Transcript CAPH-PRC Core Research Project Integrating a Health Prevention Program into a Collaborative Framework Integrating a Health Prevention Program Into a Collaborative Framework in Community-Based Research Joni.

CAPH-PRC Core Research Project
Integrating a Health Prevention
Program into a Collaborative
Framework
Integrating a Health Prevention Program Into a Collaborative Framework in
Community-Based Research
Joni Vander Bilt, Wei-Hsuan Lo-Ciganic, Sarah E. Woody, Janice C. Zgibor,
Margaret B. Conroy, Elizabeth A. Schlenk, Anne B. Newman
American Public Health Association-Round Table Discussion (October 2012)
[email protected]; 412-383-2384
The University of Pittsburgh’s Center for Aging and Population Health
(CAPH) is a member of the Prevention Research Centers Program,
supported by the Centers for Disease Control and Prevention cooperative
agreement number 1U48DP09-0014918-01.
Collaborative Research and Dissemination
2001
2005
2009
“10 Keys”™ Community Health
Campaign
2010
2011
“10 Keys”™ Collaborative
Research and Dissemination
Objectives
 To develop a collaborative model with the Arthritis
Foundation to deliver and evaluate a program targeting risk
factors for disability, and chronic disease in those age 50 and
older.
 To determine if the collaborative program improves
symptoms, self-efficacy, indicators of preventive service use,
and risk factors for disability and chronic disease.
Why the Arthritis Foundation?
Arthritis and rheumatism
Back/spine problems
Heart trouble
Lung/respiratory problem
Mental/emotional problem
Diabetes
Deafness/hearing problem
Stiffness/deformity limbs
Blindness/vision problems
Stroke
Data Source: U.S. Census Bureau, 2004 Survey of Income and Program Participation, Wave 5, JuneSeptember 2005. as reported in: Hootman JM, Brault MW, Helmick CG, Theis KA, Armour BS. Prevalence
and Most Common Causes of Disability Among Adults — United States, 2005. MMWR 2009;58(16):421426.
Arthritis and Co-morbid Conditions
Source: Murphy L, Bolen J, Helmick CG, Brady TJ. Comorbidities Are Very Common Among
People With Arthritis. Poster 43. 20th National Conference on Chronic Disease Prevention and
Control, CDC February 2009.
Risk Factors for other Chronic Conditions
Among Those with Arthritis
Source: Murphy L, Bolen J, Helmick CG, Brady TJ. Comorbidities Are Very Common Among
People With Arthritis. Poster 43. 20th National Conference on Chronic Disease Prevention and
Control, CDC February 2009.
Physical Inactivity
Physical inactivity
Shih M, Hootman JM, Kruger J, Helmick CG. Physical activity in men and women
with arthritis, National Health Interview Survey, 2002. Am J Prev Med
2006;30(5):385-93.
“10 Keys”™ to Healthy Aging
Selected based upon epidemiological, clinical and
laboratory studies
•
•
•
•
•
•
•
•
•
•
Lower systolic blood pressure
Stop smoking
Participate in cancer screening
Get immunized regularly
Regulate blood glucose
Lower LDL cholesterol
Be physically active
Maintain healthy bones, joints and muscles
Maintain social contact
Combat depression
Arthritis Foundation
 Well-established program (since 1986; formerly known
as People with Arthritis Can Exercise-PACE)
 Specifically developed/ updated by experts (’93, ’99,
’05, ’09 updates)
 Recreational; does NOT replace prescribed therapeutic
regimen
 Focus on peer support and self-help
 RCT demonstrated improvements in pain, fatigue and
self-efficacy
AFEP
+
“10 Keys”™
 An exercise program (Arthritis Foundation Exercise Program)+
healthy aging messages (“10 Keys”™)
 Promote self-evaluation and goal setting
 Improve health and wellness in older
adults.
 Transportable program for other groups
Common Goals
 The mission of the Arthritis Foundation is to improve
lives through leadership in the prevention, control and
cure of arthritis and related diseases
 Research
 Public Health
 Public Policy/ Advocacy
 The goal of the “10 keys”™ is to focus on the health and
well being of the ‘whole person’
Working Together:
Building Capacity for Implementation
 Several calls and in person meetings to integrate two
well established curricula.
 AF had access to sites and group leaders
 PRC had the implementation/research expertise
AFEP + “10 Keys”™
 A program combining gentle exercises and health
education messages
 Increased strength, balance, range of motion, etc
 Improved ability to set appropriate goals for health
behavior
 10 weeks
 60-75 min
 Enrollment of 10-30 individuals
Integration of the “10 Keys”™
 Session 1 for the week introduces the Key and the group
leader encourages discussion about this Key during the
exercise session.
 Participants are asked to set a goal and identify steps to
achieve the goals.
 Session 2 invites participants to identify successes and
challenges in working toward their goals.
 The “10 Keys”™ messages are emphasized throughout the
sessions.
 Supplemental resource materials are provided to
participants.
Implementation
 Phase 1: Pilot and feasibility of the integrated program
in four community sites
 Phase 2: Implementation of the program (informed by
Phase 1) in a cluster randomized controlled trial in 40
sites
 20 sites AFEP + “10 Keys”™
 20 sites AFEP only
Phase 1: Pilot
McKeesport
AFEP + “10 Keys”™
 Recruitment
 Sites
 Community centers, hospitals, senior centers, retirement homes
(independent living), churches, fitness clubs, etc.
 Group Leaders
 Training is designed to teach anyone how to lead the program
 Tendency towards health and exercise professionals with an interest in
older adults
 Participants




