Innovation: Posts Working for Veterans’ Health (POWER) programme

USA

AAI Domain: Independent, healthy and secure living (improved access to healthcare services, lifelong learning, physical exercise)

High blood pressure is an often undiagnosed risk factor that is associated with a range of serious health conditions such as heart disease, stroke, kidney disease and dementia. It is a condition that may affect one in four adults although it is more prevalent among people who are aged over 65 years, people are overweight or obese, eat too much salt or don’t eat enough fruit and vegetables. It is also more common among people who have a sedentary lifestyle, drink too much alcohol or drinks containing caffeine and those smoke.

High blood pressure is a health risk that usually does not have obvious symptoms making it essential to have it regularly monitored. This can be problematic for many groups who do not regularly access health care services, typically middle aged and older men, making it important to develop innovative ways of performing a simple health check that can act as an early warning to a range of serious health conditions.

The Posts Working for Veterans’ Health or POWER programme was developed by Dr Jeffrey Whittle and Kristyn Ertl at the Zablocki Veterans Administration Medical Centre in Milwaukee, Wisconsin in 2005. The POWER programme trains veterans to act as peer leaders who can check and record the blood pressure and weight of fellow veterans at their regular monthly meetings. Peer leaders receive ongoing support from programme leaders, typically medics, and a spirit of competition is created to encourage peer leaders and veterans to regularly participate in blood pressure tests.

Peer leaders also deliver scripted presentations on self-management of chronic diseases and encourage and support veterans to undertake lifestyle behaviour change such as increasing levels of physical activity, losing weight or making changes to alcohol consumption.

A randomised control trial across 58 Veterans Service Organisations posts showed positive effects among the mostly male participants in terms of reduced levels of hypertension and lifestyle behaviour change. The use of peers who receive eight hours of training on the basics of high blood pressure, how it can be effectively self-managed and how to communicate effectively with fellow veterans is both cheaper and more likely to reach a group who are elevated risk of high blood pressure.

At monthly meetings the peer leaders either take blood pressure readings or enable fellow veterans to do this themselves and then they distribute booklets such as Dietary Approaches to Stop Hypertension (DASH) and provide continuing motivation and support to veterans who have high blood pressure. The POWER programme organises a series of meetings to support peer leaders to address any issues that have arisen and to review progress.

The innovative programme operates in scores of Veterans Services Organisations across Wisconsin with many adopting contests for weight loss or steps contests for those who sign up to increase their level of physical activity.

In relation to active ageing, the POWER programme improves access to health care services through the use of trained peers. The peer leaders receive training that provides them with new skills and is essentially a form of lifelong learning and a feature of the programme is to increase levels of physical activity in order to reduce high blood pressure.

Although this is a social innovation that is aimed at a relatively narrow group in society, military veterans, this group of older men can be difficult to reach making it particularly valuable despite this limitation. It is particularly promising as there is good quality evaluation research evidence that indicates that it is an effective programme that is likely to have a sustained impact on the health and well-being of veterans.

Websites

Milwaukee health care

Agency for Healthcare Research and Quality