The common bond of a shared disease in the lay health worker (LHW) and patient relationship promoting PR in COPD: a qualitative study.
Pulmonary rehabilitation (PR) is the most effective treatment for the symptoms and disability of chronic obstructive pulmonary disease (COPD). PR is recommended in national and international guidelines. The impact of PR is restricted by poor rates of completion (typically around 40%) with numerous barriers to attendance documented. Referrals by GPs lead to lower rates of completion than by any other professional group. There is evidence of the benefits of using lay health workers (LHWs) in the management of other long-term conditions but they have not previously been used in COPD to promote PR. Support from LHWs with COPD who have first-hand experience of successfully completing PR may have the potential to improve uptake and completion amongst other COPD patients newly referred for 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: The experiences of COPD patients who received LHW support and of the LHWs themselves were investigated through qualitative interviews as part of a larger study examining the feasibility of using LHW volunteers to support patients newly referred to PR. The interviews were digitally recorded and transcribed verbatim. Thematic analysis was completed using the Framework approach. Data organisation and coding was assisted by the use of NiVivo software.
All the LHWs (n=12) and a sample of 21 (32%) of the patients they supported participated in semi-structured qualitative interviews. 13 (62%) interviewed patients had completed PR, 6 (29%) were non-completers and 2 failed to start. Five 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 LHW support that they had recieved.
The importance of PR in the management of COPD is not in doubt, but ways of overcoming barriers to uptake and completion of PR need to be explored. LHWs with first-hand experience of PR offer a possible way of improving the uptake of PR. If LHWs are shown to improve uptake and completion of PR, the support of GPs for this intervention at the time of referral will be important. In this qualitative study the shared condition of COPD and the 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.