Health behaviour change among users of NHS Health Trainer Services

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Health behaviour change among users of NHS Health
Trainer Services

• Benjamin Gardner1,
• James Cane1, Nichola Rumsey2 Susan Michie1
• 1 University College London 2 University of
  the West of England
• 3rd July 2012

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This work was undertaken as part of a BPS DHP
consultancy to the Department of
Health(2003-2010)
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Evaluations of the NHS Health Trainer Service

• 2007-09 data from hub leads (hub reports)
• Yearly audits of workforce and clients
• Who are the HTs?
• Is the workforce growing?
• Who is using the HT service? (Wilkinson et al,
  2007 D Smith et al, 2008)
• 2009 DCRS data
• Evaluation of service effectiveness
• Does behaviour change among users of the HT
  service?

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Questions

• Who uses the HT service?
• - Are we reaching hard to reach clients?
• Does (diet and activity) behaviour change
  following use of HT service?
• Do all clients benefit equally?

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Data

• Drawn from DCRS
• Period 1st April 2008 31st March 2009
• Data extracted from DCRS v2.4 by BPCSSA
• Final extraction for DCRS report December 2009
• Final extraction for paper mid-2010
• Data recording on DCRS then non-compulsory
• At start of time period, estimated from hub
  report that 62 of HTSs entered data into DCRS
• Paper accepted for publication in Dec 2011

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Data availability
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Drop-out bias?

• Setting PHPs
• White clients (35) and Asian clients (30) more
  likely to set PHPs than Black clients (25)
• More PHPs set in least deprived quintile (42)
  than others (36)
• Pre-post HTS data availability
• White clients (35) more likely to have pre-post
  than Asian (30) or Black clients (27)
• More data available in least deprived quintile
  (45) than others (29)

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MeasuresPre- and post-HTS

• - Baseline demographics
• - Pre- and post-HTS
• Behaviour measures
• BMI (height, weight)
• Self-reported behaviour (diet snacks, fruit
  veg, activity moderate/intensive sessions)

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Results1) Who uses the HTS?

• 3503 female (79) (UK population, 2001 51
  female)
• Typical age 36-45 years (22.4) (UK 2001 19)
• Deprivation
• Q1 (most deprived) 1836 (43.2)
• Q2 1093 (25.7)
• Q3 688 (16.2)
• Q4 405 (9.5)
• Q5 (least deprived) 230 (5.4)

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Results1) Who uses the HTS?

• Ethnicity (UK 2001 93 White)
• White 3647 (83.2)
• Asian 485 (11.1)
• Black 175 (4.0)
• Mixed or other 79 (1.8)

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Results1) Who uses the HTS and for what
purpose?

• Weight status
• Obese 2717 (72.3)
• Overweight 824 (22.4)
• Normal weight 218 (5.8)
• PHP focus
• Diet 3346 (75.7)
• Physical activity 1072 (24.3)

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Results2) Diet change following diet PHP
achievement
Outcome Number of clients Pre-HTS mean Post-HTS mean change
Daily fruit veg (portions) 2376 3.08 5.23 70 increase
No. of daily fried snacks 1869 1.99 0.79 60 decrease
BMI 3164 34.33 32.45 6 decrease
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Results2) Activity change following activity
PHP achievement
Outcome N Pre-HTS mean Post-HTS mean change
Weekly moderate sessions 921 3.06 4.77 56 increase
Weekly intensive sessions 637 0.63 1.71 171 increase
BMI 595 32.46 31.24 4 decrease
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3) Do all clients benefit equally?

• Ethnicity or deprivation differences?
• All clients
• Deprivation BMI
• Less BMI reduction in most deprived quintile vs
  all others (0.28 BMI points)
• Diet
• Deprivation BMI
• Less BMI reduction in most deprived quintile vs
  all others (0.24 BMI points)
• Ethnicity BMI
• Less BMI reduction in Asian versus White clients
  (0.55 BMI points)

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Conclusions

• HTS is reaching disadvantaged clients and
  changing behaviour
• Effects similar across demographic groups
• But more PHPs set and more data recorded in less
  deprived groups

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Challenges and recommendations

• Missing data problematic
• Pre- and post-HTS behaviour data essential
• Reliance on self-report
• May overestimate behaviour change
• Ideally need objective measures, e.g. biochemical
  verification, objectively measured weight
• Whether data self-report or objective should be
  recorded

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Challenges and recommendations

• Need to ensure continued fidelity to HTS as
  originally devised
• Qualitative data needed
• Quantitative data allows for birds eye view
  group-level analyses
• Qualitative data engages with contextualised
  individual experiences
• Would reveal real-life benefits of HTS

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Challenges and recommendations

• Qualitative data needed
• Brief interviews with clients/feedback from
  clients?
• How do clients feel they have benefitted?
• Written case studies?
• Description of individual clients journey
• Need a DCRS repository for qualitative evidence
  storage

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Thank you

• Acknowledgements
• Janet Andelin and Rachel Carse, Dept of Health
• Jan Smith, CORE, UCL
• Ertan Fidan David Hopkinson, Birmingham Primary
  Care Shared Services Agency
• For a copy of the published paper, contact me at
• b.gardner_at_ucl.ac.uk