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LoginRogers County Health Department - Oklahoma
Rogers County Fitness Training Program - RoCo Fit
Renetta Harrison
Health Educator
renettah@health.ok.gov
918-341-3166
Claremore
OK
74017
Your summary must address all the questions below:
Rogers County Fitness Program (RoCo Fit) is part of a physical activity initiative of the Rogers County Health Department (RCHD). The health department and fitness program are both located in Claremore, OK, the county seat of Rogers County. We serve over 91,000 residents and are also open to anyone working, playing, visiting, and/or learning in our county.
Two of Rogers County’s main causes of death are heart disease and diabetes with an obesity rate of 35.5%. Sedentary lifestyle and poor nutrition are the main reasons according to Oklahoma State Department of Health’s Wellness Profile of 2019. The health department targets the flagship issues of obesity and behavioral health and use RoCo Fit as one of its improvement programs for physical inactivity which is one cause of obesity and heart disease.
The RoCo Fit program is a free community led, organized physical activity program developed and offered free to anyone 13 yrs. and older (strollers are also welcome) who live, work, or play in Rogers County regardless of income or physical activity level. RoCo Fit is a walking and running program with volunteer mentors assisting groups of participants of all fitness levels. It is patterned after many commercial (and costly) “couch to 5k” programs; its major advantage in reaching community members is that there is no cost to participants. There are many community partners who offer additional components and program support in order to promote overall wellness.
The free program began as part of the Healthy Lifestyles Subcommittee of Healthy Community Partnership with the goal to provide free opportunities for physical activity in order to improve the poor health behavior and outcome statistics of Rogers County. The objectives are to improve the health outcomes by 1% in 5 years and reduce heart disease rate by .1/100,000 each year, and increase wellness aspects in the community by 5% in 5 years. The overarching goal is to help bring Oklahoma into the top 10 for health and wellness.
RoCo Fit has contributed to significant improvement in Rogers County’s health as evidenced by ranking 7th for Health Outcomes (up from 10th) and 13th (up from 15th) for Quality of Life in 2019. Also, the county’s Health Factors ranking rose from 14th in 2010 to 8th and Health Behaviors from 21st to 5th out of 77 Oklahoma counties in 2019, according to the Robert Woods Johnson Foundation Health Rankings and Roadmaps. According to the State of the County’s Health Reports comparison, heart disease rate decreased 2.9% from 2008-2012 data to 2011-2015 data; heart disease death rates improved from 179.10/100,000 to 165.00/100,000 between 2010 and 2017. Also, cerebrovascular disease deaths improved from a grade of D to a grade of B from 2010 – 2017, as well as diabetes deaths from a C to a B. In addition, Rogers County is lower than the state for physical inactivity, obesity, and diabetes.
Testimonials are collected from participants and cover all aspects of wellness: physical, emotional, spiritual, social, environmental, occupational, and intellectual. They are reviewed for descriptive terms and placed into the appropriate category. The current testimonial outcome report includes years 2011 through 2019. All seven aspects of wellness are reflected in 1,124 responses with their percentages as follows: physical-26%, emotional-19%, spiritual-13%, social-14%, environmental-9%, occupational-1%, and intellectual-18%.
From all evaluation tools used we can safely acknowledge the RoCo Fit program as a large part of a significant improvement of Rogers County health and lifestyles. In addition, qualitatively, the public impact is evidenced by community implementation of fundraising efforts through physical activity challenges, i.e. yearly school and community 5k walk/runs that were not selected before RoCo Fit started. Local government and community partners are also actively improving parks and sidewalks, and adding mountain biking trails, as well as having implemented several health policies, i.e. complete streets and tobacco-free communities. All objectives were exceeded.
RoCo Fit has a website – www.rocofit.org and two Facebook pages, RoCo Fit (participants) and RoCo Fit Mentors (mentors only). The Rogers County Health Department also has a website and RoCo Fit is included on it at http://rogers.health.ok.gov and a Facebook page, @RogersCoHealth.
