Fit For Life Journey to Become a Best Practice. Tim McKnight, MD

Transcription

1 Fit For Life Journey to Become a Best Practice Tim McKnight, MD

2 What is Fit for Life? Some class topics include: - The Wellness Choice - Mindfulness - Intentional Healing & the Biology of Belief - Nutrition & Disease - Nutritional & Health - Eat to Live - Making Sense of Food Labels - Flexibility Fitness - Cardiovascular Fitness - Strength Fitness/Back Pain - Disease Prevention & Healthy Aging - Conclusions 1

3 What is Fit for Life? More than a weight loss program. More than a fitness program. Teaches healing by nutrition, exercise, sleep, stress mngt, etc. Intangible components of the quality of our thoughts, emotions, behaviors and our relationships and considers each of these when addressing overall health and wellness. We believe in an Inside-Out approach to healing We believe this comprehensive approach leads to permanent change and healing at all levels. 2

4 What is Fit for Life? Fit for Life is also more than just an educational program. Classes are organized to provide motivational, inspirational and social support in order to link emotional learning with intellectual. We empower and encourage people to change through proven adult learning strategies that include: 1. Weekly personal reflection and journaling which provides an anchor to learning 2. Laboratory and anthropometric measurements which are objectively quantified and tracked over time 3. Presentations led by highly esteemed and qualified healthcare professionals 4. Guest speakers who are experts, role models and passionate about helping others 5. Visual aids, class discussions, group involvement, inspirational multi-media and demonstrations that promote novel and new approaches to healing 3

5 What is Fit for Life? OUR CORE VALUES: We value the inner strength, resilience and capacity of each person to choose a lifestyle that fosters healing regardless of their circumstances in life or physical limitations. We believe that the body was designed to heal itself when appropriately nurtured. For true healing to occur we must not only nurture physiology, we must also nurture healing thoughts, emotions, behaviors and relationships. OUR MISSION: Educate, Motivate and Inspire based upon Nature's healing messages so that anyone can heal from within at ALL levels --- Might, Mind, Heart & Spirit --- OUR VISION: Equip participants with the tools they need to truly heal by treating the WHOLE person and not simply managing symptoms or diseases. OUR PLAN: Educate through scientific evidence, emotional connection, and spiritual purpose in order to enhance lasting behavioral change through the process of: PLAN EXECUTE EVALUATE REVISE 4

6 5 FIT FOR LIFE - WEEK FOUR: NUTRITION & DISEASE

7 Fit for Life Results -Rule of 1/3 -The average Fit for Life participant: - Loses at least 7 pounds from starting weight - Lowers systolic blood pressure by about 7 points - Lowers diastolic blood pressure by about 2.5 points - Lowers total cholesterol by over 13 points - Lowers triglyceride level by over 20 points 6

8 Fit for Life Results continued -Additionally, pre and post behavioral surveys revealed: - The number of participants exercising regularly by 40%. - The number of participants exercising at least three days a week by 60%. - The number of participants eating four or more servings of fruits and vegetables daily by 37%. -Average attendance rate is 81%. 7

9 History of Fit for Life 2002 Created by Dr. Tim McKnight Applied for HRSA Grant, not awarded First class ~ $500 per participant Class size dwindles due to cost Applied for HRSA Grant 2006 Hospital receives HRSA Grant to implement FFL in the community over 3 year period Increased demand, wait list started, increased class size from 30 participants to per class, at one point 5 classes running simultaneously Applied for HRSA Grant to take FFL into worksites, successful Started marketing to area companies Held 10 FFL classes with differing sizes at local businesses HRSA Grant application: take FFL from a Promising Practice to a Best Practice model of wellness. 8

10 Our bags are packed and we re ready to go... Nearly 1800 graduates since program started Classes fill with word of mouth and minimal PSAs Doctors all over the country have said they want access to FFL Weekly feedback has taught us what the public wants, connects with & what moves them Lives have been changed, health restored, hope rekindled 9

11 The course is set... Our Vision: To become nationally recognized and used as a best practice model for enhancing the health and wellness of individuals and families. Our Mission: To serve as a model for educating, motivating and inspiring people to achieve optimal health through nutrition, fitness and behavioral change. Our Goal: To standardize course curriculum, to develop a trainthe-trainer model, to train other facilitators to teach Fit for Life classes and to produce similar results in other counties. 10

12 Finding our travelling companions -Carroll County Health Department -Long-standing grant partner, has been with us since first grant award in Health Commissioner was retiring when signed the support letter for our current grant, but strongly supported our efforts. -Harrison Community Hospital - 25-Bed Critical Access Hospital less than 30 minutes away. Met with CEO and Director of Cardiac Rehabilitation. CEO was planning on retiring within the next couple of years, but felt it was a good fit with an exercise program that they had started. -Holmes County Health Department -Passionate Family Practitioner as Health Commissioner, serving Amish community, excited about making a difference and looking for a program to implement. 11

