Perception of Patients and Caregivers toward Oxygen Therapy in Mbale Regional Referral Hospital, Eastern Uganda

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Mutesi, Ashley Nakawuki, Eunice Namubiru, Paul Oboth, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8692126/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 13 You are reading this latest preprint version Abstract Background: Oxygen refers to a colorless, odorless, tasteless gas that is essential for proper body functioning and survival. However, the effectiveness of oxygen therapy can be influenced by the perceptions of patients and caregivers. Understanding patients' and caregivers' perceptions of oxygen therapy directly impacts healthcare practices. Consequently, the information gained from such research can be used to develop interventions that can help promote oxygen therapy's benefits, leading to the acceptance and compliance with oxygen as treatment. This studied aimed to explore the perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital (MRRH). Materials and methods: This study was conducted in Mbale Regional Referral Hospital involving in-depth interviews with patients and caregivers. The study employed a descriptive qualitative study. The qualitative data collected was analyzed using the Braun and Clerk approach. Results: Both patients and caregivers reported that they perceived oxygen therapy as a life-saving yet fear-inducing intervention, spiritual and emotional interpretations of oxygen therapy, perceived physical and technological aspects of oxygen therapy. Sources of information about oxygen therapy were mainly schools, communities, hospitals, and the internet. Implementation of community sensitization campaigns and health education on oxygen therapy to promote awareness as well as counselling and psychological support for patients and caregivers struggling with emotional distress and fear associated with oxygen therapy. Further research is needed to assess the effectiveness of health education and awareness interventions in improving the perceptions of patients and caregivers towards oxygen therapy. Perception Patients Caregivers Oxygen Therapy Background Oxygen refers to a colorless, odorless, tasteless gas that is essential for proper body functioning and survival [ 1 ]. Oxygen therapy refers to the administration of oxygen to a concentration of pressure greater than that found in the environmental atmosphere. The purpose of oxygen therapy is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury for-example in severe respiratory distress, hypoxemia, chronic obstructive pulmonary disease (COPD) [ 2 , 3 ]. Oxygen therapy is used to treat pulmonary hypertension, acute myocardial infarction, short-term therapy like in post anesthesia recovery and chronic lung disease patients during exercises [ 4 , 5 ]. Globally each year, 374 million people need medical oxygen: 364 million in acute medical and surgical contexts, and 9 million with long-term oxygen needs due to COPD [ 6 ]. About 306 million of the 374 million people who need oxygen live in low and middle-income countries, 253 million in South Asia, east Asia and the Pacific, and Sub-Saharan Africa [ 6 ]. A study in Nigeria found out that caregivers were refusing oxygen treatment for their children due to misconceptions and pervasive negative narratives around oxygen therapy in their communities [ 7 ]. Despite the known benefits and applications of oxygen therapy, the perception of people varies widely. A study in Nigeria found out that in some cases, oxygen therapy is perceived as a death sentence [ 8 ]. In addition, individuals assume benefits of oxygen even outside medical prescription, for example, oxygen bars where oxygen is assumed to reduce stress, increase relaxation and energy [ 9 ]. Yet, Unregulated or excessive use of oxygen can potentially cause adverse effects [ 10 ]. Consequently, evidence based public information is essential to prevent and mitigate such misconceptions and promote acceptance of oxygen therapy among caregivers and patients. Available evidence demonstrates that the perception of patients towards oxygen therapy influences the compliance and acceptance of oxygen as treatment [ 11 ]. Despite these insights, little is known about the general public’s perception of oxygen therapy in MRRH especially across different demographic groups and cultural contexts. This gap creates an opportunity to explore the view of different populations towards oxygen therapy and what factors shape these perceptions. Understanding the patient’s and care giver’s perceptions towards oxygen therapy has a direct impact on healthcare practices. More so, the information gained from such research can be used to develop interventions that can help to promote the benefits of oxygen therapy, leading to the acceptance and compliance to oxygen as treatment. In fact, the knowledge obtained can be used to guide healthcare policy and preparation for future healthcare emergencies such as pandemics. Despite the known benefits of oxygen therapy in improving the quality of life, many patients are still hesitant or refuse oxygen therapy. This has been reported to be influenced by their misconceptions and beliefs about oxygen therapy. These negative perceptions result into late or failure to administer oxygen therapy. Late initiation of oxygen therapy negatively impacts on the quality of life, social wellbeing and last phase of life [ 12 ]. A study carried out in three government funded District hospitals in Eastern Uganda which are under MRRH catchment area, reported that the local population was fearful of oxygen therapy and hesitant to consent for administration of oxygen therapy to their children [ 11 ]. The reason for the hesitance of patients and caregivers towards oxygen therapy is not clearly documented. Therefore, understanding the perception of the caregivers and patients towards oxygen therapy may help to fill the existing gaps. Consequently, the aim of this study is to explore the perception of the caregivers and patients towards oxygen therapy at Mbale Regional Referral Hospital. Materials and methods Study design This study employed a descriptive qualitative study design to explore the perceptions of patients and caregivers toward oxygen therapy. It emphasized a detailed description of the experiences and events about oxygen therapy as well as capturing the essence of participants’ experiences, perceptions and beliefs [ 13 , 14 ]. A descriptive qualitative study design involved collecting qualitative data. Study setting The study was mainly facility-based at Mbale Regional Referral Hospital, a community-based hospital, in different wards that held patients on oxygen therapy, including the medical ward, surgical ward, casualty, surgical high dependency unit (HDU), and postnatal high dependency unit (HDU). Mbale Regional Referral Hospital, a government-funded and owned hospital, was located in the center of Mbale city, 250km east of Kampala, the capital city of Uganda. The hospital served over 4.6 million people in 16 districts of Busia, Tororo, Butaleja, Pallisa, Budaka, Mbale, Bududa, Sironko, and Manafwa. Namisindwa, Butebo, Kapchorwa, Kibuku, Bukwo, Kween, and Bulambuli [ 15 , 16 ]. Study population The target population included the patients who had undergone oxygen therapy and were at the point of discharge, as well as their caregivers, and those caregivers who had ever taken care of patients on oxygen therapy in MRRH. The group of interest was required to be adult patients who received oxygen therapy and the adult caregivers who took care of patients on oxygen therapy. Selection criteria Inclusion criteria Patients and caregivers aged 18 years and above. Patients who had received oxygen therapy and were at the point of discharge. Caregivers who had ever provided care for patients receiving oxygen therapy and their current patients are at the point of discharge. Exclusion criteria Patients who had impaired cognition or severe medical conditions that impair communication. Patients and caregivers who declined informed consent Sampling technique This study employed a purposive sampling method, a non-probability sampling technique in which decisions for participant inclusion were taken by the researcher based on knowledge, judgment, or capacity and willingness to participate in the research. Purposive sampling was important in that it provided researchers with the justification to generalize from the studied sample, it provided a wide range of non-probability sampling techniques for the researcher to draw on, and proper care was taken when selecting the sample [ 17 , 18 ]. The researcher selected patients and caregivers who had had an exposure or experience with oxygen therapy and were willing to participate in the study. Sample size determination In this study, the sample size was determined using the principle of saturation sampling. The concept of saturation referred to information redundancy or the point at which no new themes or codes emerged from the data [ 19 ]. In a systematic review of empirical tests by M. Hennink et al, the results showed that across 16 tests using various approaches to saturation, the sample size for saturation ranged between 5 and 24 interviews [ 20 ]. In this study, it was estimated that 16 participants would be recruited, comprising both patients and caregivers, which was within the approved range of interviews. However, the final number of participants was 16 patients and 30 caregivers. Data collection tools The primary data collection tool was an in-depth interview guides. This tool was designed by the researcher to allow for exploration of patients’ and caregivers’ perceptions toward oxygen therapy. The interview guide was organized into sections such as an introduction to establish rapport and gather basic demographic information; consent notes for ethical considerations; and questions exploring the background and experience, perception, and support and education about oxygen therapy. The guide included prompt and guiding questions to elicit detailed responses and explore more about the respondents' experiences. Data collection procedure The data collection involved in-depth interviews with the patients and caregivers to explore their perceptions of oxygen therapy. In-depth interviews allowed for a comprehensive understanding of participants’ experiences and beliefs in their own words [ 21 ]. The researcher conducted the interviews in the local languages best understood by the participants, which included English, Luganda, and Lumasaba with the help of language experts who had a high level of knowledge and experience in the language, who translated the interview guide into the local languages. Each interview was conducted face-to-face in a private, comfortable, and quiet setting to ensure confidentiality and minimize distractions. The interviews lasted between 30minutes-1hour minutes, and audio recordings, after obtaining consent from the participants, were taken for accurate transcription and analysis. Field notes were also taken to capture non-verbal cues and contextual observations. Participants were assured of their anonymity and their right to withdraw from the study at any point without consequences. Trustworthiness This study employed the four principles of trustworthiness by Lincoln and Gubba of Credibility, Conformability, transferability and dependability [ 22 , 23 ] as expounded below: Credibility Credibility refers to how true is the collected data, the interpretation and representation of the data by the researcher. The researcher will ensure credibility through thorough data collection including, prolonged engagement to build rapport with informants and foster rich detailed responses; and reflexivity with the informants so as and to prevent researcher bias through maintaining reflexive journals. Reflexivity means the researcher’s own thoughts, feelings and actions and how they influence the participants’ responses [ 24 ] . The researcher maintained an audit trail that documents the researcher’s decisions and assumptions which was reviewed by the supervisor so as to draw the same study conclusions [ 25 ]. The researcher described fully the strategies performed and the vivid quotes from participants, so that the reader can critique the credibility of the study. Confirmability Confirmability refers to the extent to which the researcher demonstrates that the data represents the participants responses and not researcher’s biases, motivations or interests [ 26 ]. The researcher ensured confirmability through maintaining an audit trial, reflexive journal and triangulation [ 27 ]. The researcher used reflexive journal in order to reflect on, tentatively interpret and plan data collection. Dependability Dependability refers to the consistency of findings under similar conditions or over time [ 26 ]. The researcher ensured dependability through stepwise replication where the researcher and the supervisor analyzed the same data separately and compare the results. Inconsistences that arose were addressed to improve the dependability, and for similar findings, then dependability was achieved [ 28 ]. Transferability Transferability refers to findings that can be applied to other contexts, that the findings have meaning to the individuals not involved in the study and readers can associate the findings with their own experiences [ 25 ]. The researcher ensured transferability through providing thick descriptive data concerning the methodology to allow comparison of the context to other contexts to which transfer might be contemplated [ 27 ]. Data analysis The researcher employed reflexive thematic analysis using the Braun and Clerk approach to analyze the qualitative data. Braun and Clerk described reflexive thematic analysis as divided into six (6) phases [ 29 ] and the researcher will employ them as described below: Data familiarization; This involves immersing oneself in the data to understand depth and breadth of the content, searching for patterns as well as meanings. This was done through transcribing audio data, reading data set and note taking. Generating codes; Generating of initial codes to organize the data, with full and equal attention given to each data item. This was done by labelling and organizing items into meaningful groups. Generating themes; This includes sorting of codes into themes and identifying meaning of and relationships between codes. This was done through diagramming or mapping and writing themes and their defining properties. Theme review; This consists of identifying coherent patterns at the level of the coded data and reviewing entire data set as a whole. This was done through ensuring there is enough data to support a theme, collapsing overlapping themes and reworking and refining codes and themes. Theme defining and naming; This includes identifying the story of each of the identified themes and fitting the broader story of the data set to respond to the research questions. This was done through cycling between the data and the identified themes in order to organize the story. Report production; This comprises presenting of a concise and interesting account of the story told by the data, both within and across themes. This was done by writing a compelling argument that addresses the research questions and by writing beyond the simple description of the themes. Ethical considerations The approval from was sought from Busitema University Research and Ethics Committee under the registration number BUFHS-2025-797. Mbale Regional Referral Hospital Research and Ethics Committee also granted Research and administrative clearance for this study under the registration number MRRHREC-OUT-160/2025. Informed consent was obtained from the patients and caregivers by explaining to them explicitly about what the study is all about and what it was meant for them to participate in the study. Emphasis was put on the participants’ right to either continue with the study or withdraw from the study without penalty or having to provide a reason. The participants were assured of confidentiality and anonymity so that they speak freely without fear of being identified as having given information. This involved finding a safe place with minimal distractions during the interviews. Adherence to the principles of Helsinki declaration of protection of human subject was ensured [ 30 ]. Results The study involved a total of 46 participants including 16 patients and 30 caregivers. The Social-Demographic Characteristics of the patients The majority of the patients 75% were females, while 25% were males. Most patients 43.8% had a secondary education, 37.5% had tertiary education and 18.8% had primary education. 11% of the participants were married, 25% were single and 6.3% were widowed. The participants’ ages ranged from 18 to 59 years, with a mean age of 38.5 years. Majority of the participants identified as Christians 81.3% while 18.8% identified as Muslims. The most common occupations among patients were business owners 56.3%, followed by peasants 18.8% as illustrated in Table 1. The Social-demographic Characteristics of Caregivers The majority of the caregivers 66.7% were females, while 33.3% were males. Most caregivers 30% had a secondary education, 60% had tertiary education, 3.3% had primary education and 6.7% had no education. 