Policy, trust, and symptoms: a multi-stakeholder qualitative study of COPD awareness in rural China

作者：Shiyu Zhang, Yuhao Liu, Yulin Zhang, Jingyu Fu, Yufang Liu, Zhoutao Zheng, Xiao Zhang, Chao Wang, Chao Wang, Lirui Jiao, Alec Cali, Jonas Wachinger, Aditi Bunker, Pascal Geldsetzer, Till Bärnighausen, Simiao Chen, Chen Wang, Chen Wang · 发表于：npj Primary Care Respiratory Medicine · 年份：2026 · DOI：10.1038/s41533-026-00537-y · 研究领域：Chronic Obstructive Pulmonary Disease (COPD) Research、Diabetes Management and Education、Primary Care and Health Outcomes

Abstract Despite the disproportionately high burden of Chronic obstructive pulmonary disease (COPD) in rural China, disease awareness remains profoundly low. Existing quantitative assessments outline the prevalence of this awareness deficit but offer limited insight into the complex sociocultural and structural factors driving the awareness gap of COPD. This study aimed to identify the key facilitators and barriers shaping COPD awareness among multiple stakeholders in rural southwest China. Using a purposive sampling strategy in a rural county in Guizhou Province, we conducted semi-structured interviews with 128 stakeholders: high-COPD-risk individuals ( n = 50), COPD patients ( n = 46), healthcare providers ( n = 13), and local administrators ( n = 19). Transcripts were analyzed using Practical Thematic Analysis (PTA) and structured around the macro, meso, and micro levels of the Integrated Care for Chronic Conditions (ICCC) framework. Facilitators and barriers are not isolated entities but appeared to be distinct outcomes arising from the same situational factors. At the macro-level, while national health policies often appear disconnected and impractical in real-world application, screening programs sometimes bridge this gap by grounding their approach in tangible clinical engagement. At the meso-level, single educational content often fails to resonate; however, relying on local dialects for interpersonal communication and trust in messengers can significantly improve und...