UC Davis
Student Health Services
QUALITY IMPROVEMENT STUDY
DEPARTMENT: Health Education and Promotion DATE: 3/24/12
PROJECT: Fitness and Wellness Voucher Survey
1.) Purpose of the Study
A statement of the purpose of the QI activity including a description of the known or suspected problem, and explain why it is significant to the organization.
Background:
The Fitness/Wellness Voucher program was started in winter 2006 as collaboration between Student Health Services (SHS) and Campus Recreation’s (CR) Fitness and Wellness Center. Providers were encouraged to give vouchers to students that they felt needed to increase their physical activity. From winter 2006 until summer 2008 there were four options, one personal training visit ($30), walking program membership ($10), a basic group exercise pass ($20) and an intensive group exercise pass ($50). The cost of each option was shared 50/50 between SHS and CR. In fall 2008 CR eliminated the intensive group exercise pass and created the group exercise pass ($50). In fall 2010 CR discontinued the walking program and added 3 personal training visits to the personal training option increasing the prices and thus leaving the program with two options: Personal training package ($70) or the group exercise pass ($50). In fall 2011, CR increased the cost of their personal training package ($84) to cover the additional certifications that their personal trainers have acquired.
The historical redemption rates are as follows:
Winter 2006-Spring 2007 21/35 = 40% redeemed
Fall 2007 – Spring 2008 31/92 = 34% redeemed
Summer 2008-Spring 2009 30-92 = 33% redeemed
Summer 2010-Spring 2011 44/177 = 27% redeemed
Summer 2011-Fall 2012 65/145 = 45% redeemed
The purpose of the study is to discover if our Fitness/Wellness Voucher program is meeting the needs of our non-or-irregular exercising students. While we have some broad data concerning the number of vouchers redeemed from those distributed, we have not done a follow-up study to determine the satisfaction level of the recipients, any perceived barriers from redeemers/non-redeemers or the effectiveness of the program to increase individual physical activity levels.
2.) Performance Goal(s)
Identify the performance goal against current performance.
The current performance for fall 2011 was 99 vouchers distributed, 45-Personal Training, 54-three month Group Exercise Pass with 47 redeemed with a cost of $1,425 to Student Health Services. We would like to see more vouchers distributed per quarter appropriately for a student’s stage of change, based on the Transtheoretical Model (TTM), thus hopefully ensuring that more are redeemed with higher satisfaction levels from providers and students. According to theory, students who are in the preparation and contemplation stages of the TTM would benefit the most from the voucher program.
HEP:Health Ed Admin:Quality Improvement-Annual report:QI Reports:QI-FitWell.doc
3.) Data Collection Plan
Describe the data that will be collected in order to determine current performance.
Consent forms were collected from voucher recipients at Health Education and Promotion (HEP). Confidentiality was maintained by having the forms locked up at the front desk. For those who agreed to receive a survey, we sent the survey with Survey Monkey via email approximately 6 months after they received a voucher. The survey was valid for two weeks and one reminder email was sent after one week.
4.) Describe the data collected
Describe the data you actually collected (not the conclusions). What were you looking for? What information did you extract? How did you record the data?
Data was collected every month from fall quarter 2011 until the end of winter quarter 2012 via Survey Monkey. The table below shows the timetable used.
Voucher Received / Data CollectedApril 2011 / October 2011
May 2011 / November 2011
June 2011 / December 2011
July 2011 / January 2012
August 2011 / February 2012
September 2011 / March 2012
We extracted data regarding student demographics, stage of change pre and post voucher program and how satisfied the students were with Campus Recreation’s services. The data was compiled in a report format via Survey Monkey. Our response rate was 26% with an n=21.
5.) Analysis
Determine what the data tell you about the existence of a suspected problem. Does one exist? Describe your findings about the frequency, severity and source(s) of the problem(s). What are your conclusions?
Demographics:
The average age of our survey participants was 25 years old, with 76.2% female and 23.8% male. The survey population was predominantly white, non Hispanic at 47.6%, with Hispanic or Latino/a and Asian or Pacific Islander both at 19%, Biracial or Multiracial and Other were both at 14.3%, American Indian, Alaskan Native or Native Hawaiian and Black, non Hispanic were both at 4.8%. The majority of survey respondents were also graduate or professional students (52.4%), next came 4th year undergraduates (23.8%), 3rd year undergraduates (19%) and 2nd year undergraduates (4.8%).
This survey represents more of an older, primarily white, female student.
Redemption Rate:
The majority of the survey respondents did redeem their vouchers (81%) and those that didn’t listed time and issues with the application for personal training on the Campus Recreation side. Please see full Survey Monkey report for complete responses. There were no comments on SHCS as any type of a barrier to redemption.
