Supporting engagement with pulmonary rehabilitation amongst people from minority ethnicities in the UK: A theoretically informed behavioural analysis

Supporting engagement with pulmonary rehabilitation amongst people from minority ethnicities in the UK: A theoretically informed behavioural analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Supporting engagement with pulmonary rehabilitation amongst people from minority ethnicities in the UK: A theoretically informed behavioural analysis Amanda P Moore, Tahsin Tabassum, Lorraine Lawrence, Golam M M Rabbani, and 16 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8368521/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract Background: Despite strong evidence supporting Pulmonary Rehabilitation (PR) for Chronic Obstructive Pulmonary Disease (COPD), many patients choose not to attend. Uptake is particularly low among people with COPD from UK minoritised ethnic groups. Limited data exist on their perspectives of PR. We aimed to identify factors influencing PR engagement, to inform development of appropriate interventions. Methods: We conducted focus groups and semi-structured interviews with UK COPD patients, carers and community leaders of Black Caribbean, Black African and Bangladeshi heritage (n=16). Topic guides were structured around the Capability (C), Opportunity (O) and Motivation (M) model of behaviour (COM-B). A combined deductive and inductive thematic analysis identified key influences on PR uptake, which were mapped to potential interventions using the Behaviour Change Wheel (BCW). Results: Influences on PR uptake included limited knowledge of COPD causes and the benefits of PR and exercise (C), low confidence in their ability to exercise (M), and logistical barriers such as being unable to use public transport because of breathlessness (O). Bangladeshi participants wanted PR to reflect cultural values, including women-only sessions, prayer-time accommodation, language support, and community-based venues (O). Participants across the ethnicities sampled also reported limited trust in health services (O). Conclusion: Uptake of PR can be enabled by improving knowledge, engaging families and carers, shifting beliefs about PR’s value, and addressing logistical barriers. Culturally focused strategies included involving trusted community figures, tailoring PR classes to reflect cultural values, and raising awareness at the grassroots level. Clinical trial number: Not applicable COPD ethnicity Pulmonary Rehabilitation behaviour COM-B Bangladeshi Black African Black Caribbean health inequalities Full Text Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.pdf SupplementaryFile2Themodelsandframeworksusedinthisstudy.pdf Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 05 Apr, 2026 Reviewers agreed at journal 26 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviewers invited by journal 17 Mar, 2026 Editor invited by journal 20 Feb, 2026 Editor assigned by journal 23 Dec, 2025 Submission checks completed at journal 23 Dec, 2025 First submitted to journal 23 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8368521","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":608159626,"identity":"cdf63573-3c78-487b-903b-ed28bb266348","order_by":0,"name":"Amanda P 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Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COPD, ethnicity, Pulmonary Rehabilitation, behaviour, COM-B, Bangladeshi, Black African, Black Caribbean, health inequalities","lastPublishedDoi":"10.21203/rs.3.rs-8368521/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8368521/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Despite strong evidence supporting Pulmonary Rehabilitation (PR) for Chronic Obstructive Pulmonary Disease (COPD), many patients choose not to attend. Uptake is particularly low among people with COPD from UK minoritised ethnic groups. Limited data exist on their perspectives of PR. We aimed to identify factors influencing PR engagement, to inform development of appropriate interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e We conducted focus groups and semi-structured interviews with UK COPD patients, carers and community leaders of Black Caribbean, Black African and Bangladeshi heritage (n=16). Topic guides were structured around the Capability (C), Opportunity (O) and Motivation (M) model of behaviour (COM-B). A combined deductive and inductive thematic analysis identified key influences on PR uptake, which were mapped to potential interventions using the Behaviour Change Wheel (BCW).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eInfluences on PR uptake included limited knowledge of COPD causes and the benefits of PR and exercise (C), low confidence in their ability to exercise (M), and logistical barriers such as being unable to use public transport because of breathlessness (O). Bangladeshi participants wanted PR to reflect cultural values, including women-only sessions, prayer-time accommodation, language support, and community-based venues (O). Participants across the ethnicities sampled also reported limited trust in health services (O).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eUptake of PR can be enabled by improving knowledge, engaging families and carers, shifting beliefs about PR’s value, and addressing logistical barriers. Culturally focused strategies included involving trusted community figures, tailoring PR classes to reflect cultural values, and raising awareness at the grassroots level.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e","manuscriptTitle":"Supporting engagement with pulmonary rehabilitation amongst people from minority ethnicities in the UK: A theoretically informed behavioural analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-19 00:21:40","doi":"10.21203/rs.3.rs-8368521/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-06T02:14:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"291142518015060641656141615694594784263","date":"2026-03-26T11:46:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"290688625708573487986802086688030691037","date":"2026-03-18T09:46:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T10:48:45+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-20T10:58:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-23T18:14:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-23T13:24:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-12-23T13:11:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dd101a66-2864-4a11-a57f-8b2bb978ddf4","owner":[],"postedDate":"March 19th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T00:21:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-19 00:21:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8368521","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8368521","identity":"rs-8368521","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}