In February 2023, Cornwall and Isles of Scilly Integrated Care System introduced teams of "Community Health and Wellbeing Workers" (CHWW) to support underserved communities with the aim of building relationships and identifying people's needs. The initial pilot has now been extended to run for a minimum five years, working in the Kerrier area of Cornwall, and extending to Penwith, Bodmin and Liskeard with an aim to 50-60 CHWWs in post by Autumn 2024.

CHWW's encourage householders to initially identify their biggest concern and then work with them to reduce or remove that concern. Since Autumn 2023 Measure Yourself Concerns and Wellbeing® (MYCaW) data has been collected to show the impact of the CHWW and Meaningful Measures Ltd were commissioned to analyse the MYCaW data.

The aims of our report were:
● to analyse all data on the initial and follow-up MYCaW forms from the CHWW project, as well as any relevant available demographic data about the project recipients.
● to carry out a comparison of commonly used outcome measures with concerns documented from MYCaW data.

Data was gathered by the CHWW teams during their home visits, firstly once a CHWW had got to know the resident (either on 1st, 2nd or 3rd visit) and then 3 months later.

Measure Yourself Concerns and Wellbeing® score changes

Analysis of Measure Yourself Concerns and Wellbeing® concerns

For the qualitative analysis of the concerns, there were a total of 412 concerns (from 211 people) when combining Concern 1 and Concern 2. These were coded using an existing framework of concerns developed by Meaningful Measures Ltd based on over 2,500 concerns from people around the UK using personalised care services.

Figure 1. The percentage frequency of concerns falling under each main theme.

Almost half of the concerns were practical ones including problems with finance, housing, and social justice. A breakdown of the individual concerns in each theme can be found in the report by Meaningful Measures Ltd.

Across the whole dataset we identified the top 5 individual concern categories reported - (Table 2). It is worth noting that most of these concerns are social determinants of health and it is, therefore, not surprising that people's mental health is being affected.

Table 2. The top 5 concerns most frequently reported from the 412 concerns recorded.

Outcomes

The biggest positive change for people (9%) was improvement in their finances or work situation. It was implied that the CHWWs had helped get benefit payments sorted, but predominantly people had either found a job that they were happy with or were actively looking for work now.

"CHWW 's got me attendance allowance and HHSF to purchase some white goods".

Residents were also trying to improve their wellbeing through diet and physical activity (6%), were actively improving their environment (6%) and were benefiting from the increased support from the CHWWs as well as friends and family (6%).

"I have made changes to my diet and stuck to this which has helped with my pain".
"Really starting to get things sorted now with the decluttering and decorating. Slowly but surely, but I feel better mentally the more I do. We will have a much nicer home after all this".

A further 6% of residents were getting more social activity and connections.

"I have made many social connections, through the neurodiversity group, chill and chat and I have even performed with my guitar for a singer at a concert. I have also started a level 2 autism awareness course which is very interesting".

All of these situations are known to have a positive impact on a person's health and wellbeing.

What is important about the support received?