HANS KAI: A community-led program that empowers people to take control of their own health

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1 HANS KAI: A community-led program that empowers people to take control of their own health Presenter: Mike Sadlowski CES, Bkin, MSc Applied Ergonomics Health Promoter

2 NorWest Co-op Community Health Centre Faculty: Michelle Kirkbride and Mike Sadlowski NorWest Co-op Community Health Centre Relationships with commercial interests: Grants/Research Support: none Speakers Bureau/Honoraria: none Consulting Fees: none Other: none

3 Health co-op with members giving voice in direction. Operates like a community health centre Not for profit Community elected Board Programs offered in partnerships and many funders 45 years in the community One of AON Hewitts Platinum employers in Canada History of implementing innovative health programs NorWest Co-op Community Health Centre

4 VISION People taking control of their health. NorWest Co-op Community Health Centre MISSION To engage our community in co-operative health and wellness. VALUES Respect: Integrity. Non-judgment. Dignity. Innovation: Vital. Responsive. Best-practice. Co-operation: Self-health. Engagement. Capacity-building.

5 What is the future of our HealthCare system?

6 HANS KAI What is it p6h4

8 HANS KAI What makes it different? 1. Self-Sustaining 2. Effective management of chronic disease 3. Community led program- high yield, low resource demand 4. Health education and community leadership in action 5. Cost effective 6. Focus for Community Development frameworks

9 HANS KAI Physical Activity Health Indicators Socialize Healthy Snack

10 HANS KAI Partners Manitoba, Canada: NorWest Co-op Community Health (founder) BC, Canada: YouVille Wellness institute Klinic Four Directions Co-op Rainbow Resource Centre Co-op Victoria Health Co-op Umbrella Health Co-op First Met Saskatchewan, Canada: Regina Community Clinic Co-op Ontario, Canada: Team Werks Quebec, Canada: Cooperative Sante de Robert Cliché Nova Scotia, Canada: NS Health Co-op New Brunswick, Canada: Open Sky Co-op

11 HANS KAI HANS KAI started in Winnipeg in 2009 with inviting key stakeholders These stakeholders formed a steering committee that continues to advise the program. The Health School and HANS KAI standardized curriculum and tools/resources were developed with best practice models and in collaboration with Robert Cliché Health Co-op to standardize the program across Canada. Research was provided by an external company and received ethics approval. National Network is now in place to share idea and discuss HANS at a national level. Some of the representatives from Japan co-ops and HANS KAI program took NorWest s HANS KAI training in 2014 and declared it the best model for HANS KAI going forward.

12 How Do We Measure Health? According to the World Health Organization: Positive health thus has three linked dimensions social, psycho-logical and physical which should all be included when measuring health.

Hans empowers individuals to take control of their own health and provides a unique opportunity for

14 HANS KAI What is it Hans Kai is a participant led based health program for people wanting to maintain or improve their health. Hans Kai groups consist of 8-40 people per group in communities or workplaces. Hans empowers individuals to take control of their own health and provides a unique opportunity for participants to have an active role in improving or maintaining their own health and well-being and that of their community.

15 HANS KAI How does it work? The HANS KAI Team works with interested groups or leaders in community or organizations to develop a HANS KAI training and ongoing program. Once trained, HANS KAI leaders can facilitate Health Schools so that interested participants can form HANS KAI groups. All participants will go through a free health series called HANS Health School lead by trained HANS KAI facilitator so that they will learn about the Hans Kai program. There are 9 sessions that are 1-2 hours that cover a variety of health related topics that will enable them to facilitate their own HANS KAI program.

16 HANS KAI Groups What Do They Do? HANS KAI GROUPS (After the Health School) Groups are now meeting on their own at a mutually agreed upon time and location. The groups are functioning independently and are community led (the groups make decisions by consensus) Groups meet a minimum of twice a month for 1-2 hours. At each meeting members participate in physical activity, eat a healthy snack, have time to socialize, and check their health indicators (weight, blood pressure, blood sugar) Group members responsibilities include: picking a snack, shopping for the snack, reminder phone calls, bringing the tool kit and contact HANS team for supports when needed. HANS group members often mentor other groups in the start-up stage.

