Participant and practitioner experiences of the Supervised Pulmonary Hypertension Exercise Rehabilitation (SPHERe) trial: a qualitative process evaluation

Background Pulmonary Hypertension (PH) is a debilitating condition which can lead to avoidance of physical activity and reduced health-related quality of life (HRQoL). The Supervised Pulmonary Hypertension Exercise rehabilitation (SPHERe) multi-centre RCT found that remotely supervised online group exercise-based rehabilitation was safe and well tolerated, but not superior to a single one-to-one advice session for improving walking distance and HRQoL over 12 months. An embedded qualitative study aimed to explore participant and practitioner experiences of the trial and interventions. Design Qualitative process evaluation utilising semi-structured interviews. The framework method was used to analyse findings. Setting England and Scotland, UK. Participants Adults with PH living in the community. Results Twenty intervention participants, 20 usual care participants, and five intervention practitioners were interviewed. Barriers to participation in the SPHERe intervention group included finding time and being ill, whilst the dynamics of being in an online group were seen both as positive and negative. Enablers for participation included the support that came from a shared experience and a sense of belonging. Conclusion Despite a lack of clinical effectiveness, the SPHERe intervention was mostly well received by participants and practitioners. The main barrier was finding time to exercise. The main enabler was being in a group and the support this provided. Online group interventions should be considered important for future research and service models, whilst also appreciating the challenges associated with this mode of delivery.