Voter registration mailing
Newspaper advertisement
Flyers
Word of mouth
Assessments





Height/weight (BMI)
Blood pressure
Lipids
Glucose
Short Physical Performance Battery (strength, balance,
gait)
 Questionnaires
 Demographics and arthritis symptoms
 Lifestyle, behavior, self-efficacy
Multi Method, Multi Level Methods
 Quantitative




Primary data collection at the participant level
Attendance
Participation rates
Site and community descriptive data
 Qualitative
 Participants
 Group Leaders
 Site administration
“Since I started this program,
I’ve been sleeping better than
I’ve slept in years.”
“At week 4, I didn’t have to use
my cane anymore.”
“My husband noticed that
something was different about
me, I had more energy.”
Pilot Phase Sites:
One church (right)
One retirement home (below)
One hospital
One health club
University of Pittsburgh CAPH PRC
21
Pilot AFEP + “10 Keys”™
Program
Participants
Study
Participants
enrolled
Study
attrition
Bethel Park Retirement
Home
16
12 (75.0%)
4 (33%)
Club Sport & Health
33
13 (39.4%)
2 (15%)
UPMC McKeesport
Hospital
28
15 (53.6%)
2 (13%)
First United Methodist
Church
45
11 (34.4%)
1 (9%)
Total Pilot Program
122
51 (41.8%)
9 (17.6%)
University of Pittsburgh CAPH PRC
22
Journey of an AFEP + “10 Keys”™ Program
Preparing
for
Program
Start
First two
weeks
Week 5
(halfway)
Sustainability
Graduation
Exploring the Process:
Swissvale Union Baptist Church
 First Steps
Identify Participants
Identify Leader
Identify Site
Exploring the Process:
Swissvale Union Baptist Church
Flyer &
research
brochures
Preparing
for
Program
Start
Phone calls for screening
Meeting with Leader
Preparing & providing
materials
Exploring the Process:
Swissvale Union Baptist Church
Surveys
First
two
weeks
Arthritis Foundation release
Invite
participants to
research
study--consent
Exploring the Process:
Swissvale Union Baptist Church
Check-in
Week 5
(halfway)
Raffle
Support leader
Exploring the Process:
Swissvale Union Baptist Church
Certificates
Raffle
Graduation
(Session 20)
Feedback & Testimonials
Arthritis
Foundation
Manual
Journey of an AFEP + “10 Keys”™ Program:
Assessments
Preparing
for Program
Start
First two
weeks
Baseline
Logistics & training
Post Program
1-year
6-month
Sustainability
Graduation
Week 5
(halfway)
Site variation
 Important areas of variation
 Leader
 Can be members of site/live in same community
 Can already know participants
 Background variation
 Site





