Oxford Study 2020
A study in Lifelong Learning and Health Promotion
A Barefoot Doctor goes to Oxford, searching for a cool place.
The Oxford Study is an ongoing longitudinal study into the effectiveness of health promotion programs in changing behaviors and motivation for people to live active healthy lifestyles.
Originally funded by AARP and supported by the Denver Botanic Gardens the project began as an model health promotion program "Sunrise Tai Chi and Walks in the Gardens." After winning numerous awards we were invited to present the project for debate at the Oxford Roundtable at Harris Manchester College and the Oxford Union Debating Hall at Oxford University.
The Oxford Papers
- Healthier Communities: Making Coalitions Work, 2013. Harris Manchester College, Oxford 2013
- T’ai-chi and Flow States: Key to Long Term Physical Activity Compliance, Harris Manchester College, Oxford 2013.
- A Barefoot Doctors Program, Preventive Medicine in the Community. Oxford Union Debate Hall, Oxford 2006.
- Community Based Approaches to Health and Nutrition. Oxford Union Debate Hall, Oxford 2006.
The Oxford Study 2020 (Executive summary)
Bridging the gap between world class research, and local community health promotion
A study in health promotion and lifelong learning
As health care costs continue to skyrocket the need for new approaches in preventive medicine increases. A study of the impact of health promotion programs in Denver, was reviewed and potential solutions debated, by 28 experts from leading Universities and Medical schools at Harris Manchester College in the University of Oxford. The purpose of these debates, being to bridge the gap between world class research and local community health promotion efforts, finding solutions to the challenges in community health promotion. This study is an attempt to test the effectiveness of those recommendations and improve the impact of evidence-based health promotion efforts in the community.
Oxford Study 2020: Research questions
What is needed to help health promotion organizations increase awareness about their programs?
Which program elements truly inspire people to take control of their own health?
Barefoot Doctor's Journal
Research clearly supports the idea that increasing access to information and opportunities for physical activity, lifelong learning, and health education can be effective at increasing healthy lifestyles. The project will publish an online Journal providing readers access to tools, information and community resources, needed to stay healthy naturally.
Public Education Campaign
People benefit tremendously from working with experienced and educated professionals. Providing accurate, credible health information in an inspiring way is not a common talent and the quality of health promotion programs is very teacher/practitioner-specific. The Barefoot Doctor’s Journal provides organizations and individuals with access to world-class teachers and programs for keynote lectures, group seminars, one on one tutorials, classes webinars, online tutorials and other learning resources dedicated to the needs of adult learners.
Micro-grant funding opportunities
The study will secure diverse funding streams from sponsors, local businesses and foundations public and private sources for developing seminar content, providing educational programs, production, promotion and distribution of the Barefoot Doctor's Journal.
History & Background
The work of promoting healthy lifestyles is of international importance. Data collected on the Barefoot Doctor’s Journal will add to the knowledge base of behavior change in health promotion. Inspired by the debates on healthy aging in 2006 and 2013 at Harris Manchester College in the University of Oxford, we have been piloting the Barefoot Doctor’s Journal with small groups of older adults and professionals in Colorado since 2013. Using surveys and focus group classes we have seen great enthusiasm for the inspiring nature of these presentations. Results will be presented in CDC’s Gateway and at the Oxford Roundtable, Harris Manchester College in the University of Oxford for international distribution and debate.
Description of the Problem
“Health illiteracy causes more deaths than cancer, diabetes or any other major killer” Walter Bortz M.D.
Research indicates that adults in the US have difficulty using the everyday health information that is available in health care, media, and in the community. According to the 2003 National Assessment of Adult Literacy Study2, nearly 90% adults may lack the skills needed to manage their health and prevent disease.34 Without a clear understanding of prevention and self-care, people have a hard time avoiding or managing chronic diseases. This is especially true for older adults, lower income and minority groups.5 Quality health education programs have the potential to improve the health and quality of life for millions of people in the United States.6
Rise in obesity and sedentary lifestyles in Colorado
Colorado is one of the least obese states in the country (21%), yet rates of obesity have doubled in the past ten years. If this trend continues the rise in related health care costs will be enormous. As the baby boomers get older the problems created by a lack of physical activity are only going to get worse. Physical activity is one of 10 leading health indicators for the nation (Healthy People 2020). Yet, according to the Centers for Disease Control (CDC) in the Denver-Aurora, Metropolitan area:7
- Only 51% of Coloradans get the recommended level of physical activity per week. (30 minutes/day)
- In Denver, 19 % (all ages) get no leisure time physical activity at all!
