Supporting COPD patients to access pulmonary rehabilitation with lay health workers: a feasibility study
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 including travel, transport and lack of perceived benefit prior to treatment. 40% of referred patients take up and complete PR. Referrals by general practitioners result in the lowest completion rates in the UK. 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: LHW recruitment, selection, training and retention; patient recruitment and retention; intervention fidelity; acceptability to patients of LHW support.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. Both modes of interaction were recorded on smart phone. Interactions were analysed for intervention fidelity (fidelity of the LHW intervention to the training done). Participant views were assessed by questionnaire and by qualitative interview.
110 COPD patients were invited to take on the LHW role. 15 (14%) completed training. Recruiting and training of LHWs was not constrained by lack of willing volunteers. 66 COPD patients referred for PR received LHW support. LHWs were enthusiastic about the volunteer role. LHW-patient interactions showed widespread evidence of the use of BCTs taught in training. Time spent by LHWs in training could be longer with more focus needed on skill acquistion and learning assessment. 40 COPD patients completed questionnaires. 85% were satisfied or very satisfied with LHW support. 21 patients and 12 LHW volunteers completed qualitative interviews. The common bond of having COPD was important in helping patients accept LHW support. Patients valued the first-hand experience of LHWs.
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. This intervention could be tested in a trial setting.