Understanding the implementation of PR in Bangladesh using Normalization Process Theory

Clinical Research Results Abstract Background and aimDespite the proven effectiveness of pulmonary rehabilitation (PR) for managing people with chronic respiratory diseases (CRDs), at present, only three centres provide PR services in Bangladesh. To embed and integrate PR in routine clinical practice we aimed to understand the views of healthcare professionals and other relevant stakeholders for the implementation of this new intervention in the Bangladesh context. We chose to use normalisation process theory (NPT) for the framework analysis as the constructs provided tools to explore how PR can be normalised into routine clinical practice. Method: Semi-structured interviews (30 to 45 minutes) were conducted with a purposive sample of healthcare professionals and other stakeholders. The audio-recorded interviews were transcribed and codes were generated against the 16 domains of the four constructs of NPT. A videoconference was arranged with our multidisciplinary research team to discuss and interpret the findings using the NPT toolkit to generate a radar plot that depicts a visual impression of each of the constructs of NPT. Result: We interviewed 16 stakeholders (7 clinical practitioners, 4 PR providers, 2 policymakers, and 3 other relevant stakeholders). Apart from the three pioneering PR centres, the predominant activity amongst professionals and other stakeholders was evaluation (informal monitoring and formal research). There is some evidence of sense-making amongst stakeholders, sporadic participation, but no translation into action. The barriers are no policy support, confusion about existing chest physiotherapy services, lack of clarity over referral mechanisms, and no official training/career pathways for PR staff.The strengths of these themes are illustrated in the figureConclusion: PR is a new intervention in Bangladesh. Stakeholders are aware of the evidence and are watching the impact of the pioneering PR services in Bangladesh before deciding about policy and implementation of PR in their practices Research Idea Abstract Service Development & Evaluation Abstract Declaration of Interest References and Clinical Trial Registry Information