Example 2: Take Charge Challenge: Self-Determined Physical Activity Program

BACKGROUND 

The Take Charge Challenge is a 10-week physical activity program in which participants determine their individual readiness for physical activity, set goals, and pursue activities that interest and challenge them. Originally developed as a worksite health promotion program, the New Mexico Office of Disability and Health modified the Take Charge Challenge to meet the needs of people with disabilities and to be an inclusive program where people of all abilities can participate.

IDENTIFY WHAT NEEDS TO HAPPEN IN ORDER FOR YOUR VISION OF YOUR COMMUNITY TO BE FULFILLED:

The following behaviors needed to change:

• The U.S. Surgeon General’s Report states adults should accumulate 30 minutes or more of moderate physical activity five or more days a week to reduce the risk of chronic disease. Presently, people with disabilities are less likely to engage in regular physical activity compared to people without disabilities. Thus, physical activity should be seen as important for people with disabilities.
• The Americans with Disabilities Act requires equal access to public facilities, systems, and recreation programs, but people with disabilities often face barriers that limit their ability to participate in recreational activities. To eliminate these barriers, communities should offer accessible environments that enable people with disabilities to engage in physical activity using public recreation facilities, transportation systems, parks, trails, and other outdoor spaces. And, then, people with disabilities could have the same opportunities to be physically active as those without disabilities.

People with disabilities themselves need to recognize the importance of physical activity and develop the motivation to lead active lives. However, the environment in most communities presents barriers to their increased physical activity. Therefore recreation providers and community leaders also need to recognize the rights and needs of people with disabilities for physical activity and do what they can to eliminate barriers for people with disabilities.

Needed environmental changes typically include increasing the accessibility of recreation facilities and outdoor spaces. These changes include increased physical access, such as accessible parking, ramps, smooth surfaces, Braille signage, and accessible bathrooms that accommodate people with disabilities. It also includes access to programs such as recreation classes and access to adaptive equipment. The community environment also must be surveyed and assessed to determine accessibility. Changes to improve access to public transportation, sidewalks, and other public systems and infrastructure also facilitate behavior changes.

These specific changes should occur as a result of the intervention:

• Recognition by people with disabilities of the importance of physical activity
• Motivation of people with disabilities to increase levels of physical activity through programs that use goal setting and incentives
• Effort by people with disabilities and recreation providers to find ways to make physical activity enjoyable
• Use by people with disabilities of community recreation facilities and outdoor spaces
• Modification of environments by community members and organizations to increase accessibility and use for people with disabilities

MEASURE BEHAVIORS TO GATHER INFORMATION ON THE LEVEL OF THE PROBLEM:

Physical inactivity among people with disabilities was observed directly and reported through data. Population-based surveys document the disparity that exists between physical activity levels of people with and without disabilities. The 2002 National Health Interview Survey stated that 56 percent of adults with a disability reported no leisure-time physical activity compared with 36 percent of people without a disability.  Also, according to data from the Behavioral Risk Factors Surveillance System, 25.1 percent of people with a disability reported to have not engaged in any physical activity in the past 30 days, compared to 13.3 percent of people without a disability.

Observation shows, too, that people with disabilities are often left out of health promotion programs and interventions. Though not purposeful, many program designs do not address the needs of people with disabilities or offer the flexibility that may be necessary to accommodate different abilities. Programs specifically for people with disabilities, though sometimes beneficial, are not always necessary and often do not allow people to be active with family and friends.

DESCRIBE THOSE WHOM THE INTERVENTION SHOULD BENEFIT, I.E., THOSE WHOSE BEHAVIOR SHOULD BE TARGET FOR CHANGE AND THOSE TRHOSE WHO CAN HELP MAKE CHANGE HAPPEN:

The intervention will benefit people with any type of disability. As many as 49.7 million Americans, or 20 % of the population, experience some kind of disability, including physical, mental, emotional, cognitive, and/or sensory abilities, so the intervention can benefit a significant portion of the population and their family, friends, and co-workers. In a less direct way, the intervention can benefit community members by setting an example of how simple adaptations can create a program that includes everyone.

WITH CLIENTS' INPUT, IDENTIFY ISSUES, PROBLEMS, AND/OR GOALS TO SOLVE TOGETHER

To achieve this, people with disabilities were involved in the development and implementation of the intervention. Centers for independent living, which primarily serve people with disabilities, piloted the intervention and used feedback from participants to modify the program.

ANALYZE ISSUES, PROBLEMS, AND/OR GOALS TO BE ADDRESSED BY THE INTERVENTION, USING CLIENTS' INPUT 

People with disabilities often report barriers or risk factors that make them less likely to engage in regular physical activity:

• Physical or emotional issues associated with a disability that can limit desire to seek out opportunities
• Lack of recognition from people with disabilities, family members, and/or public health professionals of the importance of physical activity as it relates to the health and well-being of people with disabilities
• Lack of knowledge about how to be physically active, or simply “what to do”
• Environmental risk factors that can include community and recreation facilities not meeting standards for accessibility; inaccessibility of parks, trails, and other outdoor recreation areas; lack of transportation; or lack of adaptive equipment
• Physical activity programs are not tailored to meet the needs of people with disabilities. Many physical activity programs are prescriptive (for example, walk three times a week) and do not take into account individual needs and abilities.

