White Patrick, Gilworth Gill, Lewin Simon, Hogg Lauren, Tuffnell Rachel, Taylor Stephanie J C, Hopkinson Nicholas S, Hart Nicholas, Singh Sally J, Wright Alison J
Department of Public Health and Primary Care, School of Population Health and Environmental Sciences, King's College London, London, UK,
Norwegian Institute of Public Health, Oslo, Norway.
Int J Chron Obstruct Pulmon Dis. 2019 Mar 12;14:631-643. doi: 10.2147/COPD.S188731. eCollection 2019.
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.
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.
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.
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.
本研究旨在评估整群随机对照试验的可行性，以测试非专业健康工作者（LHWs）在改善慢性阻塞性肺疾病（COPD）治疗中肺康复（PR）的接受度和完成率方面的疗效。
接受过保密、角色界限和行为改变技术培训的LHWs为新转诊接受PR的患者提供支持。LHWs与参与者之间的互动通过智能手机进行记录。结果指标为LHWs的招募率和留存率、通过问卷调查和访谈评估的可接受性以及干预保真度分析。
110名有PR经验的COPD患者中有40名（36%）申请成为LHWs。20名（18%）被选中参加培训。12名（11%）为患者提供支持。66名转诊接受PR的COPD患者接受了干预（每名LHWs支持5.5名参与者）。10名LHWs留存至研究结束。73%的受支持患者对干预感到满意或非常满意。LHWs以适当的方式实施干预，保真度有所不同。LHWs希望接受更深入的培训。基于这一概念验证，开展一项关于LHWs干预以改善PR接受度和完成率的整群随机对照试验是可行的。
有PR经验的COPD患者可以被招募、培训并留用为LHWs以支持参与PR，并且能够实施干预。参与的COPD患者认为该干预是可接受的。整群随机对照临床试验是可行的。
