Health Promotion: A Community Approach

1. Gerontology 820 Fall 2010 Annette Wertman Health Promotion:A Community Approach

2. Outline • What is a community-based Health Promotion approach • Examples: 1. Nigg – Pilot Study 2. CHAMPS 3. Osteofit • Benefits & Guidelines • Review of Theoretical Models • Conclusion and Discussion

3. Effectiveness? ...is not necessarily a measure of how many people attend the program, but rather the individual improvements of each...... “ people say I am standing up straighter!”

4. Community Strathcona

5. community a group of people living in a particular local area

6. What is a Community-Based Health Promotion Program? • Comprehensive, systematic, coordinated approach to affecting long-term health behaviour change by 1. influencing the community (cultural) norms 2. education and community organization • Targets the whole community • Requires action on many levels • Has many educational components • Aims at effective public participation • Promotes good health • Prevents and/or reduces the effects of ill health • Focuses on collective action

7. Pilot Study- Nigg, 2002 Stage based educational intervention along with an action base exercise program may meet the needs of older individuals a various stages of readiness to adopt and maintain exercise.

8. Pilot Study- Nigg, 2002 • Community-based physical intervention grounded in the TTM • Residents of an independent living complex • Intervention included posters and in-house exercise sessions • Overall impact of the intervention was positive (providing opportunity to exercise and/or motivating other physical activity)

9. Transtheoretical Model: Based on the premise that people move through a series of stages in their attempts to change behaviours. Successfully applied to numerous health behaviours; dieting, alcohol use, smoking cessation, sun protection & mammography screening Interventions of the basis of change: 5 stages • Precontemplation • Contemplation • Preparation • Action • Maintenance

10. Pilot Study- Nigg, 2002 cont’d • Method Participants (48)-resided at an independent living apartment complex for older adults located in the greater Providence , Rhode Island area. 78yrs. 90% female.98% white Procedure-announcements were distributed to all residents soliciting their participation. Weekly blood pressure clinics began prior to pretest and continued throughout to familiarize the residents with the researchers. A group session describing the benefits was used,an informed consent was required and participants were interviewed before and following the implementation of the exercise intervention.

11. Pilot Study- Nigg, 2002 cont’d Intervention: Inactive Stages-posters with take-home pamphlets were placed in high traffic areas targeting those in the inactive stages (first 3). Pamphlets provided information on the benefits of exercise, how to begin an exercise routine, using one panel for each of the 3 stages. 100+ pamphlets were taken . Active stages-an in-house exercise program was offered consisting of 45 minutes of group exercise conducted twice a week by a certified exercise therapist.ROM, aerobics, lower extremity strengthening and coordination and balance exercises increased if difficulty over the 7 month program

12. Pilot Study- Nigg, 2002 cont’d Intruments: The interview assessed participants demography, nutritional risk and individual physical and social factors. (DETERMINE checklist –Nutrition Screening Initiative; SF-36 Health Survey; TTM exercise stage) • Results 14 of the 48 attended regularly, 5 only some of the sessions. There was no significant difference between those attending and those not attending the exercise program on any of the measures.

13. Results: Nigg, 2002 cont’d Stage Change – (nx. Slide figure 2) 37 participants in the active stage (action and maintenance) at pretest, 32 (86%) remained. 5 (14%) participants in the active stages relapsed to the inactive stages (precontemplation, contemplation and preparation). 9/11 (82%) participants in the inactive stages moved to the active stages. Pre-and Postintervention Differences -3 catergories: maintainers, progressors, relapsers.No significant difference on any health measure before and after the intervention for the sample as a whole. Maintainers had significantly better health perception scores at pretest and post test.

14. Change in Stage

15. Results: Nigg, 2002 cont’d Health Measures Related to Stage Change – for the sample as a whole more participants had improved scores that declining scores on 3/5 measures. Bt stage group, maintainers showed more improved scores than declining scores on 3 measures, progressors on 3 measures and relapsers on only 1 measure.

16. Change in Health Measures

17. Results: Nigg, 2002 cont’d • Discussion The implementation of this exercise intervention in an elderly housing site appears to increase or keep residents exercising in general, regardless of whether they actually attend the offered in-house exercise sessions. Overall impact of the intervention was positive; providing opportunity, motivating others to increase or continue. Contributions to motivation; visibility of the program (located in the community room) educational materials provided, group sessions describing benefits of exercise and the weekly blood pressure clinic staff.

