Case Study 1: Robert
45 year old male with Type 2 Diabetes
Robert is a 45 year old man suffering from Type 2 Diabetes who was referred to the service by his GP. He manages his diabetes under the care of his GP and a dietician, but contacted the Health Trainer service as he wanted more support and understanding from someone outside the clinical setting. Robert felt he had not yet fully accepted or understood the impact diabetes had on him and hoped that sessions with a Health Trainer would allow him to talk about the disease in relation to his everyday life. He wanted: “the space for me to say stuff rather than sit there and get loads of information”.
Robert’s initial goal was to reduce the amount of the diabetic drug Metformin he took to control his diabetes and the agreed focus for action was to undertake strategies in order for him to be fitter and healthier. He felt he had not incorporated diabetes into his life and his perception of a “well controlled diabetic” was that they were “weird”, a person “who only eats a lettuce leaf or gave up work or spends 8 hours exercising.”
With the help of his Health Trainer, Robert was able to explore his life with diabetes, setting new goals each week and then reviewing them the next. This not only resulted in him making alterations to his diet but also enabled him to have the confidence to apply his knowledge of the disease to his daily life. Achieving smaller goals, such as making meals from scratch instead of buying ready-made ones, enabled Robert to set and achieve bigger ones.
The most significant goal for Robert was regular testing his blood sugar levels: “With [my Health Trainer’s] guidance I started testing myself and for me that gave me a really good understanding of ‘if I did this at 8 o’clock this is what’s happening to my blood at 10 o’clock’.”
Testing regularly has meant that Robert is now able to make more informed dietary choices when entertaining business clients, which is a big part of his working environment. “I’m determined if I go out with my clients for an evening meal my blood sugar is not going to go above 9 for example, and then I look at the menu and I’m thinking that sort of thing.”
During the sessions Robert also explored options for undertaking exercise and expressed his reticence about gyms. These discussions gave him the confidence to consider gym membership and with the help of his Health Trainer he joined a gym where a manageable exercise programme was devised specifically for him. He now attends regularly up to four times a week and finds it “really amazing what a difference it makesâ€ and feels that it has also made a difference to diet: “I’ve found that since I’ve started exercising I am actually more conscious about what I eat.”
Robert feels that the Health Trainer sessions have really improved his health and wellbeing in a very short space of time. “I am sleeping a lot better which is important for me. I don’t sweat so much, I don’t get quite so tired. The other thing my partner was always moaning at me because I was always stroppy and that turns out that’s another thing that can be up and down with the sugar so I’m a bit more calm about things.”
Before the sessions Robert was finding it difficult to motivate himself at work but found that this improved following his chats with his Health Trainer. He was able to tell his employers that he is a diabetic and acknowledged that this is part of him accepting the disease as part of his life. Since working with his Health Trainer, Robert has been better able to control his condition and he now feels he has the confidence to manage his diabetes in a way that suits him: “I know that actually there isn’t one right way whereas before it was like this is the way to do it and I was like, that doesn’t fit my life at all.”
Since the sessions Robert has begun to think and behave differently: “Just by making little changes here and there and over time, training your brain and actually it becomes something you do every day and it’s not such a big deal.”
Robert’s says his experience of the service has been “relaxed, positive, informative, supportive. Supportive – being the most important.” He particularly appreciates the ‘client centered’ approach, in terms of appointment timings and continuity of personnel. Due to his work commitments Robert was not always able to commit to regular timeslots but was reassured by the availability of telephone support if he needed it, and seeing the same person throughout the programme was really important to him.
Overall, Robert believes that the reason his experience with his Health Trainer has been so positive and much more effective than his previous experiences with other healthcare practitioners is because it is holistic in nature, dealing with general diet, wellbeing and exercise, “the whole package” as he describes it: “I think the sessions I’ve had with [my Health Trainer] have probably helped me more than any other thing that I have done in relation to the diabetes, definitely.”
Case Study 2: Bassima
43 year old female with high cholesterol
Bassima is a 43 year old mother with raised cholesterol levels who was referred into the Health Trainer service by her GP who was reluctant to treat her condition with drugs.
