Abstract
BACKGROUND: Pulmonary rehabilitation (PR) is second in importance to smoking cessation treatment in the management of chronic obstructive pulmonary disease (COPD). Access to the service is limited and less than half of those referred complete the treatment. AIMS: We assessed the obstacles to participation in PR among COPD patients in a community-based PR programme and associated general practices. METHODS: A qualitative interview study was conducted among COPD patients who completed the PR treatment, those who did not complete or declined treatment, and patients never referred. Participants were invited by letter from their own general practitioners or from the PR service. Views on exercise, disease education, social contact, group activity, accessibility, location, role of referrer, and support for participation were assessed. Data were analysed using the framework approach. RESULTS: Twenty-four patients (28%, 13 male, 12 not referred) were interviewed. The acceptability of PR was the major concern. Feasibility of attending was an issue for some. Perceptions of PR and of exercise were highlighted. How a smoker might be seen, the suitability of group activity, and the views of professionals were influential, as were positive and negative recommendations. The location of the centre was important. Participants' willingness or reluctance to take on something new was a central element of the decision. Many would welcome the role of experienced patients in introducing the treatment. CONCLUSIONS: For patients who refused referral to PR, had not completed a course, or had yet to be referred, the way the service was introduced was an important determinant of willingness to participate.