How to Own Your Own Health

Own Your Own Health Initiative
Methodology

Obesity in the African-American and Latino communities has been a growing concern in recent decades and can be attributed to a multitude of societal elements. Contributing factors include but are not limited to inequities in stable and affordable housing, income and access to quality education. Each one of these factors has the potential to directly or indirectly influence an individual’s chance to live a longer and healthier life. In addition, if one combines those circumstances with disparities in access to affordable and healthy food or safe places to be physically active, the picture of obesity in the African-American and Latino communities begins to take shape. If there is to be real change, significant change in these communities, there must be dedicated leadership and support from pillars on grass root levels. Without complete buy-in from leaders mayors, clergy, civic groups, school boards, Chambers of Commerce, city councils, sororities and fraternities alike, the overall health outlook is grim and can lead to on-going chronic disease and premature deaths.

Obesity and African Americans

• African American women have the highest rates of obesity or being overweight compared to other groups in the United States. About 4 out of 5 African American women are overweight or obese.
• In 2018, non-Hispanic blacks were 1.3 times more likely to be obese as compared to non-Hispanic whites.
• In 2018, African American women were 50 percent more likely to be obese than non-Hispanic white women.
• From 2013-2016, non-Hispanic black females were 2.3 times more likely to be overweight as compared to non-Hispanic white females.
• People who are overweight are more likely to suffer from high blood pressure, high levels of blood fats, diabetes and LDL cholesterol – all risk factors for heart disease and stroke.¹
• In 2018, African Americans were 20 percent less likely to engage in active physical activity as compared to non-Hispanic whites.

Leadership and Support

Own Your Own Health (OYOH), a physical activity and nutrition tracking program designed to help Louisianans combat obesity and its related chronic illnesses by taking small but effective steps to eat right and exercise often, encourages populations in Louisiana to develop healthy activity and eating habits. Probably one of the most important components to launching and promoting a successful health promotion program such as OYOH is having the support of leaders in organizations or communities. For some people, it’s vital to see that their leaders not only are “talking the talk” but are also walking it. OYOH offers an exceptional feature where leaders can post their stamp of approval!

Before the Bureau of Minority Health Access launched its online program, our team met often with known leaders in communities. Meetings were held with mayors and asked them to submit a letter of support by way of a press release or through their social media outlets. Having mayors physically participate with a team or as individual participants in the program really boosts the credibility of their offices and program. Positively, mayors’ personal involvement allows residents to see their leader is taking health seriously, and they will be encouraged to do the same.

OYOH has a Testimonial page for participants to view. Having community leaders, the mayor or a local celebrity athlete can do a lot in providing that extra motivation required for some to start taking action toward better health. Additionally, leaders can serve as team captains can put their “champion” on specially designed challenge map so everyone can view their progress to stay motivated. As well, these high profile people are often spotlighted in the local media or community news. So, in addition to a testimonial, BMHA ask leaders to help promote the OYOH challenge at their next speaking engagement or in their next headline! Oftentimes, we ask leaders to assist in branding the program names as well by wearing some event paraphernalia that shows off the OYOH logo so that it becomes a well-known symbol in their communities. BMHA like to get leaders involved well in advance to give them time to prepare testimonials, community newsletters, etc., so that those materials are publicized at least a couple weeks before the program launch date.

Community Involvement

Another important consideration to keep in mind when implementing OYOH wellness challenges is to ensure that the people you are intending the program for be involved in the program design and planning process. These “participatory action-based” programs often yield better results because the people feel included in the process (not a “big-brother” approach) and they can provide better insight into what the wants and needs are of the target population. In the initial stage of the planning process, BMHA and mayor’s offices sought out well-known grass roots champions in the community to help form a committee and get them involved. Their involvement might include feedback on site content, communication materials e.g. posters, challenge design (type, duration and frequency) and prize ideas. In turn, offering local champions praise for their efforts, incentives and recognition amongst their peers can retain them for future wellness initiatives. Recognizing their efforts in the community newsletter or local newspaper and incentives for creating a team are great examples of how you can retain your champions for longer periods.

