Feature

I heard it on the grapevine

Pauline Lanagan and Gordon Watson report on an innovative approach to spreading health information

Encouraging the involvement of local communities in the planning and delivery of services, whether in large statutory settings or small community projects, has real implications for organisations and the professionals who represent them. Giving up the power they usually have and responding to community voices involves taking risks and accepting that outcomes may be unpredictable.

But a pilot project set up in Chester-le-Street, North Durham demonstrated that local people can have real influence and control and that the outcomes can be extremely beneficial. The Community Health Volunteer Project was set up in September 1994 by North Durham health promotion directorate to explore the possibility of utilising informal community networks to pass on basic, up to date information on healthy living.

A community development approach was adopted: the work was to be done by people in their own communities and their knowledge and experience would be vital to the success of the project.

A variety of approaches were used to encourage the involvement of volunteers, especially in the area of Chester-le-Street with the highest deprivation indicators. The most successful of these was simple word-of-mouth through a local community worker, and the volunteers who became involved were already well informed and active in the community in some way.

Training included information on health topics which the volunteers felt were most relevant to their community. Basic communication skills were covered and time was made available for the volunteers to discuss the development of the project.

One volunteer, Audry Lines, had worked for five years as a volunteer for the British Epilepsy Association, but did not know what to expect when she volunteered for the project.

‘I really enjoyed it - the volunteers became good friends and we found that each one of us had something different to give,’ she said. ‘I was not aware of the resources available through the health promotion directorate and found those on exercise, healthy eating and stress very useful.’

Health promotion specialists soon found they had to respond to the challenges and concerns of the volunteers, who developed a real sense of ownership of the project. The volunteers gained in confidence and knowledge over nine weekly sessions and were well equipped to carry out their work in the community. They used monthly support sessions to gain more information and discuss any issues which arose.

Another volunteer, Kay Acton, had only a ‘passing interest in health’ before becoming a volunteer and found the experience rewarding. ‘I got a lot out of it and was able to pass on information about access to resources such as leaflets,’ she said.

She found people from the local community were comfortable asking volunteers for leaflets or information on a particular health topic. ‘People often saw the same leaflets in their doctor’s surgery but were too embarrassed to stand up and get them when other people were around,’ she added.

At the outset of the project it was planned that feedback would be sought from people who had received information from the volunteers. It became clear that this would be intrusive and might affect relationships between the volunteer and their family and friends. If the effectiveness were to be fully assessed some other kind of evaluation would be required.

Instead, the volunteers monitored their own work in the community over a period of six months. Their recordings and verbal feedback showed clearly that they were able to talk to people about the health topics on many occasions, giving basic information. They used health promotion resources and passed on information about accessing health professionals and the services of other organisations.

The volunteers were involved in organising a seminar presenting their work to health professionals, which was a challenging but empowering experience. The project has now taken on its own momentum, and volunteers want to be involved in more health promotion work. Several have participated in an appraisal in their area which may result in funding for community projects and other services. They are keen to share their experiences with other groups and to encourage new projects to be established.

The health promotion staff believe that the community development approach was instrumental in the success of the project but know that this is not an easy way to work. The difficulties arose were nearly always due to professionals unintentionally adopting a ‘top down’ approach to the process. For example, in designing a monitoring form for the volunteers to use, staff began planning it on their own. Difficulties soon arose about what was appropriate or possible but were resolved quickly and easily when discussed by the whole group.

The work of this project has demonstrated the possibility of using community networks and lay health workers to pass on healthy lifestyle information and also the value of a community development approach. The approach could be transferred to many other settings and other parts of the country, but making the most of community networks will depend on the priority given to this kind of work by health care policymakers.