Empowering primary care to influence health research, policy, and practice in low-resource settings: The PuRe Trial as an example

Research Question: How can primary care respiratory physicians (PCRPs) influence health care policy and practice in a low-income country such as Bangladesh using the example of the Pulmonary Rehabilitation Multinational Hybrid-I Implementation Trial: The PuRe Trial? Background: Pulmonary rehabilitation (PR), though well-established as an effective intervention for chronic respiratory diseases (CRDs), remains under-utilised due to low expectations and lack of awareness. While PCRPs see PR's potential but struggle to generate evidence for its adoption. Engaging stakeholders is crucial to overcoming these barriers. Methods: A mixed-method study evaluating a two-decade strategy to position primary care as important stakeholders in health practice and policy. This includes a review of: • The role of the International Primary Care Respiratory Group (IPCRG) as facilitator • Creation and delivery of a novel six-month distance-learning program on asthma management to build the reputation of primary care by enhancing the knowledge and clinical competencies of PCRPs, including periodic clinical audits presented at international conferences • Successful use of advanced training opportunities, including PR training, fellowships, and PhD programmes, to enhance research and implementation expertise and credibility. • Co-development of the PuRe trial involving countries (Bangladesh, India, Malaysia) facing similar resource constraints in four centres. PuRe is a three-arm, individually randomised, assessor-blinded hybrid-1 implementation trial that aims to evaluate the clinical effectiveness of PR for individuals with CRDs, with a health economic evaluation and mixed-methods process evaluation. Discussion: Primary care's role in the PuRe trial highlights its importance in tackling CRDs in low-resource settings, with Bangladesh showcasing the value of strategic global engagement and stakeholder collaboration. Questions for Discussion: 1. What would be the best research methods? 2. How can PCRPs integrate applied research into clinical practice? 3. How to create sustainable applied health research network for PCRP? 4. How to engaged stakeholders in such research programs?