Introduction Chronic respiratory diseases (CRD) are a highly prevalent public health issue with stark inequities and significant morbidity and mortality. Pulmonary Rehabilitation (PR) is an effective intervention which is proven to reduce the symptom burden for people living with a CRD. Uptake, attendance, and completion of PR worldwide are poor. New and novel ways of delivering PR are required to increase the reach of PR. This thesis aims to investigate a method of delivering PR that may increase the reach of PR services in Aotearoa New Zealand (NZ).

Methods Prior to development of a new delivery method of PR in NZ, a survey of all PR services in NZ was completed. Simultaneously, a scoping review of the literature was undertaken to determine the factors that may influence engagement in and experiences with telerehabilitation, and their experiences of engaging in this form of PR. The information from these two studies led to the iterative process of developing the content for a mHealth PR programme (mPR) – the first of its type specifically for the NZ population. The mPR intervention was developed by a multidisciplinary team including public health physician, mHealth experts, behaviour change experts, physiotherapists, computer scientists, people living with a CRD, and engineers. Throughout the development process two further studies were undertaken, which further shaped the content of mPR. Furthermore, an evaluation of our mPR programme was undertaken with a preference-based trial and the patient experience was assessed through a mixed methods study which was nested in the preference-based trial.

Results The national survey of PR services demonstrated that prior to the COVID-19 pandemic, PR services in NZ offered predominantly centre-based PR with only 5% of services offering any home-based options. No services offered telerehabilitation, and all services operated within normal working hours. The survey also found that during the COVID pandemic many services pivoted their services to provide telerehabilitation options.

The scoping review identified device, data access, digital literacy, and concerns regarding lack of support from peers and clinicians were key barriers to participation in telerehabilitation. Studies reported the convenience and reduced burden of telerehabilitation were reported as positive factors for participants engaging in telerehabilitation.

A preference-based study was used to determine whether PR attendance and completion rates may be improved by offering the participants their choice of delivery model (centre-based or mPR). Whilst 64% of participants preferred centre-based PR, of the 36% that preferred mPR, they were more likely to be younger and employed. Whilst attendance and completion rates were higher in the centre-based group - high levels of satisfaction and perceived benefit were reported from the mPR programme.

Conclusions Whilst centre-based PR remains the preferred option for many, the addition of mHealth delivered PR can increase the reach to those who might otherwise be unable to access PR services.