BREATHE-INDIA: BREATHlEssness in INDIA - Development of a breathlessness beliefs and behaviour education intervention for use in the community-setting

Project Description

PUBLIC HEALTH CHALLENGE: Chronic (persistent) breathlessness despite treatment of causal disease(s) 1 is associated with disability and a vicious cycle of avoiding physical activity-related breathlessness,2 deconditioning and increasing breathlessness. Those affected participate less in the workforce,3 risking curtailing of children’s education to increase income,4 and need more healthcare.5 Diseases causing persistent breathlessness (e.g., chronic obstructive pulmonary disease (COPD),6 coronary heart disease,7 lung cancer8) are common in India, mirroring rates of smoking, air pollution9 and poverty.10 This burden falls disproportionately on low-resource countries, accounting for 80% of global COPD/asthma mortality.11
Low-cost self-management breathlessness-targeted interventions are effective and deliverable in community-settings (e.g., breathing techniques, fans, lifestyle approaches, paced physical activity). These promote well-being, need little medical knowledge12; are teachable to lay workers, relatives or clinical support staff. Such approaches could be scaled up via population awareness, increasing human and social capital, and decreasing healthcare reliance.13 However, few are developed or tested for acceptability or effectiveness in India or other low-resource countries where, despite strong community networks, emerging data suggest that health beliefs may reduce acceptability without modification and addressing these during implementation.13
PROPOSED INTERVENTION: Our intervention will focus on community worker education. Given the “invisibility” of persistent breathlessness even in high-income countries, this will incorporate health promotion, raising awareness of breathlessness as a therapeutic target, and self-management techniques.
We will develop a chronic breathlessness education intervention. Using a Realist approach, Intervention Mapping and the Medical Research Council Complex Intervention Framework, our objectives are to:
• Understand how breathlessness self-management works in “real-life” population and individual contexts;
• Understand contexts (e.g., country, setting, community systems, intervention components) for effective implementation;
• Develop programme theory and co-produce a prototype intervention to improve chronic breathlessness self-management*;
•
• Consider adaptation for other resource-poor settings
* in India
With our stakeholder group, including community leaders, people with breathlessness, and clinicians we will conduct:
1. Realist review and evaluation to identify and refine evidence and theory for breathlessness self-management, producing intervention and implementation programme theory and map intervention components to ‘what works, for whom, and where.’
2. Intervention development using Intervention Mapping to map intervention and implementation programme theory to intervention components, develop materials to support intervention delivery, and co-design a prototype intervention ready for early acceptability and delivery-feasibility testing in India.
IMPACT: We will deliver i) important understanding of breathlessness self-management in India relevant to practitioners and policy makers; ii) the content of a prototype community-based intervention ready for further testing.