Transcript CATCH Healthy Habits - Missouri Health Equity Collaborative

Building Health Equity in the St Louis Region
Missouri Health Equity Collaborative Regional Meeting,
October 19, 2012
OASIS Health Programs:
improving health equity through evidence-based
approaches to healthy aging
Peter L. Holtgrave, MA, MPH
James Teufel, MPH, PhD
What is OASIS?
A three-fold approach to successful aging
OASIS reaches adults 50+ in 40 cities
700 partners, 35,000 participants annually
Statistics of the US Aging Population
Statistics of the US Aging Population
US National Center for
Health Statistics
Health and Aging in the US
• 80% of older adults have one chronic condition and 50%
have at least two
• 70% of all deaths (1.7 million annually) are due to chronic
disease
• Infectious diseases and injuries also take a
disproportionate toll on older adults
• 1 of 3 adults, aged 65+, fall each year
o leading cause of injury-related death for this age group
Programs support the mind, body and spirit
Lifelong learning
• Local arts & humanities
classes
• Technology training
• National humanities
programs
Health promotion
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Active Start
Chronic disease management
Matter of balance
Tai Chi, Yoga, Zumba etc
Community involvement
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Intergenerational Tutoring
CATCH Healthy Habits
Instructors and peer leaders
Program planning and support
evidence- and
research-based
programs
Evidence-Based Health Programs
Active Start
Active Start
• Winner, US Department of Health and Human Services
Innovation in Prevention Award
• Evidence- & community-based behavior change and
fitness program
• Facilitated by trained older adult lay leaders for sedentary
older adult participants
o 20 to 24 weeks, 1x/week, 1-hour/session
o Combines 2 programs:
1. Active Living Every Day [behavior change]
2. ExerStart (added week 5+) [physical fitness]
Active Living Every Day
• A 12 or 20 week behavior change class
• Designed by Cooper Institute
• Funded by Robert Wood Johnson Foundation
• American Public Health Association’s “Award of
Excellence in Program Innovation”
Active Living Every Day
• Pilot Program Locations:
o OASIS centers in Pittsburgh and St. Louis
• Program Design:
o Weekly, 1-hour group meetings
o Participants develop strategies to:
– incorporate physical activity into their routine in realistic
ways
– stay active, including when difficult life situations arise
o Approach
– Set goals, identify barriers, establish social support
systems
ExerStart
• Low-intensity exercise program for sedentary adults
• Adapted by Center for Successful Aging
o California State University – Fullerton
– Jessie Jones, PhD
• Older Adult Participants:
o Class students: learn in-class exercises, practiced at home
o Trained volunteer-facilitators/class leaders
ExerStart
• Course design: 43 exercises
o Focus: aerobic strength, flexibility, and balance
• Session design: (45 minutes)
start
5 min.
Warm-up
Increase flexibility
& balance
10 min.
Exercise
10 min.
Aerobic
Exercise
5 min. Cooldown
Increase
endurance
15 min.
Resistance
Training
Increase strength
Active Start Outcome Measures
• Pre- and Post-program surveys
• Senior Fitness Test1
o Measures physical capacity of older adults to perform usual,
everyday activities
1. Chair Stand Test (lower-body strength)
2. Arm Curl Test (upper-body strength)
3. 2-Minute Step Test (aerobic endurance)
4. Chair Sit and Reach Test (lower-body flexibility)
5. Back Scratch Test (upper-body flexibility)
6. 8-Ft Up and Go Test (agility and balance)
1Rikli
& Jones, 1999
Active Start Outcomes1
• Behavioral change support group + fitness classes =
significant improvements in physical performance
o strength, flexibility, and balance
• 93% of participants in the intervention group completed
the 24-week study
• Supports that community-based physical activity
programs benefit sedentary, ethnically diverse older
adults
1Yan,
et al., 2009
Evidence-Based Health Programs
Chronic Disease Self-Management Program
(CDSMP)
CDSMP
• Lay led education program developed by the Stanford
University Patient Education Research Center
• Recognized by US Administration on Aging and the US
Centers for Disease Control and Prevention
• Purpose: increase confidence and motivation needed to
manage challenges of living with chronic health conditions
CDSMP
• Participants:
o Older adults with chronic health conditions
– hypertension, arthritis, heart disease, stroke, lung
disease, diabetes, others
• Model:
o Provides information and teaches practical skills on
managing chronic health problems
• Design:
o 6 sessions, 1x/week for 2 ½ hours each
o Facilitated by two trained lay leaders, one or both with a
chronic condition
o Participant caregivers can attend
CDSMP
• Approach:
o Focus on problems common to individuals suffering from
chronic diseases
• Controlling symptoms through:
o Relaxation techniques
o Dietary changes
o Sleep and fatigue management
o Correct medication use
o Exercise
o Communication with health providers
CDSMP
• Skill development:
o Coping strategies
o Action planning
o Giving feedback
o Behavior modeling
o Decision-making and problem-solving techniques
CDSMP Outcomes
• After 1st Year:
o Significant improvements in energy, health status, social and
role activities and self-efficacy.