- Physical inactivity leads to many chronic diseases or conditions,such as obesity,cardiovascular disease, and osteoporosis and dramatically increases the risk of falls and hip fractures in older adults.
Boomers have experienced one fitness fad after another, yet JAMA Internal Medicine recently revealed that boomers are far less fit than their parents were at the same age and have more health problems.13 Today just 32 percent of boomers in the Denver Metro area exercise regularly (30 minutes/ day); while 52 percent exercise only irregularly. While actually exercising less, boomers think they're more active than they are. A study in Medicine & Science in Sports & Exercise finds that they exercise less than they think they do by almost an hour a week, while sitting more by almost two hours a week, more than they think they do.14
Although baby boomers (50-70 yrs.) are living longer, they aren’t necessarily living healthier lives.
Despite increasing life expectancy, the aging baby boomers are less healthy than their parents. However 61% of Boomers say they feel younger than their actual age.8 Data from the CDC shows baby boomers are more stressed and less healthy than people in the same age group a decade ago.9 The proportion of boomers with obesity, diabetes and high blood pressure is increasing. If the health of baby boomers continues to degrade at the present rate, the implications for health care costs incurred in the next ten years will be dramatic.10
Aging U.S. baby boomers (50-70 yrs.) face greater levels of disability!
Researchers are observing disturbing trends in the rising rates of obesity and disability among baby boomers One study by the RAND Corporation finds that baby boomers are not as functionally healthy as people in the same age range 20 years ago.11 One review study found twice as many baby boomers need a cane or a walker to get around as compared with the previous generation.12
Rational for the program: Comprehensive interventions that include physical activity can be effective.
Evidence suggests that creating comprehensive interventions or enhancing access to places for physical activity combined with informational outreach activities are effective at increasing physical activity levels across diverse settings and populations.15 Health education and physician based solutions are not enough.16 The patient’s need for information often exceeds available staffing resources in healthcare settings. One possible strategy would be making use of modern social media to link patients, providers with community based opportunities for healthy lifestyle participation.17,18
One half of aging baby boomers (50-70 yrs.) currently use some form of complementary and alternative medicine (CAM).
According to the National Center for Complementary and Alternative Medicine (NCCAM) and the Center for Disease Control’s National Center for Health Statistics, in 2007, adults in the United States spent $33.9 billion out-of-pocket on visits to complementary and alternative medicine (CAM) practitioners and purchases of CAM products, classes, and materials for self-care. Nearly one-third of this out-of-pocket spending was used to pay for CAM practitioner costs. Further, according to this government survey, the number of visits to acupuncturists rose 32% between 2002 and 2007. Also, nearly 12% of the out-of-pocket money was specifically spent on yoga, Tai chi and Qi gong for self-care.19 However, most of the information they receive about CAM lacks a basis in research. With skyrocketing health care costs, the need to increase public awareness of the evidence base of CAM and to its utilization where appropriate is imperative.
50% of U.S. public, use alternative Medicine.
MD’S refer for Chinese Medicine more than any other alternative medicine
51% of MD’S understand the efficacy and value of Tai Chi20
Health Education messages must be clear and inspire action in the community
Providing patients with specific activity suggestions and opportunities is more effective than providing general advice in facilitating behavior change.21,22 Many health communication experts recommend that providers increase the specificity of the information communicated to patients to enhance recall and facilitate behavior change. This strategy may be particularly important for older adults.23
Using the Internet to Promote Health Behavior Change
One review of 29 studies found that internet interventions based on the theory of planned behavior tended to have substantial effects on behavior (d+ = 0.36, 95% CI 0.15 to 0.56). Interventions that incorporated more behavior change techniques also tended to have larger effects compared to interventions that incorporated fewer techniques (P < .001).
Bandura. Self-efficacy the Exercise of Self-Control: New York, Freeman, 2001.
Using the Internet to Promote Health Behavior Change: A Systematic Review and Meta-analysis of the Impact of Theoretical Basis, Use of Behavior Change Techniques, and Mode of Delivery on Efficacy Thomas L Webb1; Judith Joseph2; Lucy Yardley2; Susan Michie3 1Department of Psychology, University of Sheffield, Western Bank, Sheffield, UK
Communications Strategy: Modern Tools to Get the Word Out
The program will seek to frame messages that inspire a sense of self-efficacy and empowerment. In the last several years, the use of e-mail and other social media to disseminate health messages has grown
significantly, and continues to increase. The internet has become an effective way to increase knowledge and awareness of credible, evidence‐based health messages. E-mail news can be used to spread health messages where and how people choose to receive them. The baby boomers (50-70 yrs.) invented the internet and are more comfortable with new technology than many people think.
