Improving uptake and completion of pulmonary rehabilitation in COPD with lay health workers: feasibility of a clinical trial

Abstract

Patrick White,1 Gill Gilworth,1 Simon Lewin,2,3 Lauren Hogg,4 Rachel Tuffnell,5 Stephanie JC Taylor,6 Nicholas S Hopkinson,7 Nicholas Hart,8 Sally J Singh,9 Alison J Wright10 1Department of Public Health and Primary Care, School of Population Health and Environmental Sciences, King’s College London, London, UK; 2Norwegian Institute of Public Health, Oslo, Norway; 3Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; 4Physiotherapy Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 5The Pulmonary Rehabilitation and Integrated Respiratory Team, King’s College Hospital NHS Foundation Trust, London, UK; 6Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 7National Heart and Lung Institute, Imperial College London, London, UK; 8Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, London, UK; 9Centre for Exercise and Rehabilitation Science, University Hospitals of Leicester NHS Trust, Leicester, UK; 10Department of Clinical, Educational and Health Psychology, University College London, London, UK Purpose: This study was designed to evaluate the feasibility of a cluster randomized controlled trial to test the efficacy of lay health workers (LHWs) in improving the uptake and completion of pulmonary rehabilitation (PR) in the treatment of COPD.Materials and methods: LHWs, trained in confidentiality, role boundaries, and behavior change techniques, supported patients newly referred for PR. Interactions between LHWs and participants were recorded with smartphones. Outcomes were recruitment and retention rates of LHWs, questionnaire and interview-evaluated acceptability and analysis of intervention fidelity.Results: Forty (36%) of 110 PR-experienced COPD patients applied to become LHWs. Twenty (18%) were selected for training. Twelve (11%) supported patients. Sixty-six COPD patients referred for PR received the intervention (5.5 participants per LHW). Ten LHWs were retained to the end of the study. Seventy-three percent of supported patients were satisfied or very satisfied with the intervention. LHWs delivered the intervention with appropriate style and variable fidelity. LHWs would welcome more intensive training. Based on this proof of concept, a cluster randomized controlled trial of an LHW intervention to improve uptake and completion of PR is feasible.Conclusion: PR-experienced COPD patients can be recruited, trained, and retained as LHWs to support participation in PR, and can deliver the intervention. Participant COPD patients found the intervention acceptable. A cluster randomized controlled clinical trial is feasible. Keywords: uptake, completion, recruitment, retention, intervention fidelity

Keywords

• Pulmonary rehabilitation
• Chronic Obstructive Pulmonary Disease (COPD)
• lay health workers
• intervention fidelity