Health Trainers: Key Outcomes PLEASE NOTE THIS SECTION WAS WRITTEN IN 2011 SO ALTHOUGH THE GENERAL FINDINGS AND PRINCIPLES APPLY, THE DATA IS OUT OF DATE. GO TO THE SECTION ON MONITORING AND LOOK AT THE EVIDENCE BRIEFINGS FOR MORE UP TO DATE INFORMATION
At of 31st May 2011, 115 services were using the DCRS with data on 239,133 clients entered into the system. A significant year on year growth in client numbers continues. National Health Trainers DCRS Report – May 2011 – BPCSSA, summarises the key outcomes which Health Trainers are delivering against and provides links for more information.
Reaching the hard to reach
Health Trainers are a targeted service aimed at the most disadvantaged people. Latest figures show that 69% of clients are from the two most deprived quintiles of the population and that nearly 7% of clients reached by Health Trainers are not registered with a GP. For a broader view on how clients benefits from the support given by Health Trainers.pdf
Health Trainers work one to one with clients to support them to meet health goals which clients have set themselves. Clients can be referred or self-refer
Over the year 2010-2011 over 31,000 full Personal Health Plans were created. Of those 47% clients fully achieved their behaviour change goals and, a further 23% partly achieved them.
Supporting people to lose weight and have a healthier diet
55% of clients wanted to change their diet, usually in order to lose weight.
Some clients had their BMI measured and details of their diet recorded pre and post their health trainer sessions. These showed consistent improvement with BMI down by 3%, fruit and vegetable consumption up by 54% and the number of high fat snacks eaten down buy 58% on average.
Supporting people to become more physically active
23% of clients chose becoming more physically active as their primary goal.
Supporting people to stop smoking
If people contacting Health Trainer Services want to stop smoking they are usually signposted to the Stop Smoking Service. A full breakdown of which lifestyle risk management services clients have been referred to is not given in the latest DCRS report, but in the September 09 report 24% of onward referrals were to smoking cessation.
9.5% of clients nationally are supported by health trainers to stop smoking. In some districts health trainers are trained as stop smoking advisers and work closely with their Stop Smoking Service to provide an additional service e.g. visiting clients at home. In Barnsley, for example, the latest available figures indicate that 41% of health trainer clients are being supported to stop smoking.
Lifestyle changes have to be maintained to have any lasting benefit to health. Of those clients who achieved/part achieved their personal health plan and had a maintenance check carried out, 85% of checks reported change had been successfully maintained.
Client’s general health was improved by an average of 35% after seeing a health trainer. Their self-efficacy (feeling able to take more control of their lifestyle) was up by an average of nearly 10%. Those who were asked about their sense of well-being pre and post seeing a health trainer reported on average that their mental health and well-being had improved by 37%. These results show clear and consistent improvements in self-efficacy and even more so general health and WHO-5 year on year, which is a very positive result.
An evidence based approach to behaviour change
Health trainers use approaches to behaviour change which have been found to work and evidenced in other settings. These include motivational interviewing and setting goals and contracts and have been summarised for the Health Trainer Programme by the British Psychological Society. View: Improving Health: Changing Behaviour. NHS Health Trainer Competence Framework Handbook.
Health trainers working with GP practices
Health Trainers are based in GP surgeries in many parts of the Country. An evaluation of health trainers working in support of GPs in NE Lincolnshire found that they were liked and valued by health professionals and perceived as ‘adaptable, hands on and tenacious’. View the North East Lincolnshire evaluation.
In Bradford some health trainers are based in GP practices and use a social prescribing model to support clients with low level mental health problems or who are socially isolated to make and maintain changes in their lifestyle. This is proving very popular with clients and with GPs. View: An Evaluation of Social Prescribing Health Trainers in South and West Bradford.
Health trainers supporting clinical outcomes
In different parts of the Country health trainers are working as part of:
- Cardiovascular Disease (CVD) screening – providing lifestyle support to patients identified as ‘at risk’ e.g. Barnsley
- Pre-operative care – supporting patients to lose weight, reduce alcohol consumption or stop smoking before an operation e.g. North Lincolnshire
- Life Checks – to support clients who want to make a change to complete an online mid or teen Life Check. The tool enables clients to consider their health and wellbeing and plan changes based on a goal setting approach e.g. Wakefield
- Long term conditions – providing support to patients diagnosed with a long term condition, or recovering from a coronary episode, to make the necessary lifestyle changes to maintain their health. E.g. Kirklees
- Mental health care pathways – supporting patients with low level mental health problems who are isolated and often in poor physical health, to make changes to improve their mental health and well-being and to support their psycho social needs, effectively signposting people to other appropriate service provision in the voluntary and public sector e.g. Bradford
- Working in primary care setting to address obesity in families e.g. Calderdale
- Working with community health champions to identify and support people with diabetes e.g. Sheffield and Bradford.
A survey conducted by NHS Direct in three districts shows high levels of client with health trainer services; full report. Widely recognised evidence shows that people’s lifestyles (e.g. smoking, physical activity, diet, alcohol consumption) affect the prevalence of cancer, coronary heart disease, diabetes, and respiratory conditions as well as mortality rates amongst adults, hospital admissions and prescribing costs. Health trainers are supporting people to make behavioural changes which are making a difference to their lives and saving money now and will contribute to reducing morbidity, mortality and inequality in years to come.
Key National documents
For further information on the approach that Health Trainers take click on the links below:
NICE have acknowledged the role of health trainers in their guidance on Behaviour Change, Smoking, Cessation, CHD & BME communities. Health trainers are also included in the guidance for stop smoking services issued by NICE in collaboration with Communities and Local Government February 2008 and in the subsequent toolkit May 2008.
The Kings Fund acknowledge the role of health trainers in their report Behaviour Change with Low Income Groups.
The Chief Medical Officers May 2008 Brief to all doctors in the country carried an article entitled “Health Trainers tackle Health Inequalities” describing the role of Health Trainers at the earliest end of the patient pathway.
The Secretary of State’s June 2008 “Health Inequalities – Progress and Next Steps” sets out the plans for beyond 2010 and includes health trainers on pages 68 & 69.
The Marmot review includes a case study on health trainers.