Abstract
Background: Pulmonary rehabilitation is known to improve function and quality of life for people with chronic obstructive pulmonary disease (COPD). However, little research has been conducted on the influence of culture on experiences of pulmonary rehabilitation. This study examined factors influencing uptake of pulmonary rehabilitation by Maori with COPD in New Zealand.
Method: Grounded theory nested within kaupapa Maori methodology. Transcripts were analyzed from interviews and focus groups with 15 Maori and ten New Zealand non-Maori invited to attend pulmonary rehabilitation for COPD. Maori participants had either attended a mainstream hospital-based program, a community-based program designed "by Maori, for Maori", or had experienced both.
Results: Several factors influencing uptake of pulmonary rehabilitation were common to all participants regardless of ethnicity: 1) participants' past experiences (eg, of exercise; of health care systems), 2) attitudes and expectations, 3) access issues (eg, time, transport, and conflicting responsibilities), and 4) initial program experiences. These factors were moderated by the involvement of family and peers, interactions with health professionals, the way information on programs was presented, and by new illness events. For Maori, however, several additional factors were also identified relating to cultural experiences of pulmonary rehabilitation. In particular, Maori participants placed high value on whakawhanaungatanga: the making of culturally meaningful connections with others. Culturally appropriate communication and relationship building was deemed so important by some Maori participants that when it was absent, they felt strongly discouraged to attend pulmonary rehabilitation. Only the more holistic services offered a program in which they felt culturally safe and to which they were willing to return for ongoing rehabilitation.
Conclusion: Lack of attention to cultural factors in the delivery of pulmonary rehabilitation may be a barrier to its uptake by indigenous, minority ethnic groups, such as New Zealand Maori. Indigenous-led or culturally responsive health care interventions for COPD may provide a solution to this issue.