Evaluation of the fit as a fiddle portfolio Final Report – Key Findings

Nicola Smith, Ecorys

Bernadette Bartlam & Julius Sim, University of Keele

Introduction

• fit as a fiddle was a £15.1 million portfolio funded by Big Lottery Fund and delivered across the 9 English regions from 2007

• fit as a fiddle aimed to “Increase the opportunities for older people to undertake physical activities and improve their eating habits, contributing to an overall improvement in mental health.”

• fit as a fiddle comprised two national and 24 regional projects, delivered by over 200 organisations (99 of which were local Age UK’s/Age Concerns)

Evaluation Methods

Longitudinal evaluation - qualitative and quantitative methods: •A paper based survey of older people across three time points .

•2,189 completed surveys• 859 at start of involvement • 816 at end of involvement • 514 three months after involvement

•20 completed case studies • One SROI case study

Evaluation Methods

• Web and paper based survey of project delivery staff, regional co-ordinators, volunteers and partners (221 responses)

• 11 Community evaluators •38 filmed interviews with older people

• 20 qualitative interviews with national stakeholders

• Data analysis •SNAP monitoring data •Project outcomes and financial data •End of project evaluation reports

Impacts on older people

Bernadette Bartlam & Julius Sim, Keele University

Impacts on older people

20 project level case studies38 in-depth interviews conducted by a team of

11 community evaluators

Survey:• 2,189 self-completion surveys

• socio-demographic details• general health and wellbeing • limiting long-standing illness • daily activities • participation in the programme

• 881 participants• 859 at start of involvement• 816 at end • 514 at least three months on • 416 at all three timepoints

Who took part

• 665 women (75%) - average age 72 • 216 men (25%) - average age 71

• Ethnicity:• White British (81%) • Indian (4%) • Black Caribbean (3%) • 11 other ethnic groups

• Limiting long-standing illness: 46% i.e. heart disease, diabetes, asthma, emphysema, and arthritis.

Who took part: living arrangements

Taking part

• 60% physical activity or exercise • 35% healthy eating activity • 2% volunteering or mentoring activity• 3% stated 'other' activity

Impacts on Healthy Eating

• Targets exceeded:• 178,521 older people eating more healthily

against an overall target of 155,836

• Activities included:• Cookery courses promoting fresh ingredients

rather than using ready meals• Smoothie making and fruit tastings• Health promotion messages on '5 a day', portion

sizes, using alternative types of 'fat', keeping hydrated, salt intake etc

• Gardening.  

At the

start of fit as a fiddle

At the end of fit as a

fiddle Follow-up

No. of responses at

the 3 time points

Full sample:

I don’t think healthy eating is important for my health

35 (4%) 32 (4%) 8 (2%)

864, 866, 424 I think … but I am not doing anything about it at the moment

154 (18%) 81 (9%) 23 (5%)

I think … and I am doing something about it at the moment

675 (78%) 753 (78%) 393 (93%)

Changes in attitude

Sample

At the

start of fit

as a fiddle

At the end

of fit as a

fiddle Follow-up

No. of

responses at

the 3 time

points Significant?

Total 4 4 4 830, 838, 407 —

Restricted 4 4 4 384 Yes*

Portions of fruit & vegetables eaten

English average= 3.5 (men); 3.8 (women) Aresu M, Bécares L, Brage S, et al (2009) Health Survey for England 2008: Physical activity and fitness. NHS Information Centre for Health and Social Care

Portions of fruit & vegetables eaten cont.

Come to tea at Haunton Hall

“One gentleman, who has no conversation, came into the allotment and said ‘green beans’ and then started to say what was growing in the allotment –

before that, he hardly said a word and so we know now that he has an interest and knowledge of gardening which we didn’t know before”.

