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Evidence-Based Health Promotion

Evidence-Based Health Promotion . MGS Conference – April 2009 Kate Houston, Metro Area Agency on Aging Debbie Hanka, UCare. Overview of Presentation. Context – Older Adult health concerns in MN WHAT is evidence-based health promotion? WHY evidence-based health promotion?

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Evidence-Based Health Promotion

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  1. Evidence-Based Health Promotion MGS Conference – April 2009 Kate Houston, Metro Area Agency on Aging Debbie Hanka, UCare

  2. Overview of Presentation • Context – Older Adult health concerns in MN • WHAT is evidence-based health promotion? • WHY evidence-based health promotion? • Examples of evidence based programs and Local implementation experience • State resources for assisting local agencies

  3. Chronic Disease in MN • Chronic diseases are the primary driver of health care costs. They account for more than 75% of total annual health care costs in the U.S. • 80% of those over 65 years have 1 or more chronic condition, 65% have multiple chronic conditions

  4. Chronic Disease in Minnesotans 65 yrs + • Age related macular degeneration - Approx. 25% (nationally) • Alzheimer's Disease - 13% (nationally) • Arthritis - 53% • Diabetes - 13 % • Heart Disease – 6+% • Stroke - 3% • Osteoporosis – 14.4%

  5. What is Evidence-Based Health Promotion? A process of planning, implementing, and evaluating programs adapted from tested models or interventions in order to address health issues at an individual level and at a community level Source: Altpeter, M., Schneider, E., Bryant, L. Beattie, B., & Whitelaw, N. (2004).Using the evidence base to promote healthy aging. National Council on the Aging Evidence-based Health Promotion Series, Vol. 1. Washington, DC: National Council on the Aging.

  6. What is an evidence-based program ? • An evidence-based program has been demonstrated to be effective in basic research that involved the same target audience • It has also been demonstrated to be effective in dissemination in the “real world.” • There are clear protocols for training and conduct of the program so that community programs can maintain fidelity and be successful.

  7. What do we mean by “fidelity”? • The core elements of the program are delivered the same way in each class or session • Fidelity ensures the same participant outcomes that the research proved can be obtained. • Each program will specify what are the core elements, and what can be modified. • Some programs require certified training and/or licenses to help ensure fidelity

  8. Improved quality of life Increased/maintained mobility Increased/maintained independence Decreased pain Reduced disability Later onset Fewer years of disability prior to death Fewer falls Improved mental health Positive effect on depressive symptoms Possible delays in loss of cognitive function Lower health care costs Decreased hospital and ED visits Possibly decreased med costs EBHP Programs have demonstrated outcomes

  9. Benefits of an Evidence-Based Approach • Increases the likelihood of positive participant outcomes • Safety is built in • Ready made package – no development costs • Makes it easier to justify funding • Helps to establish partnerships –esp. with health care • Leads to efficient use of community resources • Supports the use of common performance measures • Supports continuous quality improvement

  10. Challenges to Implementation of an Evidence-Based Approach • Feels like standardization • Sometimes difficult to build community support – everyone wants home grown • Tools and processes are unfamiliar • Requires partnerships - some communities may not have partners that can help • Start-up costs, training, monitoring and on-going evaluation require resources • Research target audience may not match yours

  11. Chronic Disease Self Management • Research project conducted by Stanford to develop and evaluate a community based self-management program to assist people with chronic illness. • 1000 people participated in RTC and were followed for 3 years.

  12. CDSMP - Outcomes • Fewer hospital stays and trend toward fewer outpatient visits and hospitalizations • 6-month improvements in exercise, cognitive symptom management, communication with physicians, self-rated health, disability, social and role activities limitations, energy/fatigue • Many results persist for 3 years

  13. CDSMP– Program Description • “Living Well with Chronic Conditions” resource book provided • Peer led small groups (10-15 participants) • Meet for 6 weeks, 2.5 hours each session • People with different chronic health problems attend together • Workshops are facilitated by two trained leaders. Topics addressed include pain management, exercise, medications, communication and nutrition

  14. CDSMP Training – Fidelity - License • Attend four day leader training • Fidelity maintained by following curriculum, follow-up with Master Trainer • Core components include co-leading class • Do not add, delete or change content or process • Do not bring in outside speakers • Follow agenda for each session • Able to paraphrase lecturette and include personal anecdotes where indicated • Licensed by Stanford

  15. CDSMP IMPLEMENTATION • License • Coordinator • Schedule workshop • Secure site • 2 trained leaders • Recruit participants • Marketing to community • Materials, books, snacks, etc.

