Presentation on theme: "Evidence Based Health Promotion: What's the Buzz All About?"— Presentation transcript:
1Evidence Based Health Promotion: What's the Buzz All About? Mary Hertel: Central MN Council on AgingDebra Laine: Arrowhead Area Agency on AgingDave Fink: Metropolitan Area Agency on AgingTuesday June 18, :00 am to 9:15Lake Superior Ballroom, City side
2Information to be presented: What are Evidence Based programs and why are they importantResearch and demonstrated outcomesHow EBP can fit within the patient engagement model, compare/contrast with patient educationOverview of specific EBP’s including Stanford Self-Management, A Matter of Balance and Tai chi: Moving For Better BalanceDescribe how you or your organization can get more involved
3What is Evidence Based health promotion programming? Simply put it is: programs based on research.Data from intervention research studies “Translational”projects that take proven interventions and adapt them in real world settingsAn evidence-based program has been demonstrated to be effective in basic research that involved the same target audience.Then it has been demonstrated to be effective in dissemination in the “real world.” There are clear protocols for training and conduct of the program so that community programs can maintain fidelity and be successful.
4What evidence do we need? Evidence that a health issue existsEvidence about design, context and attractiveness of programEvidence that a program is effective
5Why the interest in Evidence Based Programs? Magnitude and serious of health and social problems in our communitiesAwareness of preventability of many problemsEmergence of evidence-based practices and programsSpend limited resources more efficiently
7Consider:“people with chronic conditions rarely spend more than 1% of their life at a healthcare facility. It is the other 99% of one’s life - when an individual is at home - that determines whether they return to full health or not.”Those with ongoing health issues will make many daily health decisions:Diet, exercise, medication, when to seek medical caremay not fully understand implications of particular health decisionmay lack support to make better choices
8Can Clients Be Engaged?23% adopted new health behaviors (but unsure could maintain if stressed)Remaining 77%:Remain passive recipients (12%)Lack basic facts to follow treatment recommendations (29%)Have facts, but no skills, confidence (36%)Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007). Do increases in patient activationresult in improved self-management behaviors? Health Services Research, 42,
10Self-Management Differs From Patient Education (but we need both) - Manage life with diseaseProblem solve and make decisionsImprove confidence in abilities to make changesIncrease skills & self-confidence- Change behaviour'sInformation, technical skillsDisease–specific knowledge- Use specific tools (e.g., Care Plans, Action Plans)A chronic disease may never be cured. We are looking to improve quality of life. Patient education the goal is comliance with behavior to improve the outcomes. Self Management is increased efficacy to improve outcomes.They must manage the disease(s)They must maintain their life rolesThey must deal with the emotionalconsequences of the disease(s)They are sometimes the only carrierof vital information.The patient and health professional working together.Often involves the family.An holistic approach to care (i.e., medical and psycho-social components of a condition).Pro-active and adaptive strategies that aim to empower the individual.
11Advantages of Evidence Based Programs: First, they can significantly improve the health and well- being of older adults in the community.Second, they can help attract new participants and funders through innovative programming.Third, they can create powerful partnerships with other organizations, including health care providersEvidence-based programming provides value
12Lets talk about some of the Evidence Based Programs Stanford University Self Management Programs:Chronic Disease Self Management (Living Well with Chronic Conditions)Chronic Pain Self ManagementDiabetic Self ManagementAdditional programs:A Matter of BalanceTai Chi Moving for Better BalanceExample I would like to focus on is CDSMP, Tai Chi and Matter of Balance.
13Developed by Stanford University’s patient education program What is the Stanford Chronic Disease Self-Management Program (CDSMP) “Living Well with Chronic Conditions”Developed by Stanford University’s patient education programLeader Training 4 Days lead by 2 Master TrainersStructured participants in a six-week workshop series done by 2 certified leadersParticipative instruction with peer supportDesigned to enhance medical treatmentOutcome-driven: impacts show potential for reduced or avoided costsEvidence-based: a tested model (intervention) that has demonstrated results
14Living Well with Chronic Conditions Techniques Action planningFeedback/ problem solvingDecision MakingManagement ToolsPhysicalPsychologicalEmotionalThe process or the way CDSMP is taught is as important, if not more important than the subject matter that is taught.
