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Design and implementation of a clinic-to-community, physical activity health promotion model for healthcare providers

ABSTRACT: Highlights • EIMG® may offer healthcare providers a pathway to improve patient health outcomes.• The current EIMG® clinic-to-community model is well received by patients.• Adding EIMG® to patients’ usual care may reduce blood pressure and body weight. Due to the worldwide burden of noncommunicable disease, the American College of Sports Medicine (ACSM) launched a global health awareness initiative in 2007 called Exercise is Medicine® (EIM®) to create awareness in healthcare providers in promoting physical activity to their patients. To transition awareness into action, Exercise is Medicine Greenville® (EIMG®) launched in 2016 through a first-of-its-kind partnership between a medical school, large healthcare system, and community organization to comprehensively integrate physical activity as a primary prevention strategy into their health system. The EIMG® model connects patients referred by their healthcare provider due to diagnosis of a physical inactivity and/or noncommunicable disease to community partners who provide evidence-based physical activity programs as a population health management strategy. The EIMG® program is inclusive of all patients referred and provides an “open door policy” through the YMCA scholarship fund. Through 2019, 210 patients completed the program (>60% graduation rate). Patients receiving usual care by their healthcare provider decreased body weight (p < 0.001) and systolic blood pressure (p = 0.042). Patients receiving usual care by their healthcare provider who were referred with hypertension decreased body weight (p = 0.001), and both systolic and diastolic blood pressure (p < 0.001). Graduating patients were highly satisfied with the program and program personnel (>4 on a 5-point Likert scale). Aligning healthcare and community partners to implement a clinic-to-community model for patients with noncommunicable disease may be a beneficial population health promotion strategy. Future efforts will be to refine the referral process, scale the model, and continue to inform national health promotion strategies.

SUBMITTER: Porter R

PROVIDER: S-EPMC8790628 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundImmigrant women have low rates of physical activity (PA), placing them at risk for chronic diseases. Some research suggests that strategies targeting this group must be culturally-safe and community-based. This study aimed to identify the design (i.e. characteristics) and impact of culturally-safe community-based PA promotion for immigrant women.MethodsWe conducted a descriptive review by searching MEDLINE, EMBASE, SPORTDiscus, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs Institute Database of Systematic Reviews from inception to June 9, 2021 for English language studies that assessed community-based PA promotion strategies targeting adult immigrants and involved at least 50% women. We compiled findings in a preliminary context-mechanisms-outcomes conceptual framework.ResultsWe included 13 studies published from 2004 to 2020. Three included women-only; the remainder included a median of 63% women (range 50 to 98%). Studies included immigrants from Brazil, Dominican, Columbian, Haiti, Mexico, China, Vietnam, Bangladesh, India, Pakistan, Somalia, Sudan and Turkey. All but one study (89%) significantly improved one or more outcomes: PA knowledge, PA participation and anthropometric measures (e.g. weight, BMI, blood pressure). Most (89%) strategies were multi-faceted: in-person group educational sessions reinforced by take-home educational material and/or follow-up reminder phone calls. Single strategies (e.g. mailed educational material, group educational session) also achieved beneficial outcomes. We identified 17 culturally-safe characteristics of PA promotion strategies: language of choice, based in community settings or organizations, led by lay health workers, reflected ethno-cultural linguistic expressions and PA norms, and recognized and offered solutions to barriers of PA. Findings were captured in a preliminary theory of how contextual factors (gender, intersectionality) and mechanism (culturally-safe PA promotion) may influence PA-related outcomes (PA knowledge, self-efficacy and participation; anthropometric measures, quality of life).ConclusionsThis study revealed the characteristics of PA promotion strategies that significantly improved PA-related outcomes among immigrants. Given that few studies focused solely on immigrant women or reported sub-analyses, the conceptual framework generated by this study can be used in future research to more definitively establish the design and impact of culturally-safe, community-based PA promotion for immigrant women.