63.3% of the participants were married, 30% were single and 6.7% were widowed. The participants’ ages ranged from 18 to 56 years, with a mean age of 37 years. Majority of the participants identified as Christians 60% while 40% identified as Muslims. The most common occupations among patients were business owners and salary earners 33.3%, followed by peasants 20% as illuminated in Table 2. The Perception of Patients and Caregivers towards Oxygen Therapy The perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital was both positive and negative. The journey of oxygen therapy in the lives of patients and caregivers is one filled with conflicting emotions including fear and hope, dread and relief, suspicion and gratitude. Through a thematic analysis, their experiences converge around common concerns while diverging in subtle yet meaningful ways. The themes generated included; oxygen therapy as a life-saving yet fear-inducing intervention, spiritual and emotional interpretations of oxygen therapy, perceived physical and technological aspects of oxygen therapy. The findings are summarized in table 3 and table 4. Theme one: Oxygen therapy as a life-saving yet fear-inducing intervention Under this theme, both patients and caregivers recognized oxygen therapy as a critical medical tool. However, its use was often entangled with profound fear, particularly the fear of death. Oxygen therapy as a lifesaving yet fear inducing intervention is discussed under two subthemes including oxygen therapy as a lifesaving intervention and oxygen therapy as a symbol of death. Subtheme one: oxygen therapy as a symbol of death Patients equated oxygen therapy with end of life due to the belief that whoever is initiated on oxygen therapy has minimal chances of survival and is therefore nearing death. There was a belief that oxygen is initiated to an already dead person just he or she has not been confirmed dead yet. Some patients admitted that refusal of oxygen was rare because it is the last option for them to survive. Similarly, the association of oxygen use and the final moments of a patient’s life has led caregivers to perceive it as a sign that death is near. Some caregivers believed that when a patient is initiated on oxygen, either their life is no more, they are dying soon or they are already dead: “…when I was initiated on oxygen, I thought I was going to die…” [PII-12] …they say that your patient may be put on oxygen and they keep on lying to you yet the patient already died. They keep on telling you that the patient is alive yet the patient died long time back … [CGI-07] In addition, patients reported that oxygen therapy was a fast and effective intervention for emergency situations especially during respiratory distress. Oxygen therapy meant that the situation is getting out of hand and some believed that oxygen therapy can manage chronic illnesses like asthma. Some caregivers associated the initiation of oxygen with urgent medical intervention, typically involving patients who were struggling to breathe, unconscious or visibly in critical condition. This framed oxygen therapy as a marker of severe illness. Most of the caregivers reported that in their experiences, oxygen therapy is in most cases administered to the critical patients, often when recovery is unlikely. “…What I understand is, okay, they give you oxygen when you are not able to breathe. That is what I know. And when you may be very sick…” [PII-12] Furthermore, concerns about the fear of dependence on oxygen therapy were raised by patients due to the belief that the first contact with oxygen therapy predicted more other contacts with it -------and to some, it meant that you are to get oxygen therapy all your life. “…what I think that seems to be right, when you are initiated on oxygen, you might get used and need to be on it all your life because when I remove the nasal prongs tentatively to breathe in the surrounding air too, I feel like frightened as if the air am breathing is scaring me…” [PII-13] Some patients admitted that they only accepted to be initiated on oxygen therapy because of the worsening condition of not being able to breathe on their own and thus needed support from oxygen therapy. “…I also got scared because I also wanted to refuse when they wanted to put me on oxygen because I was scared and I said that last time we refused when they wanted to put me on oxygen but later I normalized but the condition this time was worse I couldn’t breathe in the air, so I had to be strong and I accepted to be put on oxygen…” [PII-13] Furthermore, fear rooted in traumatic medical outcomes captures the deep emotional fear and anxiety experienced by caregivers from past encounters where oxygen therapy was associated with poor clinical outcomes particularly death. These traumatic experiences contributed to the development of a lasting psychological link between oxygen therapy and fatality, resulting in persistent fear whenever oxygen therapy was introduced during patient care Some caregivers viewed oxygen with a degree of fear and suspicion, believing that its use could worsen the patient’s condition. Oxygen therapy was seen as risky, extremely dangerous and fatal depending on the caregiver’s previous experiences with deteriorating patients on oxygen. “…quite risky because when eeehh, someone is undergoing that oxygen therapy, you really see there’s a time where it reaches and as if he’s not breathing…” [CGI-04] Finally, some caregivers associated the initiation of oxygen therapy with the final and most desperate medical intervention suggesting that the use of oxygen indicated that the patient was at the verge of death and that all other treatment options have failed. Subtheme two: oxygen therapy as a lifesaving intervention Patients reported that oxygen therapy was supportive to those unable to support themselves while unconscious or breathless helping them to regain some life while some patients stated that if only oxygen was close to where they stay, they would be already healed and free from their long-term chronic illness. “…they put it on you and it bring back some life sometimes the person has fainted when the heart is far, when you need oxygen so that you gain consciousness and you can’t support yourself and its oxygen to support you so that you regain life…” [PII-02]. Patients admitted that whenever oxygen was initiated, they felt calm and with the feeling of air entering into the nose, it felt very comforting and soothing. …when I put it (oxygen therapy) and it helped me, I could breathe well and it made me calm down… ……..[PII-04] Following multiple exposures to oxygen therapy, some patients reported familiarity with oxygen therapy and that it was no longer scary. …this is not the first time am put on oxygen; I have been put several times. It couldn’t scare me in anyway …[PII-08] According to the caregivers, some reported that they welcomed the idea of putting their patients on oxygen because they knew that oxygen would help the patient to have life. The perception that oxygen is a life-saving intervention was based on the caregiver’s opinion, some caregivers reported that oxygen is a support system to assist those with difficulties in breathing. “…that it’s (oxygen) the air that helps the patient when unable to breathe. It helps so that the patient is able to breathe well …” [CGI-12] The psychological reassurance was expressed in diverse ways among caregivers, most notably through expression of hope for life and positive treatment outcomes: “…Because at least when he was put on that Oxygen, he was trying now to come back, to normalize, and he was not struggling like he was …” [CGI-08]. Caregivers expressed their psychological reassurance through the trust they placed in health workers especially in situations of uncertainty or fear: “…for me in my heart I am just following their decisions and I believe they know why they put her on Oxygen, so I cannot interfere with them…” [CGI-17]. Theme two: spiritual and emotional interpretations of oxygen therapy The spiritual and emotional interpretations of oxygen therapy is discussed further under two subthemes namely, spiritual and faith-based interpretations of oxygen therapy and emotion, cognitive social distress in oxygen therapy. Subtheme one: spiritual and faith-based interpretations of oxygen therapy Patients attributed survival to divine intervention with belief that its God who heals and survival is by God’s will despite the medical intervention. Positive outcomes meant that gratitude is to God and this gave hope to patients in situations where medical interventions alone would not be sufficient. However, some patients believed in fate alongside medical intervention stating that if it’s time to die, not even medical interventions can save you. “… I came here when I was ill but now with God, am alive but many have died. I have seen some being brought, they put them on (oxygen) and they die, but me am what? am alive. For that reason, I thank God, He’s great, even though I came ill, but me am what? am alive. It means, God still need me…” [PII-04]. During moments of oxygen therapy, some caregivers frequently turned to prayer and placed their trust in God as the ultimate healer despite the concurrent medical interventions. Consequently, their confidence in clinical treatment was undermined, and the resulting anxiety shifted their reliance away from oxygen therapy towards divine intervention. Subtheme two: emotion, cognitive social distress in oxygen therapy. Patients reported that oxygen therapy was initiated to them while unconscious and they woke up to shock and confusion of seeing themselves on oxygen therapy without knowing what had happened to them during the time of being unconscious. “…I woke up one day, there were things (nasal prongs) on my nose, I could not understand. And then, when I tried removing them, they told me not to remove them. Then, the people around me, they looked scared. So, I was also scared…” [PII-12] Worry, fear and inevitable anxiety following the initiation of oxygen therapy were reported by patients due to feelings of hopelessness and bewildered by thoughts of losing life soon. Some patients also stated that the room and the equipment that deliver oxygen therapy also contribute to their emotional distress as well. “…it (oxygen therapy) can’t fail to worry you, even if you are the strongest, it really worries. It really worries for sure…” [PII-02]. “…I feel so sad because it’s not something easy what comes to my mind, I see myself like a dead body being put into the grave just to fight for a life …” [PII-02]. Patients stated that they were stigmatized by the people surrounding them whenever they were seen on oxygen therapy thus resorted to isolation or social withdrawal due to fear of loss. Some patients did not want to talk about oxygen therapy around other people because they would always associate it with death. “…I don’t really tell people when I'm sick and on oxygen…That kind of feels like someone will be stigmatized. They will always be thinking that, probably you'll die in a minute. Because that's the stigma that comes with it…” [PII-05]. Patients stated that oxygen therapy had effects on them even when it was stopped. The effects were both cognitive consisting of altered mental status and emotional consisting of worry, fear and anxiety. “…but right now, when am in normal senses like this, it’s when I can tell you the truth that I worry that it (oxygen therapy) somehow scares…” [PII-02]. Furthermore , the inadequate knowledge about when, how and why oxygen therapy is used generates anxiety among the caregivers with the most asked question being: “… for how long is it (oxygen) going to be there?” [CGI-02]. This undermines the caregiver’s psychological wellbeing and may impede cooperative engagement in the patient’s care plan. Some caregivers directly attributed unexplained adverse changes in the patient’s condition to the oxygen delivery equipment: “…the person may come out on oxygen because they believe that the tubes affect. I don't know how it affects but they say, it is going to affect the person…” [CGI-16]. Theme three: perceived physical and technological aspects of oxygen therapy Perceived physical and technological aspects of oxygen therapy are discussed further under two subthemes namely; physical discomfort and intrusiveness of oxygen therapy and positive perceptions of healthcare advancements. Subtheme one: Physical discomfort and intrusiveness of oxygen therapy Patients stated that the nasal prongs were uncomfortable and pierced the nose. Oxygen was perceived as un-natural and that the air did not feel fresh. Some patients stated that oxygen therapy affected their normal body functioning because it disrupted their ability to verbally communicate with others but rather use gestures or sign language. “When you are on Oxygen, you just make signs like someone who is dumb for someone to understand you because if you are to talk that thing (nasal prongs) if you are to talk, it pierces you in the nose here and when it does so, you feel like coughing. And when you do so, the dirty discharge from the nose enters the nasal prongs…” [PII-14]. … the air am breathing in does not feel like the normal one…it feels like someone seated in a warm room, there’s no any fresh air …[PII-13]. Subtheme two: Positive perceptions of healthcare advancements. Some caregivers acknowledged the advanced machines used delivering oxygen therapy to patients, which are believed to contribute to the provision of quality care. “…Now the machines have come, eeehh the way oxygen is being given to someone is of a modern way, so, the chances of someone dying are minimal…” [GCI-04]. This perception was rooted in caregivers who have been in private facilities and a prescription for oxygen therapy was quite expensive. This brought them into a thinking that oxygen is expensive in all health facilities. Consequently, caregivers hesitate to initiate oxygen therapy due to fear of expenses. However, some caregivers found out that the services were actually entirely free in government hospitals. “…because had it been in a private sector or a private hospital, I would have incurred a lot of expenses, am told that in some hospitals even pay more than 500k per day…” [CGI-02]. Discussion This study aimed to explore the perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital (MRRH). In this study, the perception of patients and caregivers is discussed separately into different themes. Perception of patients and caregivers towards oxygen therapy The main findings of this study are as follows: i) oxygen therapy as a life-saving yet fear-inducing intervention; ii) spiritual and emotional interpretations of oxygen therapy; iii) perceived physical and technological aspects of oxygen therapy. The patients and caregivers reported that oxygen therapy is perceived as an intervention that assists individuals who are unable to breathe properly, enabling them to breathe better and sustain life. The participants expressed emotional comfort and reassurance in perceiving oxygen therapy as a symbol of hope and life-saving intervention. Patients in particular, described it as soothing and comforting upon initiation. Similarly to our findings, a scoping review by Britto et al.’ has already demonstrated that patients felt safe and comfortable as they begun to feel the flow of oxygen while caregivers felt emotional relief upon seeing an improvement in the patients’ condition [ 31 ]. The main differences between our study and the Britto et al.’ study were that it was a scoping review with most of the articles reviewed based in high income countries and physical burden as well as negative attitudes and feelings of both patients and caregivers towards oxygen therapy were reported. However, oxygen therapy was also perceived as a fear inducing intervention as participants reported episodes of fear, worry, anxiety and hopelessness. Basing on their prior lived experiences such as witnessing the death of a loved one on oxygen therapy, or through interactions with peers, caregivers and patients developed the perception that oxygen therapy is strongly associated with end-of-life with perceptions that individuals placed on oxygen therapy either are going to die, have already died or have minimal chances of survival. For some, oxygen therapy was interpreted as a clear sign that life is nearing its end. Similar findings have been reported in a descriptive cross-sectional study in Nigeria where it was found out that 21.1% patients and 19.5% caregivers believed that oxygen therapy was solely for terminally ill patients [ 32 ]. In another study carried out in Wisconsin, USA, it was found that the respondents stated that oxygen use was initiated to patients who were within days of their expected death [ 33 ]. On another hand, patients who received oxygen therapy more frequently often perceived a strong sense of social stigma and expressed fears of becoming permanently dependent on oxygen therapy. For some, the stigma is so profound that it led to social withdrawal, as those around them may associate oxygen use with impending death and thus hesitate to form meaningful relationships, viewing them as temporary. Nevertheless, a number of patients reported gradually adapting to the use of oxygen, particularly as the frequency of therapy increased. Participants also voiced concerns about long-term dependence, lamenting the loss of natural air and describing their current experience as relying solely on “unnatural” air provided by oxygen concentrators and cylinders. Studies in North England found that patients had similar concerns regarding stigma and dependence on oxygen therapy [ 34 , 35 ] Several participants reported that oxygen was initiated without their awareness, often during periods of unconsciousness. As a result, they were unaware of the events that transpired while the therapy was being administered. Upon regaining consciousness, patients described finding themselves on oxygen therapy without any understanding of how or why it had been initiated. This lack of awareness elicited feelings of shock and confusion. Consequently, many associated oxygen therapy with unconsciousness and perceived it as an intervention reserved for critically ill patients. This perception reinforced the belief that oxygen therapy is primarily an emergency measure, other than being a supportive component of care [ 36 , 37 ]. The emotional reassurance experienced by caregivers was also attributed to their trust in healthcare providers. Caregivers reported having confidence in the competence of health professionals and expressed that they did not question the providers’ ability to deliver appropriate care. This trust stemmed from the belief that healthcare providers are knowledgeable, capable, and have thoroughly assessed the patient’s condition before initiating oxygen therapy. Such trust has been reported to contribute significantly to the acceptance of oxygen therapy as a supportive treatment [ 36 , 38 , 39 ]. However, some patients narrated that they were unfamiliar with the concept oxygen therapy, largely due to residing in rural areas where they had never previously encountered or interacted with it. This study reveals that spiritual and faith-based interpretations significantly influence the perceptions of both patients and caregivers towards oxygen therapy. Caregivers often viewed the initiation of oxygen therapy as an indication of a critical health status, prompting the need for sincere prayers and reflecting a heightened sense of anxiety and concern about the patient's chances of survival. Many participants expressed a strong belief in divine healing alongside medical interventions, suggesting that survival is