Title : From symptoms to awareness: Barriers and facilitators of COPD awareness in rural China

Background: Despite a disproportionately high burden of Chronic Obstructive Pulmonary Disease (COPD) in rural China, disease awareness remains profoundly low. While existing quantitative assessments outline the prevalence of this knowledge deficit, they offer limited insight into the complex sociocultural and structural factors driving the awareness gap. This study aims to identify the key facilitators and barriers shaping COPD awareness among multiple stakeholders in rural southwest China.

Methods: A qualitative study was conducted using a purposive sampling strategy in a rural county in Guizhou Province. Semi-structured interviews were conducted with 128 stakeholders, comprising 50 high-COPD-risk individuals, 46 COPD patients, 13 healthcare providers, and 19 local administrators. 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.

Results: The analysis revealed that barriers and facilitators are not isolated entities but rather distinct outcomes arising from the same situational factors. At the macro-level, while national health policies often appear disconnected from residents' daily realities, active screening programs sometimes bridge this gap by grounding their approach in tangible clinical engagement. At the meso-level, generic educational content often fails to resonate; however, relying on local dialects for face-to-face communication and established trust in familiar messengers significantly enhances understanding. At the micro-level, gradually emerging respiratory symptoms are frequently normalized as consequences of aging or smoking, leading to delayed diagnosis. Conversely, observing the severe physical toll of COPD on peers or recognizing age-related physical vulnerabilities can prompt individuals to take proactive health-seeking behaviors.

Conclusions: The COPD awareness gap in rural settings is sustained by profound systemic misalignments rather than a simple knowledge deficit. To improve the early awareness of diseases like COPD, it is urgent to shift the governance model to a trust-based multi-dimensional collaborative paradigm. Empowering local healthcare providers to carry out culturally appropriate health education through local dialects is the key to bridging the gap between national health strategies and the reality of rural society.

Shiyu Zhang is a Ph.D. student in Public Health, specializing in Health Policy and Management at the Chinese Academy of Medical Sciences & Peking Union Medical College. She holds a Bachelor of Economics in Health Economics from Southern Medical University. Her research focuses on population medicine, chronic disease management, and health interventions, with a specific emphasis on COPD in rural China. Zhang actively contributes to the Population Medicine Pilot Program in Xishui County and has co-authored multiple publications on public health strategies.