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


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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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