Relationship and trust as a vehicle to improved health outcomes: A qualitative study of a Primary Health Care Programme for Travellers

Rapid changes in the control of health and social services have led to the increased adoption of narrow practice approaches driven by contemporary funding priorities, often running contrary to the wisdom, accumulated knowledge, experience, evidence and ethics of social and community development approaches. The Primary Healthcare Programme (PHCP) for Travellers has been developed nationally over the past two decades with the aim of improving the health of the Irish Traveller community. A particular emphasis has been placed upon the provision of health promotion, information, support and outreach through a range of peer delivered community based approaches. This study took place within one such PHCP for Travellers in County Offaly which found itself under increasing pressure from funders to prioritise nationally driven programmes over locally driven community-responsive work. Specifically, questioning the value of more supportive, relational interventions such as emotional support whilst encouraging the delivery of interventions which produced statistical information aligned to national health operational plan targets, which the funding officers were in turn under pressure to provide to national offices. This study aimed to explore the value of emotional support, relationship building and trust building in relation to the provision of this Primary Healthcare Programme for Travellers, from the perspective of the community members engaging with the programme. The study reflected the value of emotionally supportive relationships expressed by service users and the importance placed upon the subsequent building of trust. Multiple occurrences of positive shifts in health related behaviours, significant benefits to the mental health of respondents and uptake of appropriate support services are reported and discussed. The study suggests that the increased pressure being placed upon social and community practice by management control mechanisms introduced by funding bodies is rapidly eroding the hard earned experience and knowledge accumulated through decades of social and community work. A particularly negative impact upon marginalised groups such as the Traveller community who experience a complexity of health needs is found. Recommendations include a re-investment in relationship and trust building, and in flexible, responsive, community driven responses to achieving national health priorities within marginalised communities.