Bingara Healthy Lifestyles Program

21 October 2005
Hunter/New England Area Health Service

This project was entered in the Baxter 2005 NSW Health Awards, Access category.

Entries from the Baxter 2005 NSW Health Awards - full list

Authors

Suzanne Bilsborough, HNEAHS - Bingara
Stones Angela, HNEAHS - Bingara

Date(s) project undertaken: Program Commenced May 2004 – May 2005

Abstract

In 2004 Community Health staff identified a gap in provision of specific heart health education and support. No opportunities existed in the community for formal monitoring of weight, nutrition and physical activity levels within a group format (Table 1).

The Bingara Healthy Lifestyle Program (BHLP) provides ongoing support, education and physical activity opportunities. It targets participants with modifiable Cardiovascular Disease risk factors and those seeking lifestyle change.

The BHLP aims to enhance management of chronic diseases through education, increasing incidental and intentional physical activity, and encouraging healthy lifestyle behaviours. Participants attend weekly monitoring and education sessions.

Participants either self-referred or were sourced from both Community Health and Medical Centre client lists. Registrations currently total forty-eight. Thirty-one have lost a total of 99.4kg, twelve have lost a total of 58 centimeters and three have lost centimeters whilst maintaining weight.

The BHLP has proven an effective primary health care initiative.

Aim

To achieve 80% of Bingara Healthy Lifestyle Program participants exhibiting positive measurable changes in blood pressure, weight, waistline measurement and resting heart rate (modifiable risk factors for Cardiovascular Disease) over a 12-month period from May 2004 – May 2005.

Background

Bingara has a higher proportion (12.7%) of people over 70 than the state average. The age standardised mortality ratio for Coronary Heart Disease is 30% (males) and 12% (females) higher for Bingara than for NSW. The BHLP was developed in response to both this and the lack of targeted primary health care activities.

Obesity plus sedentary lifestyle are known as major risk factors for chronic diseases. Hence, diet and physical activity patterns must be modified in order to reduce these risks.

Staff recognized that along with improved health outcomes, implementation of BHLP promoted self-esteem, improved confidence and reduced social isolation.

Methodology

A 2004 audit identified a lack of specific heart health education and support in Bingara. See Table 1. Baseline Audit at Commencement of BHLP

Models applicable to towns like Bingara, such as the WellingTonne Challenge were reviewed. Key factors to achieving change included:

• Dietary and physical activity patterns as basis for correcting weight gain
• Long term support is needed for effective, sustainable weight management in conjunction with community nutrition interventions
• The most successful interventions are based on theory and include goal setting
• Promotion of a healthy weight and prevention of weight gain is a key action under Eat Well NSW, NSW Health’s Strategic Direction for Public Health Nutrition 2003-2007
• Prevention of weight gain and maintenance of a healthy weight is easier, less expensive and potentially more effective than treatment of obesity.

Initially participants either self-referred or were identified as clients with Chronic disease risk factors. The group decided when, and how often to meet. They brainstormed sessions to decide program content. Community access occurred via promotional activities and media releases. A focus group questionnaire was conducted to decide future direction. This process was facilitated by staff and driven by the participants.

Planning and Implementation

With the commitment of local community members and facilitators, the BHLP is delivered each Wednesday for two hours. A variety of strategies were implemented in order to monitor health improvement, and to achieve attitudinal change in the community (short and long-term goals):

• Assessment of each new referral by Physiotherapist and Community Health Nurse prior to engagement into program followed by an individualised physical activity prescription by Physiotherapist
• Implementation of “Food for Thought” program. Monthly presentations by Dietician to improve healthy dietary choices
• Regular weight, waist-line measures and blood pressure monitoring
• Participants encouraged to use “My Health Record” and be responsible for recording activity levels and diet
• Key speakers educate on heart health issues including stress, motivation, depression, anxiety, medication management, nutrition and physiology of physical activity.
• Community education on heart health and modifying risk factors provided through media releases, street promotions (supermarket tours, community morning teas in town centre)
• Engaging participants as promoters of the program and agents of change
• Improved access to resources, literature on heart health and risk management, recipe modification.

Outcomes and Evaluation

• There are 48 registrations with 31 losing weight, 12 losing centimeters and three losing centimeters whilst maintaining weight. A total of 34 participants (82.9%) are exhibiting positive results with the BHLP (Table 3).
• The Dietician noted an improvement in the range of healthy food choices stocked over five supermarket tours.
• Education about physical activity has resulted in increased exercise tolerance and monitoring of activity levels.
• Participants report feeling supported and motivated as a consequence of group participation. Development of peer relationships has positively impacted on psychosocial factors.
• Six diabetic participants have reported greater Blood Glucose control.
• To improve community profile, a “Good Health on the Gwydir” morning tea was held in September 2004. An increase in registrations resulted (Table 2).
• BHLP weekly attendance averages 15. The facilitators are encouraged that 82.9% of the participants achieved positive outcomes (2.9% greater than the aim).
• BHLP has been recognised by the HNEAHS as meeting essential criteria required for Cardiac Rehabilitation.
• A recent Focus Group has led to a project plan to formulate a comprehensive ten-week program.
  See TABLE 2. Monthly registrations (Total 48)
  See TABLE 3. Results

Future scope

Until now rural centres like Bingara have struggled to provide adequate primary health care programs. Development of the BHLP enabled greater access for community members to these services. The program structure is currently under review to formulate a comprehensive ten-week program incorporating pulmonary, cardiac, diabetes and exercise specific components. It will then be made available as a primary health care model for other sites within the HNEAHS & NSW health system.

Continuation of the BHLP as core business has been included in the Service Delivery Plan for the Bingara Community Health Centre and will begin in Warialda in 2005-2006.