Activate for Health
Introduction
The ‘Activate for Health’ project aims to provide access to community based physical activity opportunities and "Cook & Eat" sessions, for mental health service users, through offering an 18-week programme in each of the 3 local PCTs.
The project was originally based on a pilot in Redcar, targeted at patients with mental health problems to help them manage their weight. ‘Activate For Health’ was seen as a way of delivering some of the National Service Framework (NSF) for mental health targets locally.
Support from the dietetic teams was elicited after short term funding was secured. The dieticians influenced the project terms to: widen the focus from weight management to healthy eating and to include cooking skills. ‘Activate for Health’ runs in parallel to the local Exercise on Referral project, called ‘Exercise for Health’. This runs across the three local PCTs and there are plans to extend ‘Activate For Health’ in the same way.
Partnership organisations The current partners for ‘Activate For Health’ are:
- Doncaster Metropolitan Borough Council (specifically the Active Recreation Unit)
- Doncaster Central PCT
- Doncaster Mental Health Programme
- MIND
- The dietetic department.
Purpose and Objectives
The aim of the project is:
"To provide access to community based physical activity opportunities and "Cook & eat" sessions in order to promote a healthier lifestyle to mental health service users".‘Activate For Health’ builds on a pilot project run 18 months ago, which evaluated positively in both the topic areas of healthy eating and physical activity. The project plan is to provide two 18-week programmes in each of the three PCTs, catering for eight clients per course, so reaching a total of 48 clients over the borough.
The Target Audience is:
All people with mental health problems across the three PCTs within Doncaster. Potential participants were identified through an initial meeting with Doncaster mental health key workers to promote the scheme. Key workers promoted the scheme to potential users and facilitated transport as necessary.The specific needs of the learners were identified at the first food skills session, where the following was assessed: access to cooking equipment, food knowledge, usual eating habits and usual food shopping habits.
The target group is traditionally difficult to reach because some are institutionalised, they can lack the means to access services and may suffer from a severe lack of motivation. This group are traditionally sedentary with very low rates of participation in physical activity.
Methodology
An 18-week programme of physical activity and cooking sessions are offered to people with mental health problems. The programme consists of approximately 75% exercise sessions and 25% food and health skills sessions (due to limited cooking facilities). A typical "Cook & Eat" session would include 1-4 participants (always with a carer), 2 recipes to prepare and a recipe handout.The scheme operates in a variety of community settings, including three leisure centres:
- Adwick Leisure Centre (West PCT)
- St James Leisure Centre (Central PCT)
- Thorne Leisure Centre (East PCT)
Qualified fitness instructors deliver the physical activity element. These instructors hold an additional qualification for working with patients referred by general practitioners. During the initial sessions, the needs of the individuals are assessed and sessions are tailored to meet these needs through group work. Initial physical assessments include analysis of usual physical activity habits and data collection for blood pressure, heart rate, waist measurement, body weight, flexibility and grip.
Funding
The project was initially funded by Social Services, who at that time had a remit for mental health. The Department granted £14,000 towards the project and the HA augmented funding through set up costs.Further funding was secured when the local Health Authority was re-organised into three PCTs. Central PCT allocated Neighbourhood Renewal money to fund the project for a year, but medium – long term funding is uncertain.
The time scale of the project was: 2001 -Social services secure initial funding, 2001/2 -Set up and conduct pilot group, 2002/3 - Bids for further funding meant a halt to the project and October 2003 - the first post-pilot course commenced.
Barriers
Most of the barriers encountered have been logistical:- Recruitment of potential users of the scheme in the East PCT due to the nature of the care structures
- Co-ordination of activity sessions to fit around transport for participants
- Availability of the food educator and fitness instructor
- Availability of the kitchen facilities.
Clarification of the referral process of ‘GP exercise endorsement’, enabling the GPs to use a consent form allowing patients to join the scheme. High ‘failure to attend’ rate was perceived (although there were no figures available to back this up). Carers felt this was due to the many variables for this group including transport issues and motivation
Evaluation
Respondents described a number of different types of data that are currently being collected in order to evaluate the project including:- Reported physical activity behaviours (by questionnaire)
- Reported dietary habits (by questionnaire)
- Reported behavioural parameters
- Physiological measurements (blood pressure; waist circumference, heart rate, body weight, flexibility, grip strength)
Data is being collected at baseline, 9 weeks and at 18 weeks but as the project is midway through the first post-pilot course there is no outcome data to date. This is expected in March 2004. All data is fed into a central database designed and held by the Project Support Officer. It is his responsibility to collate, analyse and write up the evaluative element of this project.
Validated assessment tools are used for measuring eating and physical behaviours. Behaviour change assessment is based on the Trans-theoretical model, developed by Prochaska and Diclemente, "Stages of Change". It is planned to augment the quantitative data with qualitative data.
Respondents did however indicate that incomplete data sets resulting from high missed attendances could result in failure to demonstrate robust outcome data. Additionally, evaluative data is being collated and interpreted internally and this has implications for impartiality and interpretation.
Sustainability
The short-term nature of the funding has made it difficult to keep the momentum of the project going. The hiatus in the project between bursts of funding has been potentially damaging to the scheme and it has proved difficult to recruit staff for a short-term contract.The second cycle of short-term funding is now coming to an end and there is some doubt as to whether the project team will bid for a further round of short term funding.
Other options for the future include:
- Training community mental health service staff to run "Cook & Eat" sessions
- Training mental health staff in a ‘Walk Leaders’ qualification, which is part of the national ‘Walking the Way to Health’ initiative
- Integrating the ‘Activate for Health’ participants into the many mainstream "Cook & Eat" sessions already established in Doncaster
- Offering further training of fitness instructors in exercise and mental health, with a view to encouraging more mental health service users into mainstream leisure centre services.
Lessons Learnt
Set up a steering group involving all partners at the outset of the project. It is vital to include mental health service providers in this process as this is the key network through which to recruit participants.Partners to be included in the set up phase include General Practitioners (GPs), Public Health representatives, physical activity staff, exercise referral scheme staff, dieticians, mental health service team and charitable/voluntary organisations concerned with mental health.
Set up a project funding plan at the start to prevent gaps in funding which can be potentially damaging to all those involved in the initiative.
Seek the help of external evaluators/researchers for the scheme and identify funds for this at the outset.. Use evaluative data that focuses on outcomes to support the case for mainstream funding.
Ideally employ dedicated staff for the project because of the complicated nature of the logistics. Staff should have dual competencies in physical activity and food so that they can run both sessions. The project also requires a dedicated co-ordinator to manage all these various factors.
Lead contact:
Contact: Louise KellyJob Title: Public Health Dietician
Address:
Department of Nutrition and Dietetics
Doncaster Royal Infirmary
Althorpe Road
Doncaster
South Yorkshire
DN2 5LT
Tel: 01302 366 6666 Ext 3711
Email: sarah.kelly2@nhs.net