Exploring the ability of layworkers to support health-related behaviour change in deprived areas through Heart of Mersey

Lead Research Organisation: University of Liverpool
Department Name: Primary Care

Abstract

Cardiovascular disease is the main cause of death in the UK. Most of this is caused by the way people live their lives, such as smoking, high-fat diets, lack of fruits and vegetables and not much physical activity. Therefore, if we help people to make changes to their lifestyles, then we will be able to make a large reduction in the number of people who die from this disease.

We know it can be very difficult for people to make some of these changes to their usual way of life. This is not helped by environmental things, such as intensive advertising of ?unhealthy? foods, problems getting to shops that sell healthy foods at a reasonable price, or concerns about how much money it will cost to make changes to your lifestyle.

Already, we have a lot of experience of training local people in relatively poor areas, to work with local people to help them overcome these barriers. These ?lay health trainers? (LHTs) supplement the work of health professionals by providing practical support to patients / public. Knowing the local area they understand about the client?s way of life and barriers and opportunities locally for heart-health promotion. They have more time to spend with clients and visit them in their home as well, rather than expecting the client to attend relatively short ?clinic? consultations.

The government supports the development of health trainers in the NHS providing an opportunity to find our about their potential effectiveness. This is important are there is no point spending a lot of time and money on them if they do not help people make changes to their heart-health lifestyles. The best way to find this out is to use a randomised controlled trial. These types of studies can be complex. Therefore, we need to carry out a smaller version of the full trial and this is the purpose of this current application. This smaller (in terms of the number of participants) exploratory trial will be used to find out more about the LHT intervention. It will be used to find out if our trial design is acceptable to the types of people we would like to include. Finally we will collect information about the costs of this type of intervention and this form of evaluation. Then we will have good information to design a much larger trial.

Technical Summary

90% of cardiovascular disease, still the UK?s biggest killer, is associated with key modifiable lifestyles; mainly smoking, high saturated fat diet, low intake of fruit & vegetables, & lack of physical activity. Appropriate dietary support is particularly lacking within the NHS and elsewhere. Though attention on ?five a day? is welcomed; the public remain bombarded with intense commercial marketing about high-saturated fat, calorie dense foods & snacks. Significant practical barriers prevent many from translating health promotion messages, including heart-health dietary information, into sustained behaviours. These barriers are significant amongst social & economically deprived groups and individuals, contributing to their much higher rates of CVD. The government remains committed to reducing health inequalities providing opportunities within a national and local policy context to reduce such unacceptable disparities in CVD in the UK.

The public health White Paper ?Choosing Health? introduced ?health trainers? to encourage uptake of heart-health behaviours, providing an opportunity to robustly evaluate this approach in randomised controlled trials. It is imperative that these interventions are robustly evaluated to ensure their effectiveness and the most effective deployment of scarce resources.

We have extensive experience of using lay health trainers (LHTs) to work with individuals & groups, mainly in deprived areas, to improve their diet including a randomised controlled trial to get people to eat more oil-rich fish and fruit & vegetables and a Beacon Status lay-led programme of community nutrition support. We also draw on our experience of the implementation and evaluation of smoking cessation and tobacco control and of physical activity. Our work shows that lay health trainers offer important opportunities to effectively engage with local people and provide some of the practical and ?real life? skills needed to help people adopt sustained heart-health lifestyle behaviours. They are also likely to be more cost-effective than traditional health professionals.

Our aim is to robustly evaluate the effectiveness of LHTs to increase the uptake of key heart-health lifestyle behaviours among people in deprived communities with at least one existing risk factor for CHD. The current application will develop an exploratory trial. This will include investigating the training needs of LHTs, previously ignored; testing a proposed trial design; collecting robust information to inform amongst other things, the costs and sample sizes for a fully powered trial; and to identify key factors associated with the potential effectiveness of the LHT intervention to perfect before embarking on a full trial of this exciting intervention.

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