A Qualitative Exploration of User Engagement and Health-Related Behaviour Change in the NHS Health Trainers Initiative

Visram, Shelina (2012) A Qualitative Exploration of User Engagement and Health-Related Behaviour Change in the NHS Health Trainers Initiative. Post-Doctoral thesis, Northumbria University.

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Abstract

Lay health workers have been widely used to deliver health improvement activities in developed and developing countries. Although there is some data to support their efficacy, reviews of the research literature have consistently found insufficient evidence to assess which intervention strategies are likely to be most effective. Furthermore, there is a dearth of research exploring service user views and experiences. This study contributes to evidence and theory in relation to lay-led models of promoting lifestyle change. By adopting a grounded theory methodology underpinned by a subtle realist perspective, the study aimed to understand better the experiences of users and the mechanisms underlying intervention outcomes. The focus for this research was the NHS Health Trainers Initiative, which is part of an attempt to shift the emphasis in UK public health from ‘advice on high to support from next door’. Participants were sampled from three heterogeneous health trainer services in northern England. Semi-structured interviews with service users (n=26) were conducted at 0, 3, 6 and 12 months, and with health trainers (n=13) and their managers (n=5) at 0 and 12 months. A longitudinal approach was chosen to allow for a more in-depth exploration of the processes involved in attempting to make and maintain health-related behaviour changes. Informal observations of selected health trainer activities were also undertaken in order to generate additional data for triangulation. All data were analysed using the constant comparative method.

Health trainers were found to employ a tailored, holistic approach that takes into account the context of a person’s life and their access to resources for health. This builds upon the salutogenic theory of health, and is in direct contrast to the paternalistic, deficit model traditionally found in public health. It also draws on theories of ‘person-in-situation’ more commonly found in the social work literature, which present an alternative to the emphasis on person-centredness and psychological aspects of behaviour change. An integrated model is developed – called the theory of lay-led behaviour change in context – and contrasted with the logic models typically used to conceptualise similar interventions.

This research is one of few qualitative studies to investigate the role of lay health workers in the UK. Furthermore, the use of a longitudinal approach to explore behaviour change has produced results that are likely to have high policy relevance. The research represents an important application of a user-focused perspective affording new insights, which may also be applied to other complex interventions.

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