13 Our journey on the long and winding road 12 To become a Best Practice

14 Begins with Me Standardizing Course Curriculum - Hi, I m Dr. Tim McKnight and I am a perfectionist. Over the course of the first 6 years of our program, I was constantly making changes to the content. Looking for the most up to date information to impart on our participants. Adding new topics as we received feedback from our participants. I was notorious for causing last minute copy runs for binders, handouts, etc. Now I have to standardize the curriculum?! And be okay with not making any changes? ** **Note to Self: Never let Tiffany offer to put my slide show together ever again. 13

15 Determining the right direction How do we train? Multiples sites & trainers Range of access to technology and comfort using technology Travel distances from sites range 30 minutes to an hour to our central location. -Engaged Adult Learning Specialist to determine course of action. -Decision to do an onsite meeting in September to go over the 2 key roles of facilitator & coordinator and to break up training of the content into small steps. Plan was to review 2 weeks of content at a time. -Educate them on the foundation beliefs upon which the curriculum was developed. -Train on weeks 1 & 2 of the 12-week session. -Develop a plan for the training going forward. forward. -Set up a system for file sharing using Basecamp. -Try not to overwhelm the partners on the first day. 14

16 Detour Ahead Plan for continued facilitator training -Provide facilitators with powerpoints in two week increments. -Loaded PowerPoints on Basecamp for facilitators -Scheduled a conference between Dr. McKnight & facilitators to go through content and questions. didn t go as planned. -Sites all had different start dates for classes. Needed different content at different times. -Each site had different facilitator structure. Some more comfortable with content than others. -Impossible to get all facilitators on the phone at the same time. -Difficult to make changes (standardizing curriculum) and stay ahead of other facilitators needs. 15

17 Byway Weekly Facilitator Feedback Forms ( Evaluation ) -Facilitators liked the content of the class. -Participants enjoyed classes and are showed positive results. -On-site review of facilitators showed classes are engaged; -Facilitators found ways to personalize the content & make it their own. 16

18 Roadblock Struggles with data collection & evaluation tools -First time evaluation forms created by professional evaluator, needed some tweaking. -Not all of the facilitators filled out the weekly feedback forms, nor did they send back in a timely manner about 72% response rate. -Database glitches when entering data. -They looked nice and professional, but when we started to use them, we discovered some problems. -One site used the final lab work as an incentive to complete the program not ideal as recording changes in lab values is a required measurement of the grant. -When sending out final letters to participants with final results, we discovered additional glitches when mail merging results into letter. 17

19 Asking for directions As part of the formal evaluation process, evaluators analyzed the facilitator feedback tool and interviewed coordinators for feedback on FFL implementation. They found -Some statistics needed updated per their knowledge -The number of slides should be reduced -Some of the content was controversial -i.e. supplements, water, hormone replacement therapy, etc.) -Coordinators felt training could have been more organized and comprehensive. -Felt unprepared to recruit guest speakers due to curriculum content not being finalized in a timely manner -Coordinators felt overwhelmed by the volume of materials to be copied -Not all components of the classes were being used all of the time. 18

20 Rest Stop Closed Held a July training summit to gather input for improvement For Issues Regarding Organization, Support Materials & Content -Develop a reference list for additional reading on specific topics, especially those that may be on the fringe of science. -Clearly identify the class objectives either as part of the PowerPoint or in the notes section for the facilitator s review. -Determine the must haves when it come to components and activities of the class, content, the constructs and approach of the training, the credentials of the facilitators and where allowance can be made. -Determine how to deal with changing research. How We can Support Partners in Training -Individual training was noted as best as opposed to group training. -Hold office hours where partners can contact for questions and clarification and be sure of availability. -Need more support in how to identify, solicit, & prepare guest speakers. -Shorten session duration- shoot for 60 minutes total. -Identify opportunities to share additional benefits. 19

21 Photo Opportunity During the learning summit, our partners helped us identify the Crucial Elements of Success for our program. -Not a prescription -Homework gave people the building blocks to change -Gradual changes -Meeting weekly kept participants engaged -Having it in a group accountability, camaraderie, and story-sharing -Guest speakers - novelty, specialty, community -Engagement provided by visual aids- hands-on learning, specimens, etc. -Blood work -Show clear outcomes -Breadth of education -Access to healthcare professionals 20 World s Largest Ball of Twine

22 Scenic Overlook Participant Satisfaction -100% of participants say they would recommend the program to a friend or family member. Participant Comments - Increased my understanding of best food choices and why it is so important to use that knowledge to improve my health. - It covers the whole body and mind change. - While all were equally important, learning more concrete realistic strategies to lead a healthier lifestyle was most beneficial. 21

23 Overnight stay along the way Participant Behavioral Outcomes -67% improved how many days a week they engage in at least 30 minutes of exercise. -66% report exercising three days a week or more, an improvement from 31% reporting that frequency at the start of class. -% participants who report never doing strength-building exercises declined from 70% to 34% by end of class. -% participants who report never doing stretching exercises declined from 56% to 20% by the end of class. -% participants who report never doing meditation exercises declined from 76% to 41% by the end of class. -54% had an improved response rate on how many servings of fruits and vegetables they eat daily. -63% report eating four or more fruit and vegetable services daily. -Over 55% of participants showed an improvement in how often they eat who grains. -Half of participants showed a positive change in avoiding trans fats, and 46% showed positive change in avoiding high fructose corn syrup. 22

