Evidence Based Health Promotion: What's the Buzz All About? Mary
Hertel: Central MN Council on Aging Debra Laine: Arrowhead Area
Agency on Aging Dave Fink: Metropolitan Area Agency on Aging
Tuesday June 18, 2013 8:00 am to 9:15 Lake Superior Ballroom, City
side Slide 2 Information to be presented: What are Evidence Based
programs and why are they important Research and demonstrated
outcomes How EBP can fit within the patient engagement model,
compare/contrast with patient education Overview of specific EBPs
including Stanford Self-Management, A Matter of Balance and Tai
chi: Moving For Better Balance Describe how you or your
organization can get more involved Slide 3 What is Evidence Based
health promotion programming? Simply put it is: programs based on
research. Slide 4 What evidence do we need? Evidence that a health
issue exists Evidence about design, context and attractiveness of
program Evidence that a program is effective Slide 5 Why the
interest in Evidence Based Programs? Magnitude and serious of
health and social problems in our communities Awareness of
preventability of many problems Emergence of evidence-based
practices and programs Spend limited resources more efficiently
Slide 6 EBPs have Demonstrated Outcomes Slide 7 Consider: people
with chronic conditions rarely spend more than 1% of their life at
a healthcare facility. It is the other 99% of ones 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 care may not fully understand implications of particular
health decision may lack support to make better choices Slide 8 Can
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 activation result in improved
self-management behaviors? Health Services Research, 42, 1443-1463.
Slide 9 How can Evidence Based Programs help? Slide 10
Self-Management Differs From Patient Education (but we need both) -
Manage life with disease - Problem solve and make decisions -
Improve confidence in abilities to make changes - Increase skills
& self-confidence - Change behaviour's - Information, technical
skills - Diseasespecific knowledge - Use specific tools (e.g., Care
Plans, Action Plans) Self-management Patient Education Slide 11
Advantages 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 providers Evidence-based programming provides value Slide 12
Lets 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
Management Diabetic Self Management Additional programs: A Matter
of Balance Tai Chi Moving for Better Balance Slide 13 What is the
Stanford Chronic Disease Self-Management Program (CDSMP) Living
Well with Chronic Conditions Developed by Stanford Universitys
patient education program Leader Training 4 Days lead by 2 Master
Trainers Structured 10-15 participants in a six-week workshop
series done by 2 certified leaders Participative instruction with
peer support Designed to enhance medical treatment Outcome-driven:
impacts show potential for reduced or avoided costs Evidence-based:
a tested model (intervention) that has demonstrated results Slide
14 Living Well with Chronic Conditions Techniques Action planning
Feedback/ problem solving Decision Making Management Tools Physical
Psychological Emotional The process or the way CDSMP is taught is
as important, if not more important than the subject matter that is
taught. Slide 15 Living Well With Chronic Conditions Workshops
(CDSMP) Slide 16 The 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.
Keys to Success Living Well With Chronic Conditions Workshop Slide
17 Evidence CDSMP participants experienced the following outcomes 6
months after starting the CDSMP program Increased 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 Slide 18 Stanfords
CDSMP is Evidence-based Found to benefit targeted populations.
Including a decrease in health care costs Demonstrated it does not
cause harm. Demonstrated it does not waste resources. CDSMP can
facilitate the Triple Aim Goals Lets do a quick demo! Slide 19
Options for Involvement Options 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 Aging Offer the program at your clinic/organization in
partnership with a community provider Refer your patients to
programs that your organization offers or to community partners;
visit www.mnhealthyaging.org for a listing of
workshopswww.mnhealthyaging.org or call Senior Linkage Line
1-800-333-2433 Slide 20 Resources Minnesota Board on Aging:
http://www.mnaging.org/http://www.mnaging.org/ National Council on
Aging (NCOA): http://www.ncoa.org/http://www.ncoa.org/ NCOA: Center
for Healthy Aging
http://www.ncoa.org/improve-health/center-for-healthy-aging/ Online
Training Modules:
http://www.ncoa.org/improve-health/center-for-healthy-aging/online-
training-modules/
http://www.ncoa.org/improve-health/center-for-healthy-aging/online-
training-modules/ Highest Tier Evidence-Based Health
Promotion/Disease Prevention Programs
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-
library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-
library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf Stanford Patient
Education Research Center: http://patienteducation.stanford.edu/
Slide 21 A Matter of Balance: Managing Concerns about Falls (Falls
Prevention) Slide 22 What do we know about falls? Up to 30% of
community dwelling adults fall each year About 20% of falls cause
physical injury Leading cause of hospitalized injury Leading cause
of ER-treated injury MN ranks 3rd in the nation in fall related
deaths twice as many per capita as the national average Slide 23
What we know about Falls 1/2 to 2/3 of falls occur around the home
A majority of falls occur during routine activities Falls usually
arent caused by just one issue. Its a combination of things coming
together A large portion of falls are preventable! Slide 24 What we
know about Falls Falls are : Common Predictable Preventable Falls
are not a natural part of aging! Slide 25 What do we know about
fear of falling? It is reasonable to be concerned about falls -
safety is important 1/3 to 1/2 of older adults acknowledge fear of
falling Fear of falling is associated with: decreased satisfaction
with life increased frailty depression decreased mobility and
social activity Fear of falling is a risk factor for falls Slide 26
What 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 University designed to reduce the
fear of falling and increase the activity levels of older adults
who have concerns about falls Slide 27 A Matter of Balance:
Managing Concerns About Falls During 8 two-hour classes,
participants learn: To view falls and fear of falling as
controllable To set realistic goals for increasing activity To
change their environment to reduce fall risk factors To promote
exercise to increase strength and balance Slide 28 A Matter of
Balance: Managing Concerns About Falls What Happens During Classes?
