Table 2.

Summary of the Changes in the Characteristics of the 6 Case Studies at Start-up and Then at Follow-up

Case Study Service	Time Perioda	Provider/s	Funding	Senior Buy-in?b	Primary Referral Source/s	Health Trainers	Geographical/Population Service Targeting?	Formal PMc System Established?	Health Trainer / Service User Interaction
A Established in early 2007 to serve a large town	Start-up	Multiple TSOs	PCT	Yes	Self/communityd	“Person next door”	Locally defined deprived areas	No	1-2-1 behavior changee
	Follow-up	Single TSO	PCT	Senior champion left PCT	CVD risk assessment; smoking cessation; self/communityd	“Person next door”	Locally defined deprived areas	Yes	1-2-1 behavior changee; CVD risk assessment “contact”
B Citywide service starting in early 2006	Start-up	Single TSO	PCT	Yes	Self/communityd	“Person next door”	Yes	No	1-2-1 behavior changee
	Follow-up	2 TSOs (1 lead organization)	PCT	Yes	GP referral (prioritized); self/communityd	Some preference for more work-ready HTs	No	Yes	1-2-1 behavior changee (early PHP setting prioritized)
C Serving mixed urban/rural area from late 2006	Start-up	PCT and 2 TSOs	Local “nonhealth” public-sector project and regeneration funding	Yes	Via local public-sector project; self/communityd	“Person next door”	Locally defined deprived areas	No	1-2-1 behavior changee
	Follow-up	PCT and 2 TSOs	PCT	Yes	Self/communityd	“Person next door”	Locally defined deprived areas	Yes	1-2-1 behavior changee (early PHP setting prioritized)
D City-based service beginning in early 2007	Start-up	Multiple TSOs	PCT	No	Self/communityd	“Person next door”	Resident of 20% most deprived local area	No	1-2-1 behavior changee
	Follow-up	Single external provider	PCT	No	GP referrals	Mix of original health trainers and re-badged external provider staff	Universal	Yes	Telephone-based assessment and referral
E Serving a large town from early 2006	Start-up	PCT	PCT	Yes	Self/communityd	“Person next door”	Locally defined deprived areas	Yes	1-2-1 behavior changee
	Follow-up	PCT	PCT	Yes	Social marketing of and integration with weight management care pathway; GP referrals	Some preference for more work-ready HTs	Universal	Yes	Entry point for local weight management service / 1-2-1 behavior changee
F Mixed urban/rural area where service was not commissionedf	Start-up	N/A	N/A	Nof	Intended GP-focused	Re-badged/trained primary care staff	Unclear	N/A	1-2-1 behavior changee
	Follow-up	—	—	—	—	—	—	—	—

^aStart-up: time point for service establishment; follow-up: last follow-up of case study by research staff.

^bInterviewees indicated that senior managers and/or PCT board members explicitly backed the HTS policy and local service.

^cPM = performance management.

^dThrough health events, work with community health development workers, and other HT-led demand generation (eg, drop-in work, group activities, GP engagement). Please note, all services have been open to referrals from NHS professionals from inception, without explicitly targeting this source of demand.

^eClient led. Although health trainers are supposed to facilitate health-related lifestyle change (diet, smoking, exercise, alcohol), some services have expressly acknowledged that goals relating to broader social determinants of health may need to be addressed.

^fIntended delivery in proposed service.