Currently submitted to: JMIR Nursing
Date Submitted: Apr 21, 2026
Open Peer Review Period: Apr 27, 2026 - Jun 22, 2026
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Design Principles for a Nurse-Integrated Digital Pulmonary Telerehabilitation Maintenance Intervention After Pulmonary Rehabilitation in Chronic Obstructive Pulmonary Disease: Qualitative Focus Group Study
ABSTRACT
Background:
Maintaining the benefits of pulmonary rehabilitation over time is challenging, and digital follow-up interventions often fail to sustain engagement in everyday use. For nursing-led pulmonary telerehabilitation, mechanism-based design requirements remain insufficiently specified.
Objective:
This study aimed to characterize the behavioral and implementation mechanisms identified by adults with chronic obstructive pulmonary disease and rehabilitation nurse specialists to sustain engagement with pulmonary telerehabilitation maintenance after center-based pulmonary rehabilitation and to translate these mechanisms into design principles for a minimum viable digital intervention.
Methods:
A descriptive-exploratory qualitative study was conducted using online focus groups. Four focus groups were held with rehabilitation nurse specialists (n=8) and adults with chronic obstructive pulmonary disease who had completed pulmonary rehabilitation within the previous 12 months (n=8). Sessions were audio-recorded and transcribed verbatim. Data were analysed using directed content analysis based on a priori codebook; two researchers coded the transcripts independently and resolved discrepancies through discussion.
Results:
Across 121 coded excerpts and 455 code applications, participants converged on a self-regulatory behavioural loop linking structured exercise prescription and content delivery, reminders, task and symptom logging, performance feedback and reinforcement. Professionals additionally emphasised implementation mechanisms required for safe clinical integration, including personalised pathways, simplified navigation, safety alerts and adaptive recommendations.
Conclusions:
Sustained engagement in pulmonary telerehabilitation maintenance appears to depend on operationalizing a behavioral regulation loop supported by a clinical integration layer rather than on isolated app features. The findings provide nurse-relevant design principles for a minimum viable telerehabilitation intervention to support postrehabilitation maintenance in chronic obstructive pulmonary disease.
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