15Living Well With Chronic Conditions Workshops (CDSMP)
16Keys to SuccessThe format addresses specific problems and goals for people with ongoing health problems. It is not a drop-in support group.The workshops are not prescriptive. Participants choose their own goals and track their own progress toward success.Pair of trained peer leaders offer guidance and support, but participants find practical solutions individually and together.Living Well With Chronic Conditions Workshop
17Better coping strategies and symptom management; Evidence CDSMP participants experienced the following outcomes 6 months after starting the CDSMP programIncreased exercise;Better coping strategies and symptom management;Better communication with their physicians;Improvement in their self-rated health, disability, social and role activities, and health distress;More energy and less fatigue;Decreased disability;Fewer physician visits and hospitalizations.Lorig et al., 1999
18Stanford’s CDSMP is Evidence-based Found to benefit targeted populations.Including a decrease in health care costsDemonstrated it does not cause harm.Demonstrated it does not waste resources. CDSMP can facilitate the Triple Aim GoalsLets do a quick demo!CDSMP demo: healthy eating or action planning,brainstorm?Preliminary Results:~$740 per person savings in ER and hospital utilization~$390 per person net savings after considering program costs at $350 per participantReaching even 10% ofAmericans with one or more chronic conditions wouldsave ~$4.2 billion!Better Care: improving the experience of careBetter Health: improving population healthLower Cost: reducing health care costs*Berwick et al. (2008). The Triple Aim: Care, Health, And Cost. Health Affairs.
19Options for Involvement Offer the program(s) at your clinic/organization with your staff, and/or volunteer peer leaders. Training is available through the Area Agencies on AgingOffer the program at your clinic/organization in partnership with a community providerRefer your patients to programs that your organization offers or to community partners; visit for a listing of workshopsor call Senior Linkage Line
20Resources Minnesota Board on Aging: http://www.mnaging.org/ National Council on Aging (NCOA):NCOA: Center for Healthy AgingOnline Training Modules:training-modules/Highest Tier Evidence-Based Health Promotion/Disease Prevention Programslibrary/Title-IIID-Highest-Tier-Evidence-FINAL.pdfStanford Patient Education Research Center:
21A Matter of Balance: Managing Concerns about Falls (Falls Prevention)
22What do we know about falls? Up to 30% of community dwelling adults fall each yearAbout 20% of falls cause physical injuryLeading cause of hospitalized injuryLeading cause of ER-treated injuryMN ranks 3rd in the nation in fall related deaths – twice as many per capita as the national average
23What we know about Falls 1/2 to 2/3 of falls occur around the homeA majority of falls occur during routine activitiesFalls usually aren’t caused by just one issue. It’s a combination of things coming togetherA large portion of falls are preventable!
24What we know about Falls Falls are :CommonPredictablePreventableFalls are not a natural part of aging!
25What do we know about fear of falling? It is reasonable to be concerned about falls - safety is important1/3 to 1/2 of older adults acknowledge fear of fallingFear of falling is associated with:decreased satisfaction with lifeincreased frailtydepressiondecreased mobility and social activityFear of falling is a risk factor for falls
26What is A Matter of Balance? A Matter of Balance is a program:based upon research conducted by the Roybal Center for Enhancement of Late- Life Function at Boston Universitydesigned to reduce the fear of falling and increase the activity levels of older adults who have concerns about falls
27A Matter of Balance: Managing Concerns About Falls During 8 two-hour classes, participants learn:To view falls and fear of falling as controllableTo set realistic goals for increasing activityTo change their environment to reduce fall risk factorsTo promote exercise to increase strength and balance
28A Matter of Balance: Managing Concerns About Falls What Happens During Classes?Group discussionProblem-solvingSkill buildingAssertiveness trainingExercise trainingVideotapesSharing practical solutions
29Who could benefit from A Matter of Balance? Anyone who:is concerned about fallshas sustained a fall in the pastrestricts activities because of concerns about fallingis interested in improving flexibility, balance and strengthis age 60 or older, ambulatory and able to problem-solve.
