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Exploring financial incentives to increase pulmonary rehabilitation engagement

Lung disease affects one in five people and is the third biggest cause of death in England. Pulmonary rehabilitation is an exercise and education programme for people living with lung disease. It improves breathlessness and quality of life and results in fewer and shorter hospital admissions and readmissions.

Despite this, only 13% of people living with lung disease in England are referred for pulmonary rehabilitation, and those who are referred don't always choose to start or complete the programme. The NHS aims to significantly to increase the number of people receiving and completing pulmonary rehabilitation, but we don't know the best way to do this. Financial incentives, such as vouchers, have been used to promote a range of positive health behaviours, including adopting a healthy diet, stopping smoking and breastfeeding. Accordingly, using financial incentives may be a plausible way to increase pulmonary rehabilitation referral rates and engagement.

The aim of our study is to co-design a financial incentive intervention to improve pulmonary rehabilitation referral, uptake and completion among people with chronic respiratory disease and to design the future study to investigate the feasibility and acceptability of this intervention.

As part of this study, we will interview people living with lung disease, healthcare professionals who refer people to or work in pulmonary rehabilitation and clinical commissioners to explore their opinions of using financial incentives to increase pulmonary rehabilitation engagement.

We will run co-design workshops and focus groups to develop and finalise the financial incentive intervention, and design a future study to investigate this intervention.

This research will result in the development of a co-designed intervention and formation of a group of collaborators who will design the future study to test the feasibility and acceptability of this intervention. If deemed feasible and acceptable, the intervention will be subsequently tested in a full-scale trial.If shown to be effective, this intervention could increase pulmonary rehabilitation engagement, helping people with lung disease to improve their fitness levels, breathlessness, quality of life as well as reduce the number of times they're admitted to hospital. This in turn could help the NHS to save money.

If you'd like to discuss the research study or find out more information, please contact the research team on, or call +44(0)1895 265949 and leave a message and we will return your call as soon as we can.

Meet the Principal Investigator(s) for the project

Dr Claire Nolan
Dr Claire Nolan - Dr Claire Nolan is a Lecturer in Physiotherapy in the Department of Health Sciences and an NIHR Advanced Fellow with clinical expertise in pulmonary rehabilitation. Dr Nolan completed her PhD in Imperial College London in 2018 on gait speed and prognosis in idiopathic pulmonary fibrosis. Dr Nolan’s research interests include pulmonary and remote rehabilitation strategies, increasing engagement in rehabilitation programmes and outcome measure validation in people with chronic respiratory disease, particularly chronic obstructive disease and idiopathic pulmonary fibrosis, as well as multiple long-term conditions. She has expertise in mixed-methodologies, feasibility and randomised controlled trials, cohort studies as well as intervention development. Dr Nolan is an Honorary Senior Research Physiotherapist in the Harefield Respiratory Research Group, Royal Brompton and Harefield Hospitals, and a committee member of the NHSE National Respiratory Programme, NICE Early Value Assessment of digital technologies to deliver pulmonary rehabilitation for adults with COPD and the British Thoracic Society Quality Standards for Pulmonary Rehabilitation committee.

Related Research Group(s)

respiratory measurements (2)

Applied Respiratory Research Group - Applied respiratory research meeting the needs of respiratory-related healthcare

diverse group exercise (1)

Physical Activity in Health and Disease - The centre conducts interdisciplinary research to improve human health and performance through regular physical activity and exercise, and by limiting sedentary behaviour.

Partnering with confidence

Organisations interested in our research can partner with us with confidence backed by an external and independent benchmark: The Knowledge Exchange Framework. Read more.

Project last modified 11/10/2023