Community-Based Case-Finding for Chronic Obstructive Pulmonary Disease and Self-Management Education in Partnership...

Chronic obstructive pulmonary disease (COPD) is poorly diagnosed with millions unaware they have the condition, preventing or delaying treatment and behavioral changes. We partnered with faith-based organizations (FBOs) to raise awareness of COPD among Black Americans by facilitating diagnosis and offering self-management education in the community.

Cross-sectional and pre-post study designs were applied. Three churches identified representatives to serve as COPD liaisons (CLs). CLs received training on screening procedures and an overview of COPD. Case-finding was conducted at health fairs where CLs helped administer a screening tool (COPD-population screener (PS)) to identify high-risk individuals and refer those who scored ≥5 for spirometry performed by respiratory therapists (RTs). RTs referred those with high risk of having COPD (scores ≥5 and FEV1/FVC ~ 0.70) to discuss results with their provider, and those eligible (COPD high-risk, COPD diagnosed, caregivers, and current or former smokers), to attend bi-monthly educational sessions. Bristol COPD Knowledge Questionnaire was used to assess participants' knowledge pre-post intervention and CL training. CLs also completed a self-efficacy questionnaire. Independent t-test, paired t-test, and Chi-squared test or Fisher's Exact test were applied.

We attended seven health fairs and engaged four CLs. CL self-efficacy was higher, while knowledge increased by 6.2% post-training then declined by 5%. Of the 170 people who completed the screening tool, 40 received spirometry, 3 (8.1%) and 9 (24.3%) had FEV1/FVC ratios of 0.70, and >0.70 to <0.80, respectively. Prevalence of COPD was approximately 12.6%, smoking history (former: 27.3%, current: 3.6%), and sleep apnea, 23.8%. About 11/38 people attended at least one educational session and knowledge scores increased significantly from baseline to post-session, 42% to 55% (t=-4.82, df=12, p=0.00).

COPD case-finding implemented in partnership with FBOs can supplement efforts in primary care. Routine educational sessions in the community improved access to self-management education for people with COPD and their caregivers. Engaging CLs in addressing respiratory health inequities can lead to greater impact in minority populations.