Active Herts supports 2000 inactive residents to become more active
Active Herts is a Sport England, CCG and Public Health funded programme which is using behaviour change techniques to support inactive individuals in the most deprived communities within Hertfordshire to overcome barriers and to become more active.
Physical inactivity has been cited by Sport England as contributing to 1 in 6 deaths in the UK, with a cost to the UK healthcare system of £1.2 billion, and a cost of £1.5 billion to the wider UK economy through things such as social care and work absenteeism. Furthermore, physical inactivity increases the prevalence of Coronary Heart Disease, Stroke, Type 2 Diabetes and a poor mental health. Within Hertfordshire, despite having inactivity levels which are lower than the UK average, there are more than 170,000 inactive adults who are at risk of poor health and early death. In Hertfordshire, as in the rest of the UK, cardiovascular disease (CVD) and strokes are the main cause of preventable death and modifiable lifestyle factors are the major underlying cause of poor health & demand on health and social care
When reviewing the 10 districts in Hertfordshire, Broxbourne, Hertsmere, Stevenage and Watford contain the highest number of deprived LSOAs and the first three have among the highest proportion of their residents living in the 20% most deprived areas of England than other districts. The latter three have among the highest prevalence rates of depression (around 7%) and mental health (around 1%) and Mind have reported that 940 new people in areas covered by this project enter their mental health services each year. All four are in the five highest rates of under 75 mortality rate from CVD (2-3%), adult obesity (8-10%) and diabetes (4-6%). Furthermore, a life expectancy gap of 6.0 to 9.6 years exists between the most and least deprived areas across these districts, which is masked if district-wide or IMD scores are considered alone.
There has been a gap identified between primary care and the sport sector through previous projects. Active Herts is bridging this gap by providing a sport and physical intervention on the doorstep of the most deprived individuals in the county. Get Active Specialists are hosted within GP surgeries, which supports us to identify those who are inactive and are at risk of poor health related to inactivity. The relationships developed with the GPs, practice managers and nurses within the surgeries elevates their understanding of the programme, as well as aiding the two-way communication. The consultations being held within the surgery also provides a familiar setting for the participants, which removes a barrier for anybody who is ambivalent about attending a new environment.
Participants are offered 12 months of support which is underpinned by behaviour change theory to support them to become more active. In order to support those most in need, participants are triaged to ensure their eligibility. They are required to be aged 16+, living in one of the four target local authorities and doing less than 30 minutes of physical activity per week. Following referral in to the programme, participants are invited to a one-hour consultation with their local Get Active Specialist at the GP surgery, where they will talk about their barriers, motivations and aspirations around physical activity. The Specialists use a technique called motivation interviewing; a method that works on facilitating and engaging intrinsic motivation within the client in order to change behaviour. This is supported by a booklet which participants are given to document their thoughts on physical activity, their goals, coping mechanisms and their reflections on being active. The behaviour change techniques (BCTs) used within this booklet have been identified by a systematic review by Howlett (2017) which looked at physical activity interventions and the BCTs which were evident in successful programmes for increasing activity levels in adults. This gives the programme a credible academic backbone upon which the consultations have been structured around.
Following the consultation, individuals are signposted on to relevant, local, low cost or free activity options. Within Broxbourne and Watford, participants are able to access 12 weeks of free, tailored activity classes which are run by Active Herts, and also have the option of a volunteer buddy to support them to integrate in to the sessions (intervention model). This option is not available in Stevenage and Hertsmere (control model) as the independent evaluation of the project is comparing the two models to determine which is better to improve activity levels. Participants are contacted two weeks after their initial consultation to offer support and advice, and are then invited to consultations at 3, 6 and 12 months to continue this support, and to collect evaluation data.
Between November 2015 and January 2018, 2450 participants have been referred in to the programme, with 78% of those taking up the offer. The evaluation has shown a significant and lasting impact on physical activity levels. At three months in to the programme participants showed an increase in their total weekly physical activity by 50 minutes, as well as reducing their time spent sitting by 67 minutes (all statistically significant). There was also a 30% increase in the number of participants participating in 30 minutes of sport at least once weekly. These changes were also sustained at 6 months in to the programme, demonstrating a continued adherence to the programme. In addition to increased physical activity levels, there has been a statistically significant improvement in self-reported health and mental wellbeing.
These improvements have been supplemented by the process evaluation which has identified some of the key reasons for the success of the project to date. The strength of the partnerships formed throughout the project has allowed for a more seamless pathway for participants to access the Active Herts programme. Working with organisations such has Mind, IAPT (Improving Access to Psychological Therapies) and the National Diabetes Prevention Programme has allowed a broader reach in to communities that would otherwise be neglected, and has allowed provision to those who have the greatest need.
One of the key elements for participants once they have joined the programme is the social support on offer, both through the quality of the well-trained get Active Specialists, and from their peers on the programme. Through being in similar situations, participants are able to build social networks with the other class participants, which has resulted in a sense of community and belonging to the project, allowing them to feel supported as they continue to integrate being active in to their lives.
The project is due to finish in December 2018, and will continue to support people to be active, while putting together the case to secure more funding to support more people in Hertfordshire to achieve a healthier, more active lifestyle.
Case Study 1
Lorna was referred in to the programme by her diabetes nurse to help her manage her diabetes and to reduce her weight. At referral, her HbA1c levels were 60mmol/mol (normal levels are 42mmol/mol) and her weight was 152kg. She was supported to identify her motivations to become more active, and as a result now swims 3 times a week, for a mile each time, and aims for at least 10,000 steps a day. As a result, she has lost 20kg, and is now managing her diabetes to a point where she does not require any medication.
Case Study 2
Cem asked the GP to refer him to Active Herts after seeing his friend improve his health through the programme. He was unsure about the benefits of exercise and how he might integrate it in to his routine, but following being signposted to a local walking football session, he very quickly realised the benefits. Having not played any sport for years, he has now set up the first Walking Football team in Broxbourne, where they are playing competitively against other teams and in tournaments, while also making friends in the process.