Judy White

Improving health and well-being through community health champions: a thematic evaluation of a programme in Yorkshire and Humber

Aims: The contribution that lay people can make to the public health agenda is being increasingly recognised in research and policy literature. This paper examines the role of lay workers (referred to as ‘community health champions’) involved in community projects delivered by Altogether Better across Yorkshire and Humber. The aim of the paper is to describe key features of the community health champion approach and to examine the evidence that this type of intervention can have an impact on health. Methods: A qualitative approach was taken to the evaluation, with two strands to gathering evidence: interviews conducted with different stakeholder groups including project leads, key partners from community and statutory sectors and community workers, plus two participatory workshops to gather the views of community health champions. Seven projects (from a possible 12) were identified to be involved in the evaluation. Those projects that allowed the evaluation team to explore fully the champion role (training, infrastructure, etc.) and how that works in practice as a mechanism for empowerment were selected. In total, 29 semi-structured interviews were conducted with project staff and partners, and 30 champions, varying in terms of age, gender, ethnicity and disability, took part in the workshops. Results: Becoming a community health champion has health benefits such as increased self-esteem and confidence and improved well-being. For some champions, this was the start of a journey to other opportunities such as education or paid employment. There were many examples of the influence of champions extending to the wider community of family, friends and neighbours, including helping to support people to take part in community life. Champions recognised the value of connecting people through social networks, group activities, and linking people into services and the impact that that had on health and well-being. Project staff and partners also recognised that champions were promoting social cohesiveness and helping to integrate people into their community. Conclusions: The recent public health White Paper suggested that the Altogether Better programme is improving individual and community health as well as increasing social capital, voluntary activity and wider civic participation. This evaluation supports this statement and suggests that the community health champion role can be a catalyst for change for both individuals and communities.

People-centred public health

Introduction Policy context Lay workers in practice Benefits and value of active citizens The lay perspective Case study evidence Addressing the myths Common challenges and practical solutions Conclusion.

Public health skills for a lay workforce: findings on skills and attributes from a qualitative study of lay health worker roles

OBJECTIVES To present a typology of attributes associated with lay health worker (LHW) roles drawn from a qualitative study of lay roles in the delivery of public health programmes. STUDY DESIGN Qualitative research study of case studies of public health projects. METHODS Five case studies of public health projects were undertaken, reflecting diverse roles, public health issues and populations. Semi-structured interviews and focus groups were carried out with a sample of 136 stakeholders, including commissioners, practitioners, LHWs and service users. Thematic analysis was conducted within and across cases. RESULTS Findings on the pre-eminence of social skills associated with LHW roles were consistent across all five projects. Being approachable, non-judgemental and responsive to community needs were critical attributes that enabled LHWs to undertake outreach and communicate successfully with programme recipients. Experiential knowledge and cultural understanding were also important qualities. A typology of attributes associated with LHW roles is presented. CONCLUSIONS Social skills, the ability to connect with a community, and the ability to develop respectful relationships are fundamental qualities for LHW roles. Further research would be required to produce a comprehensive map of LHW skills; however, the paper questions assumptions that lay skills are necessarily of a lower order than the professional skill set.

Health trainers making a difference to mental health and wellbeing.

This short report explores the key findings from a review1 of information on health trainers in 2013/2014 which had a particular focus on mental health and wellbeing. After summarising the key findings of the review, it focuses on mental health, briefly exploring the links between mental and physical health before discussing what differences engagement with a health trainer made to people’s sense of self-efficacy and wellbeing. Health trainers are a non-clinical workforce introduced in 2004,2 who receive training in competencies to enable them to support people in disadvantaged communities to improve their health.3 The population groups or settings that health trainers focus on varies from service to service, but all work one-to-one, most spending at least an hour with a client at their first appointment, supporting and enabling them to decide what they want to do. The emphasis is on the client determining their own priorities and how to achieve them. Generally, health trainers see clients for a total of six sessions, where how to achieve goals and progress towards them is discussed. The Data Collection and Reporting System (DCRS) is used by approximately 60% of Health Trainer Services to record monitoring data. Around 90% of Health Trainer Services using DCRS record ethnographic data on health trainers and clients, plus the issues clients worked on and the progress they made. There is also a wide range of other data which can be recorded, including before and after mental health and wellbeing scores. We were given access to aggregate data in order to conduct an analysis. Descriptive statistics were generated to calculate percentage change pre- to post-intervention. A total of 1,377 (= 919 full time equivalents) health trainers were recorded in the DCRS system as working with 97,248 clients in England during 2013/2014. The health trainer model embodies the principle of lay support,4 and services aim to recruit a high proportion of their staff from similar backgrounds to their clients. They have been reasonably successful with 32% of health trainers coming from the most deprived areas (Quintile 1),i with a further 20% from Quintile 2. In all, 40% percent of health trainers lived in the same areas as their clients.

Rewarding altruism: Addressing the issue of payments for volunteers in public health initiatives

Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007-9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained.

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.

Health together: how community resources can enhance clinical practice

Embedded in local communities and a trusted source of information, GPs are in a key position to encourage their patients to use non-clinical services that promote and maintain health and wellbeing. Participation in the arts and outdoor activities like gardening are known to be beneficial to mental health as highlighted in a recent article in this Journal.1 There are also myriad activities which can complement and enhance clinical treatment in primary care and benefit not only mental but physical health. The challenge for busy GPs and primary care practitioners is how to enable patients to access these activities given that they vary from place to place and over time. Knowing what is available, having assurance regarding quality, and having the time to explore options with patients requires local knowledge, time, and capacity which clinicians simply do not have. Social prescribing is one way of addressing this challenge and involves the ‘creation of referral pathways that allow primary care patients with non-clinical needs to be directed to local voluntary services and community groups.’2 A non-clinical facilitator, generally employed by and based in the practice, is able to spend time with patients who have psychological and social needs and direct them to community-based support, including …

What’s the future for health promotion in England? The views of practitioners

Specialized health promotion is an internationally recognized occupation and field of activity which has had a chequered history in England. After flourishing briefly in some areas in the early years of the New Labour government it has been in decline in most parts of the country. The last survey of practice conducted in 2005 found that the specialized health promotion workforce was unevenly distributed and much in need of advocacy and development. Since then there has been another major reorganization of primary care trusts (PCTs) and a split between commissioning and provider functions. Practitioners’ views on the impact of this on health promotion were gathered in a survey in 2008—2009. Participants comprised 36 people attending a Shaping the Future workshop in the North of England and 40 practitioners studying a masters course in health promotion. The findings reveal that organizational structure has a major impact on the nature of health promotion activity: the split between commissioning and provider functions of PCTs has presented huge challenges to practitioners irrespective of the arm in which they are placed, as one of the strengths of health promotion has always been its ability to straddle both strategic and operational levels and offer a joined-up approach to tackling the causes of ill health. For the specialized health promotion workforce, there has been a loss of identity and critical mass as the discipline is increasingly reduced and fragmented, a trend that looks set to worsen following further reorganization and reductions in public sector spending introduced by the new coalition government.