ultimately determined by God’s will, and positive outcomes are met with gratitude to God. Such faith-based beliefs provided emotional comfort, especially during moments when medical interventions alone did not offer sufficient reassurance. A study carried out in Poland found out that individuals with a higher level of spirituality experienced fewer symptoms of anxiety and depression where as those with more negative religious coping, showed more anxiety and depression symptoms [ 40 ]. Additionally, some patients shared a belief in fate, expressing that life and death are predetermined; if it is one's time to die, it will happen regardless of medical treatment, and if it is not, the person will survive. These perceptions underscore the complex interplay between medical understanding and spiritual beliefs in shaping attitudes towards oxygen therapy. This study identifies discomfort and a sense of intrusiveness as key factors shaping their perceptions. Several patients described the nasal prongs as invasive, stating that they pierced the nose and often led to coughing, which in turn caused secretions to enter the oxygen tubes, an experience they found highly unpleasant. A study by Quinn-Lee, Weggel [ 33 ] carried out in Wisconsin found that 78% of the respondents admitted that oxygen therapy was an irritant [ 33 ]. Beyond physical discomfort, patients also expressed that the oxygen itself did not feel like normal air; it was perceived as unusually warm and lacking freshness, which contributed to a sense of unease. Furthermore, some patients felt that being on oxygen interfered with their ability to move freely. In these cases, they noted that communication became more reliant on gestures or sign language, further reinforcing the perception of oxygen therapy as a restrictive and disruptive intervention. A study carried out by Kelly and Maden [ 36 ] similarly found that patients reported discomfort with use of nasal prongs suggesting that oxygen therapy is not entirely benign but rather discomforting and intrusive [ 36 ]. Another notable perception shared by both patients and caregivers was that oxygen therapy is costly, particularly among individuals from low-income backgrounds. This belief contributed to hesitancy in initiating or accepting oxygen therapy. Several respondents indicated a reluctance to begin treatment due to fears of accumulating medical expenses while in private healthcare settings. Even when the need for oxygen therapy was recognized, some patients hesitated because the facilities offering such services were located far from their homes, resulting in additional transportation costs. These financial concerns were often shaped and reinforced by personal experiences and community conversations, further heightening anxiety and hesitation around starting oxygen therapy. Nevertheless, some participants were aware that oxygen therapy is provided free of charge in government-funded facilities and expressed a desire for similar affordability in private healthcare institutions. A study carried out in Spain had similar findings that the oxygen delivery equipment were perceived to be too expensive [ 41 ]. This study reveals that patients and caregivers obtain information about oxygen therapy from a variety of sources worldwide, including schools, communities, hospitals, and the internet. Some participants residing in rural areas reported that, although oxygen therapy was frequently discussed within their communities, they had never had the opportunity to observe how it functions or what the equipment actually looks like. Consequently, their first encounter with oxygen therapy in a hospital setting provided them with greater exposure and a clearer understanding of its purpose and application. Implications of the study This study reveals that oxygen therapy is perceived both as a life-saving intervention and as a symbol of impending death especially in emergencies. This dual perception interferes with timely acceptance of oxygen therapy, often resulting in delays in care. These findings imply a critical need to educate patients and caregivers about oxygen therapy and to implement community sensitization programs aimed at raising awareness and addressing prevailing misconceptions about oxygen therapy. Furthermore, the findings highlight the importance of providing psychological support to both patients and caregivers during the course of oxygen therapy, given the emotional distress associated with its initiation and use. This support can be strengthened through involvement of religious or spiritual leaders, as participants often perceived divine interventions as a source of hope and emotional reassurance. Study limitations and strengths This study was purely qualitative which cannot be generalized to other settings however, the use of in-depth interviews as well as including both caregivers and patients increases the transferability of the findings to other settings. Patients reported that they were unconscious during the initiation of oxygen therapy therefore feelings and experience during that time could not be assessed. Conclusion This study looked at the perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital. The findings of this study demonstrated that the perceptions of patients and caregivers towards oxygen therapy do not necessarily differ from each other. Patients and caregivers perceived oxygen therapy in terms of; oxygen therapy perceived as a symbol of impending death like oxygen equals the end-of-life; emotional and psychological distress caused by oxygen therapy like fear and anxiety; spiritual and faith-based interpretations of oxygen therapy like attribution of survival to divine interventions; oxygen therapy perceived as a life-sustaining intervention like oxygen therapy heals; psychological reassurance attributed to oxygen therapy like oxygen is a hope for life. Patients further perceived oxygen therapy in terms of; perceived physical discomfort and intrusiveness of oxygen therapy like oxygen is invasive and unnatural; and finally, cognitive disruptions of oxygen therapy like confusion post-oxygen therapy. Caregivers as well further perceived oxygen therapy in terms of; oxygen therapy is perceived as expensive in healthcare facilities; and finally, the positive perception of healthcare advancements like modernization of oxygen delivery system. Recommendations First, there’s need for implementation of community sensitization campaigns involving local leaders, politicians, religious leaders and community health workers to promote awareness and address stigma faced by patients on oxygen therapy and the misconceptions about oxygen therapy in the communities. Secondly, patients and caregivers should be health educated on oxygen therapy using local languages or if possible, using visual aids so as to address psychological distress during initiation of oxygen therapy. Additionally, counselling and psychological support is very essential for patients and caregivers struggling with emotional distress and fear associated with oxygen therapy if preferably done by trained personnel so as to promote psychological discomfort during the initiation of oxygen therapy. Finally, further research is needed to assess the effectiveness of health education and awareness interventions in improving the perceptions of patients and caregivers towards oxygen therapy. Abbreviations WHO: World Health Organization MRRH: Mbale Regional Referral Hospital BUFHS: Busitema University Faculty of Health Sciences BUFHSREC: Busitema University Faculty of Health Sciences Research and Ethics committee Declarations Ethical considerations The approval from was sought from Busitema University Research and Ethics Committee under the registration number BUFHS-2025-797 . Mbale Regional Referral Hospital Research and Ethics Committee also granted Research and administrative clearance for this study under the registration number MRRHREC-OUT-160/2025. Informed consent was obtained from the patients and caregivers by explaining to them explicitly about what the study is all about and what it was meant for them to participate in the study. Emphasis was put on the participants’ right to either continue with the study or withdraw from the study without penalty or having to provide a reason. The participants were assured of confidentiality and anonymity so that they speak freely without fear of being identified as having given information. This involved finding a safe place with minimal distractions during the interviews. Adherence to the principles of Helsinki declaration of protection of human subject was ensured [30] Consent for publication Not applicable. Availability of data and materials Data from this study will be made available by the corresponding authors on a reasonable request. Funding The authors received no specific funding to conduct this study Acknowledgement We would like to extend our gratitude to the study participants and administration of Mbale Regional Referral Hospital. Authors’ contributions J.S.M, SO, A.N, E.N, P.O, R.N, J.S.I, I.M, R.C, J.E, P.R.A, L.VN.S conceptualized the study, J.S.M and S.O participated in data collection and Analysis, J.S.M, SO, A.N, E.N, P.O, R.N, J.S.I, I.M, R.C, J.E, P.R.A, L.VN.S drafted the manuscript, J.S.M, SO, A.N, E.N, P.O, R.N, J.S.I, I.M, R.C, J.E, P.R.A, L.VN.S revised the manuscript. All authors read and approved the final version of the submitted manuscript. References Farkavets K, Marinović N. Oxygen Discovery AIDASCO Reviews. 2024;2(1):12–6. Gottlieb J, et al. German S3 guideline: oxygen therapy in the acute care of adult patients. Respiration. 2022;101(2):214–52. Moradkhan R, Sinoway LI. Revisiting the role of oxygen therapy in cardiac patients. J Am Coll Cardiol. 2010;56(13):1013–6. Liang Y, et al. Interplay of hypoxia-inducible factors and oxygen therapy in cardiovascular medicine. Nat Reviews Cardiol. 2023;20(11):723–37. Elkheshen OM, et al. 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Tables Table 1 : patients' social demographics Social-demographic characteristics Categories n (%) Sex Male 4 (25) Female 12 75) Education level Primary 3 (18.8) Secondary 7 (43.8) Tertiary 6 (37.5) No formal education 0 Marital status Married 11 (68.8) Widowed 1 (6.3) Single 4 (25) Divorced/separated 0 Age 18-23 4 (25) 24-29 5 (31.3) 30-35 2 (12.5) 36-41 1 (6.3) 42-47 2 (12.5) 48-53 1 (6.3) 54-59 1 (6.3) Religion Christian 13 (81.3) Muslim 3 (18.8) Occupation Peasant 3 (18.8) Business 9 (56.3) Unemployed 2 (6.3) Salary earner 2 (6.3) Table 2 : caregivers' social-demographics Social-demographic characteristics Category n (%) Sex Male 10 (33.3) Female 20 (66.7) Education Primary 1 (3.3) Secondary 9 (30.0) Tertiary 18 (60.0) No education 2 (6.7) Marital status Married 19 (63.3) Widow 2 (6.7) Single 9 (30.0) Age 18-23 3 (10.0) 24-29 12 (40.0) 30-35 6 (20.0) 36-41 2 (6.7) 42-47 4 (13.3) 48-53 1 (3.3) 54-59 2 (6.7) Religion Muslim 12 (40.0) Christian 18 (60.0) Occupation Peasant 6 (20.0) Business 10 (33.3) Unemployed 4 (13.3) Salary earner 10 (33.3) Table 3: Perception of Patients towards Oxygen Therapy THEMES SUBTHEMES CODES ILLUMINATIVE QUOTES Emotional, cognitive and social disruptions in oxygen therapy Disorientation during initiation of oxygen therapy Limited awareness due to altered state during oxygen therapy initiation “…I didn’t get to know, but by the time I got to know, when I was gaining consciousness, I was on those things (oxygen), that’s how I started understanding that am on oxygen…” [ PII-02] Emotional distress during oxygen therapy Stigma and social discomfort surrounding oxygen use. Emotional distress during oxygen therapy Emotional rejection despite its benefits Psychological distress and fear triggered by environment Social stigma linked to oxygen use Anxiety due to peer-shared negative experiences “…I don’t really tell people when I'm sick and on oxygen…That kind of feels like someone will be stigmatized. They will always be thinking that, probably you'll die in a minute. Because that's the stigma that comes with it…” [PII-05] Post-oxygen confusion and altered awareness Confusion/ altered mental state post-oxygen therapy Reflection of oxygen therapy after recovery Ongoing emotional worry despite recovery “…when he was put on oxygen but on gaining consciousness, he was very tough/agitated. That’s the problem I saw then; he was uttering vulgar/bad words. Then I got to know that maybe oxygen, when someone is weaned off, he comes back like a mad/crazy person …” [PII-02] Oxygen therapy as a symbol of impending death. Oxygen therapy is equated with end-of-life. Oxygen is put on people sometimes when they are dead Oxygen therapy seen as last option Probability of survival while on oxygen is a half Survival is by luck and by chance “…because it’s not something easy what comes to my mind when am on oxygen, I see myself like a dead body being put into the grave just to fight for a life …” [PII-02] “…because me I used to think that oxygen just kills. Me that’s what I knew. That anyone they put on it, dies …” [PII-04] Oxygen perceived as critical care for severe illness Oxygen is associated with critical illnesses Belief that oxygen therapy can manage chronic illnesses(asthma) Oxygen is effective in emergencies Oxygen is harmful “…so, if they put someone on oxygen like it means that the person is in a critical condition that’s why is put on it, so in that critical condition, it’s oxygen that can help …” [PII-15 ] “…But it’s hard, it’s hard, for someone to refuse oxygen because he knows that at least let him try that…” [PII-02] Fear of permanent dependence on oxygen therapy Conditional acceptance of oxygen based on symptom severity Permanent dependence on oxygen for breathing support Conditional acceptance of oxygen based on symptom severity “…it feels like I need to be on oxygen. Because when I get weaned off, there’s nothing I can do much because I need to come back and get back onto oxygen …” [PII-13] Spiritual and faith-based interpretations of oxygen therapy Survival attributed to divine intervention Faith as a coding mechanism during uncertainty Attribution of survival to divine intervention Belief in fate alongside medical intervention Spiritual plea during illness “…I was saying, almighty God help me to get better, and immediately they put it(oxygen therapy), in just a minute I felt everywhere opening, I saw I could breathe in air and it goes in well up to down. So I am okay now …” [CGI-07] Perception of oxygen therapy as life-sustaining and restorative. Oxygen perceived as supportive and healing Refusal of oxygen is rare Oxygen therapy as a supportive intervention during respiratory distress Oxygen has a life-saving role Oxygen therapy heals “…me I assure you that if I was near with these things (oxygen therapy) I would be already healed because they have helped me. So, on my side I have confirmed …” [CGI-07 ] “…I can’t refuse… I just have to accept to be put on (oxygen) even if what, but they should put it on me…” [PII-04] Oxygen therapy as a source of physical and emotional relief Oxygen leads to physical and emotional calmness Perception that oxygen is soothing and comforting “…when I put it (oxygen therapy) and it helped me, I could breathe well and it made me calm down …” [PII-04] Reduced fear through exposure and familiarity Reduced fear due to familiarity with oxygen therapy Mixed feelings about long-term oxygen use. Rejection of fear or stigma around oxygen therapy “…this is not the first time am put on oxygen; I have been put several times. It couldn’t scare me in anyway …” [PII-08] “…Actually, I don't even fear the oxygen… Yeah, I no longer fear …” [PII-09] Perceived physical discomfort and intrusiveness of oxygen therapy Oxygen therapy perceived as invasive or unnatural Perceived physical burden of oxygen therapy Oxygen as invasive Oxygen is contaminated Oxygen perceived as impure or un-natural Oxygen makes breathing faster than usual. Altered body sensation “…because if you are to talk that thing (nasal prongs) if you are to talk, it pierces you in the nose here and when it does so, you feel like coughing. And when you do so, the dirty discharge from the nose enters the nasal prongs…” [PII-14] “…the air am breathing in does not feel like the normal one…it feels like someone seated in a warm room, there’s no any fresh air …” [PII-13] Table 4: Perception of Caregivers towards Oxygen Therapy. THEMES SUBTHEMES SECOND ORDER CODES INITIAL CODES ILLUMINATIVE QUOTES Psychological reassurance attributed to oxygen therapy Emotional reassurance and psychological comfort Oxygen therapy perceived as hope of life Oxygen therapy perceived as a life line Hope of life Oxygen as hope for life “…actually, it has given me hope because if they had not put them on oxygen there would be no hope of life…” [CGI-02] “…when a person has failed to breathe, that the oxygen helps them so that they can breathe well, because for they have low oxygen and it helps them …” [CGI-10] Trust in health workers as reassurance during oxygen therapy Willingness to trust and comply with medical interventions trust in health workers “…I always follow the doctor’s instructions depending on her because I need her to live…” [CGI-21] “…for me in my heart I am just following their decisions and I believe they know why they put her on Oxygen, so I cannot interfere with them…” [CGI-17] Perceived as a life-saving intervention Oxygen is essential for survival Oxygen therapy improves someone’s condition. Oxygen is essential for survival Oxygen therapy improves someone’s condition. Life saver No oxygen, no existence Oxygen improves someone’s condition “…So, when they told me that they think that she’s going to be put on oxygen, I welcomed the idea because I knew it would help her to have life…” [CGI-02] Oxygen therapy is a temporary support during illness Perception of oxygen as a temporary sustainer Dependence on oxygen for patient stability Oxygen is a life support system “…Just, I know it is a support system to assist those with, difficulties in breathing and that is what I know, because we all breathe in oxygen, yeah…” [CGI-11] Perceived as expensive in healthcare facilities Perceived barriers to accessing oxygen therapy High cost in private healthcare settings Expensive in private facilities “…because had it been in a private sector or a private hospital, I would Spiritual and psychological distress of caregivers Attribution of patient deterioration to oxygen equipment Psychological impact of oxygen equipment Physical discomfort and fear of harm The prongs or the oxygen delivery equipment cause