CHANGE Expands its Reach to Support More Albertans

Successful program focused on improving health through positive lifestyle changes now offers family-based programming.

Danica Erickson - 16 June 2020

In the fall of 2019, the CHANGE Community Health Program (CHPC) launched offering Alberta families support to develop and maintain a healthy lifestyle. The CHCP, which is funded with support from Alberta Blue Cross, is the most recent in a series of successful, community-based health initiatives spearheaded by Dr. Doug Klein.

Klein, a family physician who is also a faculty member and researcher with the Department of Family Medicine, is a long-time proponent of helping people successfully make lifestyle changes to improve their health. What makes Klein’s efforts distinct from many other family physicians are his dedication and research-based approach. He provides considerable support to patients beyond just telling them during a clinic visit that they need to improve their diet and exercise more--he works with them to implement long-term changes to diet and exercise, which requires resources, support and ongoing encouragement.

The roots of CHCP were created in 2011, when Klein became involved with the Canadian Health Advanced by Graded Nutrition and Exercise Program (CHANGE), an initiative of Metabolic Syndrome Canada. The CHANGE program aims to improve or reverse metabolic syndrome conditions by treating underlying factors that don’t respond to medication.

Along with the CHANGE program, he has been involved with Move Edmonton, an outdoor fitness program being offered through Edmonton-area Primary Care Networks (PCNs) and led by health care team members from various primary care clinics. Klein has also created a successful program for kids, the CHANGE Adventure Camp, to encourage healthy unstructured activity and teach nutrition and fitness basics to kids in a fun and supportive environment. He even created an activity-based fundraiser, Healthy Steps for CHANGE, which challenges Edmontonians to raise funds to support the CHANGE Adventure Camp while getting active in Edmonton’s plentiful green spaces.

The CHANGE Community Health Program was the next logical step. “Through our previous research on the CHANGE program, participants highlighted the need for mental health support as part of the program.” Says Klein. This was then added into the CHANGE Health Community program model design. The program launched in Fall of 2019 following two or three years of the idea forming.

Families participating in the CHCP began meeting together in the Fall of 2019, cooking a meal together and discussing one of the four pillars of the program: nutrition, physical activity, mental health and social connections. With five different sites established in the first wave of implementation, participating families connected with other families when they came together at a designated site to cook a meal and have a lesson or activity based on one of the four program pillars. Health professionals joined each session, facilitating the activities and discussions. Community connections were fostered by setting out different fun challenges each week for the families and encouraging the exploration of local events, activities and resources such as community gardens or dance classes.

In March of 2020, CHCP Manager of Operations, Megan MacNeil and the program team were challenged to quickly reorganize the program to take place online when the COVID-19 pandemic took hold. Within two weeks of the public health order being issued, the team had organized live sessions through Zoom to resume programming for those who wished to continue. In lieu of being able to physically meet at a site each week, participating families have been receiving a program box with fruits, vegetables, recipes and family activity ideas every two weeks. These program boxes are delivered by Bag Half-Full, an organization of University of Alberta medical students which has partnered with CHCP to assist with distribution. The boxes often tie in to the weekly themes; recent boxes included supplies to plant a mini-garden and bake bread. Recognizing the technology barriers faced by some families, the team has made this program as accessible as possible. For those unable to access WIFI connection or a computer from their home, connection can be made by phone or text messaging with program staff to provide one-on-one support. Families also have the option of only receiving the program box if they are unable to participate in the other activities. This flexible approach may be the key to success of the program. “You can participate at the rate that works for your family,”  says MacNeil. “We aim to meet families where they are at and recognize that there are a number of competing priorities right now.”

Families find out about the program through various channels: schools refer families and the staff also visit daycares, libraries and recreation centres to reach out to families. Word of mouth from current participants has also been very effective. The program has a public Facebook page that provides links to numerous resources including the National Sleep Foundation, the Edmonton Public Library, the Heart and Stroke Foundation and links to many fun, family-friendly art, craft and recreation activities.

Adjusting program delivery to an online format has had an unexpected result. MacNeil believes the public Facebook page has attracted people curious about the program who feel more comfortable participating in the online format and allows for any family across the province to participate. Families that register in the program are provided with access to a private Facebook group that provides continued support and information from program staff and professionals.

The CHCP is currently active in five sites in Alberta, and will grow to be in at least 10 sites in the next year. Two sites in Calgary are ready to begin programming once public health orders allow gatherings to take place. Scaling the program up successfully to serve more communities is being investigated and key to the growth of the program will be partnerships with other existing programs who have similar goals.

The program is fun and creative for participants, but behind the scenes research continues to take place. Using a mixed methods design, the team collects a baseline survey and integrates additional data collection organically into each of the first four program sessions. Focused on readiness for change, resilience, stress and belonging along with activity levels and food decisions, these surveys help to give a broad picture of participants’ health across the four pillars of the program and results are used to inform later session content and delivery. The team will also interview participants about their experiences in the CHCP to understand how the program impacts health and well-being . “The research design is careful to avoid survey fatigue,” MacNeil notes, “The connections between people, connections within families and the session activities are much more important than doing paperwork.”

While large changes across the pillars over the course of the CHCP may be unexpected given the intensity and length of the program, intent to change and small changes are equally as important to consider because of the meaningful differences in families’ lives they may illustrate.

“The CHANGE Health Community Program hopes to demonstrate that by bring families together to build life skills, we can improve their health and wellbeing and prevent illness” explains Klein.