Title: BREATHE-INDIA: BREATHlEssness in INDIA. Development of a Breathlessness Beliefs and Behaviour education intervention for use in the community-setting
Funder: Medical Research Council

Abstract: Chronic (persistent) breathlessness despite treatment of causal disease(s) is associated with disability and a vicious cycle of avoidance of physical activity (exertion-related breathlessness), deconditioning, worse function and increasing breathlessness. People with chronic breathlessness reduce or cease activities important for individual and societal wellbeing and, in high-resource countries, are more likely to use healthcare services. Despite availability of effective breathlessness self-management interventions in richer countries, they may not be directly transferable to India, where clinicians report lack of competence in breathlessness management and there is a serious lack of support for people with breathlessness. This project will co-design a programme-theory to inform the development of a flexible population health, community-based education intervention. The intervention will address breathlessness-related beliefs and behaviours e.g., physical activity, cool airflow, healthcare utilisation. This will be informed by our realist review's programme theories presented in "if, then" formats to demonstrate what works, for whom, how and where. 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 of 'what [breathlessness self-management interventions] works, for whom, and where;' Co-produce a prototype intervention to improve chronic breathlessness self-management in India; Consider how our intervention could be scaled up via population awareness; Consider adaptation for other resource-poor settings, e.g., Nepal 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. This project 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. Future study will evaluate utility, applicability, affordability and feasibility of the intervention along with measures relating to beliefs (community influencers) and individual behaviours/clinical outcomes (physical and social activity, self-rated health and well-being, workforce and education participation, healthcare utilisation).


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: RESPIRATORY