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Cardiovascular disease (CVD) is responsible for one in four premature deaths in the UK, making the disease one of the biggest causes of mortality across the country. It is also one of the largest causes of life expectancy gaps, with people in the most deprived 10% of the population being almost twice as likely to died as a result of CVD.
In southeast London, the effects of CVD are exacerbated by very high levels of deprivation. To improve diagnosis and intervention for underserved communities in the region, South East London Integrated Care Board (ICB), King's Health Partners Population Health and Equity programme and Novartis developed three community-based pilot projects:
Community pharmacists, nurses and health champions provide residents in Lambeth with CVD risk checks, point of care testing for cholesterol, blood pressure monitoring and health education.
Lifestyle medicines coaches support individuals to gain greater control over their health through this co-designed programme.
Community connectors and social prescribers invite residents to attend learning sessions about blood pressure, cholesterol, diet and exercise.
The Health Innovation Network South London lead with the evaluation of the project, exploring whether the initiatives increased engagement with hardly reached communities to support improvements related to CVD prevention, care and patient identification.
The mixed-method study examined the approaches taken as well as the perceived impact of the three projects. Interviews with staff, stakeholders and patients also described the support provided by the pharmaceutical company and the views of staff and patients of the company's involvement in the CVD projects.
The 'point of care testing' service was developed from work carried out by Stockwell Health Heart Club, exploring a scalable model of care. Awareness of the bus and its services was increased through three approaches: location in different community settings, perceived informality of services and dedicated time for project staff from non-clinical and clinical service providers.
1,640 people used the bus between October 2023 to April 2024. 92% had their blood pressure checked and 88% had their cholesterol checked. 8% were recommended to visit their GP following their heart health check.
Participants stated that they engaged with the service due to the convenient location of the bus and its visibility in the community hall. Benefitted also included getting their blood pressure of cholesterol reading in a relatively short period of time and the friendliness of the 'Health Champions' in discussing health issues.
Extensive co-design with target community, with key recommendations from the group including using a non-medical professional to deliver the service and widen eligibility to include all patients over the age of 18, irrespective of diagnosis.
Eligible patients were contacted by wellbeing coaches and booked onto next available cohort. Six groups ran over the four month pilot cycle, with the aim of recruiting 90 patients.
Participants developed techniques for behavioural change to address identified health issues through group and 1:1 sessions. Participants benefitted from the projects' team ability to create a safe space, as well as their good listening skills and the personalised care delivered.
The workshop and resources for delivery were co-designed with the Northeast African Women's group to support participants' learning, including presentation slides and Heart Age Card.
Eligible patients contacted and booked onto the next available course by the Health Connector. Four cohorts were recruited over the pilot period.
54 patients completed the course out of the 87 invited. Participants benefitted from the project teams' ability to communicate information on heart health using accessible language, rather than alienating jargon.
Several successful spin-off activities were generated, including the Northeast African Women's group who independently formed exercise groups and a workshop to develop a cookbook for health eating,
All three projects were successful in engaging with their target communities, with most patients who attended a service continuing for the duration of its delivery. Patients also felt empowered to undertake behavioural change to support better CVD related outcomes.
The following areas are suggested for improving community engagement with these services:
Publicity of services: improve communications by using channels familiar and accessible to target communities eg local radio, community meetings. Also adapt language used for communications so that it is culturally sensitive and in languages spoken by the population.
Outreach: implement strategies to offer projects for people who work both traditional and non-traditional working hours, increasing service engagement. This could include weekend sessions, online provision of services or more outreach in community-based settings.
The projects also demonstrated the potential to enhance health outcomes and innovative patient care approaches through collaborations between the NHS and pharmaceutical companies.
Learn more about our evaluation methods for this project and the observations.
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