Summary of the impact

The `People in Public Health' (PIPH) study and related research on health trainers, health champions and volunteers has brought together evidence on rationales for lay engagement, effectiveness and models of support. Dissemination activities, supported by a Department of Health grant, have achieved reach into various policy arenas and national networks. At the same time there is evidence of research utilisation in public health practice. One of the impacts has been the establishment of `Active Citizens for Health', a national network of partner organisations to bring together evidence and learning that has been hosted by Leeds Metropolitan University.

Underpinning research

Since its inception, the Centre for Health Promotion Research (CHPR) has been a leading centre for the theory and practice of health promotion. A focused programme of research on community participation and lay health workers was developed within the CHPR, initially through the work of one member of staff (J. South). Early work involved evaluations of innovative public health programmes, which later led to further partnerships, new research grants and transfer of knowledge to practice. Examples included:

• Development and evaluation of Bradford health trainers, one of the first health trainer pilots in England (2005-7).
• Evaluation of a community health apprentices project in Bradford (2007)
• Evaluation of a social prescribing pilot (2005).

Publications resulting from this work explored various mechanisms to strengthen community-state relationships [1 & 2]. The strong links with practice and the growing base of community research led to the award of a NIHR SDO grant to examine lay roles in public health. The `People in Public Health' study (2007-9) made a major contribution to understandings of lay health worker roles and the support processes required to initiate and sustain health programmes involving the public. The systematic scoping review led to new categorisations of roles, including definitions of lay status [4]. Three national expert hearings were held in June 2008, giving the university a leading role in this field [3]. An accessible report was later produced to highlight key issues for policy and practice and this was disseminated throughout different practice networks. Overall results identified key factors for the development of lay health worker programmes and volunteering activity. Research findings have been published in international journals and presented at various national and international conferences [4-5]. In 2010, in recognition of the significance of the research, the Department of Health (DH) awarded a grant for the `Production and dissemination of accessible research-based information to support better engagement with citizens to co-produce better health and well-being outcomes'.

Lay engagement in public health and the wider issue of volunteering in health feature prominently in UK policy. J. South was commissioned in 2009-10 to undertake a series of evidence reviews and thematic evaluations on a new community health champion model and, in 2011, was awarded a NIHR HS &DR grant to undertake a systematic review of peer-based interventions in prison settings. Further research includes an evaluation of volunteer-led walking for health groups commissioned by Natural England (2011) and an evaluation of the Department of Health's new volunteering fund (2012-3). Staff at the CHPR (led by J.White) have made a major contribution to the development of a national evidence base for health trainers.

Over the past six years, public engagement activity has been strengthened as part of this research programme. Staff, (led by J.South), have pioneered new ways of public involvement, including use of deliberative methods, participatory workshops, and informal consultation methods [6]. The CHPR maintains strong links with local community organisations and in 2013 established a Community Campus Partnerships initiative to promote knowledge exchange between professionals, researchers and community members.

References to the research

Relevant grants awarded to J. South as Principal Investigator

1. A study of approaches to develop and support people in public health roles, 2007-9, National Institute of Health Research Service Delivery and Organisation programme, 08/1716/2006, £244,142.

2. Dissemination of research-based information to support better engagement with citizens, 2010-11. Department of Health, £23,520.

3. Commission for Review and Evaluation work to Support the Altogether Better Programme, 2009-2010. West Yorkshire Public Health Observatory, £52,892 [PI].

4. Health trainers — evaluation of health inequalities pilots, Yorkshire & Humber Region, 2010-11. NHS Wakefield, Teaching Public Health Network, £20,000

5. Sunderland Health Champions Evaluation. Sunderland teaching PCT, 2011-12, £44,471.

6. A systematic review of the effectiveness and cost-effectiveness of peer-based interventions to maintain and improve offender health in prison settings. NIHR Health Services and Delivery Research programme, 2012. [£179, 791]. Co-applicants: Academic Centre of Health Economics, University of Leeds; University of West of England: HMP Leeds; HMP Bristol; HMP Eastwood and Wakefield District Community Health Care Services.

7. A pilot study of the walking for wellness project and the befriender role,2010-11. Natural England, £5000.

8. Evaluation of the Department of Health's Health and Social Care Volunteering Fund. Ecorys & HSCV. 2012-13, £76,532.

Details of the impact

The NIHR `People in Public Health' study provided a foundation to develop understanding around lay health worker roles and related programme support. This was a high profile study that involved extensive public engagement and the production of outputs for practitioners and policy makers. In 2007, the PIPH website was launched. A register of interest has over 150 individuals who receive information about the study. In 2009, an online searchable database was created on the website with the results of 224 reviewed publications [1]. A research briefing for practice (2010) was published for commissioners, managers and practitioners. This carried endorsements from Local Government Improvement and Development (LGID), the Marmot Review team and from the Chair of Department of Health's 3rd Sector and Social Enterprise sounding board [2].