(Staff member)

Impacts on Physical Activity

• Significant change over the duration• More people recognising the importance• More people doing something about it

• Activities included:• Walking, including nordic walking• Swimming• Aerobic exercise classes (aqua,

armchair etc)• Gardening

Changes in attitude

 

At the

start of fit

as a fiddle

At the end

of fit as a

fiddle Follow-up

No. of

responses at

the 3 time

pointsFull sample:

I don’t think physical activity is important for

my health 27 (3%) 25 (3%) 8 (2%)

856, 858, 421I think … but I am not doing anything about

it at the moment 172 (20%) 86 (10%) 30 (7%)

I think … and I am doing something about

it at the moment 657 (77%) 747 (87%) 383 (91%)

Restricted sample:

I don’t think physical activity is important for

my health 14 (3%) 11 (3%) 7 (2%)

409*I think … but I am not doing anything about

it at the moment 73 (18%) 22 (5%) 30 (7%)

I think … and I am doing something about

it at the moment 322 (79%) 376 (92%) 372 (91%)

Changes in behaviour

Median minutes of: walking, per day (blue line); activity making breathe harder, per week (green line); activity for strength and endurance, per week (pink line)

 “It's things like climbing the stairs, I've got one flight of stairs, normally by the time I get to the top I’m knocked out, you know, I have to stop and have a rest.

Now I’m managing to get up the stairs and walk to my room without a rest…

Recently I went out to Portugal and the place we went to was quite hilly… I was finding I was managing the hills a lot better than I would have been perhaps 18 months to two years ago, so the benefits are there.”

(Participant: Older Men project at Springbok Farm Estate)

Impact

“I had had two hip replacements and a complete shoulder replacement. My mobility, stamina and confidence were poor…

I can now swim both breast stroke and crawl again, can complete an hour’s exercise in the water… I really enjoy myself and have made friends and now bring two more ladies to the sessions.

All this has made a great difference to my life, I can now walk anywhere including uneven ground, manage steps, stairs, run and dance; I recommend exercise swimming to everyone.”

(Female participant, Fit as a Fish project Devon)

Impact cont.

Impacts on Mental Health

Health is more than absence of ill-health - related to four items:

1. Health and functioning2. Existence of relationships and social

support3. Material circumstances4. Opportunities for personal growth and

development

Higgs, P., Hyde, M., Wiggins, R. & Blane, D. (2003). Researching quality of life in early old age: the importance of the sociological dimension. Social Policy

and Administration, 37, 239–252.

Complex relationship…

“In fact, I think that's the biggest impact it has really, you see the people coming in and they always say things like 'I am so glad I came to this group' and 'I haven't been going out'… You see them starting to make friends and it’s just fantastic." (Case Study East Midlands)

“Also the fact that it's a social thing, you know, it's something that somebody can attend on a social level with other participants also helps to alleviate any, perhaps, negative feelings, feelings of isolation and so on and I've got evidence of this through letters and testaments and so on.” (Project Coordinator)

Warwick Mental Health Scale

Sample

At the start of

fit as a fiddle

At the end of

fit as a fiddle Follow-up

No. of

responses at

the 3 time

points

Signific-

ant?Total 33.51 34.97 36.16 754, 770, 391 —

Restricted 33.53 35.07 36.25 337 Yes*

Significant increase in mental wellbeing across the duration of the programme and also between the beginning of the programme and follow-up

Satisfaction with life

Sample

At the start of

fit as a fiddle

At the end of

fit as a fiddle Follow-up

No. of

responses at

the 3 time

points

Signific-

ant?Total 7.26 7.62 8.06 827, 826, 403 —

Restricted 7.28 7.66 8.08 374 Yes*

Significant positive increase across the duration and between the beginning of and follow-up stage

Impacts on Mental Health

Control and autonomy: frequent examples of older people being consulted about the type of activities projects would offer & how they would be structured. Taking part in the activities clearly gave people a sense of being better able to deal with – and indeed at times overcome – impairments related to their health or mobility.

Meaning and purpose: reports throughout of participants feeling valued and contributing to their communities in ways that had not previously been available to them, e.g. healthy eating initiatives encouraging participants to grow produce that their communities then used. Participation gave many people a meaning-making structure to their daily lives that had previously been missing.

Pleasure: participants spoke frequently of how much enjoyment they got from participation, from a general improved sense of wellbeing, through to making new friends and experiencing increased self-esteem and confidence.

Impact: the example of Ella

Ella is 88 and has lived in Cranfield, a sheltered housing complex, for 35 years; she doesn’t participate in any activities outside the complex. Ella and other residents took part in armchair exercise classes based on site, which were therefore easy to access. For other activities, such as swimming, which were offered off site and which she would have considered joining in, she was unable to participate because of a lack of appropriate transport. As Ella put it "I can’t really get on the bus because if I get on, I can't get off".

