The study objectives were:
- To investigate a train-the-trainer approach to enable PR staff to recruit PR-experienced volunteers and train them as PR-buddies
- To explore the acceptability of the training and the PR-buddy role to the volunteers
A multidisciplinary team, including two physiotherapists, developed a 2.5-day training course to prepare PR staff to set up a volunteer PR-buddy service. PR staff were trained in recruiting PR-buddies and to deliver a three-day course. PR-buddy training included communication skills, role boundaries, confidentiality and selected behaviour change techniques to help patients overcome barriers to participating in PR. Training materials were reviewed by a COPD patient-advisory group.
In-person, semi-structured focus groups were conducted with PR-buddies who had completed the training and delivered the intervention to newly referred patients. The sessions were audio recorded and transcribed verbatim for coding and reflective thematic analysis.
Fifteen PR services throughout England were randomised to the intervention arm of the IMPROVE trial and invited to nominate a minimum of three PR staff for training. Fifty-nine PR staff completed the training. One PR service dropped out after staff training due to a lack of staff capacity to run the trial. The remaining 14 sites recruited 93 PR-buddies, six were unable to finish PR-buddy training. Therefore 87 PR-buddies completed the training, a mean of 6 per site.
Six focus groups were held with 31 PR-buddies (range 3 to 7). Participants had positive experiences receiving training from the PR staff and felt confident to start supporting people with COPD referred to PR. Some thought the training could have been shorter and some received additional training when required. There was agreement that the role of PR-buddy was rewarding but PR-buddies were frustrated as they would have liked more patients to support. They understood and accepted the importance of confidentiality and role boundaries.
Implementation of training for PR staff to facilitate the recruitment and training of volunteer PR-buddies was successful. The PR-buddy role was acceptable to the volunteers as they were satisfied with the training received and enjoyed helping others get the benefits from PR that they had experienced.
The train-the-trainer model is efficient in its use of resources. It is suited to wider application of PR-buddies in PR services. Similar lay health worker programmes could be valuable in other clinical areas to support treatment adherence especially where budgets are constrained.
Lay Health Workers
Focus groups