Group discussion Problem-solving Skill building Assertiveness
training Exercise training Videotapes Sharing practical solutions
Slide 29 Who could benefit from A Matter of Balance? Anyone who: is
concerned about falls has sustained a fall in the past restricts
activities because of concerns about falling is interested in
improving flexibility, balance and strength is age 60 or older,
ambulatory and able to problem-solve. Slide 30 Administration on
Aging Grant In 2003, AoA launched a three year public/private
partnership to increase older peoples 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 Slide 31 A Matter of Balance Outcomes Participant Outcomes
97 % - more comfortable talking about fear of falling 97 % - feel
comfortable increasing activity 99 % - plan to continue exercising
98 %- would recommend A Matter of Balance * % who agree to strongly
agree Comments: I am more aware of my surroundings. I take time to
do things and dont hurry. I have begun to exercise and am looking
forward to a walking program. I have more pep in not being afraid.
Slide 32 Participants Report: Increased confidence in taking a
walk, climbing stairs, carry bundles without falling More
confidence that they can increase their strength, find ways to
reduce falls, and protect themselves if they do fall An increase in
the amount they exercise on a regular basis Fewer falls after
taking MOB Slide 33 Impact in MN Steady increase of participants
2012; 845 participants with 721 completers 2011; 777 participants
2010; 444 participants Less than 1% report no improvement in:
Finding a way to get up from a fall More steady on feet Finding a
way to reduce a fall Protecting yourself incase of a fall Physical
activity Slide 34 Slide 35 Options for Involvement Options 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 Aging Offer the program at your
clinic/organization in partnership with a community provider Refer
your patients to programs that your organization offers or to
community partners; visit www.mnhealthyaging.org for a listing of
workshopswww.mnhealthyaging.org or call Senior Linkage Line
1-800-333-2433 Slide 36 Resources Minnesota Board on Aging:
http://www.mnaging.org/http://www.mnaging.org/ National Council on
Aging (NCOA): http://www.ncoa.org/http://www.ncoa.org/ NCOA: Center
for Healthy Aging
http://www.ncoa.org/improve-health/center-for-healthy-aging/ Online
Training Modules:
http://www.ncoa.org/improve-health/center-for-healthy-aging/online-
training-modules/
http://www.ncoa.org/improve-health/center-for-healthy-aging/online-
training-modules/ Highest Tier Evidence-Based Health
Promotion/Disease Prevention Programs
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-
library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf
http://www.ncoa.org/improve-health/center-for-healthy-aging/content-
library/Title-IIID-Highest-Tier-Evidence-FINAL.pdf Stanford Patient
Education Research Center: http://patienteducation.stanford.edu/
Slide 37 Slide 38 The Question: Is there an evidence-based fall
prevention program that would be culturally appropriate for and
accessible to non-English speaking older adults? Slide 39 Tai Chi:
Moving For Better Balance (TCMFBB) Developed by Dr. Fuzhong Li,
Oregon Research Institute 8 forms of Yang style Tai Chi adapted
specifically for fall prevention Reduces the risk of falls by
improving balance, muscle strength, flexibility and mobility
Twice/week for 1 hour plus practice, 2 twelve week sessions One
certified leader Slide 40 Monks in the mountains of China 600 years
ago Created as a self-defense martial art Evolved into a health
& wellness exercise program Tai Chi origins Slide 41 8 forms
that emphasize - weight shifting - postural alignment - coordinated
movements 4 Ss - slow- soft - smooth- safe - Integrated breathing
Moving meditation Slide 42 Seated & Standing Slide 43 Leader
qualifications No previous Tai Chi experience required Experience
working with older adults & group exercise programs very
helpful Enjoy leading groups Willing to learn, practice and