30Administration on Aging Grant In 2003, AoA launched a three year public/private partnership to increase older people’s access to programs that have proven to be effective in reducing their risk of disease, disability and injury Grant Goals: •Develop a volunteer lay leader model and test whether it is successful when compared with original research •Share our approach with others in Maine and around the country
31A Matter of Balance Outcomes Participant Outcomes97 % - more comfortable talking about fear of falling97 % - feel comfortable increasing activity99 % - plan to continue exercising98 %- would recommend A Matter of Balance* % who agree to strongly agreeComments:I am more aware of my surroundings. I take time to do things and don’t hurry.I have begun to exercise and am looking forward to a walking program.I have more pep in not being afraid.
32Participants Report:Increased confidence in taking a walk, climbing stairs, carry bundles without fallingMore confidence that they can increase their strength, find ways to reduce falls, and protect themselves if they do fallAn increase in the amount they exercise on a regular basisFewer falls after taking MOB
33Impact in MN Steady increase of participants 2012; 845 participants with 721 completers2011; 777 participants2010; 444 participantsLess than 1% report no improvement in:Finding a way to get up from a fallMore steady on feetFinding a way to reduce a fallProtecting yourself incase of a fallPhysical activity
34Do a MOB Activity 2. 4 – “stop light” part and then do Handout 2 Do a MOB Activity 2.4 – “stop light” part and then do Handout 2.1 – Brainstorming Confidence Building thoughts.
35Options for Involvement Offer the program(s) at your clinic/organization with your staff, and/or volunteer peer leaders. Training is available through the Area Agencies on AgingOffer the program at your clinic/organization in partnership with a community providerRefer your patients to programs that your organization offers or to community partners; visit for a listing of workshopsor call Senior Linkage Line
36Resources Minnesota Board on Aging: http://www.mnaging.org/ National Council on Aging (NCOA):NCOA: Center for Healthy AgingOnline Training Modules:training-modules/Highest Tier Evidence-Based Health Promotion/Disease Prevention Programslibrary/Title-IIID-Highest-Tier-Evidence-FINAL.pdfStanford Patient Education Research Center:
38The Question:Is there an evidence-based fall prevention program that would be culturally appropriate for and accessible to non-English speaking older adults?Have great discussion-based programs with CDSMP/Living Well and MOBHowever, not translated into all languages and not all older non-English speaking adults can read/write in their language
39Tai Chi: Moving For Better Balance (TCMFBB) Developed by Dr. Fuzhong Li, Oregon Research Institute8 forms of Yang style Tai Chi adapted specifically for fall preventionReduces the risk of falls by improving balance, muscle strength, flexibility and mobilityTwice/week for 1 hour plus practice, 2 twelve week sessionsOne certified leaderResearched evidence-based programs that had physical activity and no discussionFound TCMFBBChecked other states that had tried it – very positive response with everyone I spoke withContacted Dr. Li – felt it would be a good one to pilot test in 2012- NOTE: Also looked at Tai Chi for Arthritis, but at that time it was not on the NCOA list of evidence-based programs – AAAs mandated to focus only on the top tier evidence-based programs
40Tai Chi origins Monks in the mountains of China 600 years ago Created as a self-defense martial artEvolved into a health & wellness exercise program- Has anyone done Tai Chi? How much? Experience?
41“Moving meditation” 8 forms that emphasize - weight shifting - postural alignment- coordinated movements4 S’sslow - softsmooth - safeIntegrated breathing
42Seated&StandingOF course, for English speaking as well as non-EnglishTypically part seated, part standing – but all can be done seated and emphasize to sit when needed!
