‘We have the time to listen’: community Health Trainers, identity work and boundaries

Abstract

This article contributes empirical findings and sociological theoretical perspectives to discussions of the role of community lay health workers, including in improving the health of individuals and communities. We focus on the role of the Health Trainer (HT), at its inception described as one of the most innovative developments in UK Public Health policy. As lay health workers, HTs are tasked with reducing health inequalities in disadvantaged communities by supporting clients to engage in healthier lifestyles. HTs are currently sociologically under-researched, particularly in relation to occupational identity work, and the boundary work undertaken inter-occupationally with other health workers. To address this research lacuna, a qualitative study was undertaken with 25 HTs based in the Midlands region of the UK. In theorising our findings, we employ a combination of symbolic interactionist conceptualisation of 1) identity work, and of 2) boundary work. The article advances knowledge in the field of health and exercise by investigating and theorising how HTs construct, work at, manage, and communicate about professional/occupational boundaries, in order to provide personalised support to their clients in achieving and sustaining healthy behaviour change within the constraints of clients' lifeworlds.

“I Just Want to Be Left Alone”: Novel Sociological Insights Into Dramaturgical Demands on Professional Athletes

“…In a manner analogous to fashion models (see Entwistle and Wissinger, 2006), high profile athletes cannot easily step away from their work roles or remove their uniforms to achieve anonymity and relative privacy as can other workers who, for example, remove factory or shop overalls, or medical uniforms to signal transition away from the occupational role. The work-life boundary is often permeable, shifting, and complex (see also Allen-Collinson et al, 2019).…”

The role of community health workers in primary healthcare in the WHO-EU region: a scoping review

“…Diverse terminology was used to describe the CHWs in the included studies. CHW as a term was used in twelve studies [ 37 – 48 ], and UK studies mainly referred to CHWs as (lay) health trainers [ 49 – 56 ]. Other studies referred to outreach workers [ 57 – 62 ], lay (public) (health) workers [ 62 – 69 ], lay educators [ 70 , 71 ], dental health support worker [ 72 ], expert patient programme trainers [ 73 ], health mediators [ 74 ], lay health promotor [ 75 ] and community peer volunteers [ 76 ].…”

“…The interventions in the included studies targeted diverse populations: ‘hard-to-reach’, disadvantaged, underserved, deprived, or low-income areas or groups [ 39 , 47 , 49 – 53 , 55 , 60 – 63 , 65 , 66 , 69 , 70 , 75 ]; Bangladeshi and Pakistani men [ 46 , 57 , 58 ]; Roma groups [ 48 , 74 ]; (elderly) immigrants [ 41 , 43 , 45 ]; people with chronic conditions [ 73 ]; nulliparous pregnant women [ 59 ]; people living with diagnosed asthma or chronic obstructive pulmonary disease (COPD) [ 65 , 68 , 71 ]; people living with type 2 diabetes mellitus (T2DM) in socioeconomically deprived areas [ 42 ]; new-born children [ 72 ]; angina patients [ 67 ]; psychosocial vulnerable people [ 37 , 38 ]; men who have sex with men [ 40 ]; rural (farming) communities [ 44 , 76 ]; and people with experience in the criminal justice system [ 56 ].…”

“… Management of non-communicable diseases [ 54 , 73 ], including: cancer screening [ 64 , 76 ]; T2DM care [ 42 ]; angina management [ 67 ]; COPD management [ 65 , 68 ]; asthma self-management [ 70 , 71 ]; and cardiovascular risk assessment and management [ 52 , 53 , 56 , 60 ]. Three studies focused primarily on smoking cessation [ 49 , 57 , 58 ]. Psychosocial support of migrants with regards to their mental health [ 43 ], psychosocial support in disadvantaged urban areas [ 63 ] or in the context of the COVID-19 pandemic [ 37 , 38 ].…”

“…Management of non-communicable diseases [ 54 , 73 ], including: cancer screening [ 64 , 76 ]; T2DM care [ 42 ]; angina management [ 67 ]; COPD management [ 65 , 68 ]; asthma self-management [ 70 , 71 ]; and cardiovascular risk assessment and management [ 52 , 53 , 56 , 60 ]. Three studies focused primarily on smoking cessation [ 49 , 57 , 58 ].…”