A summary of the PIPH study was reported by the NHS Confederation's Health Policy Digest reaching over 4,500 senior NHS managers [3]. Volunteering England highlighted the study in their January e-newsletter, reaching 1200 people and a feature article was published in their on-line newsletter in March 2011. The study findings also featured by LGID on their website and a news item appeared in their Healthy Communities bulletin in March 2011, reaching over 33,000 interested parties. The article `Harnessing people power' was the lead article on cover of Primary Health Care -the RCN community health nursing journal and the Editor wrote "it's time to take a look at what the government's talk of a Big Society means for primary care nursing and public health... this article could not have been more timely" [4].

The CHPR have submitted evidence on lay health workers and volunteering to various enquiries and consultations. For example, in 2010, J. South took part in the Natural England and Local Government Information Unit national inquiry on Walking for Health and findings from PIPH were given prominence in the subsequent report [5:19]. A number of written submissions based on the research findings were also made to parliamentary groups and policy consultations, e.g. All Party Parliamentary Group on Primary Care & Public Health inquiry into NHS White Paper [6]. Meetings have been held with the Third Sector Partnership Team in the DH Policy & Strategy Directorate and with the Head of Patient Voice and Information, NHS Commissioning Board.

Research on community health champions and health trainers has achieved good reach into public health practice. Evidence reviews and thematic evaluations on community champions have been disseminated nationally through the champion network. Some indication of the reach is that the Community Health Champion Evidence Review has been downloaded 3356 times from Yorkshire & Humber Health Intelligence [7]. The community health champions approach was highlighted as a case study in the White Paper ` Healthy lives, healthy People' where it was noted that there was `a sound practical evidence base for the approach' [p. 43]. J.White has led on the development of a national web resource for health trainers: `Health Trainers England' [8]. Oral evidence on health trainers was submitted to House of Lords Science and Technology Sub-Committee on behaviour change [9]. In October, 2011 J.White gave expert testimony to the NICE Programme Development Group on `Obesity: working with local communities'.

Sources to corroborate the impact

1. People in Public Health website and databases http://www.leedsmet.ac.uk/health/piph/
2. South, J., Branney, P., White, J., Gamsu, M. (2010) Engaging the public in delivering health improvement: Research Briefing. Centre for Health Promotion research, Leeds Metropolitan University. A copy can be found:
   http://www.leedsmet.ac.uk/health/piph/documents/PIPH%20Research%20Briefing.pdf/
3. Engaging the public in delivering health improvement. Health Policy Digest 54. NHS Confederation. Issue 54, 19th October 2010. Available at: http://www.nhsconfed.org/Key-Health-Issues/HPD-December2010/Pages/Research-Findings-summary2-191010.aspx
4. South, J., Sahota, P. (2010) Harnessing people power in health promotion. Primary Health Care, 20, 8, 16-21. Available at:
   http://rcnpublishing.com/doi/abs/10.7748/phc2010.10.20.8.16.c8036
5. Heron, C. and Bradshaw, G. (2010) Walk this way: recognising the value in active health prevention. Local Government Information Unit, Natural England (p.19) A copy can be found: http://www.leedsmet.ac.uk/health/piph/documents/Walk%20This%20Way.pdf
6. South, J and Woodward, J. (2010) A response to the inquiry: "The NHS White Paper & Public Engagement". From the People in Public Health research team, Centre for Health Promotion Research. Submission to All Party Parliamentary Group on Primary Care & Public Health inquiry into NHS White Paper. Available at http://www.nhsconfed.org/Key-Health-Issues/HPD-December2010/Pages/Research-Findings-summary2-191010.aspx
7. Community Health Champions — Evidence Review `Health Trainers England': Yorkshire and Humber Health Intelligence. Available at:
   http://www.yhpho.org.uk/resource/item.aspx?RID=87494
8. `Health Trainers England' Available at: http://www.healthtrainersengland.com/
9. White, J. (January 2011). Evidence by oral presentation to the House of Lords Science and Technology Sub-Committee on behaviour change, on the evidence base for health trainers. House of Lords Science London. Available at:
   http://www.publications.parliament.uk/pa/ld201012/ldselect/ldsctech/179/179.pdf
10. South, J., Kinsella, K., Giuntoli, G. McKenna, J., Long, J., Carless, D. (2011) Walking for Health: a qualitative study of the links between community engagement, social capital and health outcomes within volunteer-led health walks. Oral presentation at `Bridging the Gap between science and practice' 3rd conference and 7th annual meeting of HEPA Europe, 11-13 October 2011, Amsterdam. Available at: http://www.euro.who.int/en/health-topics/disease-prevention/physical-activity/activities/hepa-europe/hepa-europe-membership-and-meetings/meetings-of-hepa-europe/7th-annual-meeting-and-3rd-conference-of-hepa-europe