A Model Practice must be responsive to a particular local public health problem or concern. An innovative practice must be -
RoCo Fit was formed based on observations showing Rogers County did not have any free or inexpensive opportunities for adults to exercise to help reduce their risk of heart disease. The county’s leading cause of death was heart disease and received a grade of “F” on the State’s Report Card with a rate of 258.9. In addition, the inactivity percentage was 25.4% and rising, which also received an “F” grade.
The target population is adults because schools and communities had several options for children to be physically active at no cost. Also, more than 77% of Rogers County are adults thus allowing a greater impact on the community.
RoCo Fit has had over 2300 non-duplicated adults 13 yrs. and older participate since 2010. Many of these repeated several sessions and several have continued to participate since they started and many have volunteered as mentors.
RoCo Fit is the first program of its kind in Rogers County and the first free program like it in Oklahoma. There has not been anything in the past offered free to the community targeting adults and heart disease/inactivity. The program is successful because it is the first such offered for free and innovatively involves many community partners. The format is not new to public health since it is a group walking and running program, but it is a creative use of two strategies with strong evidence for effectiveness in The Guide to Community Preventative Services. The two strategies used to create the program are Strategy 3, individually adapted health behavior change programs and Strategy 5, social support interventions in community settings.
For strategy 3, RoCo Fit uses strategies tailored to an individual’s specific interests, preferences, and readiness for change. We teach the participants behavioral skills to help them become physically active in the daily routines. The groups and mentors are social support networks that reinforce positive behavior and helps prevent the participants from dropping back into sedentary behaviors. The program has assisted in enhancing of health and environment policies in the community, i.e. tobacco-free community and Complete Streets (consideration of all modes of transportation in community design) policies. These policies and the community mindset change to include regular physical activity has supported and assisted greatly towards individual behavior changes.
The Community Guide rates the evidence as strong for intervention strategies, based on 18 studies with median effect of 35% increase in time spent in physical activity and 64% increase in energy expenditure. This is seen in Rogers County in the form of more people becoming active regularly and more frequency of schools and community using physical activity as fundraisers. RoCo Fit uses several mediated approaches, i.e. email, website, social media, to help prompt individual behavior change. These such strategies were found to be effected according to the additional Community Guide review of newer studies. The program incorporates the key considerations of this strategy including support from an organization and management, minimizing participant dropout, and using expertise of content experts. The experts also assisted in the planning and obtaining of resources for the program, and eventually forming the RoCo Fit Advisory League to review interventions and adapt them to the program. The program stresses goal setting, behavioral self-monitoring and tracking, social supports, self-rewarding, and ways to prevent relapse.
For strategy 5, RoCo Fit strongly focuses on building, strengthening, and maintaining social networks for support in adapting physical activity as a positive lifestyle. The program uses the registration and incentives as a way to encourage completing the specified level of physical activity (completion of 5k race or mock race). It is a walking and/or running group program to provide companionship, friendship, and support during physical activity. The coordinator and Advisory League connect with participants to monitor progress and encourage continuation of activities. This program removes the barrier of cost to being physical activity. It uses social support and community partners to create opportunities for free, enjoyable physical activity.
The Community Guide rates the evidence as strong, based on the review of nine studies in which the median effect was 44% increase in time spent being physically active and 20% increase in energy expenditure. RoCo Fit takes into consideration the safety of its participants and is one of the key components of education within the program. The Advisory League and local law enforcement partners educate participants on safely walking and/or running in and around a community in hopes of encouraging regular physical activity and reducing the probability of drop out. The formal program is 12 weeks twice a year, however social networks have formed from those sessions that sustain groups year-round indoors and out. Weekly emails with encouragement, reminders, and tips are sent to all participants to sustain involvement and prevent or reduce dropout. RoCo Fit mentors assist development of buddies to establish a more regular routine for physical activity in addition to the program session workouts.
