Community Health Worker Service: addressing the needs of Gypsy/Travellers in Scotland

Abstract Background Members of the Gypsy/Traveller community in the United Kingdom face significant health inequalities compared to the general population, including lower life expectancy, higher rates of morbidity and suicide and poorer infant and child outcomes. This study evaluated the implementation of community-based lay workers in Scotland - the Gypsy/Traveller Community Health Worker (CHW) service. Methods This multi-method qualitative study (December 2021 to August 2023) included 16 individual interviews, five focus groups, one workshop, two informal discussions, and one site visit. Participants were stakeholders, CHWs, and members of the Gypsy/Traveller community. Additionally, 116 documents were analysed. The framework method, Proctor’s implementation outcomes and thematic analysis were used for data analysis. Results CHWs reached approximately 1,000 individuals across six National Health Services (NHS) Boards. The implementation outcomes showed that the intervention was accepted and feasible. A third-sector organization (Black and Minority Ethnic Carers of People Project - MECOPP), played a crucial role in successfully delivering the CHW service. This innovative intervention employed members of the Gypsy/Traveller community as lay healthcare workers to break down barriers to accessing healthcare and other services (e.g., uptake of cervical screening, vaccination, housing, and sanitation). The CHWs were trusted, ensured healthcare information was culturally appropriate and successfully addressed discriminatory behaviours in health and social care. Limited resources pose challenges to the sustainability of the service. Conclusions The Gypsy/Traveller CHW service enhanced prevention, acted as a bridge between communities and health systems and addressed the wider determinants of health. The Gypsy/Traveller community still faces discriminatory, racist, and stigmatising behaviours, which further impede the quality, delivery, and accessibility of care. Key messages • The Community Health Worker service was acceptable and feasible in the Gypsy/Traveller community, acting as a bridge between community and health systems and increasing access to services. • Community Health Worker Service is an important strategy for delivering healthcare support through their sector organizations to address historical discrimination against minority ethnic groups.