- 60% of Baby Boomers (50-70 yrs.) read socially created on-line content.
- 53 % use e-mail and 31% gather information from a newsletter.
38% of whites, 30% of blacks 43% of hispanic and 23% of asians get health information from websites.
- 60% need to see a message 3-5 times before they believe the information to be true.
- In addition, people also need to see health messages from both experts and peers, to be effective.36
1 Dana E. King, et al., "The Status of Baby Boomers (50-70 yrs.)' Health in the United States: The Healthiest Generation?" JAMA Internal Medicine, published online Feb. 4, 2013, accessed Feb. 5, 2015.
2 National Assessment of Adult Literacy, National Center for Education Statistics, (NAAL), U.S. Department of Education, 2003, released in 2006.
3 Nielsen-Bohlman, L., Panzer, A. M., & Kindig, D. A. (Eds.) Health literacy: A prescription to end confusion. Washington, DC: National Academies Press 2004.
4 Kutner, M., Greenberg, E., Jin, Y., & Paulsen, C. The health literacy of America's adults: Results from the 2003 National Assessment of Adult Literacy, Washington, DC: U.S. Department of Education, National Center for Education Statistics 2006.
5 Rudd, R. E., Anderson, J. E., Oppenheimer, S., & Nath, C. Health literacy: An update of public health and medical literature. In J. P. Comings, B. Garner, & C. Smith. (Eds.), Review of adult learning and literacy . Mahwah, NJ: Lawrence Erlbaum Associates (vol. 7) (pp 175–204) 2007.
6 Berkman, N. D., DeWalt, D. A., Pignone, M. P., Sheridan, S. L., Lohr, K. N., Lux, L., et al., Literacy and health outcomes (AHRQ Publication No. 04-E007-2). Rockville, MD: Agency for Healthcare Research and Quality, 2004.
7 Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Date last reviewed: February 9, 2010.
8 Dana E. King, et al., "The Status of Baby Boomers (50-70 yrs.)' Health in the United States: The Healthiest Generation?" JAMA Internal Medicine, published online Feb. 4, 2013, accessed Feb. 5, 2015.
9 from a new report released see http://www.cdc.gov/nchs/hus/special.htm
10 National Health and Nutrition Examination Survey, CDC/National Center for Health Statistics Page last reviewed: May 29, 2015.
11 Linda G. Martin and Robert F. Schoeni, "Trends in Disability and Related Chronic Conditions Among the Forty-and-Over Population: 1997-2010," presented at an interagency conference, sponsored by the Administration for Community Living, U.S. Department of Health and Human Services, National Institute on Aging at the National Institutes of Health, National Institute on Disability and Rehabilitation Research, U.S. Department of Education, and the Interagency Committee on Disability Research, and organized by the Center for Aging and Policy Studies at Syracuse University and the Michigan Center on the Demography of Aging at the University of Michigan, May 17-18, 2012.
12 Vicki A. Freedman et al., "Trends in Late-Life Activity Limitations in the United States: An Update From Five National Surveys," Demography 49, no. 4 (2012), accessed Feb. 6, 2013.
13 AMA Intern Med.. doi:10.1001/jamainternmed.2013.2006. Published online February 4, 2013.
14 https://www.acsm.org/access-public-information/health-physical-activity-reference-database, accessed Feb. 6, 2015.
15 Seligman HK, Grossman MD, Bera N, Stewart AL. Improving physical activity resource guides to bridge the divide between the clinic and the community. Prev Chronic Dis 2009;6(1). http://www.cdc.gov/pcd/issues/2009/jan/07_0217.htm., accessed February 9 th 2015.
16 Muller-Riemenschnieder F, Reinhold T, Nocon M, Willich ST, Long term effectiveness of Interventions promoting physical activity: A Systematic Review. Preventive Medicine: 47: 354-368. 2008.
17 Macgreggor K,Handley M, Wong S et al. Behavior change action plans in primary care: a feasability study of clinicians. J Am Board Fam Med.; 19: 215-223, 2006.