At her first session, her Health Trainer recorded her weight, talked to her about diet and lifestyle and worked with her to create a Personal Health Plan. Bassima was also asked to keep a food diary in which she would record all the food she ate at mealtimes and snacks throughout each day. Bassima also received guidance on what to eat and what to avoid and given leaflets to take away.
At subsequent appointments, her food diary was reviewed and they discussed how she could adapt her diet, in particular her fat intake. This knowledge gave Bassima a greater understanding of food and nutrition and the tools to make changes to her diet: “I used to eat muffin cakes, I thought this was good because it hasn’t any cream so I thought this was ok.”
Bassima was given food plans she was able to adapt to her own cultural tastes and worked with her Health Trainer to explore practical ways that she could become more active. All these discussions were mindful of her personal preferences and took into consideration Bassima’s circumstances as a mother of two young children and work in the family bakery shop: “I don’t like swimming and I don’t have time for it.” Bassima was reluctant to join a gym for the same reasons but now enjoys walking and has incorporates this into her life as often as she can.
Bassima’s blood cholesterol levels were checked again after eight weeks of starting her sessions with a Health Trainer and were found to have lowered to normal levels. An improvement she is now determined to maintain by keeping up the healthy changes she has made: “I now know what’s best for me and what food to avoid and I know when you reach your forties you need to do more exercise and walking.” The changes have also had a positive impact on her family because she now does her best to cook healthy, homemade food for them all.
Bassima feels her success is due in part because she was able to make changes gradually and that the Heath Trainer had time for her and was able to offer a flexible service, offering different appointment times and locations to fit in with the realities of her life.
Case Study 3: Peter
64 year old male with high blood pressure and enlarged prostate
Peter is a 64 year old man who suffers from high blood pressure and an enlarged prostate, both of which he is receiving treatment. Peter was referred in to the Health Trainer service by the practice nurse at his GP surgery to help him loose weight.
During his sessions, Peter was weighed regularly and together with his Health Trainer they explored his diet and talked about what constituted a healthy diet. They set goals in order for Peter to make changes to his diet, which he adopted: “I don’t eat any fatty food at all. I mostly eat salads and stuff like that… I eat a lot of fruit as well.” They focused on the ‘every day’ so that Peter could adapt a healthy diet that suits his lifestyle.
Peter’s Health Trainer also provided him with a pedometer, which resulted in him increasing the distance he walks: “With [my pedometer] I’ve got a good idea of what I’m achieving. Even in the flat I’m still walking around. So it’s good for me because it means I know exactly, when I go home I check it and can see exactly how many miles I have walked every time.” He rarely uses a bus now unless his intended destination is far away and appreciates how exercise contributes to his health.
Peter felt he was listened to during the sessions and said that his Health Trainer motivated him by reminding him of his goals, boosting his confidence and “saying come on, do this for yourself, help yourself, get yourself fit, try and loose as much weight as you possibly can. If you loose it you’ll feel fitter in yourself.”
Peter’s Health Trainer also directed him to an anger management counsellor: “[My Health Trainer] could see that I was anxious and said do you want me to refer you to anger management?” Subsequently, Peter attended and felt it was of enormous benefit and now does not get as angry: “I changed completely. I wasn’t angry any more and now don’t get angry. When I’m indoors I sit down and do deep breathing exercises. Deep breath, I hold it for 10 seconds so if I was angry I’d do it on a regular basis and it’s helped me, helped me such a lot.”
Peter is now able to get out more as a result of the changes he has made. He lives in a flat and to reach it he has to go up four flights of stairs. He described how climbing the stairs changed because of his Health Trainer sessions: “I mean before when I used to get home I would go up the stairs and I couldn’t even breathe. Now I get in and I’m breathing, not gasping, just breathing nice and relaxed. I feel happier for it.” Peter is also sleeping better: “I’m sleeping. Before I wasn’t sleeping at all. Now I go to bed at 10 o’clock and I’m sleeping.”
