British Lung Foundation
The British Lung Foundation has a network of people-led Breathe Easy groups, run by community-based volunteers. These promote self-management, health and well-being via peer support and education for older people living with long term respiratory illness. Working with healthcare professionals (HCPs) the groups offer advice, talks and opportunities to meet others. In order to achieve sustainability and maximise impact of these groups, they have increasingly been supported to strengthen their relationships with NHS respiratory services. This has resulted in a new model of Integrated Breathe Easy (IBE). IBE keeps the best elements of peer support combined with a new focus on engagement with commissioners and health care professions to ensure sustainability and integration with respiratory pathways. These groups benefit from increased referrals and attendance, formal support for healthcare professionals and recognition by commissioning organisations.
What CSAIF funded: The British Lung Foundation was awarded £396,688 (including £90,000 for evaluation) to create new 'Integrated Breathe Easy' peer groups, supporting more than 3,000 people affected by lung conditions in England. The Breathe Easy network provide support and information for people living with a lung condition, and those who look after them. Integrated Breathe Easy groups have a high level of integration with local health services and commissioners, linking participants to clinical services such as pulmonary rehabilitation, and have formal arrangements for healthcare professionals, such as respiratory nurses, to attend their sessions.
The evidence generated through the grant has helped the team successfully secure additional grant funding from the Big Lottery Fund, to continue the growth of their peer network across the UK over the next five (5) years.
About the evaluation
Aim: The evaluation aimed to assess the impact of Integrated Breathe Easy (IBE) groups on the mental and physical well-being of people living with and affected by a lung condition.
Evaluator: University of Kent (Centre for Health Services Studies)
- People living with a lung condition in converted and new IBE groups felt more confident managing their lung condition and felt more in control of their lung condition compared to standard BE groups.
- There was a 42% reduction in unplanned GP visits and a 57% reduction in unplanned hospital admissions in IBE groups compared to the standard BE groups.
- 87% of people in converted and new IBE groups felt less likely to be admitted to hospital because of their lung condition, compared to 67% in standard BE groups. Similar figures were observed for GP and nurse visits.
- Carers in existing IBE groups felt more confident to support their partner or friend (97%), felt they had a better understanding of lung conditions (98%), and knew more about services available locally for people supporting others with lung conditions (90%).
- People living with a lung condition who attended any type of BE group had significantly greater quality of life at 6 months compared to people who did not attend a BE group. Those attending BE groups maintained quality of life throughout the study whereas quality of life decreased by more than 20% for those who did not attend a group.
- People attending standard BE groups and converted IBE groups had significantly greater levels of self-efficacy (CSES) than people who did not attend a BE group. Those attending standard BE and converted IBE groups maintained self-efficacy throughout the study whereas there was a decrease of 17% for those who did not attend a BE group.
- People attending converted and new IBE groups maintained wellbeing throughout the study whereas there was a decrease of 12% for those who did not attend a BE group.
Level on Standards: 1
Method: Baseline data was collected at the initial Breathe Easy group meetings, and follow-up data collected at six months. Supporting qualitative interviews were also carried out, alongside an economic evaluation.
Participants: 103 participants in the non-participating control group, dropping to 61 on follow-up. 142 participants in the non-integrated control group, dropping to 55 on follow-up. 246 participants in the integrated intervention group, dropping to 86 on follow-up. 134 participants in newly-established BE intervention group, dropping to 34 on follow-up. Participants were matched via propensity scoring, with some significant differences found concerning levels of deprivation, education, skills and training for newly established BE groups.
Why this Level: This evaluation suggests a positive change over time for the individuals that the British Lung Foundation supports, using a set of externally validated tools. Significance testing indicated that two of the monitored outcomes experienced significant changes. However, the main factor that prevented reaching a higher Level on the Standards was an attrition rate of over 50%.
About the evidence journey
Progress: The evaluation has been a very useful tool to promote Breathe Easy to potential NHS partners, healthcare professionals and volunteers. In 2017 BLF commences a two year project funded by Leeds City Council with support of the city’s three CCGs to establish a city-wide network of Breathe Easy groups with weekly exercise classes.
Lessons learned: The evaluation of the Integrated Breathe Easy model provided an independent assessment of the value of self help group support for people with long term respiratory illness. I addition to the positive outcomes for individuals attending Breathe Easy, we learnt much about the model itself which is informing next steps in its development.
- Volunteers are vital to the success of the model
- Monthly meetings may not offer enough choice and regularity for wide-scale uptake
- The quality of engagement in partnerships with NHS commissioners greatly influence the uptake and activity delivered.
Next steps: With further funding from Big Lottery we are using the outcomes of the evaluation and the additional learning to strengthen the Integrated Breathe Easy model and roll out UK-wide. Specifically:
- A new volunteer model is being developed to strengthen and support the volunteer base that underpins all Breathe Easy activity
- Local Planning Groups with full range of stakeholders have been introduced as an essential component of Integrated Breathe Easy work.
- Groups are being developed as ‘hubs’ of local activity and engagement (groups supported to establish weekly activity such as sing and exercise in addition to their core activity)