Barriers and facilitators to providing pulmonary rehabilitation to individuals from culturally and linguistically diverse backgrounds

Pulmonary rehabilitation is effective in improving health outcomes in individuals with Chronic Obstructive Pulmonary Disease (COPD), as well as many other chronic respiratory diseases. It is recommended that all Australians with COPD who experience dyspnoea, or shortness of breath, should be offered pulmonary rehabilitation. However, despite growing cultural diversity within the Australian population, the impact of this diversity on access to, and participation in, pulmonary rehabilitation has not been investigated. Therefore, the aim of this study was to investigate the referral and participation rates of individuals from culturally and linguistically diverse (CALD) backgrounds in pulmonary rehabilitation programs in Sydney, Australia, as well as potential barriers and facilitators to providing pulmonary rehabilitation to these individuals. This was a mixed methods study, using a sequential, qualitative dominant, participant-selection variant of explanatory design. Participants were coordinators of pulmonary rehabilitation programs in the Sydney metropolitan area. Stage one of the study involved a primarily quantitative web-based survey, stage two used semi-structured interviews to gain in-depth qualitative information, and stage three involved the integration of quantitative and qualitative data to provide a detailed analysis of the key outcomes. All participants reported that their program received referrals of individuals from CALD backgrounds, including individuals from a diverse range of cultural backgrounds, although the numbers of referrals varied between programs. Interpreters were often used for initial assessments of individuals with limited English proficiency, however were not often used for exercise classes or final assessments. Barriers identified by participants included cultural factors that programs were not able to accommodate, communication difficulties, challenges using interpreters, and resource limitations. The use of alternate methods of communication, engaging family support, and optimising utilisation of interpreters were identified as potential facilitators. This study identified that whilst many individuals from CALD backgrounds are referred to pulmonary rehabilitation there are a number of potential barriers to providing pulmonary rehabilitation to these individuals limiting optimal participation. A greater understanding of these barriers, and the harnessing of potential facilitators, such as the development of resources and innovative service delivery models, may help to improve the participation of individuals from CALD backgrounds in pulmonary rehabilitation.