Peter is determined to keep improving his life and wants to loose more weight. He describes his Health Trainer as “brilliant” and summarises his experience as: “Set yourself a goal, which is what I did. That’s why I wanted to, because I wanted to think to myself you’ve done this and I’m feeling fit, I’m feeling relaxed, I’m healthy, I’ve got no heart problems, I’ve got no medical problems, I’m feeling good and I feel happier in myself.”
Case Study 4: Helen
71 year old female with depression
Helen found out about the service following a conversation she had with a Health Trainer at a promotional event at her local library. At 71 years old, she had a history of depression and had received treatment in the past by way of a combination of drug and talking therapies.
Initially Helen had difficulty in defining her emotional issues and what she hoped to get from the service but with the help of her Health Trainer she was able to explore “what it is that gets her down”, talk about her inability to get things done and the negative impact stress was having on her body such as hypertension and clenched jaw.
Having identified her main aim as reducing stress and relieving tension, Helen was able to work with her Health Trainer to devise strategies and set regular goals. Each week goals were set and then reviewed to measure their effectiveness. For example when something disturbed Helen, she wrote it down and then tried to do something about it. A further goal was to engage in self-help techniques using books and tapes to help her relax.
Helen’s general health and wellbeing were also explored during Health Trainer sessions and she set a goal to regularly attend classes to improve this. Her Health Trainer was able to signpost her to appropriate local facilities on offer and she now regularly attends a dance based exercise, Tai Chi and drop-in computer classes at The Old Age Hub in Penfold Street.
Helen’s diet, smoking and alcohol intake were also discussed during her sessions and consequently she set herself a goal to increase her intake of fruit and vegetables. This was reviewed in the following weeks and she developed an awareness of what she was doing because she could: “focus on how much fruit I eat, how much vegetables, how much exercise” and then make informed choices with regard to her diet. Helen also said that her “awareness of how much she smoked had gone up it is a good thing” because now that she was aware of it she can start to reduce the amount she smokes.
During her sessions Helen articulated how comfortable her Health Trainer made her feel because of their relaxed and friendly manner. She found attending on a regular basis beneficial because she was “getting into a rhythm” and a motivation for her to achieve her goals: “It’s more of the reminder if someone is saying have you done this?”
Helen summarises her emotions following her sessions as “feeling in control” and this has given her the confidence to pursue her long-term aim of “looking after herself” and she continues to regularly set goals in order to achieve this.
Helen feels her general wellbeing has improved because she is “more aware and trying to take a bit more care.” Before seeing a Health Trainer she says she would have thought about going to an exercise class but not doing anything about it. She is now committed to regular exercise, uses relaxation techniques and will soon start a new mindfullness course.
Case Study 5: Anthony
62 year old male with Intermittent Claudication
Anthony is a 64-year-old man who suffers from Intermittent Claudication who had signed up for the Health Trainer service at the recommendation of his GP. Anthony’s original goals were to stop smoking, increase the amount he exercised and to loose weight.
Anthony’s initial course of six sessions with a Health Trainer has proved beneficial but once they had finished he “slid back into the old ways again.” So when his Health Trainer contacted him again after several months for a chat to see how he was getting on, Anthony immediately opted to re-register on the service. He is currently seeing a Health Trainer ever week and admits his main problem is smoking: “I can’t seem to kick it.”
Anthony regards his goal to stop smoking as “work in progress” and particularly values seeing his Health Trainer regularly and if he is unable to make an appointment he lets his Health Trainer know by phone to keep the continuity going. He is ex-military and likens his Health Trainer to a ‘Commanding Officer’: “Now the CO can be a lovely guy, he can be really helpful but heâ€™s still the CO and you still have to go along and see him. So that does give me some sort of incentive.”
Anthony believes his self-efficacy has increased by working alongside a Health Trainer, commenting: “I think I could possibly achieve it by myself but it would be so much harder to be perfectly honest. It’s 50:50 if I was just left to my own devices whereas with this programme I’d say I have 80% or 90% chance. That’s a hell of a difference.” He attributes this to accountability saying “the fact that I do have to report to somebody is definitely and probably the reason I have stayed on it, an incentive to stay on it and its why I stay on it.”