continually improve Slide 44 Leader training 2 day intensive
workshop Led by Dr. Li Follow-up sessions with local leader Leader
sharing sessions DVD and tips Slide 45 2012 pilot test Timeframe:
April December, 2012 10 bilingual leaders trained: Initial 2-day
training 3 two hr. follow-up sessions Quarterly leader sharing and
updates 7 languages: Laotian, Korean, Khmer, Hmong, Somali and
Vietnamese and English Classes: Two 12 week sessions, twice/week
for 1 hour Stipends: To organizations @ $30/class Slide 46 Pilot
test results Participants: 124 first session, 129 second Retention:
64% attended half or more, 49% attended 3/4 or more Retention
higher in organizations with active existing programming and
leaders - 86% attended half or more, 68% attended 3/4 or more
Participation and retention higher with Asian older adults than
East African older adults Timed up and go test avg. 2 second
improvement Slide 47 What 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
couldnt use my arm. But I am able to move and use my arm and lift
up to my head. Slide 48 What we learned Bilingual leaders are
effective Organizations with existing active older adult programs
had stronger participation/retention Cultural backgrounds may make
a difference in participation/retention Older adults will attend
and do benefit Slide 49 2013 participating organizations Brian
Coyle Center Oromo, Somali Centro Spanish Common Bond English,
Somali, Spanish Korean Service Center Korean Lao Advancement Org.
of Am. Laotian Presbyterian Homes & Services English United
Cambodian Assn. of MN Khmer VOA/Park Elder Center Hmong Vietnamese
Social Services Vietnamese Also, Mahube-Otwa RSVP in Land of the
Dancing Sky AAA and Central MN Council on Aging (both in English )
Slide 50 A word on funding MAAA Title IIID funds target non-English
speaking older adults MAAA pays IIID organizations to host Tai Chi
classes and funds the leader training As space allows, other
organizations attend leader training and reimburse MAAA for costs
Slide 51 Whats next Metropolitan Area Agency on Aging 3 rd
training, new organizations and leaders Land of the Dancing Sky AAA
& Mahube-Otwa RVSP 2 nd training, more leaders Central MN
Council on Aging Getting started Slide 52 Additional TCMFBB info
NCOA link to TCMFBB: http://www.ncoa.org/improve-health/center-
for-healthy-aging/tai-chi-moving-for-better.htmlhttp://www.ncoa.org/improve-health/center-
for-healthy-aging/tai-chi-moving-for-better.html Research basis for
TCMBB: Tai Chi and fall reductions in older adults: a randomized
controlled trial, Journal of Gerontology, 2005:
http://www.ncbi.nlm.nih.gov/pubmed/15814861
http://www.ncbi.nlm.nih.gov/pubmed/15814861 Translation into
Community-based Falls Prevention Program, 2008, American Journal of
Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424086/
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2424086/ Tai Chi and
Postural Stability in Patients with Parkinson's Disease, 2012, New
England Journal of Medicine:
http://www.nejm.org/doi/full/10.1056/NEJMoa1107911
http://www.nejm.org/doi/full/10.1056/NEJMoa1107911 Slide 53 MN
Healthy Aging website Slide 54 Options for Involvement Options 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 Aging Offer the program at your
clinic/organization in partnership with a community provider Refer
your patients to programs that your organization offers or to
community partners; visit www.mnhealthyaging.org for a listing of
workshopswww.mnhealthyaging.org or call Senior Linkage Line
1-800-333-2433 Slide 55 Contact Information: Mary Hertel, RN EBHP
Coordinator/Trainer Central MN Council on Aging Direct:320-202-6945
Agency: 320-253-9349 [email protected] Debra Laine, Special
Programs Developer Arrowhead Area Agency on Aging 218-529-7534
[email protected] Dave Fink, Program Developer Metropolitan Area
Agency on Aging 651-917-4633 [email protected] Slide 56 Questions ?
Those things that we do for ourselves, day-to-day that improve or
maintain our health and make us feel better
