Scaling Community Health Intervention: Investigating the Impact of the Community Health and Wellbeing Worker Model on the Uptake of preventive Care services in London, UK. (Rawan PhD)

This project investigates the impact of Community Health and Wellbeing Workers (CHWWs) on the uptake of preventive healthcare services in high-deprivation areas of London. Preventive care—including immunisations, cancer screenings, and NHS Health Checks—is vital for improving population health, yet uptake remains low in socioeconomically disadvantaged communities. Drawing inspiration from Brazil’s successful Community Health Worker model, this study evaluates whether CHWWs in the UK can similarly increase access to preventive care and reduce health inequalities. The project consists of three interconnected components. The first is a cluster-randomised controlled trial (cRCT) involving 72 neighbourhoods in Northwest London. In this trial, 24 intervention communities receive CHWW support, while 48 serve as controls. The study will assess household-level engagement using the Composite Referral Completion Indicator (CRCI), alongside secondary outcomes such as unscheduled GP and emergency visits. The second component is a qualitative study informed by behavioural science frameworks (Health Belief Model, Social Ecological Model, and COM-B model). Through focus groups with CHWWs and interviews with community members, it explores perceptions of CHWWs, facilitators and barriers to preventive care, and mechanisms driving behaviour change. The third component is a systematic review focused on Brazil’s CHW model to understand its effectiveness in improving vaccination and cancer screening rates. This will inform the applicability of lessons from Brazil to the UK context. By combining rigorous quantitative and qualitative methodologies, this project provides critical insights into the effectiveness and feasibility of scaling the CHWW model in the UK. Findings will inform health policy, support national scale-up decisions, and contribute to reducing health disparities through equitable access to preventive services.