Anthony has had some success in stopping smoking for short periods of time, which he attributes to “some brilliant ideas” that his Health Trainer has introduced. “He told me to get some jars and put the money in that I would normally spend on cigarettes which is an excellent idea and it did work when I gave it up initially. It worked so well I actually bought these shoes. Buy a treat he said, spend the money on yourself, donâ€™t put it into the general housekeeping pool or anything like that.”
In addition to responding to incentives Anthony has increased his knowledge of health and wellbeing through the literature he has been given at his sessions: “One of the things was a revolving wheel that shows you if you don’t smoke, this is how much you save and all this sort of stuff and we went through it and he didn’t just say here is a booklet for you, have a read sometime. Iâ€™d come back the next week and he would say have you read that booklet? And what did you think of page such and such so I read the literature and it was useful stuff.”
Anthony also recognises the progress he has made with regard to his other goals: “I’ve sorted my diet out”, adding “thatâ€™s a habit now the healthy eating rather than something I have to think about.”
He is walking further and stopping less: “I’m doing the walking and I’m getting a bit further every time before the pain kicks in so that seems to be working.” He acknowledges that change is hard and that he has a greater insight into his smoking behaviour: “I will never say to myself you’ve cracked it now you can have the odd one, which is exactly what I did the last time when I started smoking again… I’ll just have a couple of fags and leave it at that because it’s like being an alcoholic you know one drink, you don’t.”
Anthony summarises his time with his Health Trainer as “incredibly worthwhile and the staff from what I can see and from my experience, are some very dedicated people who do have a genuine concern for the clients. Without it I would not be where am I am now let alone on the way to finishing.”
Case Study 6: Carol
52 year old female who wanted to lose weight
Carol went to see her GP because she was suffering from knee pain. Her GP advised her to loose weight and recommended she attend a weight loss clinic at the surgery. Carol tried the clinic, however, felt it wasn’t really right for her so instead she contacted the Health Trainer service.
During her first session Carol told her Health Trainer that she wanted to loose weight to improve her health: “I told [my Health Trainer] about my lifestyle. What I eat, that I smoke, what exercise I do.” Carol’s Health Trainer discussed her diet with her and explored ways for her to embrace a healthier lifestyle.
Throughout her time with her Health Trainer Carol was able to lose some weight and has been further encouraged by comments she has received: “I know I have lost some weight because my daughter said it and the people where I work have said you’ve lost weight and I look better so I must have done something right.”
Carol has now incorporated her new attitudes to physical activity and eating healthily into her life and feels that this is due to the support and guidance she received from her Health Trainer. “I think it was the way that they were with me. You could just talk to them about anything to do with your diet.” Carol likened her previous experience at the weight loss clinic to being back at school but commented that this time: “It was really relaxed and you weren’t made to feel guilty for not loosing the weight.” Carol particularly valued the privacy of the one-to-one sessions and reflected on her previous experience: “In the other place you were sitting in a big room were everyone saw you get weighed and heard what you were saying. There was no privacy and there if you didn’t loose any weight or gained, everybody in the room could all hear what was going on …”
Goal setting increased Carol’s confidence and gave her a target: “If you achieve a goal, like ok what would be the next step? So say like for me if I found walking one bus stop was ok, the next for me was like to walk two bus stops so say like if I get two buses then get off one bus stop early and then the other bus stop early. The goals are good because say if you are at home you can look back and say that’s a goal and I’ve got to try and achieve it, especially when you’ve got it written down.”
Since finishing her sessions, Carol now appreciates that physical activity doesn’t have to mean exercise and has recommended the service to others. However, she feels there should be even more information available about the service in the community. She places a high value on health promotion events such as the one she attends at the Lisson Green Estate.
For Carol using the Health Trainer scheme has “… made me more aware of the things that I was doing wrong and some of the things that I was eating.” She is now aware of the benefits of a healthy diet and physical activity and is determined to maintain the changes she has made: “I will still keep doing what I’m doing and hopefully health permitting loose a little more weight and hopefully try and walk a little bit more … Without [my Health Trainer] I wouldn’t be losing the weight (I would be piling it all on) or put in the right direction of some of the things that I should be doing.”
