Building an evidence base for health trainers

Abstract

Programmes involving some form of lay or community health worker role have been widely used to provide basic healthcare and health promotion activities to so-called ‘hard to reach’ populations. Rather than making themselves hard to reach, these populations might be better described as underserved by mainstream services that are either inaccessible or inappropriate in terms of meeting their needs. This sense of being excluded from health services, along with a widening of the inequalities gap, provides the rationale for the implementation of a lay workforce which acts as a bridge into local communities. In England, health trainers were introduced in 2004 as part of a shift in public health approaches from “advice on high to support from next door”.1 From twelve early adopter sites that pioneered the development of the role, health trainer services have grown to become a significant part of the public health workforce, with an estimated 2,790 individuals in training or employment.2 Training packages have been developed to meet standardised competencies, a handbook based on behaviour change models has been developed, a national dataset has been established and numerous local evaluations have been undertaken. In addition, some health trainer services have been adapted to provide specialised support to specific communities of interest; …