BMHA maintains regular communication with teams and its leaders through the online Message Centre. Keeping teams influenced by community leaders informed regularly can help them support one another which help produce better program outcomes. Community leaders and their teams can also communicate with their team via the Message Centre or by hovering their mouse over their team name on the dashboard and clicking on the “send message to members’ link.” Occasionally, BMHA, community leaders and its members are asked to participate in online training sessions for them to utilize the website effectively. As a result, combining online training along with some leadership training turned out to be an effective way to recruit and retain these people on-going. BMHA offered additional website training for team captains, clerks and professionals. These trainings were essential while working in rural underserved communities.

Finally, BMHA found it important to remember that the best means of recruiting and retaining participants in the OYOH program is through word of mouth. These grass roots champions were the Bureau’s best promotional tools that spread the word quickly about the program through informal and formal means that BMHA may not have access to or knew about. BMHA made available for Team Captains the OYOH website to invite people to join their team by hovering their mouse over their team name on the dashboard and clicking on the “invite member” link.

Target Populations

It was important for BMHA you know its target population and their health needs. The Bureau’s target population in Regions 1,9, and 8 consisted of African Americans, Hispanic-Latino, American Indians and disadvantaged whites. BMHA took a “participatory action ” based approach, in administering successful challenges. For example, in a workplace situation before BMHA got started, a target population needs assessment was performed using the health assessment module (BRFSS). By determining the target population’s health needs, BMHA was to customize its challenges to address those needs. Another example is when discovering that a significant portion of the target population has unhealthy eating habits and/or are overweight, BMHA would encourage them to administer a nutrition challenge using the OYOH health trackers option, a steps tracker challenge, a weight loss challenge or administer a wellness score challenge that incorporates all three components. All components are user-friendly and interactive.

 Motivation/Incentives

Although some BMHA’s target audience was “intrinsically” motivated to participate in the challenges, that is to say they did it just because it feels good, others may still needed “extrinsic” motivation. OYOH offered a variety of motivational tools including milestones, testimonials, wellness score, health tips, message boards, buddies, events calendar, e-cards, the challenge total thermometer and bulk email. But, the best incentives were distributed through weekly drawings for items such as hats, lunch bags, workout towels, pedometers, meal utensils, workout bags, gift cards to sporting goods stores and healthy eating restaurants like Subway, Jason’s Deli and JJs Deli. BMHA had a local sponsor donate two cruise packages from New Orleans to Cozumel! Incentives such as these and other helpful tools were used to foster team spirit, inspire individuals to do their best, offered useful health information to assist participants in overcoming personal barriers and make the challenge more fun for everyone! The director of BMHA will host online live sessions on Facebook and Instagram with well-known sports celebrities that reach thousands of participants to sustain and increase motivation. He would also host ‘Trash-talkin’ Thursdays on the Message Centre to fire up all the participants! OYOH Bulk email system can reach everyone all at once that covers the entire world.

In addition to incentives and optional software components, promoting local walking trails in target communities by setting up public routes on the OYOH activity tracker page is a great way to motivate individuals in being more active in their local area and community. Another helpful tool for participants was when BMHA posted tips on how to start a walking program on the activity tracker page in a content box above the route map or on each participants’ internal welcome page.