17 HANS KAI Health School What is it? Session Overview Session 1 - Welcome to HANS- Understand HANS KAI and Core Activities Session 2 - Health Indicators- Understand and learn to check BP, BG, Waist circumference Session 3 and 3.5 Nutrition Understand menu planning, health eating and food preparation. and relation of food and health. This session is a 2 part session but can be done in 1 longer session if needed. Session 4 - Lets Get Active- Understand relation between activity and health and learn various activities. Session 5-Achieving Balance- Learn health coping strategies and impact of stress and sleep on health Session 6 Primary Care Through the Years-Understand when and why to get periodic medical exams through the lifecycle Session 7 Working Together- Understand how to work together as a group Session 8 Launch into Hans Kai- Mock HANS session with toolkit

18 HANS KAI who is it for? Hans is for anyone wanting to maintain or improve their health

19 Research and Evaluation Results Statistically significant results in 5 keys areas including: 1. Increased physical activity 2. Increased social support and community connectedness 3. Improved mental health 4. Ability to make changes to improve health 5. Connected to Health Providers 6. Also upward improvement trends in nutrition and general health

20 Research and Evaluation Results Statistically significant results in 1: 1. Mental Health Continuum Score Flourishing (<.05)

21 Results activity Participants indicated at the end of the first year that there was an increase in frequency, intensity and time engaging in physical activity. The mean increase from baseline to one year improved from a reported to based on the Total Physical Activity Score.

22 Results nutrition Nutrition scores based on the Nutrition Scoring Tool saw a mean decrease from 9.8 at baseline to 8.83, indicating better nutrition amongst participants.

5.75 to mean=6.30) Understanding how to improve their health (mean=5.

23 Results Social Support From program entry to year one, participants displayed statistically significant results in: Access to a medical care provider (mean= 5.75 to mean=6.30) Understanding how to improve their health (mean=5.3 to mean=6.30) Feeling connected to those in their neighbourhoods (mean=5.20 to mean=6.10)

24 HANS KAI What Did We Learn? HANS KAI has demonstrated through research that participants have statistically significant improvements in Mental Health. HANS KAI Has been shown through research and evaluation that participants have improved healthy eating, physical activity and connections to community. HANS KAI groups are able to meet regularly without health care providers. HANS KAI groups can effectively run their own groups. HANS KAI Participants want health knowledge HANS KAI is a sustainable program. The Health School is required for all participants Groups need to set goals. That all groups need champions within the group to keep the group motivated and on track.

HANS KAI Next Stage of Research The second phase of research is currently in effect and will roll out in September of 2017.

25 HANS KAI Next Stage of Research The second phase of research is currently in effect and will roll out in September of This phase will have a strong focus on behavior change as a result of attending Hans Kai. Areas of interest include: Self-efficacy, social support, behavior change in both physical activity and eating habits and finally measureable health outcomes, such as blood pressure, blood sugar and BMI. We believe that this study will prove that by using education, social and community support, individuals can be empowered by developing their knowledge, change and improve their health behaviors and improve their health outcome.

Successes of Partnerships * Since 2013, we have established a Canada wide network of trained HANS KAI

* The Network meets every few months, to update on HANS KAI, share successes and challenges and support

* Within our Health Authority, we have established new partnerships which enhance the learning and

26 Successes of Partnerships * Since 2013, we have established a Canada wide network of trained HANS KAI facilitators from Health Co-ops, Community Health Centres and other Health Agencies. * The Network meets every few months, to update on HANS KAI, share successes and challenges and support each other. * Within our Health Authority, we have established new partnerships which enhance the learning and sharing of health information due to HANS KAI. * Improved health and wellness in communities * Less strain on the health care system from HANS participants as they have improved knowledge of health and what they can do to improve it.

27 Successes of Partnerships HANS KAI Statistics 2010 NorWest Canada wide Number of Groups 1 Number of Participants 8 Percentage of Women 100% Percentage of Men 0% Percentage of those with Chronic conditions 100%

28 Successes of Partnerships HANS KAI Statistics 2013 NorWest Canada wide Number of Groups 12 7 Number of Participants Percentage of Women 85% Percentage of Men 15% Percentage of those with Chronic conditions 47%

29 Successes of Partnerships Manitoba stats: Longest group- 6 years and still meeting Shortest group met for 1 year. Many groups have amalgamated into other groups. Groups with smaller numbers have joined other groups with smaller numbers. HANS KAI Statistics 2017 NorWest Canada wide Number of Groups Number of Participants Percentage of Women 77% Percentage of Men 23% Percentage of those with Chronic conditions 59%

30 What Does Hans Kai Cost? We recommend 2 Hans Kai health school facilitators attend and instruct each health school session together. This allows one presenter to continue teaching while their partner assists individuals as needed without a flow disruption. *Based upon a Facilitator hourly wage of $37.80 or *Based upon 2 facilitators attending each 2 hour health school presentation *Based upon a 12 person Hans Kai group operating for one year 2 Health Facilitator attendees: $700 Health School Facilitator Time: 18 hours Equipment Cost: $300 or 170 Promotion and Group Upkeep Facilitator Time: 18 hours per year (1.5 hours per month average) A single, 12 person Hans Kai group operating for one year will cost an estimated $ or

