Evaluation of the impact of Self Management courses within Tower Hamlets Ellena Badrick and Dr Sharmin Shajahan

1. Evaluation of the impact of Self Management courses within Tower Hamlets Ellena Badrick and Dr Sharmin Shajahan

2. The Health Equity ProjectEast LondonProject Team: E. Badrick, K. Boomla, S. Hull, R Mathur, J. Robson S. Shajahan.And: members of the Clinical Effectiveness GroupCentre for Health Sciences, QMUL  TH and east London, in the top 5 most socially deprived boroughs in London Hence the value of doing the project in this area TH and east London, in the top 5 most socially deprived boroughs in London Hence the value of doing the project in this area

3. Identifying the self-management menu Step 1 in the process was to map the SMG in the area We worked with SAFH who provide EPP and Health Moves in East London Healthy moves is a hybrid between an exercise program and EPP – it was developed in response to the population – recently changed its name to good moves so apologise now if I jump between the two names Step 1 in the process was to map the SMG in the area We worked with SAFH who provide EPP and Health Moves in East London Healthy moves is a hybrid between an exercise program and EPP – it was developed in response to the population – recently changed its name to good moves so apologise now if I jump between the two names

4. What we achieved General Practices GP knowledge and referral survey Improvements to the referral pathway and forms Computer Prompts for referral Helped SAFH build a case for further funding Some very successful parts, however……… Lack of GP referrals despite linking practices with service providers GPs wanted a single referral form, unable to provide superseded by other initiatives in the PCTHelped SAFH build a case for further funding Some very successful parts, however……… Lack of GP referrals despite linking practices with service providers GPs wanted a single referral form, unable to provide superseded by other initiatives in the PCT

5. Referral options to SMG groupsReferral options to SMG groups

6. Questionnaires: 38% of practitioners replied (174GP’s, 79PN, 12NP) responses from 31/38 practicesQuestionnaires: 38% of practitioners replied (174GP’s, 79PN, 12NP) responses from 31/38 practices

7. 88% of responders had knowledge of EPP 56% had not referred any patients to EPP 52% of people were not familiar with the referral process 88% of responders had knowledge of EPP 56% had not referred any patients to EPP 52% of people were not familiar with the referral process

8. Feedback from GPs Theme analysis suggests a need for a standardised referral process & more advertising There was a suggestion that practitioners felt disease specific courses were more beneficial for there patientsTheme analysis suggests a need for a standardised referral process & more advertising There was a suggestion that practitioners felt disease specific courses were more beneficial for there patients

9. A rare illustration of Bengali women enjoying first steps into exercise classes 2 parts to our evaluation 1. evaluate a locally developed course 2. compare this course with an EPP running in the areaA rare illustration of Bengali women enjoying first steps into exercise classes 2 parts to our evaluation 1. evaluate a locally developed course 2. compare this course with an EPP running in the area

10. Evaluation of Healthy Moves courses using the SF-36 instrument SF – 36 is a 36-item composing 8 scales assessing aspects of a participants physical and menalt health. It can be summarised into two main companets the PCS and MCS. (35/284 missing pre course SF36 data and 83/284 missing post SF36 data) SF – 36 is a 36-item composing 8 scales assessing aspects of a participants physical and menalt health. It can be summarised into two main companets the PCS and MCS. (35/284 missing pre course SF36 data and 83/284 missing post SF36 data)

11. Mean improvement in SF-36 scores for Healthy moves course compared to Expert Patient programme Went on to compare a larger dataset with the EPP course, 292/473 complete data All participants attending the Good Moves and Self Management course are shown to increase their physical and mental summary components of the SF36; however, the size of improvement is different. Caution must be taken when interpreting the result as good moves participants were younger and less likely to have chronic conditions.Went on to compare a larger dataset with the EPP course, 292/473 complete data All participants attending the Good Moves and Self Management course are shown to increase their physical and mental summary components of the SF36; however, the size of improvement is different. Caution must be taken when interpreting the result as good moves participants were younger and less likely to have chronic conditions.

12. Conclusions

13. Evaluation of the impact of Self Management courses within Tower Hamlets Ellena Badrick and Dr Sharmin Shajahan

14. Qualitative study : Attendance at Self-management and Good Moves courses Dr. Sharmin Shajahan - Programme Manager Acknowledgement:Social Action For Health Researchers - data collection, translating and transcribing

15. Aim: Explore experiences of attendees and non-attendees of Self-Management and Good Moves courses Objectives: Why do people attend and continue? How did they find it? What could be improved? Why people declined or dropped out? Could anything be done differently to encourage attendance? Methods: Purposive sampling 20 in-depth face-to-face interviews: participants 10 telephone short interviews: non – attendees Thematic data analyses We already knew about health professional’s perspectives about self-management programmes and explored different ways of referrals and it all resonates with the survey findings that 88% of the survey respondents was aware of the self-management courses but 52 were not aware of the referrals process to the generic courses. So now we wanted patient perspectives of attending self-management programmes. Rationale for this study: Our partners were really interested in knowing why people attend and continue to attend and why people don’t attend and decline to attend. We used qualitative methodology to explore people’s perspectives. So the two groups of people are attendees and non-attendees People who attended we wanted to know: (1) why they did so and (2) how did they find it and (3) what could be improved? People who were invited and didn’t attend we wanted to know: (1) why did they decline or drop out and (2) what could be done differently to encourage attendance? We already knew about health professional’s perspectives about self-management programmes and explored different ways of referrals and it all resonates with the survey findings that 88% of the survey respondents was aware of the self-management courses but 52 were not aware of the referrals process to the generic courses. So now we wanted patient perspectives of attending self-management programmes. Rationale for this study: Our partners were really interested in knowing why people attend and continue to attend and why people don’t attend and decline to attend. We used qualitative methodology to explore people’s perspectives. So the two groups of people are attendees and non-attendees People who attended we wanted to know: (1) why they did so and (2) how did they find it and (3) what could be improved? People who were invited and didn’t attend we wanted to know: (1) why did they decline or drop out and (2) what could be done differently to encourage attendance?

