Lay health advisers: scoping the role and intervention landscape

Carr, Susan, Lhussier, Monique and Forster, Natalie (2017) Lay health advisers: scoping the role and intervention landscape. Journal of Healthcare Leadership, 9. pp. 59-67. ISSN 1179-3201

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Abstract

Context: The use of lay health advisers has become an established approach within public health, in particular for impacting on health inequalities and engaging socially excluded groups. Evidence on how differences in terms of the multiple role dimensions impact on the outcomes of programmes is limited. This creates ambiguity for decision makers around which roles should be implemented in different contexts for different needs.

Methods: This paper applies a realist logic of enquiry to explore the mechanisms that may operate in lay-led intervention models and understand how, why and in what respect these lead to particular outcomes. It draws on data from multiple strands of activity within our research programme including commissioned evaluation, doctoral research, debates with service providers and published work.

Findings: Analysis highlights multiple and potentially interacting aspects of lay health adviser roles that may influence their success, including: the characteristics of lay health advisers; characteristics of the target population; purpose or intent of the intervention; and how advice is given. A model is proposed from which to examine the contexts and mechanisms of lay health advisers that may impact on outcomes and subsequently applied to two examples of reported lay health adviser interventions.

Conclusions: The combinations of skills and characteristics of lay health advisers must be considered when planning which interventions might be appropriate when targeting specific needs or target populations. Focus only on the peer or lay distinction may overlook other potentially important skills and mechanisms of action integral to lay health adviser roles.

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