Administrator is engaged (or not) with the University in the process
Integrated program includes maintenance phase
AFEP alone includes “10 Keys”™ after one year
Integrated program is 75 minutes, AFEP is 60 minutes
Most sites host free program; some charge
“I think it’s very helpful to go to a structured
group...because you develop your discipline
and you’re motivated. You say ‘I’m going to go
for this period of time and you go…I think
that’s very beneficial.’ ”
-Program Participant
University of Pittsburgh CAPH PRC
31
1/18/2012
Pilot Study Demographics:
Study participants vs. non-study participants
Study
Participants
N=51
Non-study
participants
N=26
Total group
Age (mean, sd)
(range)
75.5 (9.3)
57-92
73.2 (8.0)
61-88
74.7 (8.9)
0.31
Sex (n, % female)
44 (88%)
20 (80%)
64 (83.1%)
0.36
Race (n, % white)
47 (92.2%)
25 (96.2%)
72 (93.5%)
0.41
Education
(n, % High School or
less)
14 (28%)
11 (44%)
25 (32.5%)
0.17
Diagnosis of arthritis
37 (72.6%)
24 (92.3%)
61 (79.2%)
0.02*
--Osteoarthritis
29 (78.4%)
16 (66.7%)
45 (73.8%)
--Rheumatoid Arthritis
2 (5.4%)
1 (4.2%)
3 (4.9%)
--Other
2 (5.4%)
5 (20.8%)
7 (11.5%)
--Don’t know or missing
6 (16.2%)
2 (8.3%)
9 (14.8%)
32
All data taken from survey form filled out in the beginning of the program.
P value
N=77
Stiffness, Pain, Difficulty (WOMAC):
Baseline vs. Post-Program
Pain
BL
Post
Mean
(SD)
Mean
(SD)
Endorsed
having
something in
arthritis family
N=27
6.6
(4.7)
6.2
(4.0)
Did not
endorse having
something in
arthritis family
N=10
5.0
(5.6)
4.7
(3.2)
University of Pittsburgh CAPH PRC
Stiffness
P value
BL
Post
Mean (SD)
Mean
(SD)
0.41
3.1
(2.1)
0.85
3.3
(2.8)
33
Difficulty
P
Value
BL
Post
Mean
(SD)
Mean
(SD)
2.7
(2.2)
0.07
20.6
(14.0)
17.3
(14.9)
0.046
2.9
(1.4)
0.66
18.0
(19.9)
10.4
(9.9)
0.21
Lower scores reflect less pain, stiffness, difficulty
P
value
1/18/2012
Main outcome: Self-efficacy-Baseline
vs. Post-Program
N
Baseline
Mean (sd)
Postprogram
Mean (sd)
Change
p-value
Exercise regularly
scale (3 items)
38 23.3 (6.8)
24.1 (7.0)
+ 0.79 (6.3)
0.44
Get information
about prevention
scale (1 item)
36 8.0 (2.4)
8.9 (1.8)
+ 1.06 (2.3)
0.004
Communication with
physician scale
(3 items)
35
27.4 (3.9)
+ 0.66 (3.9)
0.32
26.4 (4.7)
Note: Higher number indicates higher self-efficacy
Items adapted from Stanford Patient Education Research Center
University of Pittsburgh CAPH PRC
34
1/18/2012
“I especially appreciated the location. Easily
accessible.”
-Program Participant
“If you don’t exercise you won’t be a happy
person and if you don’t have the 10 keys to
follow you won’t be a healthy person either.”
-Program Participant
University of Pittsburgh CAPH PRC
35
11/6/2015
University of Pittsburgh CAPH PRC
36
1/18/2012
Participants
University of Pittsburgh CAPH PRC
37
Feedback from Participants
 Pilot Program
 Overall rating of program
 56.8% “excellent”
 35.1% “very good”
 8.1% “good”
“Feeling overall better – walking better.”
-Program Participant
“…I know that I am capable of exercise
now and I am far more confident in
managing pain.”
-Program Participant
University of Pittsburgh CAPH PRC
39
1/18/2012
“The program was very inspiring and a great
learning experience.”
-Program Participant
University of Pittsburgh CAPH PRC
40
1/18/2012
“I was losing confidence in how to exercise at
home. But then I came to class and learned
how to push through it, when to stop, when to
keep going. I learned what pain is about.
Sometimes it is about not pushing. I gained a
new understanding, I feel more confident.”
-Program Participant
University of Pittsburgh CAPH PRC
41
1/18/2012
Community Action Network: Node color by degree centrality
Legend: (from not connected at all—lighter, to completely connected--darker)
AFEP + “10 Keys”™









All program & research participants
Janice Zgibor
Constance Bayles
PIs & Co-investigators
Arthritis Foundation (Allison Brenckle,
Jane Brandenstein, Carol Popp)
Jenny Lo-Ciganic
Mary Parker & Linda Dobosh
Andrea Arrington & Mini Jacob
All community partners










All program leaders
Nancy Cunningham
June Sechrist
Lori Kieffer
Renee Guerin
Elizabeth Henry
Laura Borgenheimer
Sarah Seitz
Kim Westrick
All student workers
The University of Pittsburgh’s Center for Aging and Population Health (CAPH)
is a member of the Prevention Research Centers Program, supported by the
Centers for Disease Control and Prevention cooperative agreement number
1U48DP09-0014918-01.