Milestones

OYOH is designed to make sure participants work individually and sometimes collectively to achieve the best outcomes, and when came to creating milestones, BMHA had to consider the length and duration of the challenge and whether or not the milestones can be achieved by most of the participants. Ideally, milestones should be based on the 10,000 steps a day standard for better health. For example, if an individual challenge for people that is 300,000 steps total over 30 days, setting milestones starting at 10,000 steps might be encouraging for most participants since it is likely that they will all hit 10,000 steps at some point during the challenge. As the challenge progresses, milestones may then be added every 50,000 steps to encourage people to be more active. This ensures that most participants will reach a milestone every week while allowing them one or two days of rest should they require it. The Bureau had to keep in mind that when creating challenges according to its target population’s activity levels e.g. sedentary, BMHA had to create milestones that were realistic for their activity level as well. Milestones can also be set up for weight loss and tracker challenges. When creating milestones for weight loss challenges, BMHA had to set milestones that were congruent with a healthy weight loss program (1-2 pounds or up to 1 kg per week). Weight loss milestones are set by adding the percentage of weight loss required to be achieved in the progress field. So, setting up a milestone for 20% weight loss might not be realistic (nor healthy) for an 8 week weight loss challenge. In addition to providing milestones, BMHA encouraged participants to set a goal weight on their profile page. This gives participants a “destination” for their weight loss challenge.

Testimonials/Message Boards

Having a prominent person in their community (e.g. Celebrity athlete, mayor or CEO) write up a letter of support for their community’s new program on their testimonials page helped motivate and inspire others to participate and do their best. People got more involved when they see champions in their community or leaders model the change that they are looking for in their own lives. BMHA held small draw prizes e.g. stainless steel water bottles to participants that share their success stories. Moreover, the Bureau would choose some of the stories that really stood out and highlighted it in company newsletters/community newspapers along with the participant’s photo to help inspire others. The greatest highlight from testimonials and message board came by way of a mental health benefit. BMHA received numerous responses claiming the Testimonial page served as a great mental health benefit to those wh live alone, the elderly, and it helps motivate those to stay the course and not give up. It allows participants to email one another from distant lands and other countries and share stories of health and life, and well-being. Pen pals were developed, and it became the most popular feature on the site!

Having participants post messages on the Message boards is a really useful tool that encouraged team camaraderie and most efforts. The challenge message boards also promoted healthy competition amongst teams and individuals that sometimes provided that extra boost of motivation participants needed to stay on track!

 It’s a fact, people are more likely to engage in healthy activity if they have someone to do it with participants can invite a friend to join them on their wellness journey using the buddies feature on their dashboard. As a result, participants could see their buddies challenge progress and send motivational messages to each other on their own private talk board.

Wellness Score

Offering incentive points for engaging in your wellness program was a very effective way to keep participants motivated. The OYOH wellness score is a means to create a points program for your participants. In turn, participants received badges on their dashboard for achieving a specific number of points and they can use their wellness score points to purchase rewards (e.g. water bottles, back packs).

Health Tips

People in the OYOH challenges often required information about how to make healthy choices in their lives. One of the largest barriers to making these changes is finding and having access to reliable health information. Fortunately, OYOH health tips are an option that provides users with helpful up to date information about various health topics including physical activity, nutrition and stress management. Providing relevant information to participants gave them the boost they may needed to remain involved in challenges and events, and to integrate healthy choices into their lifestyle. To be sure that BMHA was providing relevant information to its participants, it was helpful to know their target population’s health needs first. Setting up an online Health Risk Assessment before launching challenges is a great way to understanding the target community’s health issues. OYOH captains can use survey monkey to get a snapshot of their participant’s health issues and lifestyle behaviors.

Events Calendar

An informed group of people is an involved group of people! Captains can use the events calendar feature as an option to promote opportunities for users in their community to participate in upcoming health related workshops, courses, activities and events. These events may provide the catalyst to change for some participants to create more positive and healthy lifestyles. As well, these events became excellent venues to promote upcoming challenges and to award past challenge winners!

OYOH Total Thermometer

For the most enthusiastic participants, BMHA would set a collective steps/points or weight loss goal for challenge participants keep interest levels high. The challenge total thermometer can be added to the dashboard if requested so participants can watch their shared efforts accumulate and eventually reach that 100% goal marker. This is a great feature to use in conjunction with charitable giving too so that participants feel they are contributing to the “greater good”. If participants would like the challenge total thermometer added to their dashboard, they would contact OYOH staff.

