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Ecorys and Keele University


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Age UK's Fit as a Fiddle final evaluation webinar, Ecorys and Keele University, 16th January 2013, presentation

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Ecorys and Keele University

  1. 1. Evaluation of the fit as a fiddle portfolio FinalReport – Key FindingsNicola Smith, EcorysBernadette Bartlam & Julius Sim, University ofKeele
  2. 2. Introduction• fit as a fiddle was a £15.1 million portfolio funded by Big Lottery Fund and delivered across the 9 English regions from 2007• fit as a fiddle aimed to “Increase the opportunities for older people to undertake physical activities and improve their eating habits, contributing to an overall improvement in mental health.”• fit as a fiddle comprised two national and 24 regional projects, delivered by over 200 organisations (99 of which were local Age UK’s/Age Concerns)
  3. 3. Evaluation MethodsLongitudinal evaluation - qualitative andquantitative methods:•A paper based survey of older people acrossthree time points.•2,189 completed surveys • 859 at start of involvement • 816 at end of involvement • 514 three months after involvement•20 completed case studies • One SROI case study
  4. 4. Evaluation Methods• Web and paper based survey of project delivery staff, regional co-ordinators, volunteers and partners (221 responses)• 11 Community evaluators •38 filmed interviews with older people• 20 qualitative interviews with national stakeholders• Data analysis •SNAP monitoring data •Project outcomes and financial data •End of project evaluation reports
  5. 5. Impacts on older peopleBernadette Bartlam & Julius Sim, KeeleUniversity
  6. 6. Impacts on older people20 project level case studies38 in-depth interviews conducted by a team of 11 community evaluatorsSurvey:• 2,189 self-completion surveys • socio-demographic details • general health and wellbeing • limiting long-standing illness • daily activities • participation in the programme • 881 participants • 859 at start of involvement • 816 at end • 514 at least three months on • 416 at all three timepoints
  7. 7. Who took part• 665 women (75%) - average age 72• 216 men (25%) - average age 71• Ethnicity: • White British (81%) • Indian (4%) • Black Caribbean (3%) • 11 other ethnic groups• Limiting long-standing illness: 46% i.e. heart disease, diabetes, asthma, emphysema, and arthritis.
  8. 8. Who took part: livingarrangements
  9. 9. Taking part• 60% physical activity or exercise• 35% healthy eating activity• 2% volunteering or mentoring activity• 3% stated other activity
  10. 10. Impacts on Healthy Eating• Targets exceeded: • 178,521 older people eating more healthily against an overall target of 155,836• Activities included: • Cookery courses promoting fresh ingredients rather than using ready meals • Smoothie making and fruit tastings • Health promotion messages on 5 a day, portion sizes, using alternative types of fat, keeping hydrated, salt intake etc • Gardening.
  11. 11. Changes in attitude No. of At the At the end responses at start of fit of fit as a the 3 time as a fiddle fiddle Follow-up pointsFull sample: I don’t think healthy eating is important 35 (4%) 32 (4%) 8 (2%) for my health I think … but I am not doing anything 154 (18%) 81 (9%) 23 (5%) 864, 866, 424 about it at the moment I think … and I am doing something 675 (78%) 753 (78%) 393 (93%) about it at the moment Portions of fruit & vegetables eaten No. of At the At the end responses at start of fit of fit as a the 3 time Sample as a fiddle fiddle Follow-up points Significant? Total 4 4 4 830, 838, 407 — Restricted 4 4 4 384 Yes* English average= 3.5 (men); 3.8 (women) Aresu M, Bécares L, Brage S, et al (2009) Health Survey for England 2008: Physical activity and fitness. NHS Information Centre for Health and Social Care
  12. 12. Portions of fruit & vegetableseaten cont.