discomfort The oxygen delivery equipment cause anxiety “…they just put this whatever direct in the nose and me I think they pierce her and she's not comfortable. Actually, she has been complaining…. To me, I feel she's not comfortable…” [CGI-11] Faith and Divine Attribution Surviving is by God’s will Faith in divine healing over medical intervention God as healer Faith in God when someone is put on oxygen, he needs prayers. “…When they put him on oxygen, I said, I just gave everything to God. I said, I hope it does not happen like, for my sister who died while on oxygen. But I thank God now, the oxygen is helping him…” [CGI-16] Anxiety and fear triggered by oxygen therapy Psychological impact of seeing a loved one on oxygen Anxiety related to oxygen therapy “…the only thing, that I keep on asking the medical workers, the doctors who put her on oxygen, is that for how long is it going to be there? Is it going to be something permanent? Is it short term? And if it is short term, how many days…” [CGI-02] Perceived as a symbol of impending death Oxygen therapy equated with end-of-life. Association of oxygen with terminal illness or dying Belief that oxygen use equals the end of life Oxygen is associated with death Oxygen means someone is going to die Oxygen is given to already dead people “…That when someone is on oxygen, can die and if oxygen is put on someone, that person is in a very bad condition. If someone hears that oxygen, just understands that that person’s life is no more…” [CGI-12] Oxygen therapy as a sign of impending death Belief that oxygen signals a critical condition Loss of hope upon oxygen initiation The emotional burden of witnessing oxygen use Minimal chances of survival “...I was like haaaa, this “mzee” is going to be put on oxygen, now it means the chances of surviving, actually I even counted, I said out of 100, I think maybe he has 10% or 5%...” [CGI-04] Oxygen therapy is an emergency measure Perception of oxygen therapy as an emergency intervention Oxygen is put on critical patients “…by the time you decide that someone needs to be supported on oxygen, it means either is even unconscious…” [ CGI-04] Fear rooted in traumatic medical outcomes Fear of internal body damage oxygen caused organs to burst “…I lost a sister, who also needed oxygen, but immediately they connected her on oxygen. I think it affected her. And what? Either the lungs or the, either the heart or whatever burst. So, I don't know whether they put too much, the level was too much, or it was whatever…” [CGI-16] Oxygen as a symbol of medical danger Oxygen as a marker of severe or worsening condition. Oxygen viewed as harmful Oxygen is a very dangerous thing Oxygen means the condition has worsened Oxygen is risky “…oxygen is a very dangerous thing depending on what people talk about it that eh… “someone has reached oxygen” let’s just pray…” [CGI-21] “…quite risky because when eeehh, someone is undergoing that oxygen therapy, you really see there’s a time where it reaches and as if he’s not breathing…” [CGI-04] Oxygen as a dual symbol of life and death Hope versus fatalism Oxygen as a marker of death imminence Oxygen means dying or improving Oxygen is a life or death situation “…when they talk about oxygen, either someone was going (dying) or someone's coming(recovering) back to life. Yeah…” [CGI-23] Oxygen is perceived as a last resort measure Sense of helplessness when oxygen is initiated They consent to oxygen reluctantly, seeing no other way to save the patient. Oxygen therapy as a last resort. Left with no other choice. “…because I think when you are told that you are to be put on oxygen it’s at least the last resort. Me I know it’s the last resort to save your life…” [CGI-07] Positive perception of healthcare advancements Recognition of advanced medical technology Recognition of advanced medical technology Oxygen delivery is modernized “…Now the machines have come, eeehh the way oxygen is being given to someone is of a modern way, so, the chances of someone dying are minimal…” [GCI-04] Additional Declarations No competing interests reported. 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Sseyonga","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"Lydia","middleName":"VN.","lastName":"Sseyonga","suffix":""},{"id":584086922,"identity":"eb6b4ed3-58c2-42dd-a6cb-80bd4ec0d938","order_by":11,"name":"SAMUEL OLOWO","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA90lEQVRIiWNgGAWjYNCCAhs5BnYQowKImZkbiNBikGbMwAxinAFpYSRKy+HEBpAWxjYQj4AW+fbTaRIfDJiN+ZmZj0l8nFcbzd8O1PKjYhtu88/kbpOcYcAmJ9nMliY5c9vx3BmHGRsYe87cxq2FIXebNI8Bj7HBYR6z27zbjuU2ALUwM7bh1iLf/3ab9B8DicQNYC1zjuXOJ6SF4QbQFgYDA6iWhprcDYS0GNx4u9myxyDBGOiX9J8zjh3I3QjUchCfX+T7czfe+FHxX46fvfmwwYeautx55w8ffPCjAo/D0MBhMHmAaPVAUEeK4lEwCkbBKBghAABFIllp4OlmtwAAAABJRU5ErkJggg==","orcid":"","institution":"Busitema University","correspondingAuthor":true,"prefix":"","firstName":"SAMUEL","middleName":"","lastName":"OLOWO","suffix":""}],"badges":[],"createdAt":"2026-01-25 11:40:00","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8692126/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8692126/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102397129,"identity":"ad4ad6d5-87f5-44b8-9307-20432161bb6e","added_by":"auto","created_at":"2026-02-11 10:01:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1668787,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8692126/v1/b007dce3-4377-4f09-9782-ada8be9c0def.pdf"},{"id":101783060,"identity":"55bae836-cf26-4633-aab9-a7dbedae13eb","added_by":"auto","created_at":"2026-02-03 15:16:33","extension":"zip","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":163339,"visible":true,"origin":"","legend":"","description":"","filename":"SupportingDataset.zip","url":"https://assets-eu.researchsquare.com/files/rs-8692126/v1/393b4a4b83048eeb111775e5.zip"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perception of Patients and Caregivers toward Oxygen Therapy in Mbale Regional Referral Hospital, Eastern Uganda","fulltext":[{"header":"Background","content":"\u003cp\u003eOxygen refers to a colorless, odorless, tasteless gas that is essential for proper body functioning and survival [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Oxygen therapy refers to the administration of oxygen to a concentration of pressure greater than that found in the environmental atmosphere. The purpose of oxygen therapy is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury for-example in severe respiratory distress, hypoxemia, chronic obstructive pulmonary disease (COPD) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Oxygen therapy is used to treat pulmonary hypertension, acute myocardial infarction, short-term therapy like in post anesthesia recovery and chronic lung disease patients during exercises [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobally each year, 374\u0026nbsp;million people need medical oxygen: 364\u0026nbsp;million in acute medical and surgical contexts, and 9\u0026nbsp;million with long-term oxygen needs due to COPD [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. About 306\u0026nbsp;million of the 374\u0026nbsp;million people who need oxygen live in low and middle-income countries, 253\u0026nbsp;million in South Asia, east Asia and the Pacific, and Sub-Saharan Africa [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA study in Nigeria found out that caregivers were refusing oxygen treatment for their children due to misconceptions and pervasive negative narratives around oxygen therapy in their communities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the known benefits and applications of oxygen therapy, the perception of people varies widely. A study in Nigeria found out that in some cases, oxygen therapy is perceived as a death sentence [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In addition, individuals assume benefits of oxygen even outside medical prescription, for example, oxygen bars where oxygen is assumed to reduce stress, increase relaxation and energy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Yet, Unregulated or excessive use of oxygen can potentially cause adverse effects [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Consequently, evidence based public information is essential to prevent and mitigate such misconceptions and promote acceptance of oxygen therapy among caregivers and patients. Available evidence demonstrates that the perception of patients towards oxygen therapy influences the compliance and acceptance of oxygen as treatment [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these insights, little is known about the general public\u0026rsquo;s perception of oxygen therapy in MRRH especially across different demographic groups and cultural contexts. This gap creates an opportunity to explore the view of different populations towards oxygen therapy and what factors shape these perceptions.\u003c/p\u003e \u003cp\u003eUnderstanding the patient\u0026rsquo;s and care giver\u0026rsquo;s perceptions towards oxygen therapy has a direct impact on healthcare practices. More so, the information gained from such research can be used to develop interventions that can help to promote the benefits of oxygen therapy, leading to the acceptance and compliance to oxygen as treatment. In fact, the knowledge obtained can be used to guide healthcare policy and preparation for future healthcare emergencies such as pandemics.\u003c/p\u003e \u003cp\u003eDespite the known benefits of oxygen therapy in improving the quality of life, many patients are still hesitant or refuse oxygen therapy. This has been reported to be influenced by their misconceptions and beliefs about oxygen therapy. These negative perceptions result into late or failure to administer oxygen therapy. Late initiation of oxygen therapy negatively impacts on the quality of life, social wellbeing and last phase of life [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA study carried out in three government funded District hospitals in Eastern Uganda which are under MRRH catchment area, reported that the local population was fearful of oxygen therapy and hesitant to consent for administration of oxygen therapy to their children [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The reason for the hesitance of patients and caregivers towards oxygen therapy is not clearly documented. Therefore, understanding the perception of the caregivers and patients towards oxygen therapy may help to fill the existing gaps. Consequently, the aim of this study is to explore the perception of the caregivers and patients towards oxygen therapy at Mbale Regional Referral Hospital.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis study employed a descriptive qualitative study design to explore the perceptions of patients and caregivers toward oxygen therapy. It emphasized a detailed description of the experiences and events about oxygen therapy as well as capturing the essence of participants\u0026rsquo; experiences, perceptions and beliefs [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. A descriptive qualitative study design involved collecting qualitative data.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy setting\u003c/h3\u003e\n\u003cp\u003eThe study was mainly facility-based at Mbale Regional Referral Hospital, a community-based hospital, in different wards that held patients on oxygen therapy, including the medical ward, surgical ward, casualty, surgical high dependency unit (HDU), and postnatal high dependency unit (HDU). Mbale Regional Referral Hospital, a government-funded and owned hospital, was located in the center of Mbale city, 250km east of Kampala, the capital city of Uganda. The hospital served over 4.6\u0026nbsp;million people in 16 districts of Busia, Tororo, Butaleja, Pallisa, Budaka, Mbale, Bududa, Sironko, and Manafwa. Namisindwa, Butebo, Kapchorwa, Kibuku, Bukwo, Kween, and Bulambuli [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe target population included the patients who had undergone oxygen therapy and were at the point of discharge, as well as their caregivers, and those caregivers who had ever taken care of patients on oxygen therapy in MRRH. The group of interest was required to be adult patients who received oxygen therapy and the adult caregivers who took care of patients on oxygen therapy.\u003c/p\u003e\n\u003ch3\u003eSelection criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePatients and caregivers aged 18 years and above.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatients who had received oxygen therapy and were at the point of discharge.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCaregivers who had ever provided care for patients receiving oxygen therapy and their current patients are at the point of discharge.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePatients who had impaired cognition or severe medical conditions that impair communication.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePatients and caregivers who declined informed consent\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling technique\u003c/h3\u003e\n\u003cp\u003eThis study employed a purposive sampling method, a non-probability sampling technique in which decisions for participant inclusion were taken by the researcher based on knowledge, judgment, or capacity and willingness to participate in the research. Purposive sampling was important in that it provided researchers with the justification to generalize from the studied sample, it provided a wide range of non-probability sampling techniques for the researcher to draw on, and proper care was taken when selecting the sample [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe researcher selected patients and caregivers who had had an exposure or experience with oxygen therapy and were willing to participate in the study.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eIn this study, the sample size was determined using the principle of saturation sampling. The concept of saturation referred to information redundancy or the point at which no new themes or codes emerged from the data [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In a systematic review of empirical tests by M. Hennink et al, the results showed that across 16 tests using various approaches to saturation, the sample size for saturation ranged between 5 and 24 interviews [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, it was estimated that 16 participants would be recruited, comprising both patients and caregivers, which was within the approved range of interviews. However, the final number of participants was 16 patients and 30 caregivers.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection tools\u003c/h2\u003e \u003cp\u003eThe primary data collection tool was an in-depth interview guides. This tool was designed by the researcher to allow for exploration of patients\u0026rsquo; and caregivers\u0026rsquo; perceptions toward oxygen therapy. The interview guide was organized into sections such as an introduction to establish rapport and gather basic demographic information; consent notes for ethical considerations; and questions exploring the background and experience, perception, and support and education about oxygen therapy. The guide included prompt and guiding questions to elicit detailed responses and explore more about the respondents' experiences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eThe data collection involved in-depth interviews with the patients and caregivers to explore their perceptions of oxygen therapy. In-depth interviews allowed for a comprehensive understanding of participants\u0026rsquo; experiences and beliefs in their own words [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The researcher conducted the interviews in the local languages best understood by the participants, which included English, Luganda, and Lumasaba with the help of language experts who had a high level of knowledge and experience in the language, who translated the interview guide into the local languages. Each interview was conducted face-to-face in a private, comfortable, and quiet setting to ensure confidentiality and minimize distractions. The interviews lasted between 30minutes-1hour minutes, and audio recordings, after obtaining consent from the participants, were taken for accurate transcription and analysis. Field notes were also taken to capture non-verbal cues and contextual observations. Participants were assured of their anonymity and their right to withdraw from the study at any point without consequences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eTrustworthiness\u003c/h2\u003e \u003cp\u003eThis study employed the four principles of trustworthiness by Lincoln and Gubba of Credibility, Conformability, transferability and dependability [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] as expounded below:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCredibility\u003c/h2\u003e \u003cp\u003eCredibility refers to how true is the collected data, the interpretation and representation of the data by the researcher. The researcher will ensure credibility through thorough data collection including, prolonged engagement to build rapport with informants and foster rich detailed responses; and reflexivity with the informants so as and to prevent researcher bias through maintaining reflexive journals. Reflexivity means the researcher\u0026rsquo;s own thoughts, feelings and actions and how they influence the participants\u0026rsquo; responses [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eThe researcher maintained an audit trail that documents the researcher\u0026rsquo;s decisions and assumptions which was reviewed by the supervisor so as to draw the same study conclusions [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe researcher described fully the strategies performed and the vivid quotes from participants, so that the reader can critique the credibility of the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eConfirmability\u003c/h2\u003e \u003cp\u003eConfirmability refers to the extent to which the researcher demonstrates that the data represents the participants responses and not researcher\u0026rsquo;s biases, motivations or interests [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe researcher ensured confirmability through maintaining an audit trial, reflexive journal and triangulation [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The researcher used reflexive journal in order to reflect