratory-related allergic diseases. Papers published by the journal represent important advances of significance to specialists within the fields of primary care and respiratory medicine. We are particularly interested in receiving papers in relation to the following aspects of respiratory medicine, respiratory-related allergic diseases and tobacco control: epidemiology prevention clinical care service delivery and organisation of healthcare (including implementation science) global health.
期刊最新文献
The asthma diagnosis jigsaw puzzle: an adaptable teaching concept to facilitate the diagnosis of asthma in adults and children presenting to primary care. BREATHLEssness in INDIA (BREATHE-INDIA): realist review to develop explanatory programme theory about breathlessness self-management in India. A service evaluation following the implementation of computer guided consultation software to support primary care reviews for chronic obstructive pulmonary disease. Assessing competence of primary care respiratory healthcare professionals to deliver a psychologically-based intervention for people with COPD: results from the TANDEM study. Burden of illness among patients with asthma prescribed inhaled corticosteroids/long-acting β2-agonists.
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