  13. 13. Come to tea at Haunton Hall“One gentleman, who has noconversation, came into the allotmentand said ‘green beans’ and then startedto say what was growing in theallotment –before that, he hardly said a word andso we know now that he has an interestand knowledge of gardening which wedidn’t know before”. (Staff member)
  14. 14. Impacts on Physical Activity• Significant change over the duration • More people recognising the importance • More people doing something about it• Activities included: • Walking, including nordic walking • Swimming • Aerobic exercise classes (aqua, armchair etc) • Gardening
  15. 15. Changes in attitude No. of At the At the end responses at start of fit of fit as a the 3 time as a fiddle fiddle Follow-up pointsFull sample: I don’t think physical activity is important for my health 27 (3%) 25 (3%) 8 (2%) I think … but I am not doing anything about it at the moment 172 (20%) 86 (10%) 30 (7%) 856, 858, 421 I think … and I am doing something about it at the moment 657 (77%) 747 (87%) 383 (91%)Restricted sample: I don’t think physical activity is important for my health 14 (3%) 11 (3%) 7 (2%) I think … but I am not doing anything about it at the moment 73 (18%) 22 (5%) 30 (7%) 409* I think … and I am doing something about it at the moment 322 (79%) 376 (92%) 372 (91%)
  16. 16. Changes in behaviourMedian minutes of: walking, per day (blueline); activity making breathe harder, per week(green line); activity for strength andendurance, per week (pink line)
  17. 17. Impact“Its things like climbing the stairs, Ive got one flight ofstairs, normally by the time I get to the top I’m knockedout, you know, I have to stop and have a rest.Now I’m managing to get up the stairs and walk to myroom without a rest…Recently I went out to Portugal and the place we wentto was quite hilly… I was finding I was managing thehills a lot better than I would have been perhaps 18months to two years ago, so the benefits are there.” (Participant: Older Men project at Springbok Farm Estate)
  18. 18. Impact cont.“I had had two hip replacements and a completeshoulder replacement. My mobility, stamina andconfidence were poor…I can now swim both breast stroke and crawl again,can complete an hour’s exercise in the water… I reallyenjoy myself and have made friends and now bringtwo more ladies to the sessions.All this has made a great difference to my life, I cannow walk anywhere including uneven ground, managesteps, stairs, run and dance; I recommend exerciseswimming to everyone.” (Female participant, Fit as a Fish project Devon)
  19. 19. Impacts on Mental Health Health is more than absence of ill-health - related to four items: 1. Health and functioning 2. Existence of relationships and social support 3. Material circumstances 4. Opportunities for personal growth and developmentHiggs, P., Hyde, M., Wiggins, R. & Blane, D. (2003). Researching quality of life in early old age: the importance of the sociological dimension. Social Policy and Administration, 37, 239–252.
  20. 20. Complex relationship…“In fact, I think thats the biggest impact it has really, yousee the people coming in and they always say things like Iam so glad I came to this group and I havent been goingout… You see them starting to make friends and it’s justfantastic." (Case Study East Midlands)“Also the fact that its a social thing, you know, its somethingthat somebody can attend on a social level with otherparticipants also helps to alleviate any, perhaps, negativefeelings, feelings of isolation and so on and Ive got evidence ofthis through letters and testaments and so on.” (ProjectCoordinator)
  21. 21. Warwick Mental Health Scale No. of responses at At the start of At the end of the 3 time Signific-Sample fit as a fiddle fit as a fiddle Follow-up points ant?Total 33.51 34.97 36.16 754, 770, 391 —Restricted 33.53 35.07 36.25 337 Yes* Significant increase in mental wellbeing across the duration of the programme and also between the beginning of the programme and follow-up
  22. 22. Satisfaction with life No. of responses at At the start of At the end of the 3 time Signific-Sample fit as a fiddle fit as a fiddle Follow-up points ant?Total 7.26 7.62 8.06 827, 826, 403 —Restricted 7.28 7.66 8.08 374 Yes* Significant positive increase across the duration and between the beginning of and follow-up stage
  23. 23. Impacts on Mental HealthControl and autonomy: frequent examples of older people beingconsulted about the type of activities projects would offer & how theywould be structured. Taking part in the activities clearly gave people asense of being better able to deal with – and indeed at timesovercome – impairments related to their health or mobility.Meaning and purpose: reports throughout of participants feelingvalued and contributing to their communities in ways that had notpreviously been available to them, e.g. healthy eating initiativesencouraging participants to grow produce that their communities thenused. Participation gave many people a meaning-making structure totheir daily lives that had previously been missing.Pleasure: participants spoke frequently of how much enjoyment theygot from participation, from a general improved sense of wellbeing,through to making new friends and experiencing increased self-esteem and confidence.
