A mixed-methods evaluation of physical activity among people with chronic obstructive pulmonary disease (COPD) and people without COPD in Saudi Arabia, and perspectives of healthcare professionals to promote physical activity

Alruwaili, Rawan 2024. A mixed-methods evaluation of physical activity among people with chronic obstructive pulmonary disease (COPD) and people without COPD in Saudi Arabia, and perspectives of healthcare professionals to promote physical activity. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Background: Chronic obstructive pulmonary disease (COPD) presents with progressive airflow limitations, commonly resulting in breathlessness, coughing, and reduced physical activity (PA). However, PA is essential to manage and improve health outcomes for people with COPD. There is limited research regarding the levels of PA among those with and without COPD in Saudi Arabia or the contributors to PA. Aim: This thesis explores PA levels in people with and without COPD and determines the barriers to and facilitators of PA among those with and without COPD and healthcare professionals (HCPs) in Saudi Arabia. This is to support the future promotion of PA in COPD. Methods: This study employed a sequential explanatory mixed-methods approach. Phase 1 was a cross-sectional study which assessed PA, health-related quality of life (HRQoL), and dyspnoea using a validated questionnaire for people with and without COPD. An online survey administered via RECAP included the International PA Questionnaire short form (IPAQ-SF) and QoL (EQ-5D-5L) for both groups. The Dyspneoa-12 (D-12) was only completed by those participants with COPD. Phase 2 was the qualitative phase. Following the survey, semi-structured interviews were conducted (guided by Social Cognitive Theory (SCT)) with 13 survey participants, some of whom had COPD and others who did not. Additionally, HCPs who had experience of working with COPD were interviewed. The interviews were conducted online in Arabic, transcribed, and then translated into English before reflexive thematic data analysis was conducted. Results: Phase 1 (quantitative) included 50 people with COPD and 51 without COPD. Mean IPAQ-SF was similar (p>0.05) and both groups reported low levels of PA, with 54% of people with COPD and 45% of people without being categorised as inactive (p>0.05). The EQ-5D-5L utility index and VAS were lower in the COPD group than in the non-COPD group (p<0.05). There was no correlation between IPAQ-SF and quality of life (QoL) but in the COPD group, IPAQ-SF and D-12 were moderately correlated (rs = -0.567, p<0.01). II Phase 2 (qualitative) included eight people with COPD, five people without COPD, and six HCPs being interviewed. Thematic analysis identified four main themes: COPD-specific factors, individual factors, environmental and social factors, and HCP factors. People with COPD reported specific factors as barriers, such as COPD symptoms, access to pulmonary rehabilitation (PR), and a lack of social support. However, personal and environmental factors acted as barriers and facilitators to PA for both people with and without COPD. They highlighted cultural and social norms, barriers, and environmental factors such as cost and accessibility. Finally, the themes identified by HCPs included insufficient knowledge, a lack of training, and limited availability of rehabilitation centres as barriers to promoting PA. The themes relating to facilitators were increased awareness of the benefits of PA, educational sessions regarding the importance of PA, and support from HCPs. Conclusion: The study conducted in Saudi Arabia found that people with and without COPD have low levels of PA. The identification of barriers to and facilitators of PA among people with and without COPD and HCPs in Saudi Arabia through the lens of SCT offers novel insights into the cultural, personal, and environmental factors that affect PA engagement in this population. Understanding these factors is crucial to develop targeted interventions and strategies to promote PA and improve the overall health outcomes of people with COPD in Saudi Arabia.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Healthcare Sciences
Date of First Compliant Deposit:	29 August 2025
Last Modified:	29 Aug 2025 10:25
URI:	https://orca.cardiff.ac.uk/id/eprint/180608

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