Active HertsA Behaviour Change Approach to Physical Activity
Adan Freeman Herts Sports Partnership
• Overview of the Active Herts project
• Showcase the success of the project
• 8 Principles for effectively delivering the Active Herts model
• Working examples of how to apply the AH model
Project overview
Aim: To engage 2760 inactive people in 1x30mins of physical activity and sport.
Who: Inactive people with lifestyle related medical conditions and mild to moderate mental health conditions (e.g. High blood pressure, type 2 diabetes, obesity, depression, anxiety)
Where: Broxbourne, Stevenage, Hertsmere and Watford
How: One to one behaviour change support and exercise programmes
Project Need
Healthcare cost from physical inactivity
Hertsmere is £1.45 million per year
Watford is £1.2 million per year
Stevenage is £1.18 million per year
Broxbourne is £1.3 million per year
Diabetes
*Diabetes Health Intelligence, 2012
Referral Criteria
All referrals must:
• Adults (aged 16 years and over)
• Resident of Hertsmere, Watford, Broxbourne, Stevenage
• Inactive (<30 mins PA per week)
Additional inclusion criteria (referrals may also have/be)
• Diabetes Mellitus
• Hypertension
• Obesity (BMI >30, or BMI >28 if one or more co-morbidities)
• Smoker
• High Cholesterol
• History of heart disease
• Mild to moderate mental health condition
Get Active Specialists
Control Model & Intervention Model
• Based in GP Surgeries & Mind Wellbeing Centres
• Support participants to move from inactive to active
• Explore motivations and barriers
• Signpost to relevant exercise opportunities
Intervention Model
• Tailored, local, low cost exercise sessions (FREE for 12 weeks)
• Volunteer buddy scheme
Client journey
Healthcare professionals
Get Active Specialist (GAS)
Referral Triage First appointment Signposting 2 week follow up Motivational texts 3,6,12 Reviews
HCP refer patients/clients to our Get Active Specialists
GAS call clients to book first appointment
GAS use behaviour change techniques to look at action planning and goal setting
GAS signposts client to exercise or sports programme
GAS follows up with client to make sure everything is good
Client receives x3 text messages to help keep them motivated
GAS invite all clients to book in for follow up appointments to review progress
Social and motivational support from volunteers
Stages of Change
• Many of the people that we work with are in the pre-contemplation stage
• When they get to contemplation, or preparation they reach the intention action gap
• What we need to do is reassure people that this is ok
• Work with it and provide support to help them
COM-B Model
Credit – Dr Angel Chater
I first started I was both overweight and also suffering from bouts of anxiety, however now , with your help, I have manged to lose 2 stones (far more than the goal I set myself).
My blood pressure has dropped dramatically, to the point where my GP is starting to remove my medication.
On top of this instead of dreading meeting people I now look forward to the class each week.
This would not have been possible without your help. You always have such a positive outlook and your professional , and friendly
approach had been an
Impact?
3,400
76.2%
Referrals since Jan 2016
Of referrals taking up the option of having a consultation
Impact?
Participants increased weekly activity by 50 minutes
Reduction of 67 minutes of daily sitting
Impact?
Participants increased weekly activity by 49.8 minutes
Reduction of 52.4 minutes of daily sitting
Impact?
