About the Project
The COVID19 pandemic has highlighted health issues in areas of social deprivation, particularly for people aged over 70 years or with pre-existing health conditions. This group has an increased vulnerability to COVID19 and are also reliant on other citizens’ behaviours and public services’ responses to the pandemic for their ongoing health. A community’s health status is confounded by poor levels of health literacy, especially in areas of social deprivation. There is also the risk of mental health problems because of self-isolation and declining physical functioning because of reduced physical activity and reduced access to healthcare, whether that is through services contracting or through individuals deciding not to access services because of COVID-19 fears.
Community Health Worker schemes have been used successfully in countries such as Brazil, Pakistan and Ethiopia [1,2]. This might be a way of supporting vulnerable groups in this country, but we do not know how well it would work alongside existing healthcare and social care teams [3,4]. A Community Health Worker scheme is being planned in Halton and Warrington. Each of these health workers will have 275 households to look after and will visit each one every month. During each visit they will discuss the health needs of the household. They will provide health promotion and can direct people to other services, such as advice about breast feeding, immunisations and medication. Hopefully, they might reduce unnecessary visits to the emergency department but encourage timely referral for other services such as cancer care.
Aims and Objectives
The aims are to describe the implementation of the CHW scheme in Halton and Warrington.
The objectives are to:
• Review the literature about CHW schemes in the context of the UK NHS.
• Describe the recruitment of CHWs, reach of CHWs into allocated households, fidelity of intervention, ability to access households and contact time with households, implementation of CHW model, contextual factors acting as barriers and facilitators
• Compare outcomes between the area covered by the scheme and a control area without the scheme
• Compare outcomes between the area covered by the scheme and areas in London (Brent and Westminster) that are also exploring this CHW model to determine whether the barriers and challenges are similar in different contexts.
• Collect data from participants (patients and CHWs) about their experience of the scheme.
• Collect data about contextual factors and test the theory underlying the scheme.
Study design
i. Systematic review
ii. Mixed methods process evaluation of Community Health Worker scheme.
iii. Observational study comparing health outcomes with those in control areas.
Settings
Four Community Health Workers (CHW) in Halton and 4 CHWs in Warrington will cover approximately 275 households each.
Data collection
Mixed methods process evaluation including recruitment of CHWs, reach of CHWs into allocated households, fidelity of intervention, dose delivered to households, implementation of CHW model, contextual factors acting as barriers and facilitators.
Quantitative data will be collected from GP record databases and other routinely collected data sources such as immunisation records, cancer screening records, community health records, etc. Also from the records of household visits made by the CHWs. We will also explore the use of the Place-Based Longitudinal Data Resource (PLDR) to identify control sites in order to make comparisons with areas without the CHW scheme. We will also compare with outcomes collected in similar schemes in London.
Qualitative data will be collected from semi-structured interviews of household contacts, the CHWs, the volunteers, primary healthcare teams, community healthcare teams and social care teams.
Qualitative interview topic guides will include:
• Understanding of the latest advice regarding COVID-19
• Wellbeing of shielding patients
• Awareness of local resources and how to access them
Outcomes
Quantitative data will include:
• The extent and type of disease within the community caused by exposure to COVID-19
• Health and social care needs of the households
• COVID-19 testing and compliance with track and trace
• Identification of vulnerable households
• Detection of severe illness
• Referral to community, primary and secondary care services
• Rates of cancer screening and immunisation
• Social prescribing, contacts with local groups
• Ability to access households and contact time with households
Qualitative interview topic guides will include:
• Understanding of the latest advice regarding COVID-19
• Wellbeing of shielding patients
• Awareness of local resources and how to access them
It is expected the successful applicant(s) must commence on or before 1st February 2021.
For enquiries please contact Professor Williams on [Email Address Removed]
To apply, please send a covering letter, full CV together with names and contact details of two academic referees, stating the research proposal/s of interest to you and why you think you are suitable. Please send to Professor Williams on [Email Address Removed] and Dr C Giebel on [Email Address Removed]
Funding Notes
The studentships will be for 4 years full-time (subject to satisfactory progress) and will cover the cost of tuition fees at Home/EU rates. A stipend in line with the UK Research Council is payable at £15285 per annum, and an additional allowance of up to £1000 per year will be paid for approved research costs. Please note that funding is only available for the first 3 years but a 4th year is unfunded for writing up. Due to funding restrictions, the studentships are open to Home/EU applicants only.
References
1. Macinko J, Harris M. Brazil’s family health strategy: delivering community-based primary care in a universal system. N Engl J Med 2015; 372: 2177–81.
2. Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, Perry HB. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Human Resources for Health 2018; 16: 39.
3. Harris M, Haines A. The potential contribution of community health workers to improving health outcomes in UK primary care. J Roy Soc Med 2012; 105: 330–35.
Haines A, de Barros EF, Berlin A, Heymann DL, Harris MJ. National UK programme of community health workers for COVID-19 response. Lancet 2020; https://doi.org/10.1016/S0140-6736(20)30735-2.