Adherence to home-based pulmonary rehabilitation (HBPR) remains inconsistent among people with chronic obstructive pulmonary disease (COPD), and new evidence published in BMC Nursing suggests that a complex mix of patient-, provider-, and caregiver-level factors contributes to the problem. The study identifies numerous barriers and facilitators influencing HBPR adherence and underscores the need for personalized, capability- and motivation-focused strategies that support engagement across all stakeholders.
“[HBPR], as a complement to traditional PR, has shown vast potential for application, especially during the COVID-19 pandemic. HBPR programs retain the core elements of
traditional PR and, by being implemented in the home setting, effectively address barriers such as transportation and cost,” explained the study authors. “However, patient adherence to HBPR programs is far from satisfactory… Furthermore, HBPR adherence is influenced by the interactions of multiple stakeholders, including family caregivers and healthcare professionals.”
The researchers conducted a systematic review of the existing evidence on barriers and facilitators influencing adherence to HBPR programs among COPD patients, from the perspectives of healthcare professionals, family caregivers, and patients. They searched major literature databases for quantitative, qualitative, and mixed-methods studies examining adherence to HBPR in COPD. Researchers integrated findings from eligible studies using a convergent synthesis approach and organized them according to the Capability, Opportunity, Motivation, Behavior (COM-B) model and by stakeholder group (patients, family caregivers, and healthcare professionals).
The review included 21 studies (9 qualitative, 8 quantitative, and 4 mixed methods), representing 1,444 patients with COPD, 153 healthcare professionals, and 17 family caregivers. Across all sources, the investigators identified 76 distinct barriers and 73 facilitators to adherence with HBPR, which were categorized using the COM-B framework.
Among patients with COPD, the most frequently reported facilitators were stronger self-management skills (capability), perceived support from healthcare professionals (opportunity), and positive attitudes toward HBPR (motivation). The most common patient-reported barriers included difficulty using technical equipment (capability), limited access to resources such as space or equipment (opportunity), and psychological tensions such as anxiety or low confidence (motivation).
Among healthcare professionals, professional competence emerged as the most frequent facilitator in the capability dimension, while positive attitudes toward HBPR were the most common facilitator in the motivation dimension. Resource constraints were the most frequently cited barrier in the opportunity dimension, whereas collaboration with other healthcare providers served as a key facilitator.
The investigators found no consistent pattern of barriers or facilitators among family caregivers, reflecting limited and heterogeneous evidence in this subgroup.
“Consistent with the COM-B model, the identified barriers and facilitators to HBPR adherence spanned capability, opportunity, and motivation dimensions and showed their multifaceted and interrelated nature,” the researchers concluded. “Our findings underline the necessity for future HBPR adherence interventions to be co-designed with all three stakeholder groups to effectively minimize barriers and leverage facilitators.”
link