31 Adult HANS KAI Training Budget For established co-ops or health related agencies Item Cost NorWest Share Facilitator costs $350 per participant Minimum for training $2, Federation Share Minimum $ Total for 2 people Minimum 8 needed Total $2, Travel Airfare, Accommodation and Food. Costs will vary dependent upon location. Teaching Toolkit $ $ (if needed) Misc $50.00 $50.00 Total for 2 day training $ minimum Or * Costs may vary depending on number of toolkits purchased *Training includes 2 facilitators *Host city is responsible for airfare and hotel accommodation for each facilitator

32 Why HANS KAI Break Even Analysis in healthcare is influenced by numerous hypothetical factors and determinants. Improvements in mental health is difficult to quantify numerically, and may or may not influence certain outcome measures or adherence to physical activity or healthy eating. This analysis will breakdown a single Hans Kai group of 12 people into statistical chronic disease measures and their associated costs, measured by the prevalence in the Inkster Area of Winnipeg. We will assume the average person without existing conditions costs the system $1,884 or annually.

33 Why HANS KAI At least 3 people in the 12 person group will have, or develop a hypertensive condition by the age of 79. The estimated annual cost to the health care system for one person is $4,939 or annually.

34 Why HANS KAI At least 2 people in the 12 person group will have, or develop type II diabetes by the age of 79. The estimated annual cost to the health care system for one person is $5,178 or annually.

35 Why HANS KAI Costs to Healthcare system for 12 people. % with a chronic condition with no intervention other than health care providers $13,188 (7 participants) $14,817 (3 participants with hypertension) $10,356 (2 participants with diabetes) $38,361 (total)

36 Why HANS KAI Suggesting that a participant of Hans Kai commits to the program for one year and that attendance will prolong the mentioned condition for one year or more in 50% of participants with the condition and the Hans Kai Operation Cost for 12 people 5 with a chronic condition is $

37 Why HANS KAI Year 1 Systems Cost 1yr Cost Reduction HT (50%) 1yr Cost Reduction Diabetes (50%) Without Hans $38,361 $0.00 $0.00 $38,361 Kai With Hans Kai $40, $4, $3,294 $32, Difference $5,515.70

38 Why HANS KAI Year 2 Systems Cost 1yr Cost Reduction HT (50%) 1yr Cost Reduction Diabetes (50%) Without Hans Kai $38,361 $0.00 $0.00 $38,361 With Hans Kai (18 facilitator hours, $50 toolkit resupply = $730.40) $39, $4, $3,294 $31, Difference $7,146.10

39 HANS KAI

40 Successes - Anecdotal evidence of improved physical health including lower blood pressures, weight loss and fewer medications. - Research indicated improved health indicators in nutrition, physical activity, connections and mental health. - Creation of community supports within groups - Groups are able to function and run effectively independent of Health Providers.

41 Resources Needed to Implement HANS KAI - Trained HANS facilitators to facilitate Health Schools - If collecting data, staff to collect, enter and store data. - Toolkits of resources for HANS group - Space to offer program. - Understanding of the role social support and community plays in overall health.

42 Why HANS KAI According to the World Health Organization, positive health has three linked dimensions social, psychological and physical. HANS KAI operates under the idea that community led groups will support personal wellness and Groups have the ability to take action to improve health Participants: Develop peer support and leadership skills within the community groups Learn to self-monitor specific indicators and their own physical, psychological, social, emotional health and well being Identify early changes in health status and improve measurable health indicators

43 Why HANS KAI HANS KAI has been easily replicated in communities across Canada. It is a relatively inexpensive strategy to promote health and prevent disease that is easily adaptable for multiple communities and demographics. Usually Social Service or Allied Health professionals are trained HANS KAI Facilitators. HANS KAI Facilitators work in partnership with physicians Can expect healthier families and communities as information from participants influences family and community. Easily modifiable. Youth HANS KAI program for year olds available.

44 Challenges - Interpersonal conflict can be a challenge within the HANS KAI groups. - Collecting data can also be a challenge. Recommended if collecting data, to ensure a group champion is responsible for ensuring group provides data.

45 Why HANS KAI We love Hans Kai because engaging the whole group in their individual wellness provides strength and support for each participant. And that leads to cohesion and success. Vanessa Hammond, Chair HealthCare Cooperatives of Canada I was so depressed after my husband died, I wouldn t come out of the house. My neighbour convinced me to try HANS KAI with her and now I am out of the house every day. I feel better both mentally and physically, I feel a part of things again. Carol 2017 HANS KAI Participant

46 HANS KAI When I is replaced by we even illness becomes wellness

HANS Kai An Innovative Health Promotion Project to Improve Health and Wellbeing

HANS Kai An Innovative Health Promotion Project to Improve Health and Wellbeing Mission Vision Values of the NorWest Co-op VISION People taking control of their health. MISSION To engage our community