Cardio-metabolic multi-morbidities screening in places of work and worship using trained lay community health advocates: A cross sectional study
Why the research is needed?
10% of the NHS budget (£10 billion pounds) is spent dealing with the management of diabetes and its resulting complications. There has been increased funding spent within the NHS for activities aimed at preventing the onset of T2DM by encouraging physical activity and a healthy balanced diet. Despite this extra investment some communities at high risk of developing long term health conditions, including those from particular do not access these programmes. Development of new approaches which engage high risk groups are needed to improve screening uptake to ensure those at greatest need are referred to programmes that empower them to reduce their risk of diabetes and cardiovascular disease.
What is already known about the subject?
We have carried out extensive feasibility work across the midlands, which shows the added benefit of screening for long-term conditions including diabetes and cardiovascular disease in community settings including faith centres. Existing work from the US shows that approaches, which engage the community in the delivery of screening and health promotion activities within community settings, are linked with better indicators of success. We have conducted extensive work with local faith communities and businesses which shows a need for this type of approach in order to deliver sustainability and effective use of existing assets (spaces and people).
Who we are working with?
We have links in Leicester with the local Interfaith Council, Faith Forum as well as national businesses with large offices in Leicester. We have recruited a local pharmacist with experience of providing community based diabetes screening who has agreed to help support delivery training and during the proposed screening events. The study has support from Novo-Nordisk, a large diabetes pharmaceutical manufacturer, and is part of their global Cities Changing Diabetes Programme. We are also working with the local Academic Health Sciences Network who have provided the testing equipment we will use to screen patients for atrial fibrillation (a common cause of stroke).
How are patients and the public involved?
Our approach will involve lay representation in the planning, delivery and management of the project:
Through Cities Changing Diabetes we have established networks with local employers and faith communicates. We have scheduled two sets of three focus groups for representatives from local faith communities in November-Jan 19-20 (faith and workplace focus groups will be held separately). These focus groups will be used to shape the delivery and content of the training for CHAs. Topic guides have been designed to focus discussion on the needs of these representatives, and requirements to allow them/others in similar positions to deliver the intervention in addition to logistical considerations for the training. The last of the three focus groups will involve pilot delivery and refinement of the training curriculum.
Our approach directly involves lay representatives from faith centres and workplaces delivering the screening intervention to members of their organisation.
We have an established working group of local faith leaders with whom we have met over the last 6 months and discussed research priorities and who have helped to shape the approach we have chosen for this study. We have identified a named stakeholder who is also chair of the local Interfaith Council. He will attend trial management group meetings where possible to advise at a strategic level. We have named representatives from national businesses who have agreed to attend selected trial management group meetings.
What we will do?
Our award winning Effective Diabetes Education Now (EDEN) team will deliver a training programme to 25 volunteers from local businesses and faith centres to equip them with an understanding of type 2 diabetes, including prevention strategies. We will provide these volunteers with resources to allow them to conduct screening for Type 2 diabetes in their local communities. These volunteers will then support us to deliver a programme of forty screening events in local faith centres and workplaces across Leicester where we will screen for cardiovascular multi-morbidity, defined as having more than one chronic condition (hypertension, obesity/overweight, T2DM, Atrial Fibrillation).
What the benefits will be?
We hope that by involving faith and business leaders, we will make more effective use of existing relationships to provide a screening programme that increases uptake and engagement at low cost. Measures of success will include uptake to screening.
When the findings will be available?
The project duration is 36 months and we anticipate publishing and disseminating findings in early 2023.
How we are planning for implementation?
We aim to engage with national faith networks and are already working with national business which will provide us with a possible route to wider scale/national implementation. As the national ARC lead for Health Inequalities and Ethnicity we will encourage involvement in the study from other successful ARCs across the UK. We will disseminate results and continue to work with global partners through Cities Changing Diabetes.
Kerry Hulley, Kerry.Hulley@uhl-tr.nhs.uk.