OASIS Health Programs:improving health equity through evidence-based

approaches to healthy aging

Building Health Equity in the St Louis RegionMissouri Health Equity Collaborative Regional Meeting,

October 19, 2012

Peter L. Holtgrave, MA, MPH

James Teufel, MPH, PhD

What is OASIS?What is OASIS?

A three-fold approach to successful aging

OASIS reaches adults 50+ in 40 citiesOASIS reaches adults 50+ in 40 cities

700 partners, 35,000 participants annually

Statistics of the US Aging PopulationStatistics of the US Aging Population

Statistics of the US Aging PopulationStatistics of the US Aging Population

US National Center for Health Statistics

Health and Aging in the USHealth 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 yearo leading cause of injury-related death for this age group

Programs support the mind, body and Programs support the mind, body and spiritspirit

• Local arts & humanities classes

• Technology training

• National humanities programs

Lifelong learning Health promotion

• Active Start

• Chronic disease management

• Matter of balance

• Tai Chi, Yoga, Zumba etc

Community involvement

• Intergenerational Tutoring

• CATCH Healthy Habits

• Instructors and peer leaders

• Program planning and support

evidence- andresearch-based programs

Evidence-Based Health ProgramsEvidence-Based Health Programs

Active Start

Active StartActive 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 participantso 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 DayActive 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 DayActive 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

ExerStartExerStart

• 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

ExerStartExerStart

• Course design: 43 exerciseso Focus: aerobic strength, flexibility, and balance

• Session design: (45 minutes)

Increase flexibility & balance

Increase endurance

Increase strength

start

Active Start Outcome Measures 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 OutcomesActive Start Outcomes11

• Behavioral change support group + fitness classes = significant improvements in physical performanceo 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 ProgramsEvidence-Based Health Programs

Chronic Disease Self-Management Program(CDSMP)

CDSMPCDSMP

• 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

CDSMPCDSMP

• 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

CDSMPCDSMP

• 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

CDSMPCDSMP

• Skill development:o Coping strategies

o Action planning

o Giving feedback

o Behavior modeling

o Decision-making and problem-solving techniques

CDSMP OutcomesCDSMP 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 OutcomesCDSMP 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 ProgramsEvidence-Based Health Programs

Better Choices, Better Health

Better Choices, Better HealthBetter Choices, Better Health

• Developed by National Council on Aging (NCOA) and Stanford Universityo Kate Lorig, RN, DrPH

• Internet version of CDSMPoConvenient 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 HealthBetter 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 HealthBetter 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 HealthBetter Choices, Better HealthOutcomesOutcomes

• 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 IntergenerationalEvidence-based IntergenerationalHealth ProgramsHealth Programs

Active Generationsand

CATCH Healthy Habits

Active Generations Active Generations (2006-2010) (2006-2010) &&CATCH Healthy Habits CATCH Healthy Habits (2010-2012)(2010-2012)

• Intergenerational, evidence-based physical activity and nutrition programs

• Fundingo Robert Wood Johnson Foundation (2006)

o WellPoint Foundation (2007-2012)

• Adaptation of Coordinated Approach to Child Health (CATCH)

• Outcomes-driven

• Award-winning

ObjectivesObjectives

• Address childhood and older adult obesity and improve overall health and wellnesso Increase physical activity and encourage active livingo Increase knowledge about nutrition to encourage

healthy eatingo Foster positive relationships between young people

and adults, age 50-plus

Program DesignProgram Design

Nutrition Lessons

Physical Activities

Snack Lessons

Program DesignProgram Design

Active Generations (2006-2010)

CATCH Healthy Habits (2010-2012)

Less funding overall More funding overall 8 U.S. Cities across 10 states 18 U.S. Cities across 14 states 200 Volunteers in direct service roles, ages 70-80

750 Volunteers in direct service and capacity-building roles, age 50+

1000 Child participants in Grades 3 to 5 4250 Child participants in Grades K to 5 One module, 8-10 sessions, 90 mins. ea Two modules, 8-25 sessions, 60 mins. ea 20 minutes of physical activity 30 minutes of physical activity No formal relationship with national youth service organizations

Formal relationship with Boys & Girls Clubs of America (national partner)

Long pre- and post-survey Abridged pre- and post-survey No observational measurement Observation of PA (SOFIT) ROI calculations not conducted Volunteerism ROI calculated (SMART)

CATCH Healthy HabitsCATCH Healthy Habits

  Phase 1 (March'11) Phase 2 (Aug'11) Phase 3 (Oct'11)Atlanta, GA Las Vegas, NV Albany, NY

Escondido, CA Portland, ME Cleveland, OHIndianapolis, IN Madison, WI (Sept’11) Denver, COLong Beach, CA Hartford, CTLos Angeles, CA Louisville, KYRichmond, VA Manchester, NH

Saint Louis, MO New York City, NYSan Diego, CA

18 Cities across 14 States18 Cities across 14 States

400+ Organizational Partners400+ Organizational Partners

Volunteer RolesVolunteer Roles

• Example Titleso 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)

oCommunity Connector (partnership development)

oOutcome Czar (evaluation, data collection /entry)

o Professional Storyteller (marketing, publicity)

oDocumentary Artist (takes photos, shoots videos)

o Volunteer Leader (program administration, volunteer supervision)

Pilot Program Child ResultsPilot Program Child Results(2006-2010; N=760)(2006-2010; N=760)

• 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

• Statistically significant health impacts:

CATCH Healthy Habits Child ResultsCATCH Healthy Habits Child Results(June 2011-September 2012)(June 2011-September 2012)

• Survey-based improvements• 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)

• SMART tool• 26,500 volunteer hours• $484,000 value

SOFIT Coding Sheet

SMART tool

Future DirectionsFuture Directions

• Diabetes Self-Management Program (DSMP)

• Community-level policy and environment change through intergenerational approaches

• Generations for a Healthy Community

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Questions and Discussion

OASIS Evidence- and Research-based OASIS Evidence- and Research-based Programs Programs

James Teufel, MPH, PhDNational Health DirectorEmail: jteufel@oasisnet.orgPhone: 314-862-2933 ext. 237

Peter L. Holtgrave, MA, MPHNational Health ManagerEmail: pholtgrave@oasisnet.orgPhone: 314-862-2933 ext. 230

Thank youThank you