18 Macgreggor K,Handley M, Wong S et al. Behavior change action plans in primary care: a feasability study of clinicians. J Am Board Fam Med; 19: 215-223, 2006.
19 National Center for Complementary and Alternative Medicine (NCCAM) and the Center for Disease Control’s National Center for Health Statistics, 2007.
20 National Health Statistics Reports (NHSR), (Number 18, July 30, 2009) as well as the earlier, NHSR (Number 12, December 10, 2008). Link to the press release: http://nccam.nih.gov/news/2009/073009.htm
21 Hilary K. Seligman, MD, MAS, Assistant Professor of Medicine, Melanie D. Grossman, MSW, PhD, Nathalie Bera,Improving Physical Activity Resource Guides to Bridge the Divide Between the Clinic and the Community MD, MPH, and Anita L. Stewart, PhD Prev Chronic Dis. 2009 Jan; 6(1): A18. PMCID: PMC2644596 Published online Dec 15, 2008.
22 Hilary K. Seligman, MD, MAS, Assistant Professor of Medicine, Melanie D. Grossman, MSW, PhD, Nathalie Bera, MD, MPH, and Anita L. Stewart, PhD, Improving Physical Activity Resource Guides to Bridge the Divide Between the Clinic and the Community, Prev Chronic Dis. 2009 Jan; 6(1): A18. PMCID: PMC2644596, Published online Dec 15, 2008.
23 Hilary K. Seligman, MD, MAS, Assistant Professor of Medicine, Melanie D. Grossman, MSW, PhD, Nathalie Bera, MD, MPH, and Anita L. Stewart, PhD, Improving Physical Activity Resource Guides to Bridge the Divide Between the Clinic and the Community, Prev Chronic Dis. Jan; 6(1): 2009 A18. PMCID: PMC2644596, Published online Dec 15 ,2008.
24 Daqing Z., Unschuld, P. "China's Barefoot Doctor: Past, Present, and Future 1865-1867." The Lancet. 29, Volume 372, Issue 9653 Nov. 2008.
Editors. A Barefoot Doctor's Manual: The American Translation of the Official Chinese Paramedical Manual. Philadelphia: The Running Press, 1977.
MacFarquhar, R., Fairbank, J. The Cambridge History of China, Volume 15, Part 2. New York: Cambridge University Press, 651-652 1991.
Valentine, V. "Health for the Masses: China's Barefoot Doctor’s." NPR. National Public Radio, 4 Nov. 2005. Web. 17 May. 2011. <http://www.npr.org/templates/story/story.php?storyId=4990242>
25 Koh TC Chinese medicine and martial arts Am J Chin Med. Autumn;9(3):181-6. 1981.
26 National Center for Education Statistics, 2003 National Assessment of Adult Literacy (NAAL), released in 2006 by the U.S. Department of Education
27 Hilary K. Seligman, MD, MAS, Assistant Professor of Medicine, Melanie D. Grossman, MSW, PhD, Nathalie Bera, MD, MPH, and Anita L. Stewart, PhD, Improving Physical Activity Resource Guides to Bridge the Divide Between the Clinic and the Community Prev Chronic Dis. PMCID: PMC2644596 2009 Jan; 6(1): A18. Published online Dec 15, 2008.
28http://www.cdc.gov/arthritis/interventions/marketing-support/ambassador-outreach/http://www.lifelongfitnessalliance.org/ambassadors/ accessed february 5th 2015.
29Ambassadors for Health Programs Examples: http://www.cdc.gov/arthritis/interventions/marketing-support/ambassador-outreach/http://www.lifelongfitnessalliance.org/ambassadors/ Health Ambassador Network - Health Promotion Board
30 Age Wave, in collaboration with Harris Interactive and sponsored by AIG SunAmerica, recently interviewed 1,000 retiree households. http://www.indiana.edu/~leisure/module2/unit4_LA2/readings/Dychtwald-Futurist.pdf accessed February 15, 2015.
31 Experian Simmons, National Consumer Study 22, Fall 2008.
32 US News and World Report, Emily Brandon May 10, 2013 | 4:34 p.m. EDT + More (Ann Rivall/ USN&WR)
33 National Center for Complementary and Alternative Medicine (NCCAM) and the Center for Disease Control’s National Center for Health Statistics, in 2007
34 Boomers Leading Change http://blcih.org/health-facts.php, accessed February 15, 2015.
35 2007 survey by U.S. News and World Report, accessed February 15, 2015.
36 The 2009 Edelman Trust Barometer, Edelman, 2009.