An evaluation of the health trainer service in Nottinghamshire County and Bassetlaw PCT

1. An evaluation of the health trainer service in Nottinghamshire County andBassetlaw PCT Jill Evans Centre for Health and Social Care Improvement

2. Health Trainer Project - Introduction • March 2010 – September 2010 • Final report submitted 17th Sep • Very successful project • £23k external funding • Multi-methodological approach

3. Project Aims • Scope the Health Trainer service in detail, focusing on: • Activities undertaken by Health Trainers • Locations in which the activities are taking place • The characteristics and qualifications of the Health Trainers • Compare and contrast the scope of the service across: • The component districts and sites within the Nottinghamshire County PCT region • Different service models • Full-time and bolt-on Health Trainers • Evaluate the impact the service has had on: • Health Trainers • Clients • Service providers and facilitators • Stakeholders

4. What is a health trainer? (NHS jobs website) • The exact role depends upon the needs of the community in which they work, but typically would involve encouraging people to: • stop smoking • participate in increased physical activity • eat more healthily • drink sensibly • practice safe sex • Most often achieved via signposting & PHPs

5. Methods • Health trainers • Semi structured interviews • Questionnaires • 8-week diaries • Clients • Participatory appraisal workshops • Semi structured interviews • Invitation to keep diary • DCRS audit • Wider workforce • Online questionnaire

6. Health Trainer questionnaire • 14 health trainers completed the questionnaire • Findings: • Healthy lifestyles considered important • Increases in skill development and career aspirations • Positive influence on own behaviour + friends/family • Adequate core training but too lengthy • Feeling of support by line manager but less so from other health trainers • Job description often inaccurate

7. Health Trainer questionnaire Suggestions and recommendations: • Increased support from senior management • Increased communication: • Within localities • Between localities • Between HTs and other health professionals • Increased direction through project management • Inclusion of mental health training • More knowledge of NHS services + contacts • Community engagement training • Equality + diversity training

8. Health Trainer interviews Three interviews conducted (1 F/T, 1 P/T, 1 B/O): • Findings: • Varied collection of activities undertaken • Client visits, PHPs and events most common • Most clients interested in healthy eating/ weight loss • Management structure varied considerably • “We felt like we were on our own quite a lot” • DCRS system perceived negatively at times • Active listening an important part of daily work • HTs appeared uncertain about the aims of the service • Generally positive personal impact of role

9. Health Trainer 8-week diary

10. Health Trainer 8-week diary

11. Health Trainer 8-week diary

12. Participatory appraisal workshops Chrice Matrix Forcefield analysis Diamond ranking

13. Participatory appraisal workshops • 8 attendees to one workshop – bit of a struggle! • Main findings: • Overall the service has been excellent • Health trainers themselves were praised • Enthusiasm is “contagious”; “nothing is too much trouble” • Feeling of being let down by cost increases and follow-on care • Frustrations with accessing the service • Some clients unaware of multiple access routes • Time/appointments taken seen as unnecessary • Feeling that GPs etc do not understand the service

14. Client interviews • 12 interviews conducted with service users: • Main findings: • Most prevalent health issues = obesity, alcohol + smoking • Service awareness through events, leaflets + WOM • Additional support often provided (emotional support, confidence building) • Excellent levels of communication from HTs • Significant improvements in clients’ health • Increased pro-activity in clients • Recommendation: increase advertising of the service

15. Stakeholder questionnaire • Online questionnaire sent to 53 stakeholders and members of the “wider workforce” • 46 responses = 87% • Based on perceptions from various POV • Findings: • Increased service uptake • Acknowledgement of HTs going ‘above and beyond’ • Value for money and justified costs • Service does not duplicate others • Recommendations: client engagement should be maximised and follow-up care increased

16. DCRS data audit • Data snapshot from 1st June ‘09 – 31st May ’10 • =977 clients • Typically recruited through promotional events and word of mouth (Nov ’09 = most new clients) • Diet + exercise most frequent priorities • 906 received initial assessments, 220 PHPs • PHPs lead to positive impacts: • Self-efficacy • General health • Wellbeing • Signposting mainly to community/voluntary groups • LARGE AMOUNT OF UNRECORDED DATA

17. Recommendations • Enhanced publicity • Meetings between districts • Action plans for: • Client follow-ups • Referral partners follow-ups to improve working relationships • Additional HTs to work alongside those currently working alone • Reduced length of core training and inclusion of mental health issues • Learning needs analysis at recruitment stage • Increased training in DCRS + regular booster courses

18. Thanks for listening Any questions?