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

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 understanding. At the micro-level, some gradually emerging respiratory symptoms are often mistaken for aging or smoking, leading to delayed diagnosis until the condition worsens severely. On the other hand, observing the physical condition of peers with COPD and being aware of age-related physical vulnerability can prompt people to take proactive health-seeking behaviors. Our findings suggest that improving early COPD awareness in rural low-resource settings may require more context-sensitive and trust-based communication strategies. Empowering healthcare providers to deliver culturally appropriate, dialect-based health education appears to be a promising way to bridge the gap between national health strategies and rural residents’ everyday experiences.