on, tentatively interpret and plan data collection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eDependability\u003c/h2\u003e \u003cp\u003eDependability refers to the consistency of findings under similar conditions or over time [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe researcher ensured dependability through stepwise replication where the researcher and the supervisor analyzed the same data separately and compare the results. Inconsistences that arose were addressed to improve the dependability, and for similar findings, then dependability was achieved [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTransferability\u003c/h2\u003e \u003cp\u003eTransferability refers to findings that can be applied to other contexts, that the findings have meaning to the individuals not involved in the study and readers can associate the findings with their own experiences [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe researcher ensured transferability through providing thick descriptive data concerning the methodology to allow comparison of the context to other contexts to which transfer might be contemplated [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe researcher employed reflexive thematic analysis using the Braun and Clerk approach to analyze the qualitative data. Braun and Clerk described reflexive thematic analysis as divided into six (6) phases [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and the researcher will employ them as described below:\u003c/p\u003e \u003cp\u003e \u003cb\u003eData familiarization;\u003c/b\u003e This involves immersing oneself in the data to understand depth and breadth of the content, searching for patterns as well as meanings. This was done through transcribing audio data, reading data set and note taking. \u003cb\u003eGenerating codes;\u003c/b\u003e Generating of initial codes to organize the data, with full and equal attention given to each data item. This was done by labelling and organizing items into meaningful groups. \u003cb\u003eGenerating themes;\u003c/b\u003e This includes sorting of codes into themes and identifying meaning of and relationships between codes. This was done through diagramming or mapping and writing themes and their defining properties. \u003cb\u003eTheme review;\u003c/b\u003e This consists of identifying coherent patterns at the level of the coded data and reviewing entire data set as a whole. This was done through ensuring there is enough data to support a theme, collapsing overlapping themes and reworking and refining codes and themes. \u003cb\u003eTheme defining and naming;\u003c/b\u003e This includes identifying the story of each of the identified themes and fitting the broader story of the data set to respond to the research questions. This was done through cycling between the data and the identified themes in order to organize the story. \u003cb\u003eReport production;\u003c/b\u003e This comprises presenting of a concise and interesting account of the story told by the data, both within and across themes. This was done by writing a compelling argument that addresses the research questions and by writing beyond the simple description of the themes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The approval from was sought from Busitema University Research and Ethics Committee under the registration number BUFHS-2025-797. Mbale Regional Referral Hospital Research and Ethics Committee also granted Research and administrative clearance for this study under the registration number MRRHREC-OUT-160/2025.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003ewas obtained from the patients and caregivers by explaining to them explicitly about what the study is all about and what it was meant for them to participate in the study. Emphasis was put on the participants\u0026rsquo; right to either continue with the study or withdraw from the study without penalty or having to provide a reason.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e The participants were assured of confidentiality and anonymity so that they speak freely without fear of being identified as having given information. This involved finding a safe place with minimal distractions during the interviews. Adherence to the principles of Helsinki declaration of protection of human subject was ensured [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study involved a total of 46 participants including 16 patients and 30 caregivers.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Social-Demographic Characteristics of the patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of the patients 75% were females, while 25% were males. Most patients 43.8% had a secondary education, 37.5% had tertiary education and 18.8% had primary education. 11% of the participants were married, 25% were single and 6.3% were widowed. The participants’ ages ranged from 18 to 59 years, with a mean age of 38.5 years. Majority of the participants identified as Christians 81.3% while 18.8% identified as Muslims. The most common occupations among patients were business owners 56.3%, followed by peasants 18.8% as illustrated in Table 1. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Social-demographic Characteristics of Caregivers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of the caregivers 66.7% were females, while 33.3% were males. Most caregivers 30% had a secondary education, 60% had tertiary education, 3.3% had primary education and 6.7% had no education. 63.3% of the participants were married, 30% were single and 6.7% were widowed. The participants’ ages ranged from 18 to 56 years, with a mean age of 37 years. Majority of the participants identified as Christians 60% while 40% identified as Muslims. The most common occupations among patients were business owners and salary earners 33.3%, followed by peasants 20% as illuminated in Table 2.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eThe Perception of Patients and Caregivers towards Oxygen Therapy\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital was both positive and negative. The journey of oxygen therapy in the lives of patients and caregivers is one filled with conflicting emotions including fear and hope, dread and relief, suspicion and gratitude. Through a thematic analysis, their experiences converge around common concerns while diverging in subtle yet meaningful ways. The themes generated included; oxygen therapy as a life-saving yet fear-inducing intervention, spiritual and emotional interpretations of oxygen therapy, perceived physical and technological aspects of oxygen therapy. The findings are summarized in table 3 and table 4.\u003c/p\u003e\n\u003cp\u003eTheme one: \u003cstrong\u003eOxygen therapy as a life-saving yet fear-inducing intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnder this theme, both patients and caregivers recognized oxygen therapy as a critical medical tool. However, its use was often entangled with profound fear, particularly the fear of death. Oxygen therapy as a lifesaving yet fear inducing intervention is discussed under two subthemes including oxygen therapy as a lifesaving intervention and oxygen therapy as a symbol of death.\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003eoxygen therapy as a symbol of death\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients equated oxygen therapy with end of life due to the belief that whoever is initiated on oxygen therapy has minimal chances of survival and is therefore nearing death. There was a belief that oxygen is initiated to an already dead person just he or she has not been confirmed dead yet. Some patients admitted that refusal of oxygen was rare because it is the last option for them to survive. Similarly, the association of oxygen use and the final moments of a patient’s life has led caregivers to perceive it as a sign that death is near. Some caregivers believed that when a patient is initiated on oxygen, either their life is no more, they are dying soon or they are already dead:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…when I was initiated on oxygen, I thought I was going to die…”\u003c/em\u003e \u003cstrong\u003e[PII-12]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e…they say that your patient may be put on oxygen and they keep on lying to you yet the patient already died. They keep on telling you that the patient is alive yet the patient died long time back\u003c/em\u003e…\u003cstrong\u003e[CGI-07]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn addition, patients reported that oxygen therapy was a fast and effective intervention for emergency situations especially during respiratory distress. Oxygen therapy meant that the situation is getting out of hand and some believed that oxygen therapy can manage chronic illnesses like asthma. Some caregivers associated the initiation of oxygen with urgent medical intervention, typically involving patients who were struggling to breathe, unconscious or visibly in critical condition. This framed oxygen therapy as a marker of severe illness. Most of the caregivers reported that in their experiences, oxygen therapy is in most cases administered to the critical patients, often when recovery is unlikely.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…What I understand is, okay, they give you oxygen when you are not able to breathe. That is what I know. And when you may be very sick…”\u003c/em\u003e \u003cstrong\u003e[PII-12]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurthermore, concerns about the fear of dependence on oxygen therapy were raised by patients due to the belief that the first contact with oxygen therapy predicted more other contacts with it -------and to some, it meant that you are to get oxygen therapy all your life.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…what I think that seems to be right, when you are initiated on oxygen, you might get used and need to be on it all your life because when I remove the nasal prongs tentatively to breathe in the surrounding air too, I feel like frightened as if the air am breathing is scaring me…”\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[PII-13]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome patients admitted that they only accepted to be initiated on oxygen therapy because of the worsening condition of not being able to breathe on their own and thus needed support from oxygen therapy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…I also got scared because I also wanted to refuse when they wanted to put me on oxygen because I was scared and I said that last time we refused when they wanted to put me on oxygen but later I normalized but the condition this time was worse I couldn’t breathe in the air, so I had to be strong and I accepted to be put on oxygen…”\u003c/em\u003e \u003cstrong\u003e[PII-13]\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFurthermore, fear rooted in traumatic medical outcomes captures the deep emotional fear and anxiety experienced by caregivers from past encounters where oxygen therapy was associated with poor clinical outcomes particularly death. These traumatic experiences contributed to the development of a lasting psychological link between oxygen therapy and fatality, resulting in persistent fear whenever oxygen therapy was introduced during patient care\u003c/p\u003e\n\u003cp\u003eSome caregivers viewed oxygen with a degree of fear and suspicion, believing that its use could worsen the patient’s condition. Oxygen therapy was seen as risky, extremely dangerous and fatal depending on the caregiver’s previous experiences with deteriorating patients on oxygen.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…quite risky because when eeehh, someone is undergoing that oxygen therapy, you really see there’s a time where it reaches and as if he’s not breathing…”\u0026nbsp;\u003c/em\u003e[CGI-04]\u003c/p\u003e\n\u003cp\u003eFinally, some caregivers associated the initiation of oxygen therapy with the final and most desperate medical intervention suggesting that the use of oxygen indicated that the patient was at the verge of death and that all other treatment options have failed.\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eoxygen therapy as a lifesaving intervention\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients reported that oxygen therapy was supportive to those unable to support themselves while unconscious or breathless helping them to regain some life while some patients stated that if only oxygen was close to where they stay, they would be already healed and free from their long-term chronic illness.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…they put it on you and it bring back some life sometimes the person has fainted when the heart is far, when you need oxygen so that you gain consciousness and you can’t support yourself and its oxygen to support you so that you regain life…”\u0026nbsp;\u003c/em\u003e[PII-02].\u003c/p\u003e\n\u003cp\u003ePatients admitted that whenever oxygen was initiated, they felt calm and with the feeling of air entering into the nose, it felt very comforting and soothing.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e…when I put it (oxygen therapy) and it helped me, I could breathe well and it made me calm down…\u003c/em\u003e……..[PII-04]\u003c/p\u003e\n\u003cp\u003eFollowing multiple exposures to oxygen therapy, some patients reported familiarity with oxygen therapy and that it was no longer scary.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e…this is not the first time am put on oxygen; I have been put several times. It couldn’t scare me in anyway\u003c/em\u003e…[PII-08]\u003c/p\u003e\n\u003cp\u003eAccording to the caregivers, some reported that they welcomed the idea of putting their patients on oxygen because they knew that oxygen would help the patient to have life.\u003c/p\u003e\n\u003cp\u003eThe perception that oxygen is a life-saving intervention was based on the caregiver’s opinion, some caregivers reported that oxygen is a support system to assist those with difficulties in breathing.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…that it’s (oxygen) the air that helps the patient when unable to breathe. It helps so that the patient is able to breathe well\u003c/em\u003e…” [CGI-12]\u003c/p\u003e\n\u003cp\u003eThe psychological reassurance was expressed in diverse ways among caregivers, most notably through expression of hope for life and positive treatment outcomes:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Because at least when he was put on that Oxygen, he was trying now to come back, to normalize, and he was not struggling like he was\u003cstrong\u003e…”\u003c/strong\u003e\u003c/em\u003e[CGI-08].\u003c/p\u003e\n\u003cp\u003eCaregivers expressed their psychological reassurance through the trust they placed in health workers especially in situations of uncertainty or fear:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…for me in my heart I am just following their decisions and I believe they know why they put her on Oxygen, so I cannot interfere with them…”\u0026nbsp;\u003c/em\u003e[CGI-17].\u003c/p\u003e\n\u003cp\u003eTheme two: \u003cstrong\u003espiritual and emotional interpretations of oxygen therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe spiritual and emotional interpretations of oxygen therapy is discussed further under two subthemes namely, spiritual and faith-based interpretations of oxygen therapy and emotion, cognitive social distress in oxygen therapy.\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003espiritual and faith-based interpretations of oxygen therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients attributed survival to divine intervention with belief that its God who heals and survival is by God’s will despite the medical intervention. Positive outcomes meant that gratitude is to God and this gave hope to patients in situations where medical interventions alone would not be sufficient. \u0026nbsp;However, some patients believed in fate alongside medical intervention stating that if it’s time to die, not even medical interventions can save you.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“… I came here when I was ill but now with God, am alive but many have died. I have seen some being brought, they put them on (oxygen) and they die, but me am what? am alive. For that reason, I thank God, He’s great, even though I came ill, but me am what? am alive. It means, God still need me…”\u003c/em\u003e [PII-04].\u003c/p\u003e\n\u003cp\u003eDuring moments of oxygen therapy, some caregivers frequently turned to prayer and placed their trust in God as the ultimate healer despite the concurrent medical interventions. Consequently, their confidence in clinical treatment was undermined, and the resulting anxiety shifted their reliance away from oxygen therapy towards divine intervention.\u003c/p\u003e\n\u003cp\u003eSubtheme two:\u0026nbsp;\u003cstrong\u003eemotion, cognitive social distress in oxygen therapy.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients reported that oxygen therapy was initiated to them while unconscious and they woke up to shock and confusion of seeing themselves on oxygen therapy without knowing what had happened to them during the time of being unconscious.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;“…I woke up one day, there were things (nasal prongs) on my nose, I could not understand. And then, when I tried removing them, they told me not to remove them. Then, the people around me, they looked scared. So, I was also scared…”\u003c/em\u003e [PII-12]\u003c/p\u003e\n\u003cp\u003eWorry, fear and inevitable anxiety following the initiation of oxygen therapy were reported by patients due to feelings of hopelessness and bewildered by thoughts of losing life soon. Some patients also stated that the room and the equipment that deliver oxygen therapy also contribute to their emotional distress as well.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…it (oxygen therapy) can’t fail to worry you, even if you are the strongest, it really worries. It really worries for sure…”\u0026nbsp;\u003c/em\u003e[PII-02].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003e“…I feel so sad because it’s not something easy what comes to my mind, I see myself like a dead body being put into the grave just to fight for a life\u003c/em\u003e…” [PII-02].