Lay food and health worker involvement in community nutrition and dietetics in England: roles, responsibilities and relationship with professionals

• Published in: Journal of human nutrition and dietetics 2008-06, Vol.21 (3), p.210-224
• Main Authors: Kennedy, L.A, Milton, B, Bundred, P
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; community health; Community Health Workers; community nutrition programs; Community-Institutional Relations; dietary change; dietetics; Dietetics - manpower; Dietetics - standards; England; Feeding Behavior; Feeding. Feeding behavior; Food Services - manpower; Food Services - standards; food workers; Fundamental and applied biological sciences. Psychology; health care workers; Health Education - manpower; Health Education - methods; health services; human nutrition; Humans; interviews; Interviews as Topic; lay helping; lay workers; Minority Groups; National Health Service; nutrition promotion; nutritional intervention; Poverty; public health; risk groups; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Volunteers
• ISSN: 0952-3871; 1365-277X
• DOI: 10.1111/j.1365-277X.2008.00876.x

Community-based food initiatives have developed in recent years with the aim of engaging previously 'hard to reach' groups. Lay workers engaged in community nutrition activities are promoted as a cost-effective mechanism for reaching underserved groups. The main objective of the study was to explore perceptions and definitions of lay food and health worker (LFHW) helping roles within the context of National Health Service (NHS) community nutrition and dietetic services in order to define the conceptual and practical elements of this new role and examine the interface with professional roles. Interpretive qualitative inquiry; semi-structured interviews with LFHW and NHS professionals employed by community-based programmes, serving 'hard-to-reach' neighbourhoods, across England. A total sampling framework was used to capture all existing and 'fully operational' lay food initiatives in England at the commencement of fieldwork (January 2002). In total, 29 professionals and 53 LFHWs were interviewed across 15 of the 18 projects identified. Although all 15 projects shared a universal goal, to promote healthy eating, this was achieved through a limited range of approaches, characterized by a narrow, individualistic focus. Lay roles spanned three broad areas: nutrition education; health promotion; and administration and personal development. Narratives from both professionals and LFHWs indicated that the primary role for LFHWs was to encourage dietary change by translating complex messages into credible and culturally appropriate advice. This research confirms the emerging discipline involving lay helping within the NHS and community dietetics. The primary role of LFHWs in the 15 projects involved was to support existing NHS services to promote healthy eating amongst 'hard to reach' communities. The activities undertaken by LFHWs are strongly influenced by professionals and the NHS. Inherent to this is a fairly narrow interpretation of health, resulting in a limited range of practice.