Developing a pulmonary rehabilitation (PR) train-the-trainer programme for PR-staff to set up a lay health workers service.

<bold>Background:</bold> Pulmonary rehabilitation (PR) is the most effective treatment for chronic obstructive pulmonary disease (COPD), but uptake and completion are low. In the multicentred cluster randomised controlled trial IMPROVE, training was developed for PR-staff to set up a PR-buddy service to increase the uptake and completion of PR by newly referred patients. This included recruitment and training of patients with COPD as volunteer lay health workers called “PR-buddies". PR-staff in the implementation sites received training in the recruitment and training of patients with COPD as PR-buddies. <bold>Methods:</bold> Training was developed by a multidisciplinary team and reviewed by patients. The training was then tested in 3 pilot PR sites and qualitative interviews with PR-staff were conducted. Results from the interviews were used to finalise the training. <bold>Results:</bold> Training drew on factors in the capability, opportunity, and motivation to facilite behaviour change (COM-B) model. The programme developed 3 manuals, 9 videos and 4 slide decks and included training on delivering a 3-day PR-buddy training programme, covering topics such as teaching communication skills, role boundaries, confidentiality, and selected behaviour change techniques to help patients overcome barriers to participating in PR. We refined the training based on 6 interviews. The identified themes were initial lack of clarity about trial demands, positive responses to training received, barriers and facilitators to setting up the PR-buddy service, motivations for and potential difficulties with participating in PR. <bold>Discussion:</bold> The train-the-trainer model can be used for PR-staff and subsequent PR-buddy training.