\u003c/p\u003e\n\u003cp\u003ePatients stated that they were stigmatized by the people surrounding them whenever they were seen on oxygen therapy thus resorted to isolation or social withdrawal due to fear of loss. Some patients did not want to talk about oxygen therapy around other people because they would always associate it with death.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…I don’t really tell people when I'm sick and on oxygen…That kind of feels like someone will be stigmatized. They will always be thinking that, probably you'll die in a minute. Because that's the stigma that comes with it…”\u0026nbsp;\u003c/em\u003e[PII-05].\u003c/p\u003e\n\u003cp\u003ePatients stated that oxygen therapy had effects on them even when it was stopped. The effects were both cognitive consisting of altered mental status and emotional consisting of worry, fear and anxiety.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…but right now, when am in normal senses like this, it’s when I can tell you the truth that I worry that it (oxygen therapy) somehow scares…”\u003c/em\u003e[PII-02].\u003c/p\u003e\n\u003cp\u003eFurthermore\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003ethe inadequate knowledge about when, how and why oxygen therapy is used generates anxiety among the caregivers with the most asked question being: “… \u003cem\u003efor how long is it (oxygen) going to be there?”\u0026nbsp;\u003c/em\u003e[CGI-02]. This undermines the caregiver’s psychological wellbeing and may impede cooperative engagement in the patient’s care plan. \u003c/p\u003e\n\u003cp\u003eSome caregivers directly attributed unexplained adverse changes in the patient’s condition to the oxygen delivery equipment:\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…the person may come out on oxygen because they believe that the tubes affect. I don't know how it affects but they say, it is going to affect the person…”\u0026nbsp;\u003c/em\u003e[CGI-16].\u003c/p\u003e\n\u003cp\u003eTheme three: \u003cstrong\u003eperceived physical and technological aspects of oxygen therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePerceived physical and technological aspects of oxygen therapy are discussed further under two subthemes namely; physical discomfort and intrusiveness of oxygen therapy and positive perceptions of healthcare advancements.\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003ePhysical discomfort and intrusiveness of oxygen therapy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients stated that the nasal prongs were uncomfortable and pierced the nose. Oxygen was perceived as un-natural and that the air did not feel fresh. Some patients stated that oxygen therapy affected their normal body functioning because it disrupted their ability to verbally communicate with others but rather use gestures or sign language.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“When you are on Oxygen, you just make signs like someone who is dumb for someone to understand you because if you are to talk that thing (nasal prongs) if you are to talk, it pierces you in the nose here and when it does so, you feel like coughing. And when you do so, the dirty discharge from the nose enters the nasal prongs…”\u003c/em\u003e [PII-14].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e…\u003c/em\u003e\u003cem\u003ethe air am breathing in does not feel like the normal one…it feels like someone seated in a\u003c/em\u003e \u003cem\u003ewarm room, there’s no any fresh air\u003c/em\u003e…[PII-13].\u003c/p\u003e\n\u003cp\u003eSubtheme two:\u003cstrong\u003ePositive perceptions of healthcare advancements.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome caregivers acknowledged the advanced machines used delivering oxygen therapy to patients, which are believed to contribute to the provision of quality care.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…Now the machines have come, eeehh the way oxygen is being given to someone is of a modern way, so, the chances of someone dying are minimal…”\u0026nbsp;\u003c/em\u003e[GCI-04].\u003c/p\u003e\n\u003cp\u003eThis perception was rooted in caregivers who have been in private facilities and a prescription for oxygen therapy was quite expensive. This brought them into a thinking that oxygen is expensive in all health facilities. Consequently, caregivers hesitate to initiate oxygen therapy due to fear of expenses. However, some caregivers found out that the services were actually entirely free in government hospitals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e“…because had it been in a private sector or a private hospital, I would have incurred a lot of expenses, am told that in some hospitals even pay more than 500k per day…”\u0026nbsp;\u003c/em\u003e[CGI-02].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore the perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital (MRRH). In this study, the perception of patients and caregivers is discussed separately into different themes.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003ePerception of patients and caregivers towards oxygen therapy\u003c/h2\u003e \u003cp\u003eThe main findings of this study are as follows: i) oxygen therapy as a life-saving yet fear-inducing intervention; ii) spiritual and emotional interpretations of oxygen therapy; iii) perceived physical and technological aspects of oxygen therapy.\u003c/p\u003e \u003cp\u003eThe patients and caregivers reported that oxygen therapy is perceived as an intervention that assists individuals who are unable to breathe properly, enabling them to breathe better and sustain life. The participants expressed emotional comfort and reassurance in perceiving oxygen therapy as a symbol of hope and life-saving intervention. Patients in particular, described it as soothing and comforting upon initiation. Similarly to our findings, a scoping review by Britto et al.\u0026rsquo; has already demonstrated that patients felt safe and comfortable as they begun to feel the flow of oxygen while caregivers felt emotional relief upon seeing an improvement in the patients\u0026rsquo; condition [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. The main differences between our study and the Britto et al.\u0026rsquo; study were that it was a scoping review with most of the articles reviewed based in high income countries and physical burden as well as negative attitudes and feelings of both patients and caregivers towards oxygen therapy were reported. However, oxygen therapy was also perceived as a fear inducing intervention as participants reported episodes of fear, worry, anxiety and hopelessness. Basing on their prior lived experiences such as witnessing the death of a loved one on oxygen therapy, or through interactions with peers, caregivers and patients developed the perception that oxygen therapy is strongly associated with end-of-life with perceptions that individuals placed on oxygen therapy either are going to die, have already died or have minimal chances of survival. For some, oxygen therapy was interpreted as a clear sign that life is nearing its end. Similar findings have been reported in a descriptive cross-sectional study in Nigeria where it was found out that 21.1% patients and 19.5% caregivers believed that oxygen therapy was solely for terminally ill patients [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. In another study carried out in Wisconsin, USA, it was found that the respondents stated that oxygen use was initiated to patients who were within days of their expected death [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. On another hand, patients who received oxygen therapy more frequently often perceived a strong sense of social stigma and expressed fears of becoming permanently dependent on oxygen therapy. For some, the stigma is so profound that it led to social withdrawal, as those around them may associate oxygen use with impending death and thus hesitate to form meaningful relationships, viewing them as temporary. Nevertheless, a number of patients reported gradually adapting to the use of oxygen, particularly as the frequency of therapy increased. Participants also voiced concerns about long-term dependence, lamenting the loss of natural air and describing their current experience as relying solely on \u0026ldquo;unnatural\u0026rdquo; air provided by oxygen concentrators and cylinders. Studies in North England found that patients had similar concerns regarding stigma and dependence on oxygen therapy [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e Several participants reported that oxygen was initiated without their awareness, often during periods of unconsciousness. As a result, they were unaware of the events that transpired while the therapy was being administered. Upon regaining consciousness, patients described finding themselves on oxygen therapy without any understanding of how or why it had been initiated. This lack of awareness elicited feelings of shock and confusion. Consequently, many associated oxygen therapy with unconsciousness and perceived it as an intervention reserved for critically ill patients. This perception reinforced the belief that oxygen therapy is primarily an emergency measure, other than being a supportive component of care [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe emotional reassurance experienced by caregivers was also attributed to their trust in healthcare providers. Caregivers reported having confidence in the competence of health professionals and expressed that they did not question the providers\u0026rsquo; ability to deliver appropriate care. This trust stemmed from the belief that healthcare providers are knowledgeable, capable, and have thoroughly assessed the patient\u0026rsquo;s condition before initiating oxygen therapy. Such trust has been reported to contribute significantly to the acceptance of oxygen therapy as a supportive treatment [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. However, some patients narrated that they were unfamiliar with the concept oxygen therapy, largely due to residing in rural areas where they had never previously encountered or interacted with it.\u003c/p\u003e \u003cp\u003eThis study reveals that spiritual and faith-based interpretations significantly influence the perceptions of both patients and caregivers towards oxygen therapy. Caregivers often viewed the initiation of oxygen therapy as an indication of a critical health status, prompting the need for sincere prayers and reflecting a heightened sense of anxiety and concern about the patient's chances of survival. Many participants expressed a strong belief in divine healing alongside medical interventions, suggesting that survival is ultimately determined by God\u0026rsquo;s will, and positive outcomes are met with gratitude to God. Such faith-based beliefs provided emotional comfort, especially during moments when medical interventions alone did not offer sufficient reassurance. A study carried out in Poland found out that individuals with a higher level of spirituality experienced fewer symptoms of anxiety and depression where as those with more negative religious coping, showed more anxiety and depression symptoms [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Additionally, some patients shared a belief in fate, expressing that life and death are predetermined; if it is one's time to die, it will happen regardless of medical treatment, and if it is not, the person will survive. These perceptions underscore the complex interplay between medical understanding and spiritual beliefs in shaping attitudes towards oxygen therapy.\u003c/p\u003e \u003cp\u003eThis study identifies discomfort and a sense of intrusiveness as key factors shaping their perceptions. Several patients described the nasal prongs as invasive, stating that they pierced the nose and often led to coughing, which in turn caused secretions to enter the oxygen tubes, an experience they found highly unpleasant. A study by Quinn-Lee, Weggel [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] carried out in Wisconsin found that 78% of the respondents admitted that oxygen therapy was an irritant [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Beyond physical discomfort, patients also expressed that the oxygen itself did not feel like normal air; it was perceived as unusually warm and lacking freshness, which contributed to a sense of unease. Furthermore, some patients felt that being on oxygen interfered with their ability to move freely. In these cases, they noted that communication became more reliant on gestures or sign language, further reinforcing the perception of oxygen therapy as a restrictive and disruptive intervention. A study carried out by Kelly and Maden [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] similarly found that patients reported discomfort with use of nasal prongs suggesting that oxygen therapy is not entirely benign but rather discomforting and intrusive [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Another notable perception shared by both patients and caregivers was that oxygen therapy is costly, particularly among individuals from low-income backgrounds. This belief contributed to hesitancy in initiating or accepting oxygen therapy. Several respondents indicated a reluctance to begin treatment due to fears of accumulating medical expenses while in private healthcare settings. Even when the need for oxygen therapy was recognized, some patients hesitated because the facilities offering such services were located far from their homes, resulting in additional transportation costs. These financial concerns were often shaped and reinforced by personal experiences and community conversations, further heightening anxiety and hesitation around starting oxygen therapy. Nevertheless, some participants were aware that oxygen therapy is provided free of charge in government-funded facilities and expressed a desire for similar affordability in private healthcare institutions. A study carried out in Spain had similar findings that the oxygen delivery equipment were perceived to be too expensive [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study reveals that patients and caregivers obtain information about oxygen therapy from a variety of sources worldwide, including schools, communities, hospitals, and the internet. Some participants residing in rural areas reported that, although oxygen therapy was frequently discussed within their communities, they had never had the opportunity to observe how it functions or what the equipment actually looks like. Consequently, their first encounter with oxygen therapy in a hospital setting provided them with greater exposure and a clearer understanding of its purpose and application.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003eImplications of the study\u003c/h2\u003e \u003cp\u003eThis study reveals that oxygen therapy is perceived both as a life-saving intervention and as a symbol of impending death especially in emergencies. This dual perception interferes with timely acceptance of oxygen therapy, often resulting in delays in care. These findings imply a critical need to educate patients and caregivers about oxygen therapy and to implement community sensitization programs aimed at raising awareness and addressing prevailing misconceptions about oxygen therapy.\u003c/p\u003e \u003cp\u003e Furthermore, the findings highlight the importance of providing psychological support to both patients and caregivers during the course of oxygen therapy, given the emotional distress associated with its initiation and use. This support can be strengthened through involvement of religious or spiritual leaders, as participants often perceived divine interventions as a source of hope and emotional reassurance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eStudy limitations and strengths\u003c/h2\u003e \u003cp\u003eThis study was purely qualitative which cannot be generalized to other settings however, the use of in-depth interviews as well as including both caregivers and patients increases the transferability of the findings to other settings.\u003c/p\u003e \u003cp\u003ePatients reported that they were unconscious during the initiation of oxygen therapy therefore feelings and experience during that time could not be assessed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study looked at the perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital. The findings of this study demonstrated that the perceptions of patients and caregivers towards oxygen therapy do not necessarily differ from each other. Patients and caregivers perceived oxygen therapy in terms of; oxygen therapy perceived as a symbol of impending death like oxygen equals the end-of-life; emotional and psychological distress caused by oxygen therapy like fear and anxiety; spiritual and faith-based interpretations of oxygen therapy like attribution of survival to divine interventions; oxygen therapy perceived as a life-sustaining intervention like oxygen therapy heals; psychological reassurance attributed to oxygen therapy like oxygen is a hope for life.\u003c/p\u003e \u003cp\u003ePatients further perceived oxygen therapy in terms of; perceived physical discomfort and intrusiveness of oxygen therapy like oxygen is invasive and unnatural; and finally, cognitive disruptions of oxygen therapy like confusion post-oxygen therapy.\u003c/p\u003e \u003cp\u003eCaregivers as well further perceived oxygen therapy in terms of; oxygen therapy is perceived as expensive in healthcare facilities; and finally, the positive perception of healthcare advancements like modernization of oxygen delivery system.\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eFirst, there\u0026rsquo;s need for implementation of community sensitization campaigns involving local leaders, politicians, religious leaders and community health workers to promote awareness and address stigma faced by patients on oxygen therapy and the misconceptions about oxygen therapy in the communities.\u003c/p\u003e \u003cp\u003eSecondly, patients and caregivers should be health educated on oxygen therapy using local languages or if possible, using visual aids so as to address psychological distress during initiation of oxygen therapy.\u003c/p\u003e \u003cp\u003eAdditionally, counselling and psychological support is very essential for patients and caregivers struggling with emotional distress and fear associated with oxygen therapy if preferably done by trained personnel so as to promote psychological discomfort during the initiation of oxygen therapy.