Using the two strategies has been instrumental in the continued success of the RoCo Fit program. The Advisory League uses and supports evidence based interventions. RoCo Fit continues to capture the attention of the community of Rogers County and registers approximately 200 participants each session, usually with 40% of those being new to the program. Close to 50% of those participants each session finish 70% of the program workouts and accomplish the goal of finishing a 5k (3.1 miles) race or mock race. They also report accomplishing other goals for themselves, i.e. weight loss, making new friends, regular exercise, etc.
Many participants start to get the incentives, but keep coming back for the physical and social benefits. Sponsors’ funding allow for the award of technical shirts for attendance goals. Special significance and recognition is acknowledged at an end-of session “graduation” celebration. Graduation also features a video slide show of members as they have progressed through the session and are given to anyone wishing to have one of their own to keep.
At the end of each session (and usually once during the session) an Advisory League consisting of six longtime mentors and the coordinator meet and discuss program components and ways to improve with many ideas coming from the other mentors.
The LHD should have a role in the practice’s development and/or implementation. Additionally, the practice should demonstrate broadbased involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.
It is the mission of the Rogers County Health Department to create a state of health. With this in mind, he goal of the Rogers County Health Department with this program is to provide free opportunities for physical activity in order to improve the poor health behavior and outcome statistics of Rogers County. The objectives are to improve the health outcomes by 1% in 5 years and reduce heart disease rate by .1/100,000 each year, and increase wellness aspects in the community by 5% in 5 years.
The Rogers County Fitness Training Program (RoCo Fit) was created in 2012 by the Rogers County Health Department (RCHD) Health Educator and past mentors of the Rogers County fee-based No Boundaries Couch to 5K partnership with Fleet Feet Tulsa. During the three No Boundaries sessions offered, the Rogers County Coalition Healthy Lifestyles Sub-committee offered paid scholarship registrations to those unable to afford the $85.00 No Boundaries registration fee. But due to the large numbers needing assistance and the price increase to $95 per person, the coalition ran out of funds quickly and did not have access to more. After the sessions of No Boundaries with lower than hoped for paid registrations and upon hearing from many who wanted to join but could not afford it, Fleet Feet Tulsa No Boundaries in Rogers County was cancelled.
However, a group of motivated and caring mentors believed there was a need to reach the community’s population who could not afford to pay for a program/facility in order to improve their community’s health. During the winter of 2011, the mentors and the health department’s health educator met, researched other “couch to 5K programs,” and found strong evidence-based strategies and interventions to support a fun, multi-faceted fitness training program. With the assistance of many community partners and local leadership, the free community wide RoCo Fit program began in February 2012.
This free fitness training program, RoCo Fit, is available to all who live, work, or play in Rogers County regardless of income or physical activity level. The free program began as part of the Healthy Lifestyles Subcommittee of Healthy Community Partnership’s work towards free opportunities for physical activity and healthy nutrition in order to improve the poor health behavior and outcome statistics for Rogers County. It has now evolved to be a community-led and driven run/walk club with the leadership of a RoCo Fit Advisory League consisting of three original members of the first No Boundaries session and other long-time mentors. The plan is to continue as a Run/Walk club with a Couch to 5k program and add other distance training programs in the future as needed.
RoCo Fit began in 2011 with partnerships with Healthy Lifestyles Sub-committee of Rogers County Coalition, Rogers County Health Department, Northeast Technology Center-Claremore, Bike About Bicycle Shop, Cherokee Nation Healthy Nation (CNHN)-WINGS program and past program mentors. The Healthy Lifestyles sub-committee and Rogers County Health Department provided leadership by providing a coordinator and guidance in the planning process. Northeast Technology Center-EAST program in Claremore provided graphic and marketing assistance for flyers and advertising. Bike About Bicycle Shop provided program planning and a beginning bicycling component for the first few sessions. Cherokee Nation Healthy Nation (CNHN) assisted by providing their two Rogers County health educators as members of the program planning committee. CNHN also contributed incentives of water bottles and tech material shirts for participants and mentors the first session of the new free program.