1. i) Bulk Email

An effective way OYOH motivated users to participate in upcoming challenges was by sending out registration information, prize announcements and motivational messages using the bulk email system. This system allowed captains to filter messages so that it reaches an intended audience. For instance, BMHA tried to encourage past users who have not participated in a challenge for a number of months, a filter was setup that sends a message out only to individuals that have not logged into the site for a certain number of days.

Prizes

As previously mentioned, prizes helped boost program registration and encouraged users to maintain activity levels throughout challenges while decreasing attrition (drop-out) rates. Typically, frequent smaller prizes (or a combination of both) keep participants motivated rather than larger “grand” prizes offered only once. In addition, although regular weekly prizes were effective in motivating participants, it was also beneficial to offer random prizes as participants were more inclined to stay involved if they did not know when to expect a reward for their efforts. BMHA had to consider whether or not the prizes were practical. Are they shipped easily? Will the person/team be picking them up? Are they prizes that appeal to your entire population, e.g. men or women?

Next, BMHA had to determine the prize eligibility process. Will they be given out by random draw? Will the prizes be linked to the number of days a person tracked activity? Whatever the Bureau chose, it had to be clear on how prizes are determined.  Most steps, most improved since start of challenge, first to the finish, etc. If looking to motivate more sedentary individuals, it BMHA had to base prizes on “Most improved” performance along with order of finish. This information could be found by using the step participation by challenge report for step based challenges. For the active participant, the Bureau set up additional optional challenges that have prizes based on total steps or first to reach the finish line. Although offering challenge prizes based on individual efforts might help maintain participant tracking throughout the challenge, prizes were given out for participation alone like frequency of login on a daily, weekly or monthly basis.

Basically, BMHA must think about its target population when determining the prizes and consider the health and wellness message that is trying to convey. Offering t-shirts, stainless steel water bottles, activity passes, etc. were good incentives for activity challenges while healthy cookbooks, fruit baskets and healthy cooking classes were more ideal for nutrition challenges. Lastly, BMHA had to promote prizes on the site’s home page and announced prize winners using the bulk email feature.

Another great source of free prizes can be your local recreation center. They may donate free swim passes, skate passes or fitness passes as a way to introduce people to being more active right in their own community. Often local sport businesses like golf courses, ski hills, bowling allies will also offer gift prizes for the whole family to try out the facilities. You can recognize them and give them some great exposure by adding their logo on the site. Captains can also use the milestones report for milestone tracking and selecting prize winners.

Provide Options

One of the key elements of a successful challenge program is fun! One way BMHA kept participants motivated throughout the challenge was to create interesting challenge routes and maps for each challenge. Creating maps for challenges doesn’t have to be mundane, just think about some exotic destinations that people often envision visiting on holidays, and then select an interesting route to get there. The step scale feature was used to ensure that challenge participants could reach these exciting destinations realistically by the end of the challenge. Along the route, some interesting points were marked and included some historical facts, pictures or customs about the area. Alternatively, information points were also another way to provide useful health tips for challenge participants. Program participants were also able to select or upload their own personal avatar (upon registration) to mark their progress along the challenge map making it more fun for everyone.

Another great way the BMHA incorporated fun into challenges was to use an overall theme and incorporate it into every aspect of your challenge. For example, participants wished to run a Crime Mystery Challenge that uses milestones for clues, provides famous detective facts in the map info, points and celebrates the challenge success with a Crime Mystery party at the end.

Offering fun, interesting challenges was definitely one way to boost participation levels. However, team captains must consider multiple health issues, levels of fitness and the stage of readiness to change of the target population. As fun and interesting as a challenge may be to some, it can be discouraging for participants if the final destination isn’t a realistic one for many of them to reach. When creating routes, BMHA had to base the distance on the 10,000 steps a day recommendation for maintaining health and well-being. Even this can be too long for people starting out an activity program, so options were provided for sedentary individuals along with one or two other routes geared for the moderately active and extreme athletes to help prevent attrition. Since some of the extremely active participants might finish a 10,000 steps a day route too early, try adding on an extra challenge at the end.

