Provider Perspectives
What makes a successful volunteer Expert Patients Programme tutor? Factors predicting satisfaction, productivity and intention to continue tutoring of a new public health workforce in the United Kingdom

https://doi.org/10.1016/j.pec.2008.09.024Get rights and content

Abstract

Objectives

Better management of chronic conditions is a challenge for public health policy. The Expert Patients Programme was introduced into the United Kingdom to improve self-care in people with long-term conditions. To deliver self-care courses, the programme relies on the recruitment and continued commitment to delivering the courses of volunteer lay tutors who have long-term conditions. Ensuring the tutor workforce is productive, satisfied in their role and retained long-term is central to the viability of the programme. This exploratory study aimed to determine what factors predict productivity, intention to continue tutoring, and satisfaction in a sample of volunteer tutors from the Expert Patients Programme.

Methods

A cross-sectional survey of 895 tutors was carried out and 518 (58%) responded. The questionnaire was designed to describe the characteristics, productivity, intention to continue tutoring, and satisfaction of tutors. Multiple linear regression analyses were used to examine the determinants of productivity, intention to continue tutoring, and satisfaction, such as patient demographics, attitudes, physical and mental health, mastery and self-esteem.

Results

Attitudes relating to personal goals, and better health were significant predictors of satisfaction with the tutor role. Only a small proportion of the variance in productivity was accounted for, and tutors were more likely to be productive when they were single, homeowners, car owners, and had lower scores on the depression scale. Overall satisfaction and personal goals were predictors of intention to continue tutoring.

Conclusion

Demographic factors, health measures and attitudes each predicted different aspects of the experience of work conducted by the volunteer tutors. The results should prove useful for planning interventions to enhance the success of this new workforce initiative.

Practice implications

Attempts to increase participation in courses by people from deprived backgrounds are likely to be enhanced if tutors come from similar backgrounds. This study demonstrated that material advantage and attitudes that value personal goals were predictors of satisfaction and productivity in the tutor role. Specific incentives and strategies may be required to recruit and support tutors from more marginalised groups in order to ensure equitable access to effective self-care support for all.

Introduction

The challenges associated with management of long-term conditions has led to the promotion of new health service configurations [1] and a new focus for public health policy and practice. Care for patients with long-term conditions in the United Kingdom [2] is based around three tiers: case management for patients with complex management problems; disease management for patients at some risk who will be supported by specific chronic disease management programmes in primary care; and self-care support for 70–80% of people with long-term conditions to improve their self-care skills.

Establishing effective self-care support for long-term conditions is a complex task. A key intervention in the United Kingdom is the Expert Patients Programme, which provides patients with a self-care support course based on the Stanford Chronic Disease Self-Management Programme [3]. This course consists of six 2-h sessions and aims to improve self-efficacy [4], [5] and enable more effective self-care through the development of problem-solving skills and the ability to exchange ideas in a group. The course is open to anyone with a self-defined long-term condition and is not disease specific [3].

EPP aspires to extend beyond a focus on the individual to include the participation of wider community and organized health care systems [6], [7], and can be viewed alongside other contemporary public health initiatives designed to reduce inequalities (e.g. HAZ policies, urban regeneration, and social inclusion). The broad programme of self-care support is being rolled out via the new primary care organizations which are more suited to implementing population-based initiatives than traditional health service providers (such as secondary care or general practice).

EPP self-care courses were originally run by trainers employed by the Department of Health but the sustainability of the programme rests on a ‘cascade’ model of developing a volunteer workforce, which requires the recruitment of a significant number of lay tutors to deliver the courses. Lay tutors are volunteers, generally recruited after they have completed an EPP course as a participant, who (after training) deliver courses themselves. They are unpaid and recruited on the basis of their personal experience of living with a long-term condition.

The idea of a volunteer workforce is closely aligned with the public health goal of generating social capital through civic participation [8]. Additionally, recruitment of tutors from a range of backgrounds, and in particular those representing ethnic minority groups and those living in deprived areas, has been an ambition of recruitment strategies [9].

Meeting the demand for self-care support requires the tutor workforce to be both productive (in terms of running courses) and stable (in terms of long-term intention to continue tutoring in the tutor role). Managing recruitment and maintaining the commitment of tutors to continue delivering courses requires an understanding of the factors that motivate volunteers. While past research has explored aspects of the specialist public health workforce [10], [11], this is the first exploratory study of this new volunteer public health workforce.

The literature on the determinants of volunteering has examined socio-demographic characteristics, motivations, attitudes and values. Studies have indicated that the type of person most likely to volunteer is a middle-aged, middle class, married woman with more than high school education and with dependent school-age children [12], [13]. Studies that compare volunteers and non-volunteers report mixed findings [14] with patterns by gender, race, or age unclear [15]. Higher education, income and being married predict an increased participation in volunteer organisations [14], [16]. Five models of determinants of volunteering have been identified [17].

  • (a)

    The ‘volunteer motivations’ model emphasizes individuals’ goals in terms of volunteering, such as learning new skills, enhancing self-esteem, or preparing for a career [18], [19], [20].

  • (b)

    The ‘values and attitudes’ model links volunteering with beliefs about the importance of charitable responsibility and civic participation which have been shown to positively influence volunteering [19], [21]. This is the model most aligned to the notion of social capital and civic participation.

  • (c)

    The ‘role-identity’ model hypothesises that past volunteering leads to the development of “volunteer role-identity” which in turn motivates future volunteer activity [22], [23], [24], [25].

  • (d)

    The ‘volunteer personality’ model suggests that pro-social personality traits such as “other-oriented empathy” and “helpfulness” are related to volunteering [24], [26].

  • (e)

    The ‘personal well-being model’ [17] suggests that an individual is more likely to volunteer when they are in good physical and mental health and have certain personal resources (confidence, control and self-worth).

This study sought to survey the current EPP volunteer tutor workforce in order to:

  • (a)

    describe the characteristics, productivity, intention to continue tutoring and satisfaction of tutors;

  • (b)

    test the different models of volunteering as predictors of the ‘success’ of volunteer tutors, defined in terms of satisfaction, productivity and intention to continue tutoring.

The results have implications for supporting and extending volunteering as a new type of public health workforce within the EPP and the wider NHS.

Section snippets

Design

The study used a cross-sectional postal survey design to test the relationships between (a) determinants of volunteering and (b) measures of volunteer productivity, intention to continue tutoring and satisfaction.

Survey response

In the postal survey, 938 questionnaires were sent in the first wave and 43 were later excluded from the study (duplicates, deceased or returned unknown). The total remaining was 895 and after a further two questionnaires were sent 518 tutors (58%) responded. The demographic characteristics of the included sample are shown in Table 1. Table 2 presents a comparison of selected demographic and socio-economic characteristics of the tutors who participated in this survey with 5000 participants in

Limitations of the study

The response rate to the survey was moderate and therefore any conclusions must be tentative. The tutors who responded to the survey may, for example, be more satisfied than non-responders, more likely to be running courses and to report intending to remain as a tutor. There was no information on non-responders beyond their name and address and so any analysis of factors determining response is impossible. The cross-sectional design used in this study cannot make statements about cause.

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