Indian Health Service Online Submission, Consultation, and Reporting (OSCAR) System for Evidence Based and Promising Practices, Local Efforts, Policies and Resources. (logo: A Circle of Healthy Initiatives for American Indians and Alaska Natives)

HealthNet New Mexico Implementation of CDC Community Guide Physical Activity Recommendations

Program Type: Promising Practice -Programs not formally evaluated (or formal evaluation is not yet complete) but identified by experts as programs with results suggesting efficacy and worthy of further study in broader pilot implementation efforts.

Many of these programs had success in participation for over 20 years in Zuni. The formula HealthNet New Mexico found useful consisted of the following features: The following "best practice processes" are reinforced by the Guide to Community Preventive Services for Promoting Physical Activity. The following are three of the six strongly recommended categories of interventions: 1) Social support interventions in community settings (Social approaches) 2) Individually-adapted health behavior change programs (Individualize approaches), and 3) Community wide campaigns. The Take Charge Challenge TCC incorporates the following features that are included in the social and individualized approaches suggested by the guide: 1) Goal setting 2) Stage of change 3) Contracts 4) Support groups 5) Structured group problem solving 6) Role models 7) Rewards, and 8) Relapse prevention. The design of "Take Charge Challenge" (TCC) is a theory based intervention that employs a team management and data collection system, goal setting, stages of change, incentives, teams and is designed with an evaluation system that measures outcomes, impact and intervention process. TCC is based on the based on the premise that among the integral elements of behavior change is social support and modeling. Peer team leaders facilitate program management, problem solving, contracting, and data collection. TCC establishes teams from an existing organizational structure in order to promote team building, morale, and organizational development and attempts to insure management and organizational commitment to employee health promotion. Personal empowerment is the ultimate goal of the TCC. When individuals are allowed to choose what they do, when they do it, how often they do it, at what intensity they do it, and where they do it, they are more likely to take responsibility for their behavior change. Goal setting is a critical skill of behavior change and provides individuals with control. TCC provides a point system for physical activity, where one point represents 10 minutes and a participant projects how many points they will attempt to accumulate during the 10 week program. The point system allows simple tracking to determine goal completion and amount of physical activity achieved. Self directed behavior change is difficult. The TCC uses a modified version of the Transtheoretical Model of Behavior. This model suggest that individuals attempting to change a health behavior move through a series of five stages: pre-contemplation (not intending to make a change), contemplation (considering making a change), preparation (planning to make or making small changes), action (actively engaging in a behavior change made in the past six months), and maintenance (sustaining a behavior change for more than 6 months). TCC modified the model by adding a sixth stage - sub-action (engaging in vigorous physical activity less than 3 times a week for 20 minutes or moderate physical activity less than 5 times a week for 30 minutes). TCC has also created a comprehensive win-win incentive system that is linked to data collection. Participants are eligible for incentives at the beginning, middle, and end of the ten-week program. One of the fundamental principles of sustaining behavior change is to change social norms. Social norms change when a critical mass of a population are problem solving. Team leaders are encouraged to recruit half of their department in order to reach the critical mass. The use of stage of change provides the opportunity to assess pre- and post behavior change for outcome measures. The consultant presented the elements and procedures of implementation to IHS management and to the Wellness Committee. Management support is critical for the implementation of the TCC and for any worksite health promotion initiative. Wellness Journey TCC posters were created an distributed throughout the respective work space. Multiple e-mails were sent out by management and progress posters were made that contained graphs and charts that represented participation rates and stages of change information by team and office.

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Physical Activity

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Site or Location Name: Zuni Reservation: 100 mile club, Zuni Fitness Challenge (Human Race), Weight Control Programs (HELP)

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