Lay Health Workers in Pulmonary Rehabilitation-Recruitment and Training of Copd Patient Volunteers

Background: Pulmonary Rehabilitation (PR) is the most effective treatment for the symptoms of COPD but less than half of referred patients complete it. Lay health workers (LHWs) have improved uptake of healthcare interventions in other settings but have not previously been used in PR. Aim: To test the feasibility of using COPD patients, trained as LHWs, to enable other COPD patients to benefit from PR. Methods: Patients successfully completing PR were invited to volunteer as LHWs. Training included confidentiality, role boundaries and the learning and application of behaviour change techniques to address known barriers to PR attendance. Patients newly referred for PR were invited to accept LHW support by letter, phone and face to face interaction. Results: Twenty three (21%) of 110 patients approached applied to become LHWs. Fifteen (14%) completed 3 training days and joined a mentored group prior to supporting newly referred patients. Reasons for non-completion of training included health and social issues and concerns about impact on benefits of payments for research participation. Letters and information leaflets were ineffective in recruiting newly referred patients for LHW support (< 1% response). Telephone and face to face recruitment (at initial assessment) by the PR teams were effective (20 – 25% response in different NHS Trusts). This became the main recruitment mode. Conclusions: COPD patients can be recruited and trained as LHWs to encourage participation in PR. Personal contacts were the most effective method of recruiting patient participants for LHW support. The effectiveness of LHWs will be tested in a definitive clinical trial following this feasibility study.