Participants increased weekly activity by 46.6 minutes
Reduction of 14.6 minutes of daily sitting
After 12 months
Patient Testimonial
increased my exercise and activity considerably, thanks in no small part to my
8 Principles foreffectively replicating
Active Herts
1. Local Need
Establish the level of need in your county / area and identify the areas that should be targeted
1. Local Need
1. Local Need
Indices of Deprivation 2015 explorer
1. Local Need
Active Lives Survey, Sport England
1. Local Need
Hertfordshire District Profiles
1. Local Need
Within Hertfordshire;
• Watford, Stevenage, Broxbourne & Hertsmere
• 4 most deprived districts
• 4 least active districts
• 4 districts with most CVD risk factors
• A perceived gap between primary care and the leisure sector which was not being addressed by the exercise on referral scheme
2. Establish Partnerships
Identify the right partners to support your project, including;
Steering Group
Delivery Organisations
Referring Partners
Evaluation
Training
2. Establish Partnerships
2. Establish PartnershipsLSOA LSOA NAME STward_name LA NAME Practices serving the identified area
E01023323 Broxbourne 003D Hoddesdon Town Broxbourne AMWELL STREET SURGERY THE LIMES SURGERY PARK LANE SURGERY
E01023342 Broxbourne 005C Wormley & Turnford Broxbourne THE MAPLES PARK LANE SURGERYCROMWELL MEDICAL CENTRE
E01023343 Broxbourne 005D Wormley & Turnford Broxbourne THE MAPLES PARK LANE SURGERYCROMWELL MEDICAL CENTRE
E01023310 Broxbourne 006D Flamstead End Broxbourne STOCKWELL LODGE MED.CTR. THE MAPLES CUFFLEY VILLAGE SURGERY
E01023326 Broxbourne 009D Rosedale Broxbourne STOCKWELL LODGE MED.CTR.
E01023300 Broxbourne 010D Cheshunt Central Broxbourne STOCKWELL LODGE MED.CTR.
E01023301 Broxbourne 010E Cheshunt Central Broxbourne STOCKWELL LODGE MED.CTR.
E01023294 Broxbourne 011B Bury Green Broxbourne STOCKWELL LODGE MED.CTR.CROMWELL MEDICAL CENTRE
E01023333 Broxbourne 012B Theobalds BroxbourneWARDEN LODGE MEDICAL PRACTICE STANHOPE SURGERY ABBEY ROAD SURGERY
E01023336 Broxbourne 013A Waltham Cross Broxbourne ABBEY ROAD SURGERY STANHOPE SURGERY
E01023337 Broxbourne 013B Waltham Cross Broxbourne ABBEY ROAD SURGERY STANHOPE SURGERY
E01023338 Broxbourne 013C Waltham Cross Broxbourne ABBEY ROAD SURGERY STANHOPE SURGERY
E01023339 Broxbourne 013D Waltham Cross Broxbourne ABBEY ROAD SURGERY STANHOPE SURGERY
GP Surgeries in identified districts
Task
In small groups, discuss what
community groups you might aim to establish
partnerships with to get more referrals in to
the Active Herts
2. Establish Partnerships
• Understand who their client group is
• Understand what their organisational objectives are
• Be aware of their offer and how you can enhance their offer
• Make it clear what is in it for them (and for their client group)
• Be clear about any expectations you have of them
• Communicate!
• Provide evidence of the value of the partnership
• Celebrate
3. Recruitment & Training of Delivery Staff
Get this right, and the project has every chance of success!
3. Recruitment & Training of Delivery Staff
Recruit based on interpersonal skills & values
Sector-
but can be learnt
3. Recruitment & Training of Delivery Staff
• Ensure there is plenty of training available (both formal and informal)
• If possible, frontload this training
• Training should be ongoing
3. Recruitment & Training of Delivery Staff
Promoting Health Behaviour Change: A solution
focused approach (BHF National Centre)More Info
Level 4 Obesity and Diabetes Management More Info
Level 3 GP Referral More Info
Motivational Interviewing training (Dr Angel Chater) Contact: Angel Chater
Mental Health Awareness Training (Mind) More Info
Recruiting and Retaining Volunteers (Volunteer Centres
Hertfordshire)More Info
4. Follow the Protocol
Use the evidence, see the results
4. Follow the Protocol
Howlett N, Jones A, Bain L, et al.
How effective is community physical activity promotion in areas of deprivation for inactive adults with cardiovascular disease risk and/or mental health concerns?
Study protocol for a pragmatic observational evaluation of the 'Active Herts' physical activity programme.