Case Study 7: Norman
57 year old male who wanted to lose weight
Norman is a 57-year-old man who has recently had clinical investigations following an episode of chest pain. He was referred to the Health Trainer service by his GP. He gave up smoking a year before and no longer drinks alcohol but wanted to see a Health Trainer because he wanted help to lose “a bit of weight.”
Norman was initially unsure what to expect from a Health Trainer, but thought it would be “some bloke in a tracksuit eating an apple, I thought he was going to give me a diet sheet and then go away.” However, in his first session he was pleasantly surprised to realise that this wasn’t the case.
With his Health Trainer, Norman explored aspects of his diet, the benefits of physical activity and increased his knowledge of heart disease. He was asked to keep a food diary and this was reviewed every week. Portion sizes were explained to him and this has resonated with him: “I take it quite seriously now. But I’ve learnt about you know what’s on the plate, what’s going in my mouth, taking it from there. My Health Trainer is very good because he’s very liberal; he says eat that little bit of chocolate if you want.” Each week he discusses with his Health Trainer what he wants to achieve and together they set goals: “at the end of each session he gives me three or four things that are tasks for me to think about, they’re ‘doable’.”
Since seeing his Health Trainer, Norman has managed to cut out bread and reduce the amount of potatoes he eats and while Norman doesn’t always achieve his goals he does value the weekly goal setting, describing it as “little milestones.” Although he admits to feeling guilty if he does not achieve his goals he very much appreciates the guidance and support.
Norman accepts that maintaining the changes he has made will be hard. “I’m hoping I can because it resonates with me and I know as you get older you’ve got to start policing a little bit better because you don’t know what is around the corner.” He is much more aware of healthy eating and has learnt to incorporate treats into his life. Whereas before, he says he would be “eating stuff every night, mad, but now I look a it and think I’ll keep that for Saturday while I watch the football on the television. Powerful thoughts because I never had any like that.”
Norman holds both a taxi and security licence and intends to return to work shortly. He attended three interviews recently and has been offered jobs but is mindful of taking a job where he is inactive for a large part of the day so is exploring how he can incorporate more physical activity into his work and home life. He feels the service should also be available in the evenings so people who work can also benefit from it.
Case Study 8: Malcah
63 year old female who wanted help with her diet
Malcah saw her Health Trainer for nearly six months and wanted help with her diet. She was diagnosed with diabetes ten years ago, which is managed under the guidance of her GP. She was given dietary advice many years ago from a dietician but felt she needed more in the way of guidance and support. Her GP referred her to the service for help with her diet as she had been feeling dizzy and unwell, and frequently experienced abdominal pain.
Malcah wanted to lose some weight and improve her health. She told her Health Trainer about her diet and lifestyle. How she is from Africa and enjoys eating starchy and fried foods such as chips, sweet potatoes and cassava. Malcah lived with her niece for many years but has recently been staying with her daughter outside the borough but is eager to return to Westminster, where her church is located because she misses the community.
With the help of her Health Trainer Malcah has been able to make significant improvements to her health and wellbeing by increasing her intake of fruit and vegetables and taking part in much more physical activity. She no longer suffers from dizziness, abdominal pain or feeling unwell and acknowledges the impact of the changes she has made: “Yes it’s a very big change. My health is now good.”
Malcah is confident she can maintain the changes she has made and her much improved health has meant she is now seeing much less of her GP and she now only goes to the surgery to get repeat prescriptions.
Case Study 9: Sylvia
49 year old female who wanted to lose weight
Sylvia heard about the Health Trainer service through her employer. She wanted to lose weight and went to her GP for a referral.
At her first session with her Health Trainer, Sylvia talked about what she ate and how much and agreed to keep a food diary which was then reviewed at each session. Her Health Trainer explained how Sylvia could eat less by reducing the size of her portions and the benefits of eating more fruit and vegetables.
Her Health trainer also suggested that Sylvia increased her physical activity by walking more and so she incorporated this into her routine: “I get the bus so far and walk the rest, the rest of the way. Like if I have got an appointment or something I’ll get the bus from Paddington Green and walk from there to Lisson Grove. That’s quite a bit of a walking, I just walk it and I enjoy it. Half bus, half walk.”
