Introduction and Objectives Oxygen is a scarce resource in many developing countries and there are current efforts to increase its availability. Clinicians in Malawi often report refusal of oxygen by patients. This qualitative study explores attitudes to oxygen therapy in Malawi.

Method Focus group discussions involving 86 participants were held in rural and urban communities in Malawi until no new ideas were found. Framework analysis of transcripts of the audio recordings was carried out by at least two researchers to identify recurring themes.

Results We found that participants’ knowledge of oxygen was limited, although many recognised that oxygen is used for respiratory diseases in adults and children. Knowledge of oxygen arose from personal experience, observation in hospital and discussion in local communities. Participants were keen to receive further education about oxygen therapy.

Attitudes to oxygen varied. Some participants recognised that it could benefit those with respiratory and other diseases, and had positive experiences of using it. Others expressed fear or anxiety about using oxygen and cited this as a reason for refusing it. Many of the participants had witnessed a patient’s death following the use of oxygen: “they are afraid that the patient is going to die ... because they had previously seen another patient dying after being placed on the machine”. Some had heard in their local communities that oxygen was used prior to the death of a patient: “even at the funeral ceremony people are told that the deceased went to the hospital and there he was put on oxygen and he died there, so this message terrifies people”.

Participants found the appearance and noise from oxygen concentrators alarming: “that device is fearsome just by looking at it. When you think of someone inserting this device in the nose or mouth, you may think they want to finish off the life of your child”.

Conclusion This study impacts on efforts to increase the use of oxygen in Malawi and other developing countries. We have shown a need for education at a community level and for guidance for health workers seeking to increase the uptake of oxygen.