Another thing BMHA had to consider is that participant interest can wane if the challenge created is too long in duration. As such, shorter step challenges (4-6 weeks) that require less commitment on the participant’s behalf, with smaller prizes. For health tracker challenges (e.g. nutrition, hydration), changing it up every 3-4 weeks and cap the number of health behaviors that individuals track at 3 or 4 at most. It can be overwhelming (especially for their first challenge) for participants to keep a record of more than two health behaviors at once. Moreover, BMHA went with shorter challenges that came with more promotional opportunities for staff to communicate with participants and/or the public which gave challenges the continued exposure it requires to maintain participation levels. In addition, running a longer challenge (with a grand prize) that is several months in duration concurrently along with these shorter challenges, e.g. a weight loss or wellness score challenge is a popular option.

Another way BMHA maintained participant interest was using the handicaps option on the “create a team” page in order to equalize the playing field. For instance, giving a sedentary group a handicap of two doubles the team total steps for every step an individual enters. This helped motivate individuals to “stay in the race” and keep up with other more active teams. As well, the unit’s multiplier was used when creating tracker icons for tracker challenges. This exponentially increases the number of points an individual can achieve if they are successful in reaching their daily goal. For example, if an individual requires checking off 6 units to reach their daily goal and the unit’s multiplier is given a value of 10, that individual is given 60 points for that day’s total which sounds much better than just 6 points if they were set to 1 point each! These extra points can provide the extra motivation that some individuals require to stay active. It can also be a great way to structure a prize incentives program, setting up point levels that individuals need to attain in order to be eligible for a draw prize. Again, the best way of determining prize eligibility was to use the milestones report in the report features of your OYOH package.

For multiple health issues, BMHA used multiple trackers (nutrition, stress management, hydration, etc...) and type of challenges (activity, weight loss, and tracker). Remember that it’s always good to “change it up” and have different challenges at different times of the year. As well, some people in your target population might not be ready to be active just yet. These people may be contemplating still and require information that will help them get active. As such, promoting and using the health tips module option, providing links to online health resources in the content boxes, offering workshops and using the events calendar option and allowing individuals to join optional challenges may be the best way to gently nudge less active people towards taking action for better health. Utilizing the health risk assessment module option at times was a helpful tool in providing information to motivate the under active or sedentary part of your population and can bring awareness to those individuals that aren’t aware they might have a health problem to begin with.

Finally, BMHA had to set up participants for success! Website demonstrations were offered to target populations on how to utilize the tracker software before the start of your challenge. This allowed participants an opportunity to ask questions as well as provides you with another promotional venue. Additionally, BMHA provided lots of opportunities for participants to engage in healthy behaviors so that interest levels remain high throughout the challenge and healthy habits are encouraged. For instance, a walking group was setup communities and at your worksite to encourage participants in a physical activity challenge. Alternatively, some members organized a fruit basket program for employees in the staff lunch room that participated in a nutrition challenge.

Know your Audience

BMHA had to consider its population’s demographics (e.g. age), level of comprehension and language. If the target population is young or has low literacy levels, the messages were kept clear and simple. When dealing with multiple languages, additional time was built into the planning process for translation of materials for limited English proficient individuals. If any participants require site configuration or support in another language, OYOH staff will be glad to assist.

Use Other Communication Alternatives

In addition to OYOH motivational tools, alternative way of promoting challenges to reach as many people within the target population as possible. Depending on the audience, company letters or bulletins, recreation program guides,  community centers, employee meetings, audio-visual presentations, posters, pay stuffers, buttons, t-shirts, Church/Community meetings, schools, Facebook groups or advertisements, community newspapers (stories, registration),links from company or community websites, reader boards, etc. also provides extra exposure for your program.

