The lay health worker-patient partnership promoting PR in COPD: what makes it work?

Abstract

Background: Pulmonary rehabilitation (PR) is the most effective treatment for the symptoms and disability of COPD. The impact of PR is restricted by poor rates of completion with numerous barriers to attendance documented. There is evidence of the benefits of lay health workers (LHWs) in the management of other long-term conditions. They have not previously been used to promote PR. Aim: To examine the LHW-patient partnership from the perspective of LHWs and patients in a study using PR-experienced COPD patients trained as LHWs to support newly referred patients. Methods: We examined the experiences of COPD patients who received LHW support and the LHWs as part of a larger feasibility study. All LHWs and a sample of 21 (32%) of the patients they supported participated in semi-structured qualitative interviews that were digitally recorded and transcribed. Thematic analysis was completed. Results: 13 (62%) interviewed patients had completed PR, 6 (29%) were non-completers and 2 failed to start. Five (42%) LHWs had previous experience of volunteering. For most LHWs this was their first time volunteering. LHWs were fulfilled by helping others. LHWs enthusiasm for PR was striking. The common bond of COPD was positive for patients and LHWs. Together with LHWs’ first-hand experience of PR these were dominant and reoccurring themes. LHWs engaged to different degrees with patients. Some patients felt their LHW was not available enough. Most patients were satisfied by the interaction. Conclusions: The shared condition of COPD and frequent experience of similar symptoms was valued by patients. This emerged as an important element in helping participants to feel a connection and in patients accepting LHW support.