Visram Shelina
Senior Lecturer,School of Medicine, Pharmacy and Health,Durham University,Queen's Campus,UK.
Prim Health Care Res Dev. 2017 Jul;18(4):333-343. doi: 10.1017/S146342361700010X. Epub 2017 Apr 10.
Aim To evaluate the impact and acceptability of offering one-to-one lifestyle interventions delivered by lay health trainers in the primary care setting.
Chronic conditions represent major causes of ill-health, avoidable disability, pain and anxiety, and tend to be more prevalent in less affluent groups. This is due, in part, to the link between unhealthy lifestyles and lower socio-economic status, although factors such as poverty, worklessness and social exclusion play a larger role. Lay health trainers were introduced in England with the aim of providing personalised lifestyle advice, support and access to services for people living in disadvantaged areas. There is a body of literature on the effectiveness of lay or community health workers in the management of chronic conditions. However, little is known about their potential to promote lifestyle changes in newly diagnosed patients. An innovative health trainer service was piloted in the primary care setting, to work with people diagnosed with a chronic condition or identified as potentially benefitting from one-to-one support.
A mixed method study design was utilised. Semi-structured interviews and focus groups were conducted with practice staff (n=11) and patients (n=15) from one primary care practice in North East England, United Kingdom. Discussions were audio-recorded and analysed using a thematic content approach. Routinely collected pre-/post-intervention data (n=246 patients at baseline; sample sizes varied at end line) were analysed and appropriate descriptive and summary statistics produced. Findings The discussions highlighted a high level of satisfaction with the health trainer model in terms of supporting positive lifestyle changes. Locating the intervention within the practice removed access barriers, particularly for those with long-term conditions. Anecdotal evidence of health improvement was supported by the quantitative analyses, which revealed statistically significant improvements in body mass index, blood pressure, dietary habits, exercise levels, alcohol intake, self-rated health and self-efficacy amongst those who completed the intervention.
目的是评估在初级保健环境中由非专业健康培训师提供一对一生活方式干预的影响和可接受性。
慢性病是健康不佳、可避免的残疾、疼痛和焦虑的主要原因，并且在较贫困群体中往往更为普遍。部分原因是不健康的生活方式与较低的社会经济地位之间的联系，尽管贫困、失业和社会排斥等因素起了更大的作用。英国引入了非专业健康培训师，旨在为生活在贫困地区的人们提供个性化的生活方式建议、支持和服务获取途径。有大量关于非专业或社区卫生工作者在慢性病管理中有效性的文献。然而，对于他们在促进新诊断患者生活方式改变方面的潜力知之甚少。在初级保健环境中试点了一项创新的健康培训师服务，与被诊断患有慢性病或被确定可能从一对一支持中受益的人合作。
采用混合方法研究设计。对来自英国英格兰东北部一个初级保健机构的执业人员（n = 11）和患者（n = 15）进行了半结构化访谈和焦点小组讨论。讨论进行了录音，并采用主题内容分析法进行分析。对常规收集的干预前/后数据（基线时n = 246名患者；终线时样本量有所不同）进行了分析，并得出了适当的描述性和汇总统计数据。结果讨论强调了对健康培训师模式在支持积极生活方式改变方面的高度满意度。将干预设置在机构内消除了获取障碍，特别是对于那些患有长期疾病的人。定量分析支持了健康改善的传闻证据，该分析显示，完成干预的人群在体重指数、血压、饮食习惯、运动水平、酒精摄入量、自我评估健康和自我效能方面有统计学上的显著改善。