  16. EnhanceFitness® Beginnings • 1994 Randomized Clinical Trial – University of Washington Health Promotion Research Center, Group Health Cooperative, Senior Services (published in 1998)¹ • Class held 3 times/week, 1 hour sessions • Originally developed to transition participants from class to doing exercises at home

  17. The Results • Participants improved significantly in: • 35% improvement in physical functioning • 13% improvement in social functioning • 52% improvement in depression¹

  18. On-going evaluation • Cost analysis showed EnhanceFitness participants’ healthcare costs were 21% less than those of non-participants’ cost after one year.² • Participants in ethnic community sites although less physically fit to start with when compared to majority-white communities, showed greater improvement after 4 months than those in majority-white sites.³

  19. EF Training – Fidelity - License • Instructors must become EnhanceFitness certified • Fidelity maintained through observation by and contact with local Master Trainer • Core components of class include specific strength, flexibility and balance exercises • Aerobic section of class may be modified in content (time must not be modified) • Licensed by ProjectEnhance • Master License • Site License

  20. EF IMPLEMENTATION • License • Coordinator • Schedule workshop • Secure site • Trained instructors • Recruit participants • Marketing to community • Weights, cart, stop watch, etc.

  21. Components of a EF Class • Classes meet 2-3 times per week for 60 minutes • Each class includes: • 5-8 minutes of Warm-up • 20 minutes Cardiovascular activity • 3-5 minutes of Cool-down • 20 minutes of Strength Training • 8-10 minutes of Stretching

  22. Fitness Checks • Pre and Post fitness checks • Timed Sit to Stand • 8 foot timed up and go • Bicep curl • From Rikli-Jones Functional Fitness Test

  23. EnhanceFitness at UCare • EnhanceFitness selected based on: • Need for a group exercise option. • Evidence- based approach with proven results. • High quality instructors and training. • Offered as part of the multi-faceted UCan! UCare Activity Network including health club dues reduction and Do-It-Yourself Kit • Classes are available in about 35 sites in a 16 county UCare for Seniors service area.

  24. EnhanceFitness – Metro AOA Demonstration 2007-2010 • Three current sites – 4 to 5 will be added in 2009 • Partnership with UCARE, Senior Community Services, Wilder Services to the Elderly • Sustainability – financial, fidelity, licensing , trained instructor pool • Fit within statewide Falls Prevention strategies

  25. Participant Outcomes in MN

  26. Testimonials • “I feel the class has helped me tremendously. I was experiencing shortness of breath and with these classes I began taking deeper breaths and noticed a big improvement. On a very busy strenuous trip, I was able to keep up with the younger people.” • “I really found out I needed this class as I was really bad at coordination. I liked how she made sure we did the weight lifting correctly.”

  27. HOW do I decide to implement evidence-based health promotion?

  28. Are You Ready to Implement Evidence-Based Health Promotion Programs? • National Council on Aging Organizational Readiness Checklist • Agency/partnership is willing to do evidence-based health programs and stay true to the model being implemented • There is funding for the program • There is access both to personnel with the expertise to do these programs and to the population that needs these programs • there is buy-in from leadership

  29. How Can You Shift Your Current Programming to Evidence-Based? • Can you substitute an evidence-based program for your current program? • Check if the evidence-based program components match your needs: • Target population: age, gender, race/ethnicity, health status • Setting: in-home or group • Class leader: personnel with needed qualifications • Matches desired health topic and outcomes

  30. You Don’t Have to Do It Yourself: Partner With Other Organizations • Everyone has a role and something to offer: • Referral to program or between programs • Program site, refreshments, class materials • Staff or volunteers to be trained as class leaders • Participant recruitment/outreach efforts through existing communications to older adults • Data collection/analysis capacity

  31. Where do I find Evidence-Based Programs? • Administration on Aging www.aoa.gov • National Council on Aging www.healthyagingprograms.org, • CDC Arthritis Program endorsed programs www.cdc.gov/arthritis/ • Arthritis Foundation Exercise and Warm Water Exercise Programs, Self-Management Program • EnhanceFitness • Chronic Disease Self-Management Program • Active Living Every Day

  32. Where do I find Evidence-Based Programs? • Other “Stanford Model” programs http://patienteducation.stanford.edu/ • The Community Guide to Preventive Services www.thecommunityguide.org • Cancer Control Planet http://cancercontrolplanet.cancer.org • www.health.state.mn.us search on “arthritis” choose Minnesota Arthritis Program • Look under news and events for current training schedule • Coming – training schedules and registration info for other programs

  33. Currently available Arthritis Foundation Exercise Program Arthritis Foundation Warm Water Exercise Program Arthritis Foundation Self-Management Program* Early implementation – will be expanded EnhanceFitness Senior Exercise Program CDSMP – Chronic Disease Self Management Program * Coming Matter of Balance * Healthy Eating for Successful Living in Older Adults * Eat Better and Move More (modified) Evidence-based Interventions in MN –Statewide Dissemenation * ”Stanford Model” program or based on the Stanford Model in design

  34. Kari Benson Minnesota Board on Aging kari.benson@state.mn.us Kate Houston Metro Area Agency on Aging Kate@tcaging.org Pam Van Zyl York Minnesota Department of Health, Division of Health Promotion and Chronic Disease pam.york@health.state.mn.us Debbie Hanka UCare dhanka@ucare.org Contact Information

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