Rogers County Health Department continues to provide the coordinator position and Northeast Technology Center-Claremore EAST program continues to assist with any needed graphic design aspects, as well as promoting the program and providing participants and mentors. Northeast Technology Center-Claremore also offers a room with AV equipment for all meetings (informational, graduation, etc.) in addition to advertising on their sign. Bike About Bicycle Shop continues to market and for a time assisted in expanding the offerings for program participants, for example they created a short term partnership with Runners’ World of Tulsa (an athletic shoe and apparel store). Bike About coordinated with Runners World Tulsa to offer free shoe fittings for two sessions at the Bike About Bicycle Shop in Claremore complete with delivery of any shoes purchased back to the Claremore bicycle shop. They are also working to offer more running and walking apparel and accessories in their shop in an effort to encourage shopping local and assist to increase opportunities for free physical activity in Rogers County. Cherokee Nation Healthy Nation continue to offer free membership into their WINGS program for all residents of any county which they are affiliated, which includes free registrations to run/walk events they sponsor in their counties.
Other partnerships have been formed:
The many partnerships offer funds, support, and assistance with creation, facilitation, organization, marketing, incentives, materials, supplies, and much more. Startup costs were minimal for the health department as the partners offered much support as shown above. There are few things other than volunteers, paper and copying, and coordination services actually needed for starting the program. Some costs covered by health department were the time for the coordinator and the use of office equipment for data collection/analysis and communication, approximately in-kind of $25/hr for 15 hrs/week. The main costs paid for by the health department were the purchase of incentive shirts which are not required for participants and hats for mentors, but during year 9 this was changed to unique custom medals in the form of lanyards, keychains and zipper pulls put together to make a Mock 5k finisher “medal.” Cost for the medals are less than $5 each. The Advisory League pursued other community partners for shirts and other incentives. The partnerships help make this fitness program sustainable.
The Rogers County Health Department continues to support and grow collaboration with community partners for RoCo Fit and other health initiatives. This is a strong part of their mission in working towards a state of health in Oklahoma. They believe it takes all members of the community working together collaboratively to make positive and sustainable change. All strides in improving the health of a community also helps improve social, economic, and environmental aspects of a community. Therefore, seeking and creating diverse partnerships of all types within their community is of vital importance.
Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improve practice. Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
The objectives of RoCo Fit are to improve the health outcomes in Rogers County by 1% in 5 years and reduce heart disease rate by .1/100,000 each year, and increase wellness aspects in the community by 5% in 5 years. As of the end of 2019, and since the run/walk program began in 2010, there have been 2,384 non-duplicated participants including 139 different mentors (all but 21 having completed the program at least once before mentoring, the 19 are/were avid walkers and runners-now it is a rule that mentors have to complete the program before mentoring). Each session averages over 200 registrations with at least half completing 70% of the workouts and receiving a custom RoCo Fit logo technical fabric shirt for the first 10 years. New Movement Motivators (branded unique custom medals) are now given to all participants completing 70% of workouts, finishing the Mock 5k, and attending the graduation celebration. The Movement Motivators will continue for all three programs in NE Oklahoma.
Many individuals find out about the program after registration closes and continue to call or email to make sure they are able to register early for the next session. A list of participants is kept from each session and each participant receives notice of registration for upcoming sessions. Many participants repeat sessions and move groups as they improve their fitness level. Several participants have volunteered as mentors and several helped create the program and continue to assist and mentor. Most sessions have 25-30 mentors volunteering, some multiple sessions, and participants assist as unofficial mentors periodically as well.
