Pulmonary rehabilitation healthcare professionals understanding and experiences of the protected characteristics of service users: A qualitative analysis.

Background: Health inequalities can affect access and uptake to pulmonary rehabilitation (PR). An individual's protected characteristics (age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation) may contribute to health inequalities. Healthcare professionals (HCPs) experiences of the inclusivity and representativeness of PR services and knowledge of protected characteristics are unknown, however are vital for the identification and resolution of health inequalities. This qualitative study explored HCPs understanding of protected characteristics and their perception of the inclusivity, representativeness and equitable benefit of their PR services.
Methods: Semi-structured qualitative interviews were conducted in person or via videoconferencing with HCPs involved in PR from two healthcare providers. Interviews were analysed using reflexive thematic analysis.
Results: 12 interviews were conducted with physiotherapists ( n = 6), occupational therapists ( n = 2), nurses ( n = 2) and exercise physiologists ( n = 2). Participants had a median (IRQ) age of 43 (13) and 75% ( n = 9) were female. Four themes were generated. 1: 'I don't really know as much as I should' [about protected characteristics]; 2: It's uncomfortable collecting protected characteristics…; 3: 'I don't think [service users] are as representative as they could be'; 4: A conventional rehabilitation programme does not meet the needs of all.
Conclusions: This study highlighted several challenges in HCPs understanding of protected characteristics and the representativeness of PR that must be addressed to ensure equity. Strategies, to understand barriers in accessing PR that limit representativeness should be explored.
Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: H. Drover reports a role as NRAP Honorary Clinical Fellow on the Pulmonary Rehabilitation workstream. S.J. Singh reports roles as NIHR Senior Investigator, NRAP Clinical Lead for the Pulmonary Rehabilitation workstream and Editorial Strategy Board of Chronic Respiratory Disease. M.W. Orme reports a role on the Editorial Review Board of Chronic Respiratory Disease. E. Daynes reports lecture honoraria from Clinical Physio, honoraria from Neuroscience and Mental Health Institute (funding committee 2023) and roles with the BTS as chair of the Pulmonary Rehabilitation Specialist Advisory Group, Lead Expert Member NICE HTA EVA for Digital Rehabilitation, ATS Pulmonary Rehabilitation Assembly committee member, NRAP steering group, PRSAS steering group, CAHPR East Midlands Hub Lead, NIHR HS&DR funding committee member and Associate Editor of Chronic Respiratory Disease.