Stage of Change pre and post voucher:
Most of the respondents received a voucher in the maintenance phase (38%), next were those in the preparation phase (29%), followed by the action phase (24%) with one person in contemplation (5%) and one person in pre-contemplation (5%). Six months after receiving the voucher, the respondents in the maintenance phase of their physical activity increased by 4.8%, those in the action phase decreased by 9.5%, those in preparation increased by 9.5% there was no change in contemplators (4.8%) and there were no pre-contemplators. Individually, of those in the maintenance phase at the time they received the voucher (8), six stayed in maintenance, while two dropped to preparation phase. Of those in the action phase (5), two moved into the maintenance phase while three dropped to the preparation phase. Of those in the preparation phase (6), one moved into maintenance, three moved into action and two stayed in the preparation phase. The one person in contemplation stayed in contemplation and the one person in pre-contemplation moved to preparation. Overall, five people worsened their stage of change status over the six month period, nine stayed in their same stage of change and 7 bettered their stage of change status. See the Figure 1.
The Fitness and Wellness Vouchers are more suited for those in contemplation and preparation stages of the TTM, as those in the action and maintenance phases are already motivated to exercise and those in the pre-contemplation stage are not yet ready to be active. It appears like the voucher program was most successful in motivating those in the preparation stage. It is also notable however, that the pre-contemplator was motivated to a preparation stage six months after receiving the voucher and that two of the respondents that were in the action stage had kept up their exercise to be considered in the maintenance stage six months post voucher.
SHCS Satisfaction:
85.7% of respondents said that they were very satisfied, 14.3% were somewhat satisfied with the ease of receiving a voucher at the Student Health and Wellness Center. These ratings confirm that SHCS procedures for distributing the vouchers are not perceived as a barrier to receiving or redeeming a voucher, however, we do not know how many students were sent to HEP to receive a voucher and did not make it to the office. This may be an area for further study.
Motivation to live a healthier lifestyle:
57.1% were neutral and 42.9% strongly agreed that the group exercise pass experience motivated them to live a healthier lifestyle. 27.3% strongly disagreed, 27.3% were neutral, 18.2% agreed and 27.3% strongly agreed that the personal training experience motivated them to live a healthier lifestyle. In addition, 27.3% strongly disagreed, 9.1% were neutral, 9.1% agreed and 54.5% strongly agreed that they had gained knowledge that would help them continue to exercise on their own after their personal training sessions. It seems like the group exercise pass experience had more of an effect on motivation to live a healthier lifestyle, but the personal training sessions did seem to increase knowledge to continue exercising on their own.
6.) Compare current performance with previously stated goal.
Compare current performance vs. goal.
Currently SHCS is on track to distribute more vouchers than in previous years with more redemptions.
7.) Corrective Action(s)
Determine what corrective action(s) needed to improve performance. Implement the corrective action and determine the appropriate length of time until re-measurement is to occur.
SHCS has little control over any criticism with the voucher process on the Campus Recreation side. The results of this survey will be forwarded to Campus Recreation with the hope that they will rectify any issues that were uncovered with the survey.
As for SHCS’s corrective actions, it is recommended that providers identify which stage of change their patient is in regarding physical activity via the intake questionnaire or by verbal exchange during an appointment. If a student is identified as being in the contemplation or preparation stage, a Fitness and Wellness Voucher should be given. If a student is in the action or maintenance stage, the distribution is at the discretion of the provider. Pre-contemplators should be referred to our physical activity resources and educated about the importance of physical activity and health in hopes that they will make progress into the contemplation or preparation stage. With more of a tailored approach to the Fitness and Wellness Voucher program, the redemption rate should increase and the number of students moving into action and maintenance stages should increase. A re-measurement should occur after providers have been introduced to the concept of distributing vouchers in accordance with the stage of change model and they have utilized this method for at least three months.
8.) Re-measurement
At the appropriate time, repeat steps 4 and 5. Describe second round of data collected and how you collected it. Also state your comparison of the new current performance vs. goal(s). Objectively determine if corrective action(s) achieved and sustained demonstrable improvement.
9.) Additional corrective action(s)
If you have met and are sustaining your performance goal, this step does not apply. If applicable, describe additional corrective action(s) taken, including how implemented (repeating steps 7 & 8). Also describe your data and how it was collected; and state comparison of new current performance vs. goal.
10.) Reporting and Education
Describe how the governing body will review the results, and how that review will be documented. Describe other education activities surrounding the study’s results, and how this notification will occur (“closing the QI loop”).