A qualitative longitudinal approach to exploring service user experiences of lay-led heath improvement interventions

Abstract

Lay health advisors (LHAs) have been widely used to deliver primary care and health promotion programmes. Although there is some data to support their efficacy, reviews have consistently found insufficient evidence to assess which LHA strategies are likely to be most effective. Furthermore, there is a dearth of research exploring service user views and perceptions. This paper aims to contribute to evidence and theory in relation to lay-led models of working with health deprived communities. By adopting an interpretive, longitudinal approach informed by grounded theory, the intention was to provide insight into the users’ experiences and the mechanisms underlying the intervention outcomes. In-depth interviews with service users (n=26) were conducted at 0, 3, 6 and 12 months, and with LHAs and supervisors (n=18) at 0 and 12 months. The interviews were audio-recorded, transcribed verbatim and analysed using the constant comparative method. LHAs were found to employ a holistic, asset-based approach that takes into account the context of a person’s life and their access to resources for health. This builds upon the salutogenic theory of health, and is in direct contrast to the paternalistic, deficit model traditionally found in public health medicine. This research is one of few qualitative studies investigating the role of LHAs in the UK. Furthermore, the use of a longitudinal approach is innovative and likely to produce results that have high policy relevance. It represents an important application of a user-focused perspective affording new insights which may also be applied to other complex health interventions.