RoCo Fit has contributed to significant improvement in Rogers County’s health as evidenced by ranking 7th for Health Outcomes (up from 10th) and 13th (up from 15th) for Quality of Life in 2019. Also, the county’s Health Factors ranking rose from 14th in 2010 to 8th and Health Behaviors from 21st to 5th out of 77 Oklahoma counties in 2019, according to the Robert Woods Johnson Foundation Health Rankings and Roadmaps. According to the State of the County’s Health Reports comparison, heart disease rate decreased 2.9% from 2008-2012 data to 2011-2015 data; heart disease death rates improved from 179.10/100,000 to 165.00/100,000 between 2010 and 2017. Also, cerebrovascular disease deaths improved from a grade of D to a grade of B from 2010 – 2017, as well as diabetes deaths from a C to a B. In addition, Rogers County is lower than the state statistics for physical inactivity, obesity, and diabetes.
Therefore, it is safe to acknowledge the RoCo Fit program as a large part of a significant improvement of Rogers County health and lifestyles. Qualitatively, the community has implemented fundraising efforts through physical activity challenges, i.e. school and community 5k walk/runs. They are actively improving parks and sidewalks, and adding mountain biking trails, as well as working towards implementation of several health policies, i.e. tobacco-free and Complete Streets (all forms of transportation considered for street design) communities. The program will continue to grow and improve the community of Rogers County. This is even more important because Rogers County is the fastest growing community in Tulsa Metro area according to the Community Service Council of Tulsa, with adults over 25 being almost 65% of the population.
The methods used to evaluate the RoCo Fit program have included a knowledge survey, Quality of Life Survey, pace assessments, pre and post behavioral health surveys, and qualitative data via testimonials. The pre/post surveys are sent to the Oklahoma State Health Department Epidemiologist for analysis and a report is sent to coordinator/Health Educator to share with Advisory League. These methods are all also periodically reviewed by the coordinator, Advisory League, and state health department epidemiologist. The Advisory League reviews all evaluations and makes changes when necessary. Changes have included the survey questions focusing more on number of days and time of physical activity per participants and water consumption. They also added a question asking for feedback on improving the program which has been useful. The pre and post 1 mile pace assessments have been discontinued to avoid focus on speed and instead focus on improving time physically active by concentrating on increasing the distance each week and safely getting more participants to a 5k distance at their own pace.
RoCo Fit also collects qualitative data via voluntary testimonials at the end of each session. The participants state in their own words how the program has helped them in their lives. They submit these testimonials to the coordinator in the form of written, email, or presentation and may include photos. In addition to evaluation purposes, they are used anonymously to advertise the program with the media, explain benefits to interested people at the information meetings, and highlight the program at the graduation celebration. The testimonials cover all aspects of wellness: physical, emotional, spiritual, social, environmental, occupational, and intellectual. The coordinator reviews each for descriptive terms and places them into the appropriate category. The current testimonial outcome report includes years 2011 through 2019. The testimonial outcome report will continue yearly.
The categories of wellness discussed in the testimonials are broken down further to explain what each includes. Physical wellness relates to nutrition, fitness, and medical. Emotional wellness includes stress, hope, joy, and fear. Spiritual wellness relays peace, harmony, and purpose. Social wellness embraces family, friends, and relationships. Environmental wellness contains community, water, and land. Occupational wellness encompasses career and organization. Intellectual wellness incorporates ideas, experiences, group interaction, and community betterment. Many of the testimonial statements include several different wellness aspects and most will fit into more than one category. The coordinator reviews the context of the testimonial to determine which category to place each comment and/or benefit. The information is compiled and repeated comments counted for each. The breakdown of the 1,124 responses is as follows: Physical – 26%; Emotional – 19%; Spiritual – 13%; Social – 14%; Environmental – 9%; Occupational – 1%; and Intellectual – 18%.
All evaluation methods are researched and created by the Coordinator, Advisory League, and an Oklahoma State Department of Health Epidemiologist. The Epidemiologist also assists the coordinator in evaluating and compiling the data from the evaluation tools. Several Public Health Accreditation Board (PHAB) performance measures were taken into consideration when developing the evaluation tools.
