Digital delivery and assessment of holistic interventions for breathlessness

Breathlessness is a common and important symptom, resulting from the interaction between multiple physical, psychological and social factors, and causes substantial negative impacts to health-related quality of life. Interest has grown in therapeutic potential of holistic participatory arts-in-health activities using singing and dance for people with breathlessness, within the broader context of social prescribing. A small body of research has indicated such interventions might be effective, however properly conducted studies investigating impact, and mechanisms of impact, are lacking. Additionally, advances in digital health have expanded remote healthcare delivery, a trend accelerated by the COVID-19 pandemic, creating novel opportunities and challenges. This thesis aims to assess the impact, potential mechanisms, and possible future approaches, of digitally delivered holistic arts-in-health interventions for people with breathlessness. I present six results chapters addressing current research gaps. First, an observational study comparing the physiological demands of Singing for Lung Health (SLH) with treadmill walking, to investigate potential mechanisms of impact. Second, I present data from the first group of a planned larger randomised controlled trial (RCT) investigating the impact of face-to-face SLH. This group transferred to online SLH halfway through the intervention due to the COVID-19 pandemic, but viewed as a convenience pilot study, the findings provide valuable insights into digital adaptation of complex interventions. Third, a digitally delivered, remotely assessed, RCT comparing online SLH to usual care in COPD. Fourth, a digitally delivered and assessed RCT comparing the English National Opera’s Breathe programme to usual care in people with Long COVID and breathlessness. The fifth and sixth results chapters are qualitative studies investigating the experience of dance group participants for people with breathlessness in England and Uganda. Together these studies suggest that digitally delivered participatory arts interventions for people with breathlessness can improve aspects of health-related quality of life, and other symptoms including breathlessness.Open Acces

Online Public Health Education for Low and Middle-Income Countries: Factors Influencing Successful Student Outcomes

Background: Affordable, online public health education could assist health and development in low and middle-income countries. The Peoples-uni (www.Peoples-uni.org ) aims to provide this through a fully accredited, low cost, online Masters in Public Health. Although literature exists relating to online learners in general, we lack research regarding the characteristics of successful learners in this new student group. This study assessed which readily available information on learners could predict success in course modules. Methods: A descriptive survey method was used to assess correlations between pass rates with students’ personal characteristics (gender, nationality etc) and indicators of course engagement (discussion contributions, online profile etc). We sampled all students starting modules between September 2009 and March 2010 (n=218). Results: All indicators of engagement correlated strongly with pass rates, particularly online presence (photo/personal information on profile). Paying for modules correlated with higher pass rates than not. Interestingly, waiving fees correlated with lower pass rates than those who had not paid. Personal characteristics were not related to pass rates. Conclusion: Engagement is important for success, and indicators of which can predict pass rates, the personal characteristics investigated were not related to success. Further research is required to understand the nature of associations this study highlights

Smoking and socioeconomic factors linked to acute exacerbations of COPD: analysis from an Asthma + Lung UK survey

Background Understanding the factors driving acute exacerbations of chronic obstructive pulmonary disease (COPD) is key to reducing their impact on human health and well-being.Methods 5997 people with COPD, mean 66 years, 64% female, completed an online survey between December 2020 and May 2021 about living with COPD, developed by the charity Asthma + Lung UK.Results The 3731 (62.2%) survey participants reporting frequent (≥2/year) exacerbations were more likely to smoke (adjusted OR (AOR) 1.70, 95% CI 1.470 to 1.98), have lower annual household income (≤£20 000 (AOR 1.72, 95% CI 1.36 to 2.17), live in a cold and damp home (AOR 1.78, 95% CI 1.50 to 2.11) and report previous occupational exposure to dust, fumes and chemicals. Smokers were more likely to report attending hospital to manage their most recent acute exacerbation of COPD compared with ex-smokers (AOR 1.25, 95% CI 0.99 to 1.59).Discussion Strategies to improve COPD outcomes must address issues of deprivation and social justice

The physiology of singing and implications for ‘Singing for Lung Health’ as a therapy for individuals with chronic obstructive pulmonary disease

Singing is an increasingly popular activity for people with chronic obstructive pulmonary disease (COPD). Research to date suggests that ‘Singing for Lung Health’ may improve various health measures, including health-related quality-of-life. Singing and breathing are closely linked processes affecting one another. In this narrative review, we explore the physiological rationale for ‘Singing for Lung Health’ as an intervention, focusing on the abnormalities of pulmonary mechanics seen in COPD and how these might be impacted by singing. The potential beneficial physiological mechanisms outlined here require further in-depth evaluation

Dance for people with chronic respiratory disease: a qualitative study

Objectives: to explore the experiences and perceived impact on health and well-being related to participation in a dance group for people with chronic respiratory disease (CRD).Design: an exploratory qualitative study using thematic analysis of semistructured interviews.Setting: a community dance group in a UK health centre.Participants: convenience sample of long-term dance group participants.Intervention: weekly community dance sessions designed for people with breathlessness, lasting 75 min, led by a trained community dance leader.Results: convenience sample of eight participants, six females, aged 57–87 years (mean 75), with a median 2-year attendance at weekly dance sessions. Long-term attendance was driven by strongly held beliefs regarding the health and well-being benefits of participation. Four key themes were identified: dance as (1) a holistically beneficial activity, with physical and psychosocial health benefits including improved or maintained physical fitness and psychological well-being, and reduced need for healthcare; (2) an integral part of their life; (3) an enjoyable activity; and (4) a source of deep social cohesion.Conclusions: dance group participants perceived a broad range of health benefits of relevance to the biopsychosocial impacts of their respiratory disease. The themes identified are useful in the ongoing planning and evaluation of dance as a holistic complex intervention for people with CRD. Further research is required to assess the extent of health impacts identified, and how dance might be most effectively placed as an option in the management of CRD.Trial registration number: NCT04006015