Supporting COPD patients to access pulmonary rehabilitation with lay health workers: a feasibility study

Abstract

Background: Pulmonary rehabilitation (PR) is the most effective treatment for the symptoms and disability of COPD. Access to PR is inadequate in many settings and barriers have been identified. New interventions are needed to achieve better access. Lay health workers (LHWs) – lay people trained to undertake a specific set of health tasks - are effective in support of patients in a number of health settings. COPD patients with first-hand experience of completing PR may have potential as LHWs in PR. Aim: To assess the feasibility of a trial of the effectiveness of LHWs in improving uptake of PR in terms of: recruitment, selection and training; intervention fidelity; acceptability to patients of LHW support. Methods: Volunteer COPD patients attended 3 days of training including behaviour change techniques (BCTs). LHWs made contact with newly referred COPD patients by telephone and face to face. Interactions were recorded and analysed for intervention fidelity. Participant views were assessed by questionnaire and by qualitative interview. Results: 110 COPD patients were invited to take on the LHW role. 15 (14%) completed training. 66 COPD patients referred for PR received LHW support. LHW-patient interactions showed widespread evidence of the use of BCTs taught in training. 40 COPD patients completed questionnaires. 85% were satisfied or very satisfied with LHW support. 21 completed qualitative interviews. The common bond of having COPD was important in helping patients accept LHW support. Conclusions: Recruitment and training of volunteer COPD patients as LHWs for the support of COPD patients referred to PR are feasible. LHWs are acceptable to referred patients.