An initiative to encourage people with experience of mental health and/or addiction problems to think about their physical health in a more positive and proactive way is gaining momentum in Hamilton, through a user-friendly warrant of fitness for physical health.
A self-assessment tool, the W.O.O.F (Warrant of OK fitness) and a brochure that details how to get the most out of GP visits are the brainwave of the HealthWatch initiative. The initiative was set up by Centre 401 Trust to support people to be more proactive about their physical health.
“Our aim was to get our members thinking about their physical as well as their mental health,” Centre 401 Trust manager Donna Bright says.
“To do this we needed an approach that was user-friendly, non-judgemental and encouraged people to be more informed and proactive about their health. We believe both the W.O.O.F and GP pamphlet meet these outcomes.”
At the centre the tools are offered in conjunction with HealthWatch information pamphlets and monthly health-related workshops. While initially designed to help people with experience of mental health and/or addiction problems, the tools are also now available to any organisation that wishes to utilise them. This includes a basic version of the W.O.O.F on the Centre 401 Trust website.
The W.O.O.F, which has been on offer since February 2012 has been well received by NGOs and people who complete it, Donna says.
“People like the simplicity of it, particularly the traffic light system summary. It is a great way to open a conversation about health and to assist people to look at ways to keep better health. It also introduces screening programmes that most people are not aware they can enrol in.”
The word ‘okay’ was inserted into the warrant of fitness title to encourage people to feel that change could be attainable.
“We wanted people to believe they could work towards better health and not be put off by the idea it is impossible to achieve good health,” explains Donna.
How the W.O.O.F works
Individuals self-select into one of four groupings - women 16-44 years, women 45 years and older, men 16-39 years and men 40 years and older.
“These divisions were based on the ages of screening programmes available and general medical recommendations about age-specific screening. While most questions are generic across the four divisions, there are some specific questions relating to gender and age,” Donna says.
There are three sections. The first is a general health quiz, with answers provided, that is designed to get people thinking about what they know or don’t about common health topics.
In the W.O.O.F’s second section, participants answer two or three simple questions about seven aspects of their health - lungs, heart, reproductive, exercise, nutrition, liver and skin. These topics were based on medical research around the most frequent causes of death in the general adult population, explains Donna.
“This section includes looking at body mass index (BMI). Members can ascertain their own BMI using tape measures, weight scales, height stations and BMI calculation forms provided by HealthWatch.”
On completing the answers the participant receives a traffic light colour. Green equals good health, orange indicates room for improvement and red signals an area of health that needs to be checked up.
The final section is titled Your Plan to Go Green and provides the opportunity for people to think about areas of concern and ways they may be able to work on those concerns over the following month.
For some members, seeing a particular aspect of health highlighted as a concern is enough to motivate change.
“Others choose to work with us on their Your Plan to Go Green to take an aspect of their health from a red light towards a green light,” Donna says.
Every new member at Centre 401 is offered the opportunity to do a W.O.O.F and then helped to complete it. It is also completed as a group exercise in some of the HealthWatch workshops and has recently been integrated into another programme, the Quest Work, a recovery and life goals programme.
“We have a loyalty card system to encourage members to make the most of the services we offer. After gaining 10 stamps, they receive a HealthWatch bag which is full of items and healthy food that have been donated by various organisations. A workshop earns one stamp, completing a W.O.O.F earns a member four stamps,” Donna says.
Why the physical health emphasis?
Over several decades it has been well established in both international and New Zealand literature that there is a significant gap in health between people who experience of mental health and/or addiction problems and the general population, with life expectancy of those with serious mental illness estimated to be up to 25 years shorter.
Blueprint II highlights overall poorer physical health as a challenge in Supporting people with severe needs (Priority Area 4), stating that action is needed towards “increasing the physical health and wellbeing of people with severe mental health and addictions disorders” (Blueprint II: Making change happen, 2012). This is also identified as a priority in Rising to the Challenge (Ministry of Health, 2012).
This challenge has been picked up by Platform and Te Pou, who have started working on a programme of concerted action in New Zealand, Equally Well, to improve the physical health of people diagnosed with serious mental health and/or addiction problems. The first phase of this work has involved a review of international and New Zealand literature to understand the extent of the health gap, the causes and what can be done to improve physical health at systems and individual levels. The review is near completion and will be available on the Te Pou website in due course.
