Table 6.

Supporting the offer.

Frame of reference (current PR/menu-based approach pathway) and Item type	Participation rate (%)	Category	Sub-category
Current; Hindering	40	Constraints of the healthcare service	Varying healthcare priorities AB05P: “Well my daughter was given lots of papers to talk about COPD. She was given 4 monthly check ups… She was sent to xxx for her breathing exercises…the only thing I had was two steroids and a yearly visit from the nurse.”
Current; Hindering	36	A lack of HCP–patient relationship AB17H: “…if I’m seeing somebody on a ward I don’t know that well but just fits into a particular category… a patient with COPD who’s come in with an infectious exacerbation then you say ‘There’s good evidence for pulmonary rehab so at some point, maybe not now but when you’ve recovered, it would be a good idea for you to do this…’ Whereas, with some of the asthma patients… you know a particular element of their symptoms is due to deconditioning and their breathlessness isn’t responding to things like inhaled steroids then you might spend a bit more time going through it and saying ‘This is why I think you particularly might benefit from this cos it will build your muscle strength and over time I think you’ll see an improvement in that particular symptom.’”
Menu; Hindering	36	The beliefs of HCPs AB13H: “I personally think physically going to a group run by physios with other people there and turning up on the day I would be more likely to maintain the exercise…”
Current; Helping	48	HCP engagement in PR	Facilitating a joined-up service AB12H: “Because of the type of intervention it is they need to be empowered to do it… so sometimes trickling [the idea of PR] in and definitely putting on my plan to revisit and revisit and revisit… a really good example would be that somebody else has gone along, normally a COPD nurse specialist, and they’ve spent loads of time talking about inhaler technique and maybe future care planning but they haven’t spent that much time around pulmonary rehab and I can go along sometimes and because of the slight different perspective, slight different training, can change their view on that and get them in a different way.”
Current; Helping	32	Valued support	Support from HCPs AB07H: “…you’re sort of left on your own [when completing home-based PR] and [patients] could do with a bit of interaction. So it’s just making them aware that as part of that, ‘Oh that’s fine but you can call the rehab office and they’ll help you if you’re not sure about anything or if you’re worried about something.’”
Current; Helping	44	The HCP–patient relationship AB04H: “I think the person who’s actually counselling them to go on pulmonary rehab. What sort of relationship do they have with that particular professional? What’s their consultation skills like? You know, cos consultation skills and being in synch with somebody’s health behaviours and psychology I think is really, really important… So if you’re gonna have somebody completely out of the blue trying to counsel patients to go to pulmonary rehab it won’t work as well as perhaps as having somebody who knows the patient, who has a trust with the patient and they’ve got a rapport built in.”
Current; Wish list	72	Improving access to PR	Improve how PR is offered AB08P: “I’ve learned I can perhaps do something about [my COPD]… I can do that and try and help myself or other people can help me as well… If I’d seen this about 8 years ago [I] might have… I’ve never heard of it.”
Menu; Wish list	56	Developing a PR service for all	Introduce the menu of programmes to all AB15H: “I think it’s nice before they actually come to have some awareness…to say that ‘This is something that’ll be discussed when you go for your assessment, but these are the different options that are available. So have a think about what you think might work for you.’”
Menu; Wish list	48	Guiding patient decisions AB24P: “…it’s okay giving you all these choices but you do need somebody to go through it with you…”