The issue
Cornwall faces considerable health inequalities, especially in deprived communities. Each household has a complex unique combination of personal strengths and unmet health and social needs – from vaccination and cancer screening to long term condition, frailty and mental health support. Traditional healthcare models often fail to reach people in these areas before crises arise.
What we are doing
Imported from Brazil to the UK, Community Health and Wellbeing Workers (CHWWs) are a way of engaging residents in deprived areas who are typically excluded from the health system. In a pilot programme ten CHWWs in Cornwall were trained and embedded within existing voluntary sector and primary care structures, undertaking proactive and preventative community outreach, often via door-knocking or local hubs.
A process evaluation of the pilot (led by PenARC) showed evidence of improved access to services and identified unmet needs in the population, especially related to mental health, debt, and loneliness, and influenced the scaling up across Cornwall, with 55 CHWWs now in post across 12 host organisations.
We are now evaluating the Cornwall CHWW service across these 12 host organisations. The overall aim of the study is to understand the value and impact of the Cornwall CHWW service on resident health and wellbeing and on the wider system. There are three main evaluation questions framing the study:
- What are the individual and contextual factors that influence implementation and delivery (service configuration and partnership arrangements across sites)?
- What are the infrastructural supports needed for successful CHWW implementation and delivery (finance, equipment, training, supervision, support, standard operation procedures, policy)?
- What is the value and impact of the CHWW service on residents, staff, communities and the wider system?
The evaluation is a mixed methods study using a researcher-in-residence model, whereby an ex-CHWW is now a member of the research team and is embedded in different CHWW teams to understand the variations in CHWW service configuration across the sites. Qualitative (interviews, focus groups, world café focus groups, case studies, semi-structured observations, and Ripple Effect Mapping) and quantitative (survey and analysis of a collaboratively constructed dataset) methods are being used as well as cost-offset analysis to examine the value and impact of the service.
The overall aim of the study is to understand the value and impact of the Cornwall CHWW service on resident health and wellbeing and on the wider system. We aim to produce an interim and final evaluation report as well as present findings in conferences, practitioner events and academic publications.