\u003c/p\u003e \u003cp\u003eFinally, further research is needed to assess the effectiveness of health education and awareness interventions in improving the perceptions of patients and caregivers towards oxygen therapy.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO: World Health Organization\u003c/p\u003e\n\u003cp\u003eMRRH: Mbale Regional Referral Hospital\u003c/p\u003e\n\u003cp\u003eBUFHS: Busitema University Faculty of Health Sciences\u003c/p\u003e\n\u003cp\u003eBUFHSREC: Busitema University Faculty of Health Sciences Research and Ethics committee\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe approval from was sought from Busitema University Research and Ethics Committee under the registration number \u003cstrong\u003eBUFHS-2025-797\u003c/strong\u003e. Mbale Regional Referral Hospital Research and Ethics Committee also granted Research and administrative clearance for this study under the registration number \u003cstrong\u003eMRRHREC-OUT-160/2025.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the patients and caregivers by explaining to them explicitly about what the study is all about and what it was meant for them to participate in the study. Emphasis was put on the participants’ right to either continue with the study or withdraw from the study without penalty or having to provide a reason.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe participants were assured of confidentiality and anonymity so that they speak freely without fear of being identified as having given information. This involved finding a safe place with minimal distractions during the interviews. Adherence to the principles of Helsinki declaration of protection of human subject was ensured [30]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from this study will be made available by the corresponding authors on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding to conduct this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to extend our gratitude to the study participants and administration of Mbale Regional Referral Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.S.M, SO, A.N, E.N, P.O, R.N, J.S.I, I.M, R.C, J.E, P.R.A, L.VN.S conceptualized the study, J.S.M and S.O participated in data collection and Analysis, J.S.M, SO, A.N, E.N, P.O, R.N, J.S.I, I.M, R.C, J.E, P.R.A, L.VN.S drafted the manuscript, J.S.M, SO, A.N, E.N, P.O, R.N, J.S.I, I.M, R.C, J.E, P.R.A, L.VN.S revised the manuscript. All authors read and approved the final version of the submitted manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFarkavets K, Marinović N. Oxygen Discovery AIDASCO Reviews. 2024;2(1):12\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGottlieb J, et al. German S3 guideline: oxygen therapy in the acute care of adult patients. Respiration. 2022;101(2):214\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoradkhan R, Sinoway LI. Revisiting the role of oxygen therapy in cardiac patients. J Am Coll Cardiol. 2010;56(13):1013\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang Y, et al. Interplay of hypoxia-inducible factors and oxygen therapy in cardiovascular medicine. Nat Reviews Cardiol. 2023;20(11):723\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElkheshen OM, et al. 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Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Volume 292. Social science \u0026amp; medicine; 2022. p. 114523.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAzad A, et al. Conducting in-depth interviews via mobile phone with persons with common mental disorders and multimorbidity: the challenges and advantages as experienced by participants and researchers. Int J Environ Res Public Health. 2021;18(22):11828.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEnworo OC. Application of Guba and Lincoln's parallel criteria to assess trustworthiness of qualitative research on indigenous social protection systems. Qualitative Res J. 2023;23(4):372\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlexander AP. Lincoln and Guba\u0026rsquo;s quality criteria for trustworthiness. IDC Int J. 2019;6(4):1\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShufutinsky A. 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Ann Afr Med. 2022;21(3):269\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuinn-Lee L, Weggel J, Moch SD. Use of oxygen at the end of life: attitudes, beliefs, and practices in Wisconsin. WMJ. 2018;117(1):7\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoldbart J, et al. It is not going to change his life but it has picked him up\u0026rsquo;: a qualitative study of perspectives on long term oxygen therapy for people with chronic obstructive pulmonary disease. Health Qual Life Outcomes. 2013;11:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim HJ, et al. Perception of long-term oxygen therapy for chronic lung diseases may affect poor adherence in Korea. Tuberc Respir Dis. 2023;87(1):100.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKelly CA, Maden M. How do respiratory patients perceive oxygen therapy? A critical interpretative synthesis of the literature. Chronic Resp Dis. 2014;11(4):209\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBritto M, et al. Patient and caregiver perceptions of oxygen therapy in facility-based settings for acute hypoxemic conditions: a scoping review. J Glob Health. 2025;15:04084.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbhilash KP, et al. Impact of oxygen therapy algorithm on oxygen usage in the emergency department. J Postgrad Med. 2020;66(3):128\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGillett GR. Intensive care unit research ethics and trials on unconscious patients. Anaesth Intensive Care. 2015;43(3):309\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotlińska-Lemieszek A, Fopka-Kowalczyk M, Krajnik M. Spirituality in people with advanced chronic obstructive pulmonary disease\u0026ndash;challenge for more effective interventions, support, and healthcare education: Mini-review. Front Med. 2022;9:954519.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTikellis G et al. Barriers to and facilitators of the use of oxygen therapy in people living with an interstitial lung disease: a systematic review of qualitative evidence. Eur Respiratory Rev, 2023. 32(169).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e: patients\u0026apos; social demographics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial-demographic characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategories\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e12 75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eEducation level\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e3 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e7 (43.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e6 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e11 (68.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eDivorced/separated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e18-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e4 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e24-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e5 (31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e30-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e36-41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e42-47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e48-53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003e54-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e1 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eReligion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eChristian\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e13 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eMuslim\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e3 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eOccupation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003ePeasant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e3 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eBusiness\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e9 (56.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 204px;\"\u003e\n \u003cp\u003eSalary earner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e2 (6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e: caregivers\u0026apos; social-demographics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSocial-demographic characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e10 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e20 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e9 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e18 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eNo education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e2 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eMarital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e19 (63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e2 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e9 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"7\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e18-23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e3 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e24-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e12 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e30-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e6 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e36-41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e2 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e42-47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e4 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e48-53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e1 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003e54-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e2 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eReligion\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e12 (40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e18 (60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eOccupation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003ePeasant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e6 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eBusiness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e10 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e4 (13.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 168px;\"\u003e\n \u003cp\u003eSalary earner\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 174px;\"\u003e\n \u003cp\u003e10 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3: Perception of Patients towards Oxygen Therapy\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"659\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUBTHEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eILLUMINATIVE QUOTES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eEmotional, cognitive and social disruptions in oxygen therapy\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eDisorientation during initiation of oxygen therapy\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eLimited awareness due to altered state during oxygen therapy initiation\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I didn\u0026rsquo;t get to know, but by the time I got to know, when I was gaining consciousness, I was on those things (oxygen), that\u0026rsquo;s how I started understanding that am on oxygen\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[\u003cstrong\u003ePII-02]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eEmotional distress during oxygen therapy\u003c/li\u003e\n \u003cli\u003eStigma and social discomfort surrounding oxygen use.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eEmotional distress during oxygen therapy\u003c/li\u003e\n \u003cli\u003eEmotional rejection despite its benefits\u003c/li\u003e\n \u003cli\u003ePsychological distress and fear triggered by environment\u003c/li\u003e\n \u003cli\u003eSocial stigma linked to oxygen use\u003c/li\u003e\n \u003cli\u003eAnxiety due to peer-shared negative experiences\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I don\u0026rsquo;t really tell people when I\u0026apos;m sick and on oxygen\u0026hellip;That kind of feels like someone will be stigmatized. They will always be thinking that, probably you\u0026apos;ll die in a minute. Because that\u0026apos;s the stigma that comes with it\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[PII-05]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePost-oxygen confusion and altered awareness\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eConfusion/ altered mental state post-oxygen therapy\u003c/li\u003e\n \u003cli\u003eReflection of oxygen therapy after recovery\u003c/li\u003e\n \u003cli\u003eOngoing emotional worry despite recovery\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;when he was put on oxygen but on gaining consciousness, he was very tough/agitated. That\u0026rsquo;s the problem I saw then; he was uttering vulgar/bad words. Then I got to know that maybe oxygen, when someone is weaned off, he comes back like a mad/crazy person\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u0026rdquo; [PII-02]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen therapy as a symbol of impending death.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen therapy is equated with end-of-life.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen is put on people sometimes when they are dead\u003c/li\u003e\n \u003cli\u003eOxygen therapy seen as last option\u003c/li\u003e\n \u003cli\u003eProbability of survival while on oxygen is a half\u003c/li\u003e\n \u003cli\u003eSurvival is by luck and by chance\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;because it\u0026rsquo;s not something easy what comes to my mind when am on oxygen, I see myself like a dead body being put into the grave just to fight for a life\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u0026rdquo; [PII-02]\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;because me I used to think that oxygen just kills. Me that\u0026rsquo;s what I knew. That anyone they put on it, dies\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u0026rdquo; [PII-04]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen perceived as critical care for severe illness\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen is associated with critical illnesses\u003c/li\u003e\n \u003cli\u003eBelief that oxygen therapy can manage chronic illnesses(asthma)\u003c/li\u003e\n \u003cli\u003eOxygen is effective in emergencies\u003c/li\u003e\n \u003cli\u003eOxygen is harmful\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;so, if they put someone on oxygen like it means that the person is in a critical condition that\u0026rsquo;s why is put on it, so in that critical condition, it\u0026rsquo;s oxygen that can help\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u0026rdquo; [PII-15\u003c/strong\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;But it\u0026rsquo;s hard, it\u0026rsquo;s hard, for someone to refuse oxygen because he knows that at least let him try that\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[PII-02]\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eFear of permanent dependence on oxygen therapy\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003eConditional acceptance of oxygen based on symptom severity\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePermanent dependence on oxygen for breathing support\u003c/li\u003e\n \u003cli\u003eConditional acceptance of oxygen based on symptom severity\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;it feels like I need to be on oxygen. Because when I get weaned off, there\u0026rsquo;s nothing I can do much because I need to come back and get back onto oxygen\u003cstrong\u003e\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e[PII-13]\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSpiritual and faith-based interpretations of oxygen therapy\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSurvival attributed to divine intervention\u003c/li\u003e\n \u003cli\u003eFaith as a coding mechanism during uncertainty\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAttribution of survival to divine intervention\u003c/li\u003e\n \u003cli\u003eBelief in fate alongside medical intervention\u003c/li\u003e\n \u003cli\u003eSpiritual plea during illness\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I was saying, almighty God help me to get better, and immediately they put it(oxygen therapy), in just a minute I felt everywhere opening, I saw I could breathe in air and it goes in well up to down. So I am okay now\u003c/em\u003e\u0026hellip;\u0026rdquo; \u003cstrong\u003e[CGI-07]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePerception of oxygen therapy as life-sustaining and restorative.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen perceived as supportive and healing\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eRefusal of oxygen is rare\u003c/li\u003e\n \u003cli\u003eOxygen therapy as a supportive intervention during respiratory distress\u003c/li\u003e\n \u003cli\u003eOxygen has a life-saving role\u003c/li\u003e\n \u003cli\u003eOxygen therapy heals\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;me I assure you that if I was near with these things (oxygen therapy) I would be already healed because they have helped me. So, on my side I have confirmed\u003c/em\u003e\u0026hellip;\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[CGI-07\u003c/strong\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I can\u0026rsquo;t refuse\u0026hellip; I just have to accept to be put on (oxygen) even if what, but they should put it on me\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[PII-04]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen therapy as a source of physical and emotional relief\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen leads to physical and emotional calmness\u003c/li\u003e\n \u003cli\u003ePerception that oxygen is soothing and comforting\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;when I put it (oxygen therapy) and it helped me, I could breathe well and it made me calm down\u003cstrong\u003e\u0026hellip;\u0026rdquo;\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[PII-04]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eReduced fear through exposure and familiarity\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eReduced fear due to familiarity with oxygen therapy\u003c/li\u003e\n \u003cli\u003eMixed feelings about long-term oxygen use.