Skip to main content Accessibility help

Impact and acceptability of lay health trainer-led lifestyle interventions delivered in primary care: a mixed method study

  • Shelina Visram (a1)



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.


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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Impact and acceptability of lay health trainer-led lifestyle interventions delivered in primary care: a mixed method study
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Impact and acceptability of lay health trainer-led lifestyle interventions delivered in primary care: a mixed method study
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Impact and acceptability of lay health trainer-led lifestyle interventions delivered in primary care: a mixed method study
      Available formats


Corresponding author

Correspondence to: Dr Shelina Visram, Wolfson Building, School of Medicine, Pharmacy and Health, Durham University, Queen’s Campus, Thornaby, Stockton-on-Tees, TS17 6BH, UK. Email:


Hide All
Andrews, J., Felton, G., Wewers, M. and Heath, J. 2004: Use of community workers in research with ethnic minority women. Journal of Nursing Scholarship 36, 358365.
Attree, P., Clayton, S., Karunanithi, S., Nayak, S., Popay, J. and Read, D. 2011: NHS health trainers: a review of emerging evaluation evidence. Critical Public Health 22, 2538.
Bagnall, A., Trigwell, J. and White, J. 2014: Health trainers end of year review 1st April 2013 – 31st March 2014. Leeds: Leeds Metropolitan University.
Ball, L. and Nasr, N. 2011: A qualitative exploration of a health trainer programme in two UK primary care trusts. Perspectives in Public Health 131, 2431.
Barlow, J., Turner, A. and Wright, C. 2000: A randomized controlled study of the arthritis management programme in the UK. Health Education Research 15, 6656810.
Barton, G., Goodall, M., Bower, P., Woolf, S., Capewell, S. and Gabbay, M. 2012: Increasing heart-health lifestyles in deprived communities: economic evaluation of lay health trainers. Journal of Evaluation in Clinical Practice 18, 835840.
Bertakis, K., Azari, R., Helms, J., Callahan, E. and Robbins, J. 2000: Gender differences in the utilization of health care services. Journal of Family Practice 49, 147152.
Betzlbacher, A., Grady, K., Savas, L., Cotterill, S., Boaden, R., Summers, L. and Gibson, M. 2013: Behaviour change among people with impaired glucose tolerance: comparison of telephone-based and face-to-face advice. Journal of Health Service Research and Policy 18, 26.
Borghi, J., Thapa, B., Osrin, D., Jan, S., Morrison, J., Tamang, S., Shrestha, B.P., Wade, A., Manandhar, D.S. and de L Costello, A.M. 2005: Economic evaluation of a women’s group intervention to improve birth outcomes in rural Nepal. The Lancet 366, 18821884.
Boyatzis, R. 1998. Transforming qualitative information: thematic analysis and code development. London: Sage.
Buck, D. and Frosini, F. 2012: Clustering of unhealthy behaviours over time. Implications for policy and practice. London: The King’s Fund.
Carr, S., Lhussier, M., Forster, N., Geddes, L., Deane, K., Pennington, M., Visram, S., White, M., Michie, S., Donaldson, C. and Hildreth, A. 2001: An evidence synthesis of qualitative and quantitative research on component intervention techniques, effectiveness, cost-effectiveness, equity and acceptability of different versions of health-related lifestyle advisor role in improving health. Health Technology Assessment 15, 1300.
Chen, G., Gully, S. and Eden, D. 2001: Validation of a new general self-efficacy scale. Organizational Research Methods 4, 6283.
Denzin, N.K. 1978. The Research Act: a theoretical introduction to sociological methods. New York: McGraw-Hill.
Department of Health 2004. Choosing health: making healthy choices easier. London: The Stationery Office.
Dugdill, L., Coffey, M., Coufopoulos, A., Byrne, K. and Porcellato, L. 2009: Developing new community health roles: can reflective learning drive professional practice? Reflective Practice 10, 121130.
Gary, T., Bone, L., Hill, M., Levine, D., Mcguire, M., Saudek, C. and Brancati, F. 2003: Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes-related complications in urban African Americans. Preventive Medicine 37, 2332.
Goodall, M., Barton, G.R., Bower, P., Byrne, P., Cade, J.E., Capewell, S., Cleghorn, C. L., Kennedy, L.A., Martindale, A.M., Roberts, C., Woolf, S. and Gabbay, M.B. 2014: Food for thought: pilot randomized controlled trial of lay health trainers supporting dietary change to reduce cardiovascular disease in deprived communities. Journal of Public Health 36, 635643.
Griffiths, C., Motlib, J., Azad, A., Ramsay, J., Eldridge, S., Feder, G. and Al, E. 2005: Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease. British Journal of General Practice 55, 831837.
Islam, M., Wakai, S., Ishikawa, N., Chowdhury, A. and Vaughan, J. 2002: Cost-effectiveness of community health workers in tuberculosis control in Bangladesh. Bulletin of the World Health Organisation 80, 445450.
Johnson, R. 1997: Examining the validity structure of qualitative research. Education 118, 282292.
Kaczorowski, J., Chambers, L., Dolovich, L., Paterson, J., Karwalajtys, T., Gierman, T., Farrell, B., Mcdonough, B., Thabane, L., Tu, K., Zagorski, B., Goeree, R., Levitt, C., Hogg, W., Laryea, S., Carter, M., Crosee, D. and Sebalt, R. 2011: Improving cardiovascular health at population level: 39 community cluster randomised trial of Cardiovascular Health Awareness Program (CHAP). British Medical Journal 342, d442.