16. PERSPECTIVES OF ATTENDEES  People felt encouraged by the family friends, GPs and then a phone call from the course provider, their friendly approach was appropriately engaging that motivated people to attend. People’s expectation was also to learn new skills and gain new knowledge to self-manage their condition better, so the intention behind attending was to look after themselves in the long-run. So a combinations of factors, initial encouragement triggered motivation and they had expectation that they would benefit by attending the course and also they were confident to attend and continue the course. People felt encouraged by the family friends, GPs and then a phone call from the course provider, their friendly approach was appropriately engaging that motivated people to attend. People’s expectation was also to learn new skills and gain new knowledge to self-manage their condition better, so the intention behind attending was to look after themselves in the long-run. So a combinations of factors, initial encouragement triggered motivation and they had expectation that they would benefit by attending the course and also they were confident to attend and continue the course.

17. Interview 0016 (male): … usually I go from here to there. No, I don’t stay inside, I go to the mosque everyday, perform my Johor prayer, recite holly Quran and after finishing Asor prayer, I come back. I go to East London mosque. Interview 0001 (female): You know, I have diabetes. Already I got diabetes. So I have to survive from it. They informed things. I felt happy PERSPECTIVES OF ATTENDEES   The confidence people gained after attending courses was that they applied little things like walking as part of their daily routine to be healthy. The confidence people gained after attending courses was that they applied little things like walking as part of their daily routine to be healthy.

18. Perceived benefits of attendees Perceived benefits: Most people who continued to attend and completed the course was because people felt happy and their basic expectation from the course was met and they gained confidence to apply what was learnt in their daily life, for example, learning about healthy cooking and portion sizes. Changes in all of our lives takes time and sustaining a change to be healthy is even harder without right support and motivation. So in order to keep up the motivation of attendees, refresher courses need to be considered. Attendees informed others about being healthy but some of them also have other pressing issues like housing, social services and most people had multiple illnesses, so that’s again an important issue to be aware that in our lives we have multiple priorities and often we overlook our health needs when other social and financial needs are pressing, so its important to acknowledge why people cant attend or drop out because they have deals with other priorities in life. Perceived benefits: Most people who continued to attend and completed the course was because people felt happy and their basic expectation from the course was met and they gained confidence to apply what was learnt in their daily life, for example, learning about healthy cooking and portion sizes. Changes in all of our lives takes time and sustaining a change to be healthy is even harder without right support and motivation. So in order to keep up the motivation of attendees, refresher courses need to be considered. Attendees informed others about being healthy but some of them also have other pressing issues like housing, social services and most people had multiple illnesses, so that’s again an important issue to be aware that in our lives we have multiple priorities and often we overlook our health needs when other social and financial needs are pressing, so its important to acknowledge why people cant attend or drop out because they have deals with other priorities in life.

19. PERSPECTIVES OF NON-ATTENDEES   We explored why people declined to attend and drop out and the reasons are as follows: An important point to note is that most people who did not attend would like to attend future courses if invited again and if they are available, so that means a series of flexible courses needs to be available to cater for this people who have other commitments eg. work. We explored why people declined to attend and drop out and the reasons are as follows: An important point to note is that most people who did not attend would like to attend future courses if invited again and if they are available, so that means a series of flexible courses needs to be available to cater for this people who have other commitments eg. work.

20. DNA 8 (male): I declined the invitation because I was very ill. I also have a problem with hearing. I like to go outside, but I can’t. DNA 2 (female): I was interested but could not manage to get there because my daughter in law was admitted to hospital and I needed to look after the family and her children…. DNA 5 (male): I was interested in the first place…………. I have a full time job and have a big responsibility to look after my family.

21. Targeted, flexible and ongoing courses Better communication between course providers Set programme for the year Appropriate mechanism of referral Promotion of services is essential Evaluation of uptake and patient satisfaction should be ongoing  Issues for commissioners, course providers and health professionals  The findings of the survey of health professionals and the sf36 evaluation and the qualitative study show implications on both service providers, service commissioners and health professionals. Promotion of courses, referral mechanism and different types of courses are needed to sustain the motivation of the people and to help people manage their condition better. The findings of the survey of health professionals and the sf36 evaluation and the qualitative study show implications on both service providers, service commissioners and health professionals. Promotion of courses, referral mechanism and different types of courses are needed to sustain the motivation of the people and to help people manage their condition better.

22. Good news – NHS Tower Hamlets website launch On a positive note, our findings of the health professional survey, SF36 evaluation and issues around referrals were fedback to our partners and these findings have informed THPCT Public Health on developing a website to enable easy access to information and services and will also enable easy way of referrals to Healthy lifestyle initiatives in Tower Hamlets. The website will be launched at the end of August this year and again I would like to emphasise that the profile of this website need to be promoted heavily in all awareness campaigns locally to provider services to receive referrals. On a positive note, our findings of the health professional survey, SF36 evaluation and issues around referrals were fedback to our partners and these findings have informed THPCT Public Health on developing a website to enable easy access to information and services and will also enable easy way of referrals to Healthy lifestyle initiatives in Tower Hamlets. The website will be launched at the end of August this year and again I would like to emphasise that the profile of this website need to be promoted heavily in all awareness campaigns locally to provider services to receive referrals.