BMJ Open, 2017; 7:e017783. doi:10.1136/bmjopen-2017-017783
Howlett N, Trivedi D, Troop NA, et al. What are the most effective behaviour change techniques to promote physical activity and/or reduce sedentary behaviour in inactive adults?A systematic review protocol.BMJ Open 2015; 5:e008573.doi:10.1136/bmjopen-2015-008573
4. Follow the ProtocolHowlett et al. (2015) Identifies the Behaviour Change Techniques which are most successful to support inactive individuals to increase their physical activity levels.
• Systematic review of 14,471 academic papers
• 26 studies met the parameters of the Active Herts project
• 18 Behaviour Change techniques embedded in the project
4. Follow the Protocol
Behaviour Change Technique
COM-B Construct Targeted
Content
Pros and ConsReflective Motivation
A page asking whether exercise is good for you and programme users are given two blank columns to fill out with possible advantages and disadvantages of becoming more active. They are then asked how confident they feel about becoming active on a scale of 1–10.
Behaviour Change Technique
COM-B Construct Targeted
Content
Action PlanningPsychological capability; reflective motivation
A page allowing programme users to complete sections referring to their plans to becoming more active in terms of what they are going to do, where they are going to do it, when they are going to do it and who they are going to do it with. A second page allows them to explore their time management by mapping out the week in terms of morning, afternoons and evenings.
Behaviour Change Technique
COM-B Construct Targeted
Content
Information about health consequences: information on emotional consequences
Psychological capability; reflective motivation
A page summarises the health and emotional benefits of being active in a positively framed manner. For example, did you know that being active can ‘help you manage high blood pressure’ and ‘make you feel good and improve your mental health’?
Behaviour Change Technique
COM-B Construct Targeted
Content
Self-rewardAutomatic Motivation
Programme users are told the importance of rewarding themselves for the effort they make towards their activity goals. Examples are then given of how to reward themselves in ways that are healthy and free. For example, ‘listen to music’ or ‘have a nice relaxing bath’. Self-reward is also discussed briefly during the goal-setting page when thinking about what success looks like.
5. Effective Promotion
Use the right messages, for the right people, to see the right results
5. Effective Promotion
In three minutes, draw up a rough plan of;
Who you would market
How you would market it
5. Effective Promotion
Get the GPs on board Early!
5. Effective Promotion
Important to co-design the messaging to get optimal buy-in from participants
5. Effective Promotion
6. Encourage the Social Element
Research is showing that the sense of belonging to
them to come along every week
6. Encourage the Social Element
6. Encourage the Social Element
• Tea & Coffee afterwards
• T-Shirts
• WhatsApp groups / Facebook Groups
• Conversation Cafes
7. Activities
Ensure there is a range of activity options for people, including free and low cost options. But be prepared for people to not know what they want to
do.
7. Activities
Introduction to Exercise
Walking Football
Swim & Social
Circuit Sessions
Sustainable Group Sessions
parkrun
Health Walks
Etc…
ADLs
Home-based Exercise
Walking
Community Based Activities
8. Evaluation
One of the most important elements of any
Knowing whether it works!
8. Evaluation Logic Model
What is the problem? What
does the evidence show?
Human, financial or material resources
required for the intervention?
What activities will be carried
out for the intervention? E.g. training
What do you hope to see
happen?
What effect do you expect this intervention to
make?Short, Medium &
Long term
CONTEXT INPUT ACTIVITIES OUTCOMES OUTPUTS
8. Evaluation Logic Model
Using the handout, begin filling out the logic model
for your project
Homework
Complete a logic model and apply to your next
project
8. Evaluation
8. Evaluation
International Physical Activity Questionnaire(IPAQ)
Warwick Edinburgh Mental Wellbeing Scale(WEMWBS)
EQ-5D-5L
8. Evaluation
8 Principles for Effectively Replicating Active Herts
• Local Need• Establish Partnerships• Recruitment & Training of Delivery Staff• Follow the Protocol• Effective Promotion• Encourage the Social Element• Activities• Evaluation
• Overview of the Active Herts project
• Showcase the success of the project
• 8 Principles for effectively delivering the Active Herts model
• Working examples of how to apply the AH model