24 Overnight stay along the way continued -63% of participants report never drinking soda and after the program, 80% report never drinking soda. -72% of participants report having never consumed sweetened fruit drinks before the program, compared to 90% after. -At post survey, 90% of participants report using the nutrition facts panel most of the time or always up from 54% at pre-survey, and that no participants report rarely or never using the nutrition facts panel, down from 20% on the pre-survey. - Slight decrease in the number of times a participant would eat out during the week. -The number of participants reporting that, when they eat out, their meals never or rarely contain fried foods went up 32% from pre- to post- survey. 23

25 Overnight stay along the way continued Readiness to Change Avoid sweets and sugars Live an overall healthy lifestyle Percent of Matched Participants With Positive Change from Pre- to Post-survey No present interest in making a change Plan to make a change in next 6 months OR Plan to change this month Recently started doing OR Doing it regularly for the last 6 months or more 57.1% of participants moved in a positive direction 57.1% of participants moved in a positive direction Limit amount of fat intake Overeat less often Practice good eating habits Handle stress better Be physically active 55.7% of participants moved in a positive direction 55.7% of participants moved in a positive direction 53.6% of participants moved in a positive direction 45.7% of participants moved in a positive direction 44.9% of participants moved in a positive direction 24

26 Overnight stay along the way continued Participant Health Indicators -81% of participants lost weight. -The average participant lost 6 pounds. -Slight reduction in hip and waist measurements and BMI. -67% of the participants had a decrease in body fat percentages. -6 point decrease in systolic blood pressure, and a slight drop in diastolic blood pressure. -69% of participants experienced a decrease in total cholesterol. -The average total cholesterol decreased by 11 points. -LDL cholesterol was reduced -Triglycerides dropped an average of 17 points. -HDL cholesterol, or the good cholesterol, went up 0.6 points, a positive change. 25

27 Overnight stay along the way continued Conclusion -No statistically significant difference were found between Trinity Hospital Twin City participants and those in the replication sites on 8 of the 9 questions analyzed. -Therefore, FFL participants across all counties showed similar levels of change from pre- to post-survey. -No statistically significant differences were found in 4 of the 5 health indicators, again showing that participants in the replication sites experienced similar changes to Trinity Hospital Twin City participants at the end of the program. -The only indicator that showed significant difference was change in systolic blood pressure. 26

28 Fueling Up As part of our Strategic Planning Process to become known as a Best Practice model for health and wellness it was determined that we needed to focus on 4 areas. -Regional replication -Marketing/Branding -Evaluation/Publication -National Replication 27

29 Fueling Up continued... Focus Area: Regional Replication Goal 1: Fit for Life curriculum is replicated in 3 counties in the Appalachian region of Ohio. Objective 1: Standardize FFL curriculum for all 12 classes by Dec Objective 2: Train 3 partner organizations to implement FFL by June Objective 3: Conduct 5 FFL sessions of 12 classes in each of 4 counties by April (In Process) Focus Area: Evaluation/Publication Goal 1: The effectiveness of Fit for Life will be acknowledged through publication in a peer-reviewed journal. Objective 1: Complete an evaluation of the regional replication of Fit for Life by April (In Process) Objective 2: Have an article on the effectiveness of Fit for Life published in a peer-reviewed journal by June

30 Fueling Up continued... Focus Area: Marketing/Branding Goal 1: Markets for Fit for Life are identified. Objective 1: Analyze market potential for national replication by June Objective 2: Develop Fit for Life Branding. (In Process) Focus Area: National Replication (New) Goal 1: Fit for Life is replicated within the Sylvania Franciscan Health (SFH) System. Objective 1: Fit for Life is utilized by two additional hospitals in the Sylvania Franciscan Health System by June (In Process) 29

31 Change in Itinerary While all indicators point toward our destination, we know that the itinerary can change and the road ahead may still be bumpy. -2 of our partners will not be continuing on as a partner in this grant. -Trinity Health System, our sister hospital within the Sylvania Franciscan Health system has agreed to partner with us on our trainthe-trainer program. -Sylvania Franciscan Health is very interested in rebranding FFL and positioning it for a national campaign. New logo development, brand essence and new layout and format of the curriculum is underway. 30

32 Next leg of the trip includes -Training new partner -Continued evaluation of project -Testing of new layout and format of curriculum -Expanding into new regions -Publishing an article on the effectiveness of Fit for Life in a peerreviewed journal Because our success matters to thousands of people like 31 Larry and

33 Joe 32 FIT FOR LIFE - WEEK FOUR: NUTRITION & DISEASE

34 Joe 33 FIT FOR LIFE - WEEK FOUR: NUTRITION & DISEASE

35 34 Jennifer

36 Questions? All you need is the plan, the road map, and the courage to press on to your destination. - Earl Nightingale