Health Champions are volunteers based in trusted local community organisations and trained to support healthy eating, physical activity and mental wellbeing in communities with worse than average health outcomes. Champions provide appropriate peer support, helping build confidence and self-esteem and offering free activities people can join in their community. Without this support, many disadvantaged clients are unlikely to act on their own to make sustainable changes based solely on health information.
This submission reflects recommendation 3 of PH42 in that Community Health Champions should be identified and contribute to preventing obesity. It also supports recommendation 6 which is about involving the community.
Aims & Objectives
1. To empower volunteers in local communities to support lifestyle change;
2. To support Champions to access employment.
The programme does not aim specifically to tackle obesity, but to support people to make the changes that matter to them, using an asset (rather than deficit) model of community development. However, the programme does address and prevent obesity as many people do choose to get more active, eat better and lose weight.
With this awareness of health inequalities by neighbourhood and the success over time of Sheffield's Introduction to Community Development and Health (ICDH) training programme in training over 1000 people from disadvantaged communities, the Community Health Champions project was set up by the Sheffield Wellbeing Consortium (now Sheffield Cubed) in partnership with Sheffield City Council and NHS Sheffield. The aim of the programme was to establish, maintain and support a participant led network that empowers Community Health Champions to recruit from Sheffield's most deprived neighbourhoods, to improve the health and wellbeing of their communities.
Some ICDH "graduates" have become Champions: some Champions sign up for ICDH. Most of Sheffield?s Health Trainers began as volunteer Champions and there is synergy between the two programmes, both based in community organisations.
We have carried out a Social Return on Investment assessment which indicates savings of £2.07 for every £1 spent on the programme without measuring the impact on the clients that the Champions support (because we don't have robust evidence of this yet - though now working on this.) Some Champions have specialised in supporting clients with Type 2 Diabetes, where the likely savings are significantly higher (£8.22 for every £1 invested according to a report by the Yorkshire Health Economics Consortium)
Costs per Champion average out at £2,700 and on average each has contact with 30 "clients", either as individual buddies or through groups. NHS Sheffield and Sheffield City Council have been enthusiastic partners, which has helped a great deal. Even so, resources have often felt tight - not least, in limiting the collection of evidence of impact on Champions' "clients" - and a lack of long-term funding has in some cases limited what can be achieved.
Having Community Health Champions who have gone through similar life experiences to the beneficiaries they are supporting, has been hugely significant for building positive and workable relationships with individuals and within communities. Similarly, supporting people from 'hard to reach' groups to become Community Health Champions has opened doors into communities that otherwise would remain closed. A further essential aspect of the project from the outset has been to involve the Community Health Champions at every stage, as they are the ones who have the knowledge and skills to identify what will work and what won't within their communities. Finally we have found that it is more effective to work with disadvantaged communities on the issues that matter to them, rather than to go in with a programme labelled 'obesity prevention'.
Results and evaluation
The programme has since been extended to March 2013, has supported around 400 active Champions who have been in contact with over 10,000 people. Over 70 Champions have gained employment since the programme began.
Champions complete Baseline and Exit questionnaires which are tracked to evidence distance travelled, and over 40 Case Stories of Champions have been collected. Feedback from Champions and from clients consistently demonstrates that people are making and sustaining lifestyle changes, Although the programme does not aim specifically to tackle obesity, many people are eating better, losing weight and becoming more active. In a 2011 evaluation, 81% of the 62 Health Champions asked said that they had made changes to their diet as a result of their involvement with the programme, including eating more fruit and salad, paying attention to portion size and reducing their intake of fatty foods. 89% also said that their knowledge around healthy eating had improved as a result of being involved in the programme. A Health Champion from Autism Plus reported: "I eat healthier and I eat more fruit and veg. I have tried new recipes from doing cook and eat sessions and now really enjoy cooking and often try my own recipes"
Sheffield University and Sheffield Hallam University have both contributed to the evaluation of the work in Sheffield, while regional evaluation has been carried out by Leeds Metropolitan University. Please see attached evaluation in 'supporting material' below for more information.
Key learning points
A great strength of the programme is in the accessibility and community "reach" of the host organisations. They can welcome and support volunteers who do not come from a health background but whose enthusiasm makes them excellent role models. Providing good-quality training is another key element in the success of the programme. This obviously has costs, but it gives confidence to the Champions and reassurance to health professionals. Volunteers can greatly increase the capacity of voluntary organisations to deliver health outcomes (and, for example, reach into marginalised BME communities) but they do not replace paid staff and we need to be realistic in what we ask of them. Many aspects of the programme have taken longer to get started than was expected. A key challenge has been to gain the trust of professional bodies that have, in some cases, been hesitant to allow Community Health Champions in to their organisations. Excellent communication has been paramount to overcoming this barrier, including sharing examples of best practice and individual case studies. In turn this has led to lasting working partnerships being built. Once established, however, these projects are proving relatively easy to maintain given adequate resources. Maintaining a core programme has enabled specific pieces of work (eg on Diabetes) to be added on at limited cost and with quick results .