Jenny Woodward

New beginnings: stakeholder perspectives on the role of health trainers:

Aims: First proposed in the 2004 White Paper Choosing Health, health trainers are a new addition to the public health workforce. Health trainers are recruited from local communities and provide support to enable individuals to adopt healthy lifestyles. The aim of this paper is to examine the emerging role of the health trainer in the context of one of the twelve early adopter programmes. The paper describes the support and signposting model developed in Bradford. Methods: An evaluation of the pilot scheme was undertaken using both quantitative and qualitative methods. The paper draws on two pieces of qualitative data from the evaluation. Two focus groups were held with 15 health trainers in their first months of practice. Telephone interviews were held with a sample of 16 key informants from community based placement organizations. Thematic analysis of the data was undertaken. Results: The new health trainers were very clear about their role in listening and giving support. Clients presented with a diverse range of needs and often had complex problems. The health trainers perceived that a client-centred approach was of value but there were some issues about the boundaries of appropriate advice. Outreach and networking were considered important skills. In the telephone interviews, interviewees understood the health trainer role and identified potential benefits for service users. The significance of health trainers having local knowledge was highlighted, although some organizations were able to assist with networking. The health trainer programme was seen as an additional and distinct resource complementing existing provision. Conclusion: The new role of health trainer is a significant development for the public health workforce. Health trainers can offer something quite distinctive and separate from professional advice, and there is potential to help individuals to access support and services in local communities. More research is needed on the relative value of different models of health trainer.

Addressing inequalities in health – what is the contribution of health trainers?

Aims: The role that members of the public (non-professional lay people) can play in improving health is being increasingly recognised in research and policy. This paper explores what contribution lay people employed as health trainers are making to addressing health inequalities in England. Methods: Data from eight local evaluations of health trainer services were synthesised using a data-extraction framework to find out about client populations, any lifestyle changes made, health trainers’ background and community engagement activities. These data were compared with national data to assess how findings relating to addressing inequalities compared with the national picture. Results: Local data largely matched national data and showed that health trainers are reaching people living with disadvantage and enabling them to make lifestyle changes. The data suggest that they do this by engaging with communities and taking a person-centred approach. Being non-clinical peers is also important. However, no evidence was found that health trainers were impacting on health inequalities at a population level. Conclusion: Health trainers are contributing to addressing health inequalities but the services evaluated were small and had been operating for a limited time, so to expect reductions in inequalities at a population level within districts would be unrealistic. The findings of this synthesis present a challenge to primary care and public health to employ health trainers in order to engage marginalised communities as one element of plans to address health inequalities.

An evaluation of a toothbrushing programme in schools

Purpose – The purpose of this paper is to assess the effectiveness of a toothbrushing intervention delivered in primary schools in Yorkshire and the Humber, a Northern district of England. The toothbrushing intervention was designed with the intention of improving the oral health of young children. The paper reports the effectiveness of the intervention and explores process issues related to its co-ordination and delivery. Design/methodology/approach – The evaluation had three data gathering approaches. These were: in-depth case studies of three selected schools participating in the toothbrushing programme; interviews with oral health promoters responsible for the programme in the district; and a small scale questionnaire-based survey which was sent to the 18 schools participating in the intervention. Findings – The intervention was accepted by children and they enjoyed participating in the toothbrushing scheme. Children had often become more knowledgeable about toothbrushing and the consequences of not regularly cleaning their teeth. The scheme was contingent on key staff in the school and the programme was more successful where schools embraced, rather than rejected the notion of improving childrens health alongside educational attainment. Whether the intervention made differences to brushing in the home requires further investigation, but there is a possibility that children can act as positive “change agents” with siblings and other family members. Practical implications – This paper suggests that schools can be an effective setting for implementing toothbrushing interventions. Originality/value – Toothbrushing in schools programmes are a relatively new initiative that have not been fully explored, especially using qualitative approaches or focusing on the views of children. This paper makes a particular contribution to understanding the process and delivery of toothbrushing interventions delivered in primary schools. The implications for programmes outside of the UK context are discussed.

Interventions to increase free school meal take-up

Purpose – The purpose of this paper is to design and implement interventions to increase free school meal (FSM) uptake in pilot schools. This paper describes the interventions, reports on acceptability (as perceived by school working parties) and explores the process of implementing change. Design/methodology/approach – The research consisted of two phases, an exploratory phase followed by an intervention phase. Findings from the latter are presented. Ten pilot schools (five primary and five secondary) in Leeds, England were recruited. Each established a working party, examined current claiming processes and implemented individualised action plans. This paper draws on the final action plans and interviews/focus groups with working parties. Findings – Interventions to improve FSM claiming process, minimise discrimination and maximise awareness were designed. The majority were implemented successfully, the exception being amending anti-bullying policies. Creative ways of delivering interventions were demons...

Understanding the older traveller: stop, look and listen!

Getting around would be difficult without roads, rail and pedestrian walkways. Despite what we take for granted, the older traveller is often left feeling frustrated by the current transport infrastructure. Based on their research, Dr Greg Marsden et al explore in this article why this is the case, they look at the barriers that prevent older people getting out and about and the considerations when planning transport for the older traveller.