"Now we chat away like we are bosom pals" "I go shopping into town with the other girls.“The classes have resulted in making Monday "a special day and have provided me with an extension of my life."

Cascade effect…

Participants:Frequent reports of bringing friends along, encouraging others to take part, disseminating informationStaff: Increased sense of professionalism, support, and achievement

Ella has a partner of 86 who suffers from osteoporosis. At home she encourages him to try some of the exercises. The exercise class leader produces a written outline of the exercises so that participants are very clear about what they are doing in each class. Ella finds this very helpful on the day but it also acts as a memory aid for practising between sessions, and as a tool to help her explain the exercises correctly to her partner.

Nicola Smith, Ecorys

Wider impacts of the programme

Partnership Working

"All partners, whether from the statutory, community or voluntary sector have brought enthusiasm, commitment, energy and ideas. All partners… have given contribution "in kind" to help [us] continue." (Project and partner survey feedback)

48% project co-ordinators worked with other organisations97% of projects felt partnerships were effective

Impact of partnership working • Engaging target groups e.g. BME, frail older people and

older men• Boosting project reach – extending capacity • Delivering new activities • Avoiding duplication

Challenges• Funding cuts to statutory services • Staff turnover in partner organisations • Communication with partners

Equality and Diversity

"It's important to think creatively about how you might deliver something, sometimes you might make certain risks and see what might happen.” (Project staff)

• Key target groups - older men, Black Minority Ethnic groups and frail / isolated older people

• Mix of specifically targeted projects and outreach work by partners

• Activities for target groups need to be appropriate to ensure participation

• above national average levels of engagement by some ethnic groups

• Men 2 Mentor engaged men with targeted activities e.g. men only keep fit and golf

Equality and Diversity

• National cascade project worked with a range of faith and community groups to engage them in activities and reached 5,532 older people

• Effective approaches working with BME groups included• Men and women only sessions• Using translators • Using local community venues and volunteers • Intergenerational work

• Working in care homes and sheltered accommodation to attract frail elderly people, chair based exercises• Come to Tea and Life and Soul project

Health Literacy

• 808,060 educational resources distributed to older people • 168,357 Blood Pressure Association leaflets• 100 older men’s leaflets • 50 Equalities and Human Rights Guides

• Promotional material including t shirts, ‘stress relieving’ fruit, recipe books, DVDs and newsletters

• Case study of health literacy materials in care homes • 95% rated very or fairly useful • Promoted the portfolio and raised

awareness of the programme • Raised awareness of healthy eating

Tackling Obesity Age Concern Kingston

Project Aim: To tackle obesity through physical activity and promotion of a healthier lifestyle

•Ten 6 week courses attracting 166 older people in activities such as Nordic Walking, Keep Fit and Bollywood dancing •88% of participants taking part in moderate exercise 3-5 times a week •Social Return on Investment (SROI) analysis suggests an approximate social return on investment generated by the project of £3.50 for every £1 invested•Generated through reductions in use of GP services, treatment for falls related incidents and reductions in unpaid informal care

Sustainability

“Some parts are likely to continue with local PCTs or social services covering some costs. Also where volunteers are used it is hoped they will continue.” (Project coordinator)

• Projects being effective in planning for the continuation of their activities

• A third of projects expected to continue some form of fit as a fiddle activity

• Projects likely to continue are to be scaled down

• Statutory bodies and volunteers will play a role in continuing sustained activity

• Greater focus on sustaining physical activities

Models of Sustainability

• External follow on or continuation funding

• Internal of core funding models

• Fee paying models

• Volunteer led models of sustainability

• Constituted groups

• Instructor packs

• Continuation with no funding

Conclusions and recommendations

• fit as a fiddle widely viewed as a success achieving national recognition and offering a unique service to older people

• fit as a fiddle identified by Age Action Alliance as a model for delivering healthy ageing services

• fit as a fiddle achieved positive outcomes for older people and clear impacts on healthy eating, physical and mental wellbeing

• fit as a fiddle achieved positive outcomes on volunteers and volunteering capacity

• Cost per participant ranged from £36.56 to £408.12