43Leader qualifications No previous Tai Chi experience requiredExperience working with older adults & group exercise programs very helpfulEnjoy leading groupsWilling to learn, practice and continually improve
44Leader training 2 day intensive workshop Led by Dr. Li Follow-up sessions with local leaderLeader sharing sessionsDVD and tips
452012 pilot test Timeframe: April – December, 2012 10 bilingual leaders trained:Initial 2-day training3 two hr. follow-up sessionsQuarterly leader sharing and updates7 languages: Laotian, Korean, Khmer, Hmong, Somali and Vietnamese and EnglishClasses: Two 12 week sessions, twice/week for 1 hourStipends: To $30/class- Comment on data- But maybe the most telling are the comments people have made
46Pilot test results Participants: 124 first session, 129 second Retention: 64% attended half or more, 49% attended 3/4 or moreRetention higher in organizations with active existing programming and leaders - 86% attended half or more, 68% attended 3/4 or moreParticipation and retention higher with Asian older adults than East African older adults“Timed up and go” test – avg. 2 second improvement- Comment on data- But maybe the most telling are the comments people have made
47What participants said… “The Tai Chi class helped me be able to use old muscles I have not used in a while. Now I can stretch my arms up very high.”“I was walking with a cane for a couple of years. After I join the class I am able to walk without a cane.”“The Tai Chi exercise program helped me a lot with emotional stress and physical improvement.”“Because of a stroke, I couldn’t use my arm. But I am able to move and use my arm and lift up to my head.”– you can read for yourself – but span from concrete physical improvements to enhanced more and reduced stress.
48What we learned Bilingual leaders are effective Organizations with existing active older adult programs had stronger participation/retentionCultural backgrounds may make a difference in participation/retentionOlder adults will attend and do benefitBilingual leaders were able to learn the program and deliver it effectively to older adults in their communities in their native language.Leaders who already had some kind of program role and relationship with older adults in the community had a higher participation and retention rate.Previous knowledge of Tai Chi was not a critical success factor but previous experience leading groups of older adults in physical activities was valuable.Participation and retention tended to be higher in sites with participants from Asian cultures than participants with East African cultures where Tai Chi specifically and organized exercise in general have been less prominent. However, the Asian organizations represented also tended to already have programs in place and a relationship with the Tai Chi leader, which could well have contributed to the participation differences
492013 participating organizations Brian Coyle Center Oromo, SomaliCentro SpanishCommon Bond English, Somali, SpanishKorean Service Center KoreanLao Advancement Org. of Am LaotianPresbyterian Homes & Services EnglishUnited Cambodian Assn. of MN KhmerVOA/Park Elder Center HmongVietnamese Social Services VietnameseAlso, Mahube-Otwa RSVP in Land of the Dancing Sky AAA and Central MN Council on Aging (both in English)
50A word on fundingMAAA Title IIID funds target non-English speaking older adultsMAAA pays IIID organizations to host Tai Chi classes and funds the leader trainingAs space allows, other organizations attend leader training and reimburse MAAA for costs
51What’s next… Metropolitan Area Agency on Aging 3rd training, new organizations and leadersLand of the Dancing Sky AAA & Mahube-Otwa RVSP2nd training, more leadersCentral MN Council on AgingGetting started
52Additional TCMFBB info NCOA link to TCMFBB:Research basis for TCMBB:“Tai Chi and fall reductions in older adults: a randomized controlled trial,” Journal of Gerontology, 2005:“Translation into Community-based Falls Prevention Program,” 2008, American Journal of Public Health:“Tai Chi and Postural Stability in Patients with Parkinson's Disease,” 2012, New England Journal of Medicine:
54Options for Involvement Offer the program(s) at your clinic/organization with your staff, and/or volunteer peer leaders. Training is available through the Area Agencies on AgingOffer the program at your clinic/organization in partnership with a community providerRefer your patients to programs that your organization offers or to community partners; visit for a listing of workshopsor call Senior Linkage Line
55Contact Information:Mary Hertel, RN EBHP Coordinator/TrainerCentral MN Council on AgingDirect:Agency:Debra Laine, Special Programs DeveloperArrowhead Area Agency on AgingDave Fink, Program DeveloperMetropolitan Area Agency on Aging
56Questions ?“Those things that we do for ourselves, day-to-day that improve or maintain our health and make us feel better”