Riley, Andrew 
ORCID: 0000-0001-5569-8694
(2025)
A comparative case study process evaluation of a
Community Health and Wellbeing Worker pilot in
three settings in England
PhD thesis, University of Liverpool.
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Text
201574095_June2025.pdf - Author Accepted Manuscript Download (11MB) | Preview |
Abstract
Background In 2021, three localities in England implemented Community Health and Wellbeing Worker (CHWW) pilot programmes aimed at enhancing preventive public health within primary care. Modelled on the Brazilian Family Health Strategy, the initiative was founded on four key principles: 1) recruiting, training, and paying local laypeople to deliver the intervention; 2) implementing proportionate universal outreach based on geographical area, with each CHWW assigned approximately 150 households to visit monthly, regardless of demand or need; 3) providing support to the entire household, without differentiation by age or health condition; and 4) integrating the workers into primary and community care services. A process evaluation was essential to understand this innovative and complex healthcare intervention. The evaluation examined the pilots' planning, delivery, and uptake, identified causal pathways, and documented contextual factors influencing implementation and outcomes. Methodology From February 2021 to September 2024, I conducted a mixed-methods comparative case study process evaluation to investigate the determinants of implementation and to generate practical programme theories for the CHWW model. Data collection methods included participant observation, interviews, focus groups, and the analysis of secondary qualitative and quantitative reports. The Consolidated Framework for Implementation Research (CFIR) guided the identification and interpretation of contextual factors, while programme theory was developed using context-mechanism-outcome configurations derived from case comparisons. Additionally, a systematic review of barriers to and facilitators of CHW programmes in high-income countries was conducted. Results The process evaluation provided comprehensive evidence of contextual determinants influencing each programme across the CFIR's five domains. These included: 1) Innovation: Programmes were commissioned and hosted heterogeneously—by the local authority and a GP surgery in Westminster, through the Community Mental Health Transformation framework and a mental health charity in Calderdale, and by a Community Healthcare NHS Foundation Trust in Warrington. 2) Outer Setting: National partnerships promoted fidelity to the CHWW model and facilitated cross-pilot collaboration. 3) Inner Setting: Host organisation culture, resources, training opportunities, and mission alignment were crucial for CHWW confidence, workflow integration, and community outreach. 4) Individuals: A GP service champion and proactive supervisors were critical for workforce integration, resilience, and self-efficacy. Service users valued the support offered and the workers’ relatability, accessibility, and continued support. 5) Implementation: Productivity data indicated limited uptake, and programme impact data were generally low quality. CHWW case reports illustrated their varied, challenging, and effective work. Eight overarching programme theories were developed, describing key implementation mechanisms and the contextual factors that shape them. Conclusions This study provides comprehensive and contextualised evidence regarding the commissioning and delivery of the innovative CHWW model, along with practical recommendations for its implementation, scaling, and further evaluation. These findings will be highly valuable to the growing number of implementation sites, which, as of 2025, includes 26 localities.
| Item Type: | Thesis (PhD) |
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| Uncontrolled Keywords: | Community Health Worker, Community Healthcare, Comparative Case Study, Mixed Methods, Primary Care, Process Evaluation |
| Divisions: | Faculty of Health & Life Sciences Faculty of Health & Life Sciences > Inst. Population Health |
| Depositing User: | Symplectic Admin |
| Date Deposited: | 14 Aug 2025 08:46 |
| Last Modified: | 14 Aug 2025 12:21 |
| DOI: | 10.17638/03193468 |
| Supervisors: |
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| URI: | https://livrepository.liverpool.ac.uk/id/eprint/3193468 |
| Disclaimer: | The University of Liverpool is not responsible for content contained on other websites from links within repository metadata. Please contact us if you notice anything that appears incorrect or inappropriate. |
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