Self help approach
At Centre 401, the staff decided a self-help tool would be the most useful way to encourage members to become more aware of their physical health, and came up with the idea of a health warrant of fitness using a traffic light grading system.
The development of the W.O.O.F took about a year. Once Centre 401 staff had decided on the W.O.O.F. concept, a service user consultant was given the job of researching resources already available before creating and testing the W.O.O.F. It was then looked over by a GP who made a number of amendments and suggestions that were incorporated before the publication of the tool. This ensured the information was medically current and accurate. The Centre then trialled it, making amendments where required.
HealthWatch has also developed a GP pamphlet that is given out in conjunction with the W.O.O.F. It is designed to support members by helping them make the most of doctor visits. One of the main issues for members was that the brevity of GP appointment times often made it frustrating and difficult to explain problems or concerns. The pamphlet includes a list of ‘Dos and Don’ts’ and questions they might like to ask and how to make a complaint.
“By offering suggestions on how to approach GPs, members can visit the doctor and leave feeling they were heard, their concerns taken seriously, and a plan of action is in place,” explains Donna.
She says Centre 401 held several focus groups with members to hear about their experiences with GPs and find out what information would be most helpful for people to know before going to the doctor. They also utilised information from the Royal NZ College of General Practitioners website and www.netdoctor.co.uk. The GP brochure development was led by a focus group, Brainwave. Feedback was also provided by Citizens Say, a Centre 401 forum at which people discuss topical issues.
Other organisations find value
The W.O.O.F and the GP pamphlet are also available to the wider mental health sector in Hamilton and have been welcomed as a useful resource, according to Waikato District Health Board funder and planner Katherine Fell.
Pathways is one Hamilton organisation that uses the W.O.O.F frequently. Pathways service and relationship manager Jodi Fata says the trust’s nurses and support workers find the W.O.O.F an excellent conversation starter that gets people thinking and talking about their physical health.
Donna says another provider has told the Centre they use the W.O.O.F during the induction process to open up talk about various health issues. They find it often highlights health issues that people may not have wanted to talk about before doing the W.O.O.F and gives a reason to use screening services such as breast screening.
The main challenge
Thinking about physical health as a priority is a big challenge for some Centre 401 members, Donna says.
“Having somewhere to live, being able to pay the rent and to buy food come higher up the priority list for many members than thinking about their health when they don't necessarily feel unwell.”
She adds that the cost of GP and dentist visits is also a big negative – an impossible stretch for some people.
Personal use of the W.O.O.F and GP initiative – three examples
Members enjoy the simplicity and effectiveness of the tools, especially the W.O.O.F, and a number have made health changes after completing the W.O.O.F.
I found the W.O.O.F really informing and it gave me a bit of a wake-up call. It made me follow up and go and see a doctor...a really big wake-up call. It made me aware of what I need to keep an eye on, especially with my diet and other age related things,” Shirin says.
In her mid-sixties she decided to do the W.O.O.F. because of her past lifestyle.
“I’m getting older. I used to smoke and drink heavily so I decided I should get things checked out. And it was worth it. When I went to the doctor, I got my blood pressure checked, and also found out that I was B12 deficient and require monthly injections. I would never have realised otherwise.”
Shirin says the GP brochure also helped her feel confident about visiting the doctor.
Learning about portion size and the right food to eat as a person with diabetes was a big win for Tukua.
I knew I had been neglecting my diet so the W.O.O.F. was a good way to check in and find out more about my diet and how to become healthier,” explains Tukua, who is in his mid-forties.
He says the W.O.O.F. was straightforward to use, as was the GP brochure, and he found it easy to make the changes recommended.
“Anything that helps us stay healthy is helpful.”
The desire to be healthy in order to fulfil life goals was the impetus behind John’s decision to do the W.O.O.F.
I want to try and preserve myself so I can live long and to do that I have to be healthy.”
As a result of completing the W.O.O.F., he is walking more to increase his exercise levels and make dietary changes.
It wasn’t hard to make the changes but I didn’t do it straight away. I was still smoking when I first did the W.O.O.F. and I needed to get off that to have the finances to buy the health foods I wanted to eat.”
He says he feels much better for the change of diet and now talks to others at the Centre about eating in a healthier way.