The problem of physical inactivity can be attributed to these factors, many of which can be influenced by raising awareness and providing information. However, environmental factors can be more difficult to change, often requiring systems change and involvement at different levels of community government.

People with disabilities are not the only ones responsible for the problem of physical inactivity. Professionals in the medical and public health fields, family members, and others who fail to promote the health of people with disabilities also contribute to the problem. In addition, environmental barriers often result from decisions made by government leaders, developers, and planners. Therefore, the issue needs to be addressed on multiple levels including the individual, family, professional, community state, and federal levels.

SET GOALS AND OBJETIVES (WITHOUT ISOLATING WHAT THE EXACT INTERVENTION SHOULD BE)

Physical activity should be seen as important for and by people with disabilities, and they should have the same opportunities to be physically active as those without disabilities.

RESEARCH WHAT OTHERS HAVE DONE BEFORE YOU, I. LEARN WHAT HAS SUCCESSFULLY WORKED BEFORE IN THE COMMUNITY( OR ANOTHER COMMUNITY)

Before designing an intervention from scratch, consider existing programs that can be adapted for use in a different situation or with a different population. For example, the original Take Charge Challenge was a worksite physical activity program discovered by a staff member at the New Mexico Office of Disability and Health and was then adapted for people with disabilities. Various organizations successfully have used this individualistic and non-prescriptive approach that also often works well for people with disabilities.

BRAINSTORM POTENTIAL INTERVENTIONS OF YOUR OWN:

Interventions to increase physical activity among people with disabilities can take many forms, including:

• Sports teams or recreation activities planned for specific disability groups (e.g., wheelchair basketball, Special Olympics)
• Programs that use a specific exercise protocol such as swimming
• Programs that take place in a specific setting, such as a gym-sponsored aerobics class
• Provision of equipment and/or information to promote home exercise
• Educational programs offered in worksites or other community venues

DETERMINE WHAT YOU CAN GENUINELY AFFORD TO DO FINANCIALLY, POLITICALLY, AND IN TERMS OF TIME AND RESOURCES.

While funding is limited to implement the intervention, the intervention costs are limited to only the provision of incentives, which can be determined on a case-by-case basis depending on available funds. Incentive examples include tangible items such as tote bags, gift certificates, and T-shirts. The intervention’s low cost contributed to its potential replication in a variety of settings, thus its practicality, simplicity and effectiveness.

IDENTIFY ANTICIPATED BARRIER AND RESISTANCE AND HOW THEY MIGHT BE OVERCOME PR DIMINISHED.

Developed as a worksite intervention, the original Take Charge Challenge has benefits such as a captive audience and existing organizational structure provided by the work environment. Lack of structure in some community groups, as well as recruitment difficulties, could be potential barriers to a community implementation of the program.  Other barriers might involve environmental factors such as inaccessible facilities that may limit where or how a participant can be physically active.

EXPRESSLY DISTINGUISH CORE COMPONENTS AND ELEMENTS OF THE INTERVENTION. 

The program’s core components include providing information, motivation, and an individualistic approach. The following table distinguishes the components or “strategies” from the elements or “tactics” of the intervention.

DEVELOP AN ACTION PLAN TO CARRY OUT THE INTERVENTION. PILOTi-TES THE INTERVENTION ON A SMALL SCALE, IMPLEMENTIT, AND PLAN TO CONSISTENTLY MONITOR AND EVALUATE YOUR WORK.

The Take Charge Challenge can be implemented in any group setting, either already existing or developed specifically for the intervention, involving people with and without disabilities. Marketing the program and recruiting participants in the community would take some effort. Using existing community groups can help, but efforts need to be made to reach those outside of structured groups.

When the program is implemented, participants receive information about the challenge, the importance of physical activity, and how they can increase their physical activity level. A physical activity readiness scale is administered at the beginning and end of the program. An additional short health survey is administered at the beginning and end of the program and three months post-program for evaluation purposes. Participants set individual goals for physical activity at the program start, and report on progress at a midpoint and at the end of 10 weeks. Progress is tracked by the individual using a re-useable calendar provided at the beginning of the intervention. Incentives are given at the beginning, middle and end of the program to motivate and reward success.

The program is implemented by a site coordinator, called a “champion,” and a team head, called “coach.” Champions help with marketing and recruitment and motivate the coaches, who, in turn, motivate the participants during the program.

The New Mexico Office of Disability and Health provides resources and support in the initial stages. The intervention is designed to be replicated, and the Office of Disability and Health develops materials to support this process. In the future, any person or group should be able to access these materials on-line and implement the program with minimal funding for incentives.