In particular, PHAB Domain 3: Inform and Educate about Public Health Issues and Functions, Standard 3.1 – Provide Health Education and Health Promotion Policies, Programs, Processes, and Interventions to Support Prevention and Wellness, Measure 3.1.1 A.2 Consultation with the community and target group during the development of the educational material/messages and 3.1.1 A.3 Health education messages that are coordinated with Tribal, state, and/or local health departments; and/or community partners. Further, Measure 3.1.2 A 1. A planned approach for developing and implanting health promotion programs, 2. Development and implementation of health promotion strategies, 3. Engagement of the community during the development of a health promotion strategy, and 4. Implementation of strategies in collaboration with stakeholders, partners, and/or the community.
All steps are taken to insure the program meets the above performance measures when developing, implementing, evaluating, and improving the RoCo Fit program. The current evaluation methods have proven the program successful and have earned it the award for 2019 Community Health Champion by Oklahoma Turning Point.
Sustainability is determined by the availability of adequate resources. In addition, the practice should be designed so that the stakeholders are invested in its maintenance and to ensure it is sustained after initial development (NACCHO acknowledges that fiscal challenges may limit the feasibility of a practice's continuation.)
RoCo Fit is sustainable and remains free to participants because of the partnerships and volunteers in the Rogers County community. The Healthy Community Partnership recognizes the community program as part of the coalition’s “Positive Community Norms” campaign and provides support. RoCo Fit will continue to be offered in Rogers County and will be replicated in other counties of Oklahoma with the leadership of the Advisory League.
The Rogers County Health Department has committed the Health Educator’s time for coordination of the program as well as the supplies needed for the tasks involved in organization of the program. The health educator is also invested in training other counties and/or cities in Oklahoma how to replicate the program as an assistant of the Advisory League. The health department funded the tech shirt incentives for the participants who complete 70% of the program workouts each session from fall 2012 through spring 2019, and provides storage space for the inventory of program supplies and materials.
The volunteer mentors have expertise in many areas within the components of the fitness program. The mentors rotate in and out of the program as they have time. Several mentors have continued since the creation of the program and continue to offer their assistance with various aspects of the program, such as DVD compilation for graduation, schedule adjustments, website and Facebook administration, training and recruiting other mentors and counties. In 2017, a RoCo Fit Advisory League was formed of six long-time mentors to lead in decisions regarding the program and now are the leadership of the club and program with continued assistance from the health educator/coordinator.
Other partners see the benefit RoCo Fit provides to the community and have committed to continue support and assistance with sustaining RoCo Fit. Local businesses and media help with marketing and advertising. The City of Claremore and health professionals continue to offer their assistance. The RoCo Fit Advisory League was formed in 2017 and took over responsibility of program in fall of 2019. The health department continues to give coordinator time and equipment to the program as well as low-cost movement motivators. The Advisory League has approached more than two businesses interested in helping grow and sponsor the program. One of which is the County Commissioners of Rogers County who approached the League and expressed great interest in being the main support for this county program. The League will present to them in January 2020. New partnerships will continue to be recruited.
In addition, the Advisory League and health educator/coordinator of RoCo Fit began training other counties and cities how to begin and sustain the fitness program. Replication began in 2013 with Garfield County and expanded to Washington County in 2014. In early January of 2015, five additional counties attended replication training for RoCo Fit. Mayes County started MaCo Fit in the fall of 2015, but was discontinued in 2017 due to losing county leadership. Chelsea in Rogers County inquired and received minimal training, becoming a satellite group for one session in spring 2015. In 2016, the Advisory League and coordinator assisted Osage County Health Educator Intern and community members of Skiatook to start a group named LoCo Fit (Loving Osage County Fitness). In several of the counties and/or cities, local coalitions/partners are agreeing to take the lead and offer funds for startup and coordination of the program.