  24. 24. Impact: the example of EllaElla is 88 and has lived in Cranfield, a sheltered housingcomplex, for 35 years; she doesn’t participate in anyactivities outside the complex. Ella and other residents tookpart in armchair exercise classes based on site, which weretherefore easy to access. For other activities, such asswimming, which were offered off site and which she wouldhave considered joining in, she was unable to participatebecause of a lack of appropriate transport. As Ella put it "Ican’t really get on the bus because if I get on, I cant get off"."Now we chat away like we are bosom pals""I go shopping into town with the other girls.“The classes have resulted in making Monday "a special dayand have provided me with an extension of my life."
  25. 25. Cascade effect…Participants:Frequent reports of bringing friends along, encouragingothers to take part, disseminating informationStaff:Increased sense of professionalism, support, andachievement Ella has a partner of 86 who suffers from osteoporosis. At home she encourages him to try some of the exercises. The exercise class leader produces a written outline of the exercises so that participants are very clear about what they are doing in each class. Ella finds this very helpful on the day but it also acts as a memory aid for practising between sessions, and as a tool to help her explain the exercises correctly to her partner.
  26. 26. Nicola Smith, EcorysWider impacts of the programme
  27. 27. Partnership Working"All partners, whether from the statutory, community or voluntary sector have brought enthusiasm, commitment, energy and ideas. All partners… have given contribution "in kind" to help [us] continue." (Project and partner survey feedback)48% project co-ordinators worked with other organisations97% of projects felt partnerships were effectiveImpact of partnership working • Engaging target groups e.g. BME, frail older people and older men • Boosting project reach – extending capacity • Delivering new activities • Avoiding duplicationChallenges• Funding cuts to statutory services• Staff turnover in partner organisations• Communication with partners
  28. 28. Equality and Diversity"Its important to think creatively about how you might deliver something, sometimes you might make certain risks and see what might happen.” (Project staff)• Key target groups - older men, Black Minority Ethnic groups and frail / isolated older people• Mix of specifically targeted projects and outreach work by partners• Activities for target groups need to be appropriate to ensure participation• above national average levels of engagement by some ethnic groups• Men 2 Mentor engaged men with targeted activities e.g. men only keep fit and golf
  29. 29. Equality and Diversity• National cascade project worked with a range of faith and community groups to engage them in activities and reached 5,532 older people• Effective approaches working with BME groups included • Men and women only sessions • Using translators • Using local community venues and volunteers • Intergenerational work• Working in care homes and sheltered accommodation to attract frail elderly people, chair based exercises • Come to Tea and Life and Soul project
  30. 30. Health Literacy• 808,060 educational resources distributed to older people • 168,357 Blood Pressure Association leaflets • 100 older men’s leaflets • 50 Equalities and Human Rights Guides• Promotional material including t shirts, ‘stress relieving’ fruit, recipe books, DVDs and newsletters• Case study of health literacy materials in care homes • 95% rated very or fairly useful • Promoted the portfolio and raised awareness of the programme • Raised awareness of healthy eating
  31. 31. Tackling Obesity Age Concern KingstonProject Aim: To tackle obesity throughphysical activity and promotion of ahealthier lifestyle•Ten 6 week courses attracting 166 older people inactivities such as Nordic Walking, Keep Fit andBollywood dancing•88% of participants taking part in moderate exercise 3-5 times a week•Social Return on Investment (SROI) analysis suggestsan approximate social return on investment generatedby the project of £3.50 for every £1 invested•Generated through reductions in use of GP services,treatment for falls related incidents and reductions inunpaid informal care
  32. 32. Sustainability “Some parts are likely to continue with local PCTs or social services covering some costs. Also where volunteers are used it is hoped they will continue.” (Project coordinator)• Projects being effective in planning for the continuation of their activities• A third of projects expected to continue some form of fit as a fiddle activity• Projects likely to continue are to be scaled down• Statutory bodies and volunteers will play a role in continuing sustained activity• Greater focus on sustaining physical activities
  33. 33. Models of Sustainability• External follow on or continuation funding• Internal of core funding models• Fee paying models• Volunteer led models of sustainability• Constituted groups• Instructor packs• Continuation with no funding
  34. 34. Conclusions and recommendations• fit as a fiddle widely viewed as a success achieving national recognition and offering a unique service to older people• fit as a fiddle identified by Age Action Alliance as a model for delivering healthy ageing services• fit as a fiddle achieved positive outcomes for older people and clear impacts on healthy eating, physical and mental wellbeing• fit as a fiddle achieved positive outcomes on volunteers and volunteering capacity• Cost per participant ranged from £36.56 to £408.12