Sylvia still regularly sees other health care professionals such as her Psychiatrist, Care Manager, Employment Advisor, Support Worker and Community Nurse, but finds it difficult to talk to them about her health and weight and says she is more comfortable discussing these topics with a Health Trainer. Reflecting back on her experience, Sylvia recognised the changes she has made. She walks a lot more getting off the bus early. She understands what food and how much food to eat and believes she can maintain these changes in the future.
Case Study 10: Claudia
35 year old female wanted help with diet and exercise
Claudia is a 25 year old married woman with two young children, aged two and four. Originally from Bolivia, she contacted the Health service because she wanted some advice on diet and physical activity for herself and her family: “Although I try to do my best to prepare a lot of vegetables to give to my children I wanted to know what else could I do for them, for my husband and for me?”
During her first session Claudia and her Health Trainer reviewed what food she bought and how she cooked it. They soon discovered that though the food she was buying for herself and her family was healthy they identified that the amount Claudia was eating was a problem because she ate large portions; not because she was hungry but because she was anxious. Claudia recalls that during her first session she was: “Very stressed, very, very stressed and I can say a little bit depressed, I’m still a little depressed.”
Claudia explained to her Health Trainer how she always felt very tired after lunch: “I just want to go to bed with my children but I can’t because I have to clean the house, do many things at home.” To compensate for this tiredness Claudia would eat more. Her Health Trainer helped her review how much she ate and discussed how she could incorporate more physical activity in to her life, exploring the type of activities that Claudia enjoyed, and how to fit it in to her life to take into account her husband’s job, looking after her children and her studies at college. Her Health Trainer suggested: “I could go to swim with my baby and she showed me how to enjoy this with my children… and I went with my child once a week and it really helped. Every time I can go with my husband and my children it’s really nice, it’s just I need to do something for me.”
Claudia found the service helpful because it gave her confidence and she was reassured that she was eating healthy food, taking part in more physical activity and providing nutritious meals for her family: “It was always my concern how I was doing and my Health Trainer said you are doing well but you have to change this and this and I did it, so of course it helped a lot.”
Before I came to the health trainer service, I had experienced a great deal of upheaval, change and stress in my life over the past two or so years. I was struggling to come to terms with many things that had happened, including the sudden development of a large number of food allergies, weight gain, and mental health issues. The number of changes and adjustments that I had experienced and needed to make was overwhelming, and I felt out of control of my own life; every time I would try to improve and lay down a routine and plan for a healthy lifestyle, I would be unable to meet the routine continually and I would quit and give up.
When I attended my first session, I was unsure of what to expect. I had previously met with my GP repeatedly and had been referred, but I only knew that the service could meet the somewhat nebulous ‘lifestyle coaching’ description. I was surprised and pleased to be met with someone who was kind, non-judgemental and open to discussing what I wanted to get out of the sessions, letting me know what did and didn’t fall under their remit and exactly how they could help me. I completed some forms that would help establish my base from before regular sessions, to be compared with the results at the sign-off after the sessions were completed.
We were able to discuss the changes in my life, and the difficulty I was having in adjusting my lifestyle to be healthy and maintainable. By discussing this I was able to outline some concrete goals to work towards. Aiming to control my diet so I did not eat anything that made me ill; to figure out how best to fit exercise into my routine; and to find a way to practise self-care and help my mental health.
During the sessions, we were able to progress my goals by firstly working together to find easy to cook recipes that fit my needs (speed and ease of preparation). Figuring out how to incorporate a fitness routine into my schedule was also paramount; as a full-time student time is always at a premium. By being able to figure out what types of fitness worked for me and when, I have been better able to keep up a fitness regime. I also worked on including things such as meditation and being informed of how to access other resources to help with my mental wellbeing. Along with these things, I was able to discuss how my mind-set was stopping me from progressing. I came to realise that I would always seek perfection, when in reality change is about taking small steps and keeping going even when you do something a little bit wrong.
Overall, I feel that by going to the sessions, I was able to talk with someone friendly and open about my situation, and receive guidance that ultimately brought out my own ideas on how to improve my wellbeing and set me up with the tools to continue to improve.