Shared learning database

Sheffield Cubed
Published date:
July 2013

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.

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 aim of the programme is twofold:
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.

Reasons for implementing your project

According to the 2008/9 Health Profile, 109, 431 people were resident in the most deprived Quintile of Neighbourhoods, out of a Sheffield population of 556, 853. Of this number, approximately 18,000 were on benefits, life expectancy and breastfeeding levels were lower and child obesity and smoking levels were higher.

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)

How did you implement the project

Delivery of the programme has been carried out by 22 community organisations who "host" an agreed number of Champions and support them to deliver activities. Sheffield Cubed manages the contract, and organises training and networking events. Activities have been flexible to meet local demand and the interests of the volunteer Champions, ranging from food growing and cooking sessions, to walks, cycling, and sports Health Champions have supported staff from host organisations to run social cafes, personal development courses, older people's day centres, sports sessions, health walks and many more activities. Others have supported Health Trainers to carry out health checks and run Children's Weight management programmes. In many incidences, individuals have benefited themselves from health interventions (e.g. a Diabetes awareness day) before going on to support the programme as a Health Champion in their own community, working with groups that would otherwise be very hard to reach because of language or cultural barriers.

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'.

Key findings

Initial objectives (with funding through the Altogether Big Lottery programme (2009-11), were to recruit, train and support 180 Community Health Champions, who would support 2700 people within Sheffield's least healthy communities to improve their health and wellbeing. In fact the figure was around 6,000, meaning that on average each Champion supports 30 people during their 100 hours' volunteering.

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

Sheffield Cubed has been able to performance manage the programme flexibly and effectively. Contracts have been allocated through a transparent tendering process involving partners. Health Champions have been reallocated between hosts to ensure output targets are met, and organisations that under-perform have dropped out of the programme (and in some cases returned to it later) following a process of discussion.

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 .

Contact details

Lisa Cox/ Bethan Lacey
Community Health Champions Project Worker
Sheffield Cubed

Is the example industry-sponsored in any way?