18. Results: Nigg, 2002 cont’d • Effect Of the exercise intervention on other health measures underlines the potential efficacy of the intervention Maintainers reported highest general health perception score (mental health, bodily pain, nutrition risk) Maintainers & progressors had more improved than declining scores on 2 and 3 measures Results point to the potential quality-of-life impact an exercise intervention can have among the elderly

19. Nigg, 2002 cont’d • Guidelines-practical implications Establishing a presence to familiarize participants to encourage participation and build trust Targeting resources on those identified as not exercising regularly may provide the greatest impact Providing motivators to keep maintainers exercising regularly may decrease the high relapse rate (commonly seen in this population)

20. Nigg, 2002 cont’d • Limitations Small sample size Lack of control group Including a more culturally diverse sample • Future research More rigorous replication of this pilot project using a fully randomized experimental design by individual or by site would clarify the relationship found.

21. Community Healthy Activities Model Program for Seniors (CHAMPS) • An inclusive, choice-based physical activity promotion program to increase lifetime physical activity level of seniors. • CHAMPS guided participants to chooseactivities that took into account their health, preferences and abilities. • Type, frequency, format, intensity and location vased on participant’s needs. • Offered information on ways for them to exercise safely, motivate themselves, overcome barriers and develop a balanced exercise regimen. • This individually tailored program, uses behavioural change strategies, to encourage lifestyle , effective and applicable to health care and diverse community settings.

22. Osteofit Trademark program, format & curriculum provided by BC Women’s hospital & Health Centre. A safe, effective and medically endorsed program recognized for its innovative program design. Can easily be implemented in community settings.

23. Women stay 'Osteofit' over break • Not content to put her Osteofit exercise routine on hold for the summer, Ladner resident Myra Kuriyama stepped up and did something about it. •  Other local women felt the same way. •  Over the past 10 weeks, a half a dozen or so participants have been coming to a drop-in workout session each Wednesday at Kuriyama's 44A Avenue home. "The reason why I wanted to form this drop-in was just to continue to meet with other women and exercise because we experienced so much fun.”

24. Osteofit continued: • Classes are offered in many local community recreation facilities and seniors centers throughout BC. • Safe, effective and medically endorsed program is recognized for its innovative program design and leader in falls prevention. • One of the goals of the Osteofit program is to prevent falls. • Exercise can modify some fall risk factors and thus reduce falls in older adults. • A physically active lifestyle is associated with a reduced risk of osteoporotic fracture.

25. Osteoporosis ‘the silent thief’ • A condition of decreased bone strength such that fractures occur with minimal trauma • Osteoporosis and osteoporotic fractures are a major public health concern (1/4 women, 1/6 men > 50) • Economic cost and debilitating effect on independence and quality of life • Causes: less active life style, poor nutrition

26. Benefits of Community Approach • Visibility of the programs • Education materials provided (exercise, nutrition, fall prevention) • Reaching out to individuals • Group sessions motivate & support individuals • Support ‘aging-in-place’ • Socialization • Stimulation – physical, mental, emotional, spiritual • Can be tailored to individual need • Strength in numbers re reporting environmental hazzards

27. Guidelines • Choose appropriate name (Active Independence was chosen by seniors in Alberta instead of HSEP) • Include perspectives and input form participants for everything • Individualize exercises • Start with small steps but progress • Provide challenge • Establish a presence – encourages participation and builds trust • Present materials and programs to all individuals (TTM)

28. Review of Theoretical Models • Health belief Model • Ecological Models • Social Ecological Theory • Transtheorectical Model • Theory of Reasoned Action • Theory of Planned Behaviour • Integrated Behaviour Model

29. Key Words motivation participation opportunity exercise behaviour exercise maintenance building trust benefits targeted to individuals efficacy preventive community room coordination group sessions cultural norms educational materials socialization health perception score senior centres strategies community centres

30. Community Together is amazing

31. Discussion • Wide spread recognition within public health that proven programs must be translated, implemented and adopted to have widespread effect ( including diverse community settings) • Low cost & little equipment is good • Measurement for long-term program sustainability is needed • Conducting cost-benefit, cost-utility or cost-effectiveness analyses (improve health while reducing health care costs.

32. The End Ritual is the backbone of any community...creating security, warmth and a sense of community.