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

Adan FreemanProject Manager Active Herts

Herts Sports Partnership

01707 285880

a.freeman2@herts.ac.uk