Using Peer Educators to engage with BME communities in Bristol

Background

• FSA was keen to engage with those BME communities which were not reached by national campaign messages • Funded Bristol PCT for a 1 year pilot project to recruit and train Peer Educators from 4 BME communities to deliver salt awareness and behaviour change sessions to groups in those target communities

Bristol Salt Awareness Project: In a nutshell

• Formed a partnership of Dieticians, Public Health and the Black Development Agency • Recruited and trained 10 Peer Educators from African Caribbean, South Asian and Somali communities (Chinese did not apply) • Delivered 45 Interactive sessions to 27 different organisations reaching over 500 people

Approach used • Behaviour change was an FSA requirement • We chose a series of sessions structured to increase awareness and knowledge but also to tackle barriers (both practical & cultural) which any changes in behaviour would first need to overcome

The sessions

Session 1 ‘Healthy Eating’

What is healthy eating and how do we get the balance right?

Session 2 ‘Salt and Your Body’

What is ‘too much salt’ and why is too much salt a problem?

Session 3 ‘How much salt is in our food?

’ Where does salt appear in our food? An exploration of cooking methods, food preparation and packaged food.

Session 4 ‘Grocery Store Tour’

How to shop for lower salt options and find alternative flavourings to salt.

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Session 5 ‘Feast’

A taste of ‘home-cooked’ food with no added salt using alternative flavourings.

What was the role of the evaluators?

• • • • Engaged external evaluators to: Assess views of individuals and Black and minority ethnic communities on salt and health, usage of salt and frequency of consuming high salt containing foods Contribute guidance for the development, piloting and evaluation of the Peer Educators’ training programme, training resources and the course Peer Educators would deliver. Assess the delivery, effectiveness and impact of the Peer Education sessions to members of black and minority ethnic communities participating in the project Assess the effect of the peer educator initiative on salt knowledge, attitude, ability to address barriers to change and practice amongst black and minority ethnic participants in the intervention

What affects were the evaluators trying to capture?

The aim of these interviews was to discover: • whether subjects continue to be concerned about the impact of excess salt on their own and their family’s health • whether they have changed how they shop and the foods they buy • whether they now cook differently, using less salt • whether they and their families eat less salt • how family members have reacted to their preaching about salt • whether they have told others, for example friends, about the dangers of excess salt.

Method

Interviews took place six to seven weeks after most of the individuals had participated in salt awareness sessions • Every participant had been given a post-session questionnaire • There were 4 focus groups • The interviews included all the target populations and were held in culturally specific groupings • Translators were present in the groups and where necessary for the 1 to1s • Of the 1 to 1 interviews, two took place by telephone; the other 8 were face to face

Findings: the peer approach

The women reiterated how valuable they had found the sessions run by the peer educators. They liked: • their style • their innovative way of putting across information • that they spoke the women’s first language • that they were well informed, and found out answers to questions if they couldn’t answer them immediately.

• They particularly valued the peer educators being members of their own ethnic community.

Findings: the behaviour change

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Overall conclusions of evaluators

The evidence gathered during the four evaluation stages of the pilot Salt Awareness Project using peer educators to create awareness and behaviour change in Black and minority ethnic communities has clearly demonstrated that: Awareness of salt and its impact on health in Black and Minority Ethnic communities has been improved Awareness of how much salt should be consumed, and how to identify the salt content of food, has been increased in these communities Awareness of alternatives to salt in food preparation, cooking and eating has increased People from Black and Minority Ethnic communities who participated in the peer education sessions reduced their use of salt, and that of their families, in their subsequent shopping, cooking and eating There is evidence of a cascade effect where the message about salt and health has been communicated into the wider community The peer education model is an effective and efficient mechanism for delivering health-related messages to hard-to-reach communities.

What worked?

• Strong acceptance of Peers and their messages • Evidence of both behaviour change and intention to change • Influence cascaded out to wider community • Goodwill for future programmes created • PCT gained an enthusiastic and skilled workforce • Demand for Peers on other subjects

BRISTOL SALT PROJECT RECRUIT PEER EDUCATORS TRAINING & PROGRAMME WRITING DELIVERY OF THE INTERVENTION CONTINUING WORK MEDIA WORK GROUP WORK EVENTS & STALLS STATISTICS METHODS & RESOURCES CELEBRATING AGE EVENTS

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27 Organisations

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Over 500 People

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45 Interactive sessions

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Presentations

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Shopping Tours

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Cooking Demo & Food tasting

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Flip Chart Presentations

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Activities

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Q & A sessions

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DVD/ Projector

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Visual Aids

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Recipes

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Leaflets & Literature from FSA in different languages HEALTH & WELBEING DAY MULTICULTURAL FOOD DAY SOMALI RADIO B.D.A MAGAZINE

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NTERNET SALT AWARENESS WEEK DRAMA PRODUCTION WITH THE ‘MISFITS’ SCHOOLS TEACHING PACKS MEDIA EVENT IN CITY CENTRE CHINESE COMMUNITY WITH INTERPRETERS OTHER DEMANDS BY PCT FOR PEER EDUCATORS

What did we learn?

We Learned that:

• Peers need and enjoy a wide range of training • Peers need close accessible management • The community should be involved in the planning of programmes • There is a demand from the community for further Peer-led programmes • Other health professionals are keen to use Peers • Longer term evaluation would be needed to capture longer term change

What were the greatest challenges?

• Recruiting Peers in a short timeframe • Trying to fit a pre-prepared 5 session programme into the varying opportunities to execute it • The timescale of the Project generally and certainly as they impinged on the evaluation of change • Bringing all the Peers together (for training or meetings)

What would we do differently?

• Work at a pace determined by the task • Work with Peers to assess their training needs and include them in designing the programme • Consult more closely with communities before writing the programme • More team meetings (though difficult to arrange) • Build in a one year later evaluation visit

What’s next?

• Domestic violence • Weight management • Healthy eating (including more salt) • Promoting healthy walking routes for breast screenings appointments • Recruiting subjects for a mid-life online health questionnaire (MLLC) • South Asian community heart health education campaign • Supporting Diabetic patients toward healthy lifestyles