o Less fatigue or health distress
o Fewer visits to the emergency room
o No decline in activity or role functions
– even with slight increase in disability after 1 year
Lorig et al. (2001a), Stanford University
CDSMP Outcomes
• After 2 years:
o No further increase in disability
o Reduced health distress
o Fewer visits to physicians and emergency rooms
o Increased self-efficacy = reduction in health care use
Lorig et al. (2001a), Stanford University
Evidence-Based Health Programs
Better Choices, Better Health
Better Choices, Better Health
• Developed by National Council on Aging (NCOA) and
Stanford University
o Kate Lorig, RN, DrPH
• Internet version of CDSMP
o Convenient option for those comfortable with web-
based learning
• Purpose: Build confidence and develop self-management
skills to address problems associated with chronic
conditions
Better Choices, Better Health
• Design:
o Pair of trained facilitators (at least one with a chronic health
problem) lead 6-week web-based workshop
o Participants:
– Had MD-diagnosed chronic condition: heart disease,
lung disease, type 2 diabetes
o Process:
– Log contributions (Email, message boards) 3+
times/week (c. 1-2 hours) for 6 weeks
– Not required to log-in at same time
Better Choices, Better Health
• Topics:
o Making informed treatment decisions
o Appropriate use of medications
o Communicating effectively with family, friends, and health
professionals
o Healthy eating
o Disease-related problem solving
• Activities:
o Action planning
o Sharing experiences
o Building mutual support
Better Choices, Better Health
Outcomes
• Randomized, controlled trial1:
o Significant improvement in health status & self-efficacy
– Improvement in health distress, fatigue, pain, shortness
of breath, and illness intrusiveness
• Longitudinal study2:
o Significant improvement in symptoms, health behaviors, self-
efficacy, health-care system satisfaction
o Lessened need for hospital and doctor visits
– net cost saving in first year
1Lorig,
Ritter, et al (2006); 2Lorir, Ritter, et al (2008)
Evidence-based Intergenerational
Health Programs
Active Generations
and
CATCH Healthy Habits
Active Generations (2006-2010) &
CATCH Healthy Habits (2010-2012)
• Intergenerational, evidence-based physical activity and
nutrition programs
• Funding
o Robert Wood Johnson Foundation
(2006)
o WellPoint Foundation (2007-2012)
• Adaptation of Coordinated Approach to Child Health
(CATCH)
• Outcomes-driven
• Award-winning
Objectives
• Address childhood and older adult obesity and
improve overall health and wellness
o Increase physical activity and encourage active living
o Increase knowledge about nutrition to encourage
healthy eating
o Foster positive relationships between young people
and adults, age 50-plus
Program Design
Nutrition
Lessons
Snack
Lessons
Physical
Activities
Program Design
Active Generations
(2006-2010)
Less funding overall
8 U.S. Cities across 10 states
200 Volunteers in direct service roles,
ages 70-80
1000 Child participants in Grades 3 to 5
One module, 8-10 sessions, 90 mins. ea
20 minutes of physical activity
No formal relationship with national
youth service organizations
Long pre- and post-survey
No observational measurement
ROI calculations not conducted
CATCH Healthy Habits
(2010-2012)
More funding overall
18 U.S. Cities across 14 states
750 Volunteers in direct service and
capacity-building roles, age 50+
4250 Child participants in Grades K to 5
Two modules, 8-25 sessions, 60 mins. ea
30 minutes of physical activity
Formal relationship with Boys & Girls
Clubs of America (national partner)
Abridged pre- and post-survey
Observation of PA (SOFIT)
Volunteerism ROI calculated (SMART)
CATCH Healthy Habits
18 Cities across 14 States
Phase 1 (March'11)
Atlanta, GA
Escondido, CA
Indianapolis, IN
Long Beach, CA
Los Angeles, CA
Richmond, VA
Saint Louis, MO
San Diego, CA
Phase 2 (Aug'11)
Las Vegas, NV
Portland, ME
Madison, WI (Sept’11)
Phase 3 (Oct'11)
Albany, NY
Cleveland, OH
Denver, CO
Hartford, CT
Louisville, KY
Manchester, NH
New York City, NY
400+ Organizational Partners
Volunteer Roles
• Example Titles
o Team Member (everyone!)
o Pioneer (joined in first year)
o Talent Scout/Coach (recruitment/screen/train volunteers)
o Food Scout/Culinary Steward (purchase food for healthy snacks)
o Community Connector (partnership development)
o Outcome Czar (evaluation, data collection /entry)
o Professional Storyteller (marketing, publicity)
o Documentary Artist (takes photos, shoots videos)
o Volunteer Leader (program administration, volunteer supervision)
Pilot Program Child Results
(2006-2010; N=760)
• Statistically significant health impacts:
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Eating 3+ vegetable servings daily
Eating no vegetable daily
Understanding min. fruit and vegetable consumption
Understanding link between nutrition and disease
Self-efficacy engaging in PA 3-5 times per week
Self-efficacy running or biking
Self-efficacy exercising at a steady pace
Decrease daily TV watching
Play no video games daily
CATCH Healthy Habits Child Results
(June 2011-September 2012)
• Survey-based improvements
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Days physically active after school
Decrease screen time
Food label reading
Eating 3+ fruits a day
Eating 2+ fruits a day
• SOFIT Observations
• 61% MVPA (vs. 50% CATCH)
SOFIT Coding Sheet
• SMART tool
• 26,500 volunteer hours
• $484,000 value
SMART tool
Future Directions
• Diabetes Self-Management Program (DSMP)
• Community-level policy and environment
change through intergenerational approaches
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Generations for a Healthy Community
OASIS Evidence- and Research-based
Programs
Questions and Discussion
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Thank you
James Teufel, MPH, PhD
National Health Director
Email: [email protected]
Phone: 314-862-2933 ext. 237
Peter L. Holtgrave, MA, MPH
National Health Manager
Email: [email protected]
Phone: 314-862-2933 ext. 230