Choose to Move: Speeding up the knowledge-to-action cycle
Even though we know physical activity is important for our physical and mental health, translating this into action can be a challenge. In this blog, Christa Hoy of the Centre for Hip Health and Mobility’s Active Aging Research Team discusses how to translate evidence-based health promotion programs from controlled to real-world settings.
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Choose to Move: Speeding up the knowledge-to-action cycle
British Columbia is home to a rapidly aging population. By 2022, 1 in 5 people will be over 65. Mobility, maintained through physical activity, is key to retaining an older person's health and independence. It may also delay or reduce admission to higher levels of care in later life – a solution that would address escalating health care costs.
It's plain to me that there is no shortage of evidence to support the positive impact of physical activity on health and wellbeing across the lifespan. But despite irrefutable benefits, fewer than 15% of BC seniors engage in the recommended 150 minutes per week of physical activity for health and mobility benefits.[2,3] Although we know physical activity is good for us, inactivity is still on the rise: there is a gap between what we know, and what we do. How can we, as researchers, apply this knowledge to successfully translate evidence-based, effective interventions at a larger scale to promote the health of populations?
I found and joined a community of like-minded researchers who are asking the same questions: the Active Aging Research Team led by Professor Heather McKay and Dr. Joanie Sims-Gould at the Centre for Hip Health and Mobility. We know that only 14% of research is ever translated into practice and to do so takes an alarming average of 17 years. Clearly this presents a problem, so we work toward finding solutions to implement effective interventions at the population level.
In response to the escalating number of inactive seniors in BC, we developed Choose to Move. Choose to Move is an evidence- and choice-based physical activity intervention designed to be delivered at scale. Working with a trained activity coach, participants develop a personalized physical activity action plan customized to each person's needs, interests and abilities. Participants are encouraged to choose organized activities that already exist in their communities and/or non-organized activities they can do on their own, and receive ongoing support from an activity coach.
Our ultimate goal is to implement Choose to Move across a range of BC communities so that we, with our partners, can shift the dial on older adult physical activity in BC.
How do we scale up?
It is no easy task to scale an evidence-based intervention from a controlled setting up to the community level, to serve a broader population. In the case of Choose to Move, we follow the process below to help us along the way (not an exhaustive list):
- Provide evidence of what works. We searched the literature for effective physical activity models for older adults that could be scaled up, then adapted an intervention to fit the BC context.
- Partner with community organizations with similar goals and values and with experience in program delivery. We partnered with the BC Recreation and Parks Association and the YMCA of Greater Vancouver to deliver Choose to Move across the province. These organizations have expertise in program delivery and geographic reach across BC.
- Build on existing relationships with partner organizations, and that these organizations have with communities across BC. We increase capacity by training staff in program delivery.
Engaging with partners to adapt Choose to Move
Fundamental to implementation at scale is acknowledging that communities and organizations know best what works for them. In my role with Choose to Move I travel around the province to build relationships and better understand how Choose to Move functions in each community. It is amazing how visiting a community, seeing it with your own eyes and interacting with the locals delivering and taking part in the program provides a huge amount of context that is so difficult to convey through other forms of data.
A solid understanding of the unique needs of each community helps us understand where flexibility is needed so that Choose to Move can be adapted to each community context. We consult with participants, program deliverers, local coordinators and managers, and provincial leadership to better understand what does and does not work about Choose to Move in each area. We do this through:
- Key informant interviews with participants, activity coaches, recreation coordinators and managers and leadership members of our partner organizations.
- Stakeholder meetings within and across organizations where we discuss what we have learned from evaluation data, including key informant interviews, and together decide on the best path forward.
- Focus groups to help us answer specific questions on how to adapt the model moving forward.
This gives us a constant flow of information and adds to our continuous research to action cycle, which allows us to respond to the needs of communities and organizations, adapt the intervention and its implementation to reflect the feedback we receive, and share feedback and results with our partners to help inform their decision making.
Throughout the process we have learned a lot about how best to adapt our model for the diverse communities across the province. For example, our active travel content initially focused on public transit, which is appropriate in larger communities but is not always available in smaller ones. As a result, we included more simple strategies seniors can use to incorporate more movement into their lives (e.g. park at the far end of the grocery store parking lot) to ensure the program is relevant to smaller communities where public transit is less accessible.
Early successes and future plans
To date, we have delivered 55 programs in 26 communities across BC to over 500 older adults. Early results indicate that participants are more physically active and socially connected after participating in Choose to Move. Many participants report improvements in their activities of daily living – activities that are critical for them to continue to live on their own. One of my favourite success stories is of a 90 year old who, after participating in Choose to Move, is now able to stand on one leg and put a sock on – something she hadn't been able to do in years.
We are currently planning with a range of stakeholders how to scale Choose to Move to reach even more British Columbians. Our next step is to adapt Choose to Move to serve BC seniors in rural and remote regions of the province. We will once again need to adapt the model to fit the context. Our first step will be talking to those in the community who will help us to determine what is possible.
Evaluation Manager, Active Aging Research Team, Centre for Hip Health and Mobility
Christa is the Evaluation Manager with the Active Aging Research Team based at the Centre for Hip Health and Mobility, a UBC-affiliated research centre. Her background is in human kinetics – born of a firm belief in health promotion through physical activity. She is driven by a desire to understand how evidence-based health promotion programs work in the real world. She is currently leading the evaluation of the scale up of Choose to Move, a choice-based physical activity program for sedentary older adults across BC.
- Population projections. Victoria: Government of British Columbia; 2017. Available here.
- Copeland JL, Clarke J, Dogra S. Objectively measured and self-reported sedentary time in older Canadians. Prev Med Rep. 2015;2:90-5. Available here.
- Colley RC, Garriquet D, Janssen I, et al. Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22(1):7-14. Available here.
- Balas EA, Boren SA. Managing clinical knowledge for health care improvement. Yearb Med Inform. 2000;(1):65-70. Available here.