Shared learning database

Humber NHS Foundation Trust
Published date:
July 2013

Health trainers work with disadvantaged communities with the aim of encouraging and supporting lifestyle behaviour change. We work with people on a 1-2-1 basis and sometimes in small groups to enable them to develop their own personal health action plan including goal setting, building self-esteem, providing motivation and connecting people to activities in their communities which will help them make and sustain the behaviour change goals they have set. In East Riding we work in a variety of innovative ways in order to reach isolated and marginalised groups. This includes using our Change4Life bus to visit the remote rural parts of the district and to workplaces and visiting mobile home parks on the east coast to make personal contact with residents and offer a service. We have just opened the health trainer one stop shop in Bridlington in order to make our service more accessible. We are town centre based and encourage individuals to walk in, collect information and access support.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

The Health Trainer Service works to support individuals who want to change their lifestyles using a behaviour change model. Our aim is to reach those in disadvantaged communities who are most at risk of poor health and who generally make less use of health improvement services. To do this we actively reach out to communities and encourage people to self refer as well as taking referrals from professionals. Ultimately we aim to reduce health inequalities.

The main reason that people self refer or are referred to the Health Trainer Service is obesity and weight management - 72% of all referrals are for weight loss and/or nutrition information. 63% of these are self referrals and the rest come from health and social care professionals locally.

The Heath Trainer service demonstrates how part of an obesity prevention and management strategy may be delivered and aligned with other disease ?specific prevention. This submission supports recommendation 4 which indicates that coordinators and community engagement workers should work together to develop and maintain a map of local people and assets. Recommendation 6 highlights that community engagement methods should be used and these are exactly what have been used to engage the community within this service.

The current service is mentioned in the East Riding of Yorkshire Health and wellbeing strategy for improved health 2013 - 2016.

Reasons for implementing your project

East Riding of Yorkshire is one of the largest unitary councils in the county covering 930 square miles of rurally, over half the population live in rurally isolated areas, many of which are small, scattered and geographically isolated. It has been identified that within the East Riding, comparing our bariatric results to that of national average we as an area had one of the highest rates of bariatric surgery in England between 1999 - 2010, this identified a need to implement and improve access to weight management services locally. The Health Trainer Service began following identification of a need to support disadvantaged communities experiencing high levels of obesity related conditions including Type 2 diabetes, heart disease and stroke. However the service is not just about weight management - we work with clients on lifestyle issues which they identify as a priority for them, such as smoking, alcohol intake, emotional wellbeing and levels of physical activity.

The East Riding of Yorkshire has high levels of deprivation and isolation as it has a large rural hinterland plus a number of small seaside resorts which are generally run down with a poor level of local amenities and services.

We have been working with the fishermen since July 2011, learning about their trade and supporting them where possible to take a lead in making the lifestyle changes they choose. We have had a total of 16 stone in weight loss amongst clients since we began the programme. This project has identified the benefits of working with a group of individuals who would not necessarily have done anything to improve their own health. We also have a programme designed to work with individuals who have a BMI of 45 > and who have co -morbidities that may eventually see them looking to have bariatric surgery. This programme sees all those referred by their GP. The programme is 18 weeks in length and provides education, support, knowledge and guidance on weight loss. All those that attend have to show that they have tried everything possible to commit to weight loss. If following the programme they have not lost weight then the decision falls back to the GP. However if they have shown no commitment then they will be re referred. Health Trainers offer emotional support, goal setting and barrier identification as well as motivation to ensure that those on the programme have all the help and support necessary to make the changes long term.

How did you implement the project

Given the nature of the area, we have worked to address obesity in a number of ways depending on the needs of the target group including: community workshops where people get information and support and reaching out to groups which can be marginalised such as the local fishermen. It was identified in 2009 that 57 out of 120 fishermen working in Bridlington had health problems which were mostly associated with poor diet and nutrition, weight gain and poor lifestyle generally. We see each client for up to three sessions following their initial referral and talk through goal setting, barriers to change and motivation throughout those initial sessions, getting the client ready to make life long changes. If we feel there are other barriers that require tackling then we will continue to see the client mainly for emotional support or we will signpost the client onto other local services that can help tackle these barriers.

If a client has the initial three one to one sessions with us and does not require other intervention we will encourage them to get involved in our group led sessions for a further five weeks where they start to support each other to maintain the changes they have made. Following the full eight sessions we will then sign them off but invite them to a weekly drop in session were they can get weighed and be motivated to keep going, ask questions and share experiences with others. The health trainers will over time ensure they slowly detach and that clients begin supporting themselves. We will then look to sign those who want to support and help others up as health champion buddies who can mentor new clients.

This model of working ensures that people get lots of support but in different forms - initially one to one then group - so that they get the individual attention they need to develop a personal action plan, and the support of others to make it happen. The weekly drop in means that they retain their link with the service and can seek support as and when they need it.

We comprehensively monitor the service and periodically commission evaluation of its different elements (in 2010 of work in outlying areas and in 2013 we will commission an evaluation of our Fishermen?s project).

Key findings

We collect demographic data on all clients, the area they live in and whether they are from a vulnerable group, and record what goals they set themselves and what they achieve in terms of behaviour change. Health trainers write up case stories of individual clients which capture the impact that they can have. Below, one health trainer describes what a 48 year old man living in a very deprived area achieved with her support:
'The client completely overhauled his diet; throwing away his deep-fat fryer, swapping to low sugar drinks, no longer snacking in the evenings and eating healthy soups and jacket potatoes for lunch. Whenever a goal was set, he stuck to it and within 4 sessions achieved the weight loss he wanted. I think he was encouraged by having someone to feedback to and praise him for his achievements. He rated the HT service a ?10? on every question on the evaluation form.'

Clients, like the one quoted above, report high satisfaction with the service and gains in confidence and self-esteem as well as making a variety of lifestyle changes.

In 2011/12 the service supported over 1432 individuals directly with weight management. 98% of clients had made positive behaviour changes after eight sessions and 76% of those had continued weight loss after 6 months. We saw a total of 16 Type 2 diabetics being taken off medication due to their lifestyle changes, made with the support of a health trainer. We have prevented 28 individuals being diagnosed with Type 2 diabetes by a change in lifestyle. We have seen 56 individuals achieve a reduction in cholesterol levels. 689 clients have gone from being sedentary to taking part in their daily recommended levels of activity and 376 clients keeping this up after 6 months follow up. 534 reported making long term changes to their overall diet and maintaining the change after 6 months. Data collected by the service on clients and their achievements has been used to calculate value for money, using a ready reckoner tool developed by Professor Graham Lister a health economist, for the Department of Health. According to this tool the East Riding Health Trainer Service saved the NHS a total of £657,370 in 2011 based on assumptions about how changes in lifestyle lead to reductions in disease and consequently to NHS expenditure.

Key learning points

Key points are to invest in initiatives that work with and for the local community. Don't wait for people to be diagnosed with a health condition or to present when they are already overweight, make sure there are resources available locally that the public can call upon to help them in their behaviour change at an early stage.

For further learning points, please see the supporting material.

Contact details

Natalie Belt
Health Trainer Service Manager
Humber NHS Foundation Trust

Primary care
Is the example industry-sponsored in any way?