\u003c/li\u003e\n \u003cli\u003eRejection of fear or stigma around oxygen therapy\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;this is not the first time am put on oxygen; I have been put several times. It couldn\u0026rsquo;t scare me in anyway\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u0026rdquo; [PII-08]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;Actually, I don\u0026apos;t even fear the oxygen\u0026hellip; Yeah, I no longer fear\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u0026rdquo; [PII-09]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePerceived physical discomfort and intrusiveness of oxygen therapy\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003eOxygen therapy perceived as invasive or unnatural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 167px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePerceived physical burden of oxygen therapy\u003c/li\u003e\n \u003cli\u003eOxygen as invasive\u003c/li\u003e\n \u003cli\u003eOxygen is contaminated\u003c/li\u003e\n \u003cli\u003eOxygen perceived as impure or un-natural\u003c/li\u003e\n \u003cli\u003eOxygen makes breathing faster than usual.\u003c/li\u003e\n \u003cli\u003eAltered body sensation\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;because if you are to talk that thing (nasal prongs) if you are to talk, it pierces you in the nose here and when it does so, you feel like coughing. And when you do so, the dirty discharge from the nose enters the nasal prongs\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[PII-14]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;the air am breathing in does not feel like the normal one\u0026hellip;it feels like someone seated in a\u003c/em\u003e \u003cem\u003ewarm room, there\u0026rsquo;s no any fresh air\u003c/em\u003e\u0026hellip;\u0026rdquo; \u003cstrong\u003e[PII-13]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4: Perception of Caregivers towards Oxygen Therapy.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"661\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUBTHEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSECOND ORDER CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINITIAL CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eILLUMINATIVE QUOTES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePsychological reassurance attributed to oxygen therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eEmotional reassurance and psychological comfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen therapy perceived as hope of life\u003c/li\u003e\n \u003cli\u003eOxygen therapy perceived as a life line\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eHope of life\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eOxygen as hope for life\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;actually, it has given me hope because if they had not put them on oxygen there would be no hope of life\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-02]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;when a person has failed to breathe, that the oxygen helps them so that they can breathe well, because for they have low oxygen and it helps them\u003c/em\u003e\u0026hellip;\u0026rdquo;\u003cstrong\u003e\u0026nbsp;[CGI-10]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eTrust in health workers as reassurance during oxygen therapy\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eWillingness to trust and comply with medical interventions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003etrust in health workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I always follow the doctor\u0026rsquo;s instructions depending on her because I need her to live\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[CGI-21]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;for me in my heart I am just following their decisions and I believe they know why they put her on Oxygen, so I cannot interfere with them\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-17]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePerceived as a life-saving intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen is essential for survival\u003c/li\u003e\n \u003cli\u003eOxygen therapy improves someone\u0026rsquo;s condition.\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen is essential for survival\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eOxygen therapy improves someone\u0026rsquo;s condition.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eLife saver\u003c/li\u003e\n \u003cli\u003eNo oxygen, no existence\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eOxygen improves someone\u0026rsquo;s condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;So, when they told me that they think that she\u0026rsquo;s going to be put on oxygen, I welcomed the idea because I knew it would help her to have life\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-02]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eOxygen therapy is a temporary support during illness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePerception of oxygen as a temporary sustainer\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eDependence on oxygen for patient stability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOxygen is a life support system\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;Just, I know it is a support system to assist those with, difficulties in breathing and that is what I know, because we all breathe in oxygen, yeah\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-11]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePerceived as expensive in healthcare facilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003ePerceived barriers to accessing oxygen therapy\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eHigh cost in private healthcare settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eExpensive in private facilities\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;because had it been in a private sector or a private hospital, I would\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eSpiritual and psychological distress of caregivers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eAttribution of patient deterioration to oxygen equipment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003ePsychological impact of oxygen equipment\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003ePhysical discomfort and fear of harm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eThe prongs or the oxygen delivery equipment cause discomfort\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThe oxygen delivery equipment cause anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;they just put this whatever direct in the nose and me I think they pierce her and she\u0026apos;s not comfortable. Actually, she has been complaining\u0026hellip;. To me, I feel she\u0026apos;s not comfortable\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[CGI-11]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eFaith and Divine Attribution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSurviving is by God\u0026rsquo;s will\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eFaith in divine healing over medical intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eGod as healer\u003c/li\u003e\n \u003cli\u003eFaith in God\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003ewhen someone is put on oxygen, he needs prayers.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;When they put him on oxygen, I said, I just gave everything to God. I said, I hope it does not happen like, for my sister who died while on oxygen. But I thank God now, the oxygen is helping him\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-16]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eAnxiety and fear triggered by oxygen therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ePsychological impact of seeing a loved one on oxygen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eAnxiety related to oxygen therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;the only thing, that I keep on asking the medical workers, the doctors who put her on oxygen, is that for how long is it going to be there? Is it going to be something permanent? Is it short term? And if it is short term, how many days\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-02]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePerceived as a symbol of impending death\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen therapy equated with end-of-life.\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eAssociation of oxygen with terminal illness or dying\u003c/li\u003e\n \u003cli\u003eBelief that oxygen use equals the end of life\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen is associated with death\u003c/li\u003e\n \u003cli\u003eOxygen means someone is going to die\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eOxygen is given to already dead people\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;That when someone is on oxygen, can die and if oxygen is put on someone, that person is in a very bad condition. If someone hears that oxygen, just understands that that person\u0026rsquo;s life is no more\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-12]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eOxygen therapy as a sign of impending death\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eBelief that oxygen signals a critical condition\u003c/li\u003e\n \u003cli\u003eLoss of hope upon oxygen initiation\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThe emotional burden of witnessing oxygen use\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eMinimal chances of survival\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;...I was like haaaa, this \u0026ldquo;mzee\u0026rdquo; is going to be put on oxygen, now it means the chances of surviving, actually I even counted, I said out of 100, I think maybe he has 10% or 5%...\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-04]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eOxygen therapy is an emergency measure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003ePerception of oxygen therapy as an emergency intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOxygen is put on critical patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;by the time you decide that someone needs to be supported on oxygen, it means either is even unconscious\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e[\u003cstrong\u003eCGI-04]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eFear rooted in traumatic medical outcomes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eFear of internal body damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eoxygen caused organs to burst\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;I lost a sister, who also needed oxygen, but immediately they connected her on oxygen. I think it affected her. And what? Either the lungs or the, either the heart or whatever burst. So, I don\u0026apos;t know whether they put too much, the level was too much, or it was whatever\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[CGI-16]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen as a symbol of medical danger\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen as a marker of severe or worsening condition.\u003c/li\u003e\n \u003cli\u003eOxygen viewed as harmful\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen is a very dangerous thing\u003c/li\u003e\n \u003cli\u003eOxygen means the condition has worsened\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eOxygen is risky\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;oxygen is a very dangerous thing depending on what people talk about it that eh\u0026hellip; \u0026ldquo;someone has reached oxygen\u0026rdquo; let\u0026rsquo;s just pray\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-21]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;quite risky because when eeehh, someone is undergoing that oxygen therapy, you really see there\u0026rsquo;s a time where it reaches and as if he\u0026rsquo;s not breathing\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[CGI-04]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003eOxygen as a dual symbol of life and death\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eHope versus fatalism\u003c/li\u003e\n \u003cli\u003eOxygen as a marker of death imminence\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen means dying or improving\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eOxygen is a life or death situation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;when they talk about oxygen, either someone was going (dying) or someone\u0026apos;s coming(recovering) back to life. Yeah\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e[CGI-23]\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen is perceived as a last resort measure\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eSense of helplessness when oxygen is initiated\u0026nbsp;\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThey consent to oxygen reluctantly, seeing no other way to save the patient.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eOxygen therapy as a last resort.\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eLeft with no other choice.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;because I think when you are told that you are to be put on oxygen it\u0026rsquo;s at least the last resort. Me I know it\u0026rsquo;s the last resort to save your life\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[CGI-07]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePositive perception of healthcare advancements\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eRecognition of advanced medical technology\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cul\u003e\n \u003cli\u003eRecognition of advanced medical technology\u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eOxygen delivery is modernized\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;Now the machines have come, eeehh the way oxygen is being given to someone is of a modern way, so, the chances of someone dying are minimal\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[GCI-04]\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Perception, Patients, Caregivers, Oxygen Therapy","lastPublishedDoi":"10.21203/rs.3.rs-8692126/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8692126/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eOxygen refers to a colorless, odorless, tasteless gas that is essential for proper body functioning and survival. However, the effectiveness of oxygen therapy can be influenced by the perceptions of patients and caregivers. Understanding patients' and caregivers' perceptions of oxygen therapy directly impacts healthcare practices. Consequently, the information gained from such research can be used to develop interventions that can help promote oxygen therapy's benefits, leading to the acceptance and compliance with oxygen as treatment. This studied aimed to explore the perception of patients and caregivers towards oxygen therapy in Mbale Regional Referral Hospital (MRRH).\u003c/p\u003e\u003ch2\u003eMaterials and methods:\u003c/h2\u003e \u003cp\u003eThis study was conducted in Mbale Regional Referral Hospital involving in-depth interviews with patients and caregivers. The study employed a descriptive qualitative study. The qualitative data collected was analyzed using the Braun and Clerk approach.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eBoth patients and caregivers reported that they perceived oxygen therapy as a life-saving yet fear-inducing intervention, spiritual and emotional interpretations of oxygen therapy, perceived physical and technological aspects of oxygen therapy. Sources of information about oxygen therapy were mainly schools, communities, hospitals, and the internet. Implementation of community sensitization campaigns and health education on oxygen therapy to promote awareness as well as counselling and psychological support for patients and caregivers struggling with emotional distress and fear associated with oxygen therapy. Further research is needed to assess the effectiveness of health education and awareness interventions in improving the perceptions of patients and caregivers towards oxygen therapy.\u003c/p\u003e","manuscriptTitle":"Perception of Patients and Caregivers toward Oxygen Therapy in Mbale Regional Referral Hospital, Eastern Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 15:16:23","doi":"10.21203/rs.3.rs-8692126/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T04:20:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T14:16:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T12:15:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121987091720574077217761903644259650541","date":"2026-04-16T16:49:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339102983476967759129580868599327784280","date":"2026-04-13T07:17:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T12:51:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"336805106986380529177782841518870409112","date":"2026-02-10T14:08:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339168160154962742747283930410094993103","date":"2026-02-04T16:49:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-02T06:33:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-30T06:48:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-29T10:02:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T09:54:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-01-25T11:19:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce4061d2-f94e-4f3f-a922-cc979020a7bc","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T04:20:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-06T14:16:54+00:00","index":89,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T12:15:20+00:00","index":88,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-07T04:24:44+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 15:16:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8692126","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8692126","identity":"rs-8692126","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}