Community-Based Participatory Research to adapt and evaluate a Community Health and Wellbeing Worker intervention to reduce health inequalities within the most deprived neighbourhoods in Bristol

Funding

NHS Bristol, North Somerset and South Gloucestershire ICB Research Capability Funding­­.

What is the problem?

NHS primary care struggles to alleviate health inequalities (systematic, unfair health outcomes across population groups) [1]. Areas of high deprivation often have fewer GPs, while residents face multiple barriers to accessing care. Social and economic factors such as ethnicity, poverty, homelessness, and disability are strongly linked with higher rates of common and serious health conditions, including diabetes, heart disease, chronic lung disease, and cancer, as well as harmful lifestyle factors such as smoking and obesity. People experiencing multiple long-term conditions are disproportionately concentrated in these same communities, where life expectancy remains significantly lower than the national average.

New community-centred models of delivery are urgently needed to address these problems [3] all identified as priorities for the ICB. An example is the Community Health and Wellbeing Worker (CHWW) model [4], mentioned in the NHS 10-year plan.  CHWWs work in the 20% most deprived areas building trusted, long-term relationships with residents, focusing on the issues that matter most to them- often housing, finances and mental health. Illness is prevented, and often vulnerable people are supported to access services and community assets. A pilot in Westminster, in 1 year, has shown significant improvements in NHS health check uptake, cancer screening uptake, and unscheduled GP visits [5].

BrisDoc has secured long-term (15 years) funding for CHWWs in Bristol’s most deprived wards (BS5), where communities face multiple health inequalities, low trust in statutory services, and barriers such as poverty, migration, and digital exclusion. CHWWs will be supported and integrated into the Brisdoc Charlotte Keel Medical Practice.

This project embeds a community-based participatory research [6] model to improve representation, strengthen and inform implementation locally and provide scalable evidence nationally. It also aligns with DHSC, Core20PLUS5 and ICB priorities to reduce health inequalities as well as the NHS 10 Year Plan to shift from hospital to community and treatment to prevention.

What is the aim of the research?

This RCF project will establish a participatory Community Advisory Board (CAB) to co-design and oversee the evaluation of the Community Health and Wellbeing Worker (CHWW) model in Bristol [6]. The CAB will include local residents, CHWWs, health and social care providers and practitioners, commissioners, community organisations and healthcare researchers, ensuring diverse representation across age, gender and ethnicity and inclusive of systematically disadvantaged populations. Members will develop the CAB’s structure and processes, testing facilitation, decision-making and engagement methods that prioritise equality, inclusion, power-sharing and trust.

The CAB will act as both mentor and bridge to the residents and stakeholders. Community members will guide researchers in local culture, priorities and lived experience. Researchers will provide training in evaluation and analysis, while health service providers and practitioners bring experience in NHS systems and delivery. This reciprocal model strengthens equitable relationships and builds skills for community-led research.

Through a series of workshops, the CAB will develop a shared understanding of Community-Based Participatory Research (CBPR), examine the CHWW intervention in detail, and agree on fair structures for effective collaboration, communication, and benefit sharing. The group will co-create evaluation objectives and outputs that aim to serve communities, clinicians, commissioners and researchers. Alongside this, we will review UK and international CHWW evaluations to inform BrisDoc’s implementation plan and identify collaboration opportunities nationally. Findings will directly shape an NIHR funding application to support a rigorous, large scale, multi-site, national programme of CHWW implementation, development and evaluation, incorporating a richly participatory model of service development.

How will this be achieved?

The intended NIHR project will deliver a major participatory evaluation of the Community Health and Wellbeing Worker (CHWW) model in multiple sites across the UK, including Bristol. The project will investigate the role of CHWWs and how to maximise their impact on health inequalities, system pressures, and community trust, and the use of participatory approaches to improve evaluation quality and relevance.

The evaluation will be co-designed with the Community Advisory Board (CAB) to ensure that methods, outputs and focus areas are relevant to local communities, clinicians, commissioners and researchers. Potential evaluation elements include:

  • Health and community outcomes – e.g. vaccination rates, cancer screening rates, diabetes and cardiovascular care and outcomes, smoking rates, mental wellbeing, case studies of appropriate referrals and improved support.
  • System outcomes – changes in primary care use, emergency service use, economic impacts, influence on development of the neighbourhood health model
  • Trust and relational care – how CHWWs build and sustain trust, responsibilities that underpin trust, and implications for primary care services.
  • Skills and support – attributes required for effective CHWWs work, recruitment, training, supervision, and safeguarding CHWWs wellbeing.
  • Participatory evaluation process – reflections on equity, inclusivity, contributions, and benefits, with comparison to other UK and global CHWWs programmes.

This work will generate robust, multi-dimensional evidence to inform the scale-up of CHWWs as a national model for addressing health inequalities.

Who is leading the research?

This research is led by Dr Kiran Cheedella, GP.

Further information

For more information or to get involved with this project, please email bnssg.research@nhs.net.