Evaluation

BMHA knows that one of the key components to successful challenges is to evaluate its efficiency and effectiveness and to make program modifications based on these results. A good program evaluation looks at information to learn both how well the program is working (process measures) and whether or not it is achieving the expected results (outcome measures).

Before launching a wellness challenge, BMHA hired an external and internal evaluator to establish a baseline of participant health behaviors. Establishing a baseline is an excellent way to see whether or not an individual and the population as a whole have improved their health as a result of participating in the wellness program. In other words, having outcome measures alone isn’t that effective if you don’t know where you started! Generally, having participants track their normal health behaviors for approximately 3-7 days at the start of any challenge will help establish a reliable measure to determine whether or not the challenge itself improved participants’ health behaviors. Establishing this baseline initially is also important because typically many people start “fast out of the gate” and are eager to make healthy changes but begin to wane a bit as life demands and motivation becomes an impediment to maintaining their momentum. BMHA need to know how effective the program was in reaching its objectives. This can be done throughout the program or upon its completion.

In addition to the evaluators, the online Step Participation by Challenge report shows the number of steps participants have entered, average steps per day, baseline average steps, as well as their improvement since baseline and the number of days steps were entered. The baseline can even be changed in the report to match what was decided initially when setting up the challenge. Another helpful report is the site statistics report. This report allows managers to view a summary of the overall site usage.  Important information such as the number of participants, teams, number of logins, challenges created, challenge sizes, total challenge steps and steps by activity is available for managers to utilize in their evaluations. Other ways to evaluate challenges while it’s still in progress, using OYOH, is to create milestones and draw upon the milestones report to track how many people have reached that goal. Regardless of how managers choose to structure their evaluation efforts though, it is essential that the evaluation methods link back directly to the program’s goals and objectives.

Moreover, using reliable evidence based statistics by the external and internal evaluators is essential in creating successful challenges. OYOH offer a variety of reporting features that allow captains to determine how well a program is performing and whether or not the objectives are being achieved. For example, BMHA might want to know if the challenge promotion efforts were efficient. Did the registration campaign recruit people from the intended target group? If so, how many registered and are currently active? To find out, BMHA can draw upon a user profile report to determine if they reached their target group (e.g. sedentary individuals or a specific age group), as well as the number of participants from that target group. Fortunately, the Steps and Weight loss challenge statistics reports offer this type of information including estimated savings for active participants as well as absenteeism, presentism, short term disability and drug costs for inactive participants, and estimated annualized medical cost savings for BMI points lost.

As well, a generic survey by Dr. Elizabeth Gollub is provided with an understanding of whether or not participants perceived health improvements during the challenge and if they would participate in future challenges (and what type). The online aggregate survey results are available in the Steps, Points, Weight loss and Wellness Score challenge statistics report. BMHA also needs to know what participants thought of the challenge itself. Finding out about how participants viewed the registration process, communication methods, prizes, website content and ease of use was helpful to improve future challenges. As such, Dr. Gollub customized pre or post challenge survey added to the dashboard in order to collect all the necessary data you require to assess your program accordingly.

It’s was important for BMHA to communicate any evaluation results to program participants so that they have an opportunity to see how well their dedication and efforts paid off, inspiring them to participate in future programs. The best way to inform participants of course is by using the bulk email feature or posting directly on the internal welcome page. The bulk email feature can also be used to send a message to past participants (using a “days since logged-in” filter) to encourage them to fill out a post-challenge survey in order to determine whether or not they sustained their healthy behaviors months beyond the end of the challenge.

Finally, the last ingredient to successful challenges is to ensure that the information utilized to plan and evaluate programs as well as any health related information is up-to-date and reliable. Using dependable information helped BMHA avoid issues in both the planning and implementation phases. As well, it is especially important when providing any health related information that it is accurate because misinformation may have serious consequences on an individual’s well-being. 

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