Community health workers serving Veterans with chronic obstructive pulmonary disease: A pilot intervention development and feasibility study

Abstract: BACKGROUND: Chronic obstructive pulmonary disease (COPD) causes significant morbidity and mortality and is a substantial burden on healthcare systems. Disease self-management programs can reduce symptoms, lower hospitalizations, and improve patient quality of life. We adapted and piloted a COPD self-management program delivered by community health workers (CHWs) to Veterans. This study aimed to assess participants' perceived acceptability, appropriateness, and feasibility of the intervention. We investigated barriers and facilitators to achieving disease self-management practices. We explored participants' COPD health outcomes. Finally, we gathered insights from participants and CHWs to inform potential improvements. METHODS: Nine Veterans enrolled in the 12-week intervention and received a series of 9 CHW home, phone, or video visits. We assessed perceived intervention acceptability, appropriateness, and feasibility qualitatively and quantitatively. We conducted a qualitative content analysis of semi-structured interviews with intervention participants and their CHWs on overall perceptions of the intervention. An additional analysis phase included translation of the results into suggestions for future adaptations by the multi-disciplinary investigator team. We administered surveys on self-reported acceptability, appropriateness, and feasibility of the intervention, as well as COPD health outcomes. RESULTS: The intervention had high participant-perceived acceptability (4.2 ± 0.8), appropriateness (4.3 ± 0.5), and feasibility (4.2 ± 0.6), on a scale from 1 to 5. Interviewed participants highlighted the benefits of CHW-led education on COPD understanding, breathing techniques, and proper inhaler use. Participants further emphasized the social support and connection to resources provided by the program. Overall, the participants and their CHW providers shared feedback that demonstrate the acceptability, appropriateness, and feasibility of this intervention. Exploratory results also showed improved health-related outcomes. Some suggested adaptations emerged, such as including optional caregiver involvement and addressing potential stigma related to COPD. CONCLUSIONS: The pilot presents a promising CHW-led intervention to improve COPD self-management. These initial results suggest the intervention is acceptable, feasible, and appropriate and could improve health outcomes, including quality of life. Future programs or randomized controlled trial design could benefit from the study's recommended adaptations.