Active Herts
Active Herts was a community-based physical activity programme delivered across four areas of Hertfordshire for inactive adults. Programme users were referred to the programme from one of 23 GP surgeries across Broxbourne, Hertsmere, Stevenage, or Watford, or could self-refer. A ‘Get Active Specialist’ was employed to deliver the programme by a local organization (e.g., borough council or football club) in each of the four Hertfordshire localities. The original programme was managed by the Herts Sports & Physical Activity Partnership and ran for three years with the aim of improving the health of community members by getting as many people as possible to be regularly active.
Background
The public health team at Hertfordshire County Council wanted to help four communities living with high levels of deprivation to address their health and wellbeing concerns, focusing on cardiovascular disease (CVD) risk and mental wellbeing. Over £1 million of funding from Sport England and other organisations was established for a community physical activity programme was established but there was limited behaviour change theory in the initial design, training, delivery, and evaluation. Dr Neil Howlett alongside colleagues from the Universities of Hertfordshire, Bedfordshire, and East Anglia were ideally placed to provide academic expertise and support.
Dr Neil Howlett led a review of physical activity interventions for inactive adults that highlighted which behaviour change techniques were most effective to change short and long-term physical activity levels.
Read the review paper
Alongside the findings from the review, we analysed the COM-B model, which suggests that behaviour results from an individual having sufficient Capability, Opportunity, and Motivation. The results highlighted the key drivers of physical activity and sitting behaviours.
Read our COM-B PA paper and COM-B sitting
Design
These combined findings informed the design of the Active Herts programme. Service users were provided with a consultation with a Get Active Specialist, who talked them through a behaviour change booklet, and then signposted them to free or subsidized local physical activity sessions, with a follow-up booster call 2 weeks later. Service users were then offered further support at 3, 6, and 12 months. The Get Active Specialists had a minimum of level 3 Register of Exercise Professionals and GP Exercise Referral qualifications, with additional training provided in motivational interviewing, health coaching, behavioural diagnosis, and delivery of behaviour change techniques.
The full Active Herts protocol
Evaluation
Between 2015-2018, 3500 inactive adults were referred. A longitudinal evaluation demonstrated sustained improvements in physical activity (300 minutes per/week), sitting (reductions of over an hour/day), sporting participation, and perceptions of health and mental wellbeing. These gains were achieved in a sample with a high prevalence of hypertension, obesity, Type 2 diabetes, and depression.
A process evaluation also captured how the Active Herts programme was implemented, how the delivery evolved over time, and lessons learned along the way. Adaptations that contributed to the success of the programme included changing the design of promotional material, additional tailored physical activity sessions, additional ‘booster’ reflection and training sessions with learning and skill development for the Get Active Specialists, and the introduction of regular community events for service users to meet each other and feedback on progress.
Ongoing impact
The Active Herts approach has since been adopted in multiple spinoff programmes, which have explicitly credited the underpinning research published by Dr Neil Howlett and colleagues. One example, the Active Watford and Three River (AW3R) programme received 1,900 referrals, resulting in over 1370 consultations with inactive adults at risk of ill health. By 3 months, at least 75% of participants were classed as active, with around two-thirds remaining active at 6 months and 12 months. These improvements in physical activity were accompanied with substantial gains in life satisfaction and happiness, increases in feelings that life is worthwhile, and reduced anxiety.