Employ health trainers

The government has ditched its fear-factor advertising in favour of a more personal approach to keeping people alive. Jo Stephenson reports

Although many people want to improve their health, they find it difficult to turn good intentions into sustained action. They find it hard working out the right changes and keeping motivated, and they want help and support in achieving their health goals.

People in deprived areas are most in need of this support. They are more likely to smoke and more likely to eat an unhealthy diet; they cannot afford private gym memberships and other support mechanisms to help them make positive changes. The Choosing Health white paper in January 2006 announced that anybody wanting help making healthier choices will be able to get help in the form of NHS health trainers.

Health trainers are being introduced through the Spearhead Group, following a successful Early Adopter phase embracing nearly half the NHS which ended in March 2006. An implementation team, comprising 16 partnerships, was key to the Early Adopter phase and are still working closely with Department of Health. In time they will also lead the NHS Life Check programme announced in the white paper.

NHS Life Checks are health checks targeted initially at three critical life stages: within the first year; between primary and secondary education; and at 50 years. These will be developed, piloted and evaluated in a group of spearhead PCTs during 2007.

People will be able to complete a simple paper-based or online assessment themselves, or complete it in conjunction with a health trainer or other professional. Based on the outcome of that assessment, people will be offered tailored advice, support and signposting to local services to reduce their current and long-term risk of ill health.

Health trainers will not be instructors, but offer practical support to help people make informed choices. They will give basic information, such as what constitutes a healthy diet and potential ways of losing weight, rather than advising what to do. Trainers will be drawn from local communities so that they understand the day-to-day concerns and experiences of the people they are supporting, and undergo appropriate training.

The core competences, drawn up by Skills for Health, representatives from the British Psychological Society and DoH, have been drafted on the basis that health trainers will initially work with adults, and specifically those not in contact with healthcare services. These will be reviewed, based on experience from the pilots.

In Bradford people are invited to enrol with the health trainer and say what changes they want to make, rather than pick from a menu of potential changes. Alyson McGregor, the health trainer project co-ordinator for Bradford PCT, says: 'We haven't trained health trainers to deal with specific topics; we have trained them to understand behaviour change. They should be able to deal with anything that comes through the door.'

Bradford has found the changes people want to make are the same as the targets the PCT has to address, such as mental health, obesity and healthy eating.

Losing weight was the most common goal for people in Bradford and often linked to lack of confidence and self-esteem, which the programme could help people tackle, Ms McGregor says. 'This programme is not just looking at people physically - and I think that is why some other initiatives have not worked.'

She gives an example of an isolated woman on antidepressants who wanted to stop them but could not stay off. 'She did not have any interests, nothing she was very good at, and low self-esteem. The health trainer said there must be something you are good at and she laughingly said the only thing she was good at was making a brew, so they started to talk about that. This lady ended up making teas on a voluntary basis at a tea dance on a Wednesday afternoon in the community where she lived.

'The health trainer went with her on the first couple of occasions. Now she is off the antidepressants, goes along alone, and knows what she is confident in doing - they love her there and she has made friends.

'We could not have prescribed for that. It is the tiniest of steps with the hugest of differences.'

Unfortunately the Bradford pilot has not been successful at reaching men. Most of the men involved were referred by their GP, and Ms McGregor believes this is because the health trainer method is not attractive to men. 'Sitting down and coming up with your own solutions does not appeal to men, but it does work for them - provided they do not realise that is happening.' She thinks something more concrete is needed to attract men and that the Life Check, which will be piloted in Bradford next year, may provide this.

'The Life Check enables us to give people something physical, because they do this online health assessment and they get a print off which tells them how they are doing,' she says. 'They go off and do some work and they can come back and get another printout and see they have made progress.'

Tameside & Glossop PCT has piloted an electronic health assessment (Connect 4 Life) that resembles the Life Check for mid-life and has been very successful in recruiting men. Forty-one per cent of the 172 people in the pilot were men.

The health trainers identified 50 to 65-year-olds with two or more cardiovascular risk factors (obesity, smoking, alcohol abuse, stress and sedentary lifestyles) from the lists of target general practices, and the GPs wrote to these patients inviting them to meet the health trainer. One in four accepted, and completed a computerised questionnaire developed by the PCT's private company partner Vielife. The questionnaire gives an overall health and well-being score of 100, which can be broken down into 14 specific areas.

Based on the results, the health trainer helped the client set goals and informed them of local health services available. Over the next six months health trainers provided regular phone support and clients were also sent monthly health packs tailored to their issues/risk factors. They were reassessed using the questionnaire after six months.

There was a 22.2 per cent improvement in the overall health and well-being score, and the most significant improvements were in nutritional balance (23.1 per cent), risk behaviour (22.5 per cent), sleep status (21.6 per cent) and regular physical activity (17.3 per cent). In addition 34 per cent of smokers quit, alcohol intake fell by 37.5 per cent and those reporting five or more health risk factors fell by 27 per cent.

Linda Dunn, senior health improvement manager at Tameside & Glossop, says: 'We feared the computer questionnaire might put people off, but it was really valuable because you got an awful lot of information out in a very short time. We are getting to the point of goal-setting in one meeting, whereas it is taking people in other PCTs three meetings to build up trust and get to the point where you set goals.'

The pilot will be rolled out to other areas of inequality in the PCT from January and two additional trainers are being recruited. The target age group is also being lowered to 40 years.