Project description:Background and Aims:Despite the many known health benefits of physical activity (PA), older adults are the least active citizens in many countries. Regular PA significantly decreases the odds of functional limitation and social disengagement. However, there is a dearth of publicly funded support services for older adults. The primary objective of this study is to conduct a formative evaluation to examine the implementation of community-driven health promotion programs for older adults in British Columbia, Canada. Methods:The Active Aging Grant (AAG) initiative funded 30 community-based organizations in British Columbia to design and deliver community-driven health promotion programs for older adults, with an explicit focus on PA and social connectedness. Guided by the Framework for Successful Implementation, we recruited program coordinators and participants and used semistructured interview guides to focus on design, delivery, and experience within the program. Framework analysis was used with NVivo 11. Results:Thirty-six in-depth, semistructured interviews were conducted in 2017, after program completion. Data saturation was achieved after interviewing 10 coordinators and 26 program participants from seven of the organizations. Eighteen were female; nine were male; 68% fell in the age range of 65-84. We detail the innovation characteristics, provider characteristics, and contextual factors that facilitate and impede program implementation. Aspects that facilitate implementation include that they promote PA, foster social connectedness, and address isolation and loneliness; personal accountability; affordability; program design; providers' appropriate skills; community collaborations; and transportation support. Aspects that hinder implementation include lack of resources for marketing and communications, lack of volunteers and dedicated staff, and access to transportation. We also highlight two themes that emerged outside the theoretical framework, the roles of gender and funding in program implementation. Conclusions:As part of a formative evaluation, the information will help adapt and enhance implementation of a larger scale-out intervention aimed to increase PA and social connectedness amongst older adults in British Columbia, Canada.

Project description:BackgroundThe Health Information System (HIS) is a set of computerized tools for the collection, storage, management, and transmission of health data. The role of such tools in supporting the modernization of health systems, improving access to quality healthcare, and reducing costs in developing countries is unquestionable, but their implementation faces several challenges. In Gabon, a unique national electronic HIS has been launched. It will connect healthcare institutions and providers at all levels in the whole country.ObjectiveThis study aims to explore and identify the factors influencing healthcare providers' perceptions of the national electronic HIS in Gabon.MethodsA 44-item questionnaire based on the Information System Success Model (ISSM) was administered between February and April 2018 among 2600 healthcare providers across the country. The questions assessed the different aspects of the HIS that could influence its perceived impact on a 5-level Likert scale (from fully agree to totally disagree). The reliability and construct validity of the questionnaire were checked using Cronbach alpha and congeneric reliability coefficients. A logistic regression was used to identify the factors influencing healthcare providers' perceptions of the system.ResultsA total of 2327 questionnaires were completed (i.e. 89.5% response rate). The logistic regression identified five elements that significantly influenced perceived system impact: System Quality (Odds Ratio-OR?=?1.70), Information Quality (OR?=?1.69), Actual Use (OR?=?1.41), Support Quality (OR?=?1.37), and Useful Functions (OR?=?1.14). The model explained 30% of the variance in providers' perception that the national HIS leads to positive impacts.DiscussionThe results show that healthcare providers' perceptions regarding the positive impact of the national HIS in Gabon are influenced by their previous use of an HIS, the scope of their usage, and the quality of the system, information, and support provided to users. These results could inform the development of strategies to ensure adequate change of management and user experience for the implementation of the national HIS in Gabon, and eventually in other low resource environments.

Project description:BACKGROUND:To achieve real-world impacts, behavior change interventions need to be scaled up and broadly implemented. Implementation is challenging however, and the factors influencing successful implementation are not fully understood. This study describes the nationwide implementation of a complex theory-based program targeting physical activity and sedentary behavior in vocational schools (Lets's Move It; LMI). The implementation primarily involved a systematic and theory-based training and user manual for school staff. We explore how the perceived acceptability of this training (in line with the Theoretical Framework of Acceptability) relates to (un) successful implementation. The study evaluates (1) the experienced acceptability of the training and anticipated acceptability of later delivering the program; (2) reach and implementation, including adaptations and barriers; (3) whether acceptability ratings predict teachers' intentions for implementation. METHODS:Upper secondary school staff from vocational and high schools (n?=?194) enrolled in a two-part training, covering implementation of the LMI program and training in motivational interaction styles. One hundred fifty-one participants attended both parts of the training. Participants reported their perceived acceptability of the training and their implementation efforts in online questionnaires at baseline, after training sessions and at long-term follow-up. Qualitative data (open-ended questions) were analysed with content analysis to collate responses. Quantitative data analyses involved correlations and logistic regression. RESULTS:Participants rated the training as highly acceptable on all dimensions (average ratings exceeded 4.0 on a 5-point scale). The implementation reached at least 6100 students and 341 school classes. Most teachers intended to continue program implementation. Acceptability ratings explained 51.7% of teachers' intentions to implement the student program (?2?=?30.08; df?=?8; p?<?.001), with affective attitude, perceived effectiveness and self-efficacy the most influential. Teachers commonly reported condensing program content, and reported deficits of time and collegial support as common barriers to implementation. CONCLUSION:High acceptability and reach of the training indicate strong potential for implementation success. Multiple facets of acceptability seem important to successful implementation. Future research should explore ways to improve acceptability, thereby promoting successful implementation in real-world settings.

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Design and implementation of a clinic-to-community, physical activity health promotion model for healthcare providers

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