Developing new community health roles: can reflective learning drive professional practice?

A variety of new non-professional roles, such as health trainers and community food workers, have evolved from recent UK public health policy developments. These roles predominantly operate in communities characterised by extreme social deprivation. Their remit is to offer local people support to help change lifestyle ‘choices’, for example, healthy eating or drinking responsibly. However, encouraging people to change health-related behaviour often ignores the underlying social determinants of health related behaviour. Health trainers and community food workers have been identified as being able to bridge the gap between the health professional and lay person, because of their ability to identify with local people. The challenges faced by these non-professionals, working at the coal-face of communities, and in a new and evolving role, are as yet poorly understood and this paper details the mechanism of reflective learning adopted by these practitioners in order to explore the professional practices involved. Emergent issues faced by these new practitioners include: understanding the boundaries between the trainer role and other health services; and the issues raised by the community, for example, presenting with non-health reasons such as financial crisis, which the trainers were often unprepared to deal with, rather than ‘lack of health skills’ (e.g. cooking skills). This paper explores how reflective learning processes can deconstruct the experiences of this ‘new level of the health workforce’ who have on the one hand the sensibility and sensitivity to develop relationships with individuals and households in poorer communities, yet are ill equipped to deal with the wider structural factors often determining behaviour.