Kennedy, A. 2007: The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. Journal of Epidemiology and Community Health 61, 254261.
Lawlor, D., Frankel, S., Shaw, M., Ebrahim, S. and Davey-Smith, G. 2003: Smoking and ill-health: does lay epidemiology explain the failure of smoking cessation programs among deprived populations? American Journal of Public Health 93, 266270.
Lorig, K., Sobel, D., Stewart, A., Brown, B., Bandura, A., Ritter, P., Gonzalez, V.M., Laurent, D.D. and Holman, H.R. 1999: Evidence suggesting that a chronic disease self-management programe can improve health status while reducing hospitalization: a randomized trial. Medical Care 1, 514.
Lorig, K.R., Mazonson, P.D. and Holman, H.R. 1993: Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis and Rheumatism 36, 439446.
Lujan, J., Ostwald, S. and Ortiz, M. 2007: Promotora diabetes intervention for Mexican Americans. Diabetes Education 33, 660670.
Manandhar, D., Osrin, D., Shrestha, B.P., Mesko, N., Morrison, J., Tumbahangphe, K.M., Tamang, S., Shrestha, D., Thapa, B., Shrestha, J.R., Wade, A., Borghi, J., Standing, H., Manandhar, M. and Costello, A. 2004: Effect of a participatory intervention with women’s groups on birth outcomes in Nepal: cluster-randomized controlled trial. The Lancet 364, 970979.
Mathers, J., Taylor, R. and Parry, J. 2017: Measuring the impact of Health Trainers Services on health and health inequalities: does the service’s data collection and reporting system provide reliable information? Journal of Public Health 39, 139144.
Michie, S., Jochelson, K., Markham, W. and Bridle, C. 2009: Low-income groups and behaviour change interventions: a review of intervention content, effectiveness and theoretical frameworks. Journal of Epidemiology and Community Health 63, 610622.
Murphy, B. 2007: Medical role substitutions and delegations – overcoming the fear. Australian Health Review 31, S20S24.
Naylor, C., Parsonage, M., Mcdaid, D., Knapp, M., Fossey, M. and Galea, A. 2012. Long-term conditions and mental health. The cost of co-morbidities. London: The King’s Fund.
Pennington, M., Visram, S., Donaldson, C., White, M., Lhussier, M., Deane, K., Forster, N. and Carr, S. 2013: Cost-effectiveness of health-related lifestyle advice delivered by peer or lay advisors: synthesis of evidence from a systematic review. Cost Effectivness and Resource Allocation 11, 30.
Reinschmidt, K., Hunter, J., Fernandez, M., Lacy-Martinez, C., Dezapien, J. and Meister, J. 2006: Understanding the success of promotoras in increasing chronic disease screening. Journal of Health Care for the Poor and Underserved 17, 256264.
Richardson, G., Kennedy, A., Reeves, D., Bower, P., Lee, V., Middleton, E. and AL, E. 2002: Cost effectiveness of the Expert Patients Programme (EPP) for patients with chronic conditions. Journal of Epidemiology and Community Health 62, 361367.
Robson, C. 2011. Real World Research: a resource for users of social research methods in applied settings. Oxford: Blackwell.
Sinanovic, E., Floyd, K., Dudley, L., Azevedo, V., Grant, R. and Maher, D. 2003: Cost and cost-effectiveness of community-based care for tuberculosis in Cape Town, South Africa. International Journal of Tuberculosis and Lung Disease 7, S56S62.
Smith, J., Braunack-Mayer, A. and Wittert, G. 2006: What do we know about men’s help-seeking and health service use? Medical Journal of Australia 184, 8183.
South, J., Woodward, J. and Lowcock, D. 2007: New beginnings: stakeholder perspectives on the role of health trainers. Journal of the Royal Society for the Promotion of Health 127, 224230.
Swider, S. 2002: Outcome effectiveness of community health workers: an integrative literature review. Public Health Nursing 19, 1120.
Tock, L. 2001: Participatory appraisal: a brief introduction [Online]. London: shortwork. Retrieved 23 November 2016 from
Visram, S., Clarke, C. and White, M. 2014: Making and maintaining lifestyle changes with the support of a lay health advisor: longitudinal qualitative study of health trainer services in northern England. PLoS One 9, e94749.
Visram, S. and South, J. 2013: Guest editorial: building an evidence base for health trainers. Perspectives in Public Health 133, 193194.
Viswanathan, M., Kraschnewski, J., Nishikawa, B., Morgan, L., Thieda, P., Honeycutt, A., Lohr, K. and Jonas, D. 2009: Outcomes of community health worker interventions. Evidence Report/Technology Assessment No. 181. Rockville, MD: Agency for Healthcare Research and Quality.
Ward, L. and Banks, L. 2009. Evaluation of health trainers in West Sussex. Brighton: Social Science Policy and Research Centre, University of Brighton.
White, J., Bagnall, A.-M. and Trigwell, J. 2015: Health trainers making a difference to mental health and wellbeing. Perspectives in Public Health 135, 130132.
White, J., Woodward, J. and South, J. 2013: Addressing inequalities in health – what is the contribution of health trainers? Perspectives in Public Health 133, 213220.
Wilkinson, D., Sniehotta, F. and Michie, S. 2011: Targeting those in need: baseline data from the first English National Health Service (NHS) Health Trainer Service. Psychology, Health & Medicine 16, 3648.
Young, R., Taylor, J., Friede, T., Hollis, S., Mason, J., Lee, P., Burns, E., Long, A., Gambling, T., New, J. and Gibson, J. 2005: Proactive call centre treatment support (PACCTS) to improve glucose control in type 2 diabetes. Diabetes Care 28, 278282.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed