Play 4 Prevention – Engaging Native Populations to Improve Cardiac Health

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Participants in MPQHF's Play 4 Prevention Program
Participants in MPQHF's Play 4 Prevention Program
When Mountain-Pacific Quality Health Foundation, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Montana, Wyoming, Hawaii and Alaska, launched the Play 4 Prevention program in Hawaii in 2013, its goal was simple: to develop an interactive and engaging way to improve the cardiac health of native populations. 
The 12-week, physician-sponsored program is based on health care self-management, lifestyle and nutrition education, socialization, stretching and low-impact exergaming” using video game-based, controller-less sports and exercises. The physical activities are suitable for a range of beneficiaries, including wheelchair-bound seniors and individuals with hand mobility problems.
We reached out to native Hawaiian populations, who, for the most part, were a little afraid or ashamed of the current state of their health,” said Mark Marabella, project manager at Mountain-Pacific. Once these individuals realized we were providing them with an unconditional support group, their fears slipped away and they embraced the idea of improving their lives.” 
As beneficiaries started actively participating in Play 4 Prevention, Mountain-Pacific took note of issues and trends that helped them enhance the program. 
We realized almost immediately that many of the beneficiaries had low health literacy,” said Marabella. They needed basic education and assistance just to understand the medications they were being prescribed.” 
Besides adapting the program to include medication safety, Mountain-Pacific formed community partnerships with organizations like ALU LIKE to help with outreach to native Hawaiian communities. Mountain-Pacific also worked with culinary advisors and fitness instructors from Kapiolani Community College to provide nutritional education and custom exercises for seniors. 
Designing exercises that mimicked experiences program participants have at home – such as getting a towel off the top shelf or picking up their moʻopuna (grandchild) – has tremendously increased their trust in the program and positively impacted their health,” Marabella said. 
Initially, only 15 minutes of each Play 4 Prevention class were devoted to the socialization and peer-to-peer aspects of the program; however, the participants’ enthusiasm in engaging with each other led Mountain-Pacific to expand that portion to nearly an hour. 
The program currently serves over 120 native Hawaiians, many of whom have seen dramatic improvements in their health. In addition, the Play 4 Prevention group –led by program participants – is developing an exercise video for seniors that will be broadcast on Ōiwi TV, a native Hawaiian public access television station. 
The key for Play 4 Prevention is to focus on beneficiaries’ keystone habits of health and motivate them to measure their daily activities and health status, including number of steps taken, blood pressure, glucose level, and other data. Then the program provides participants with customized resources to drive behavior change. 
We had to get participants activated, stabilize them and then mobilize them,” said Marabella. Most importantly, we had to motivate them to adopt a preventive approach to health,” he added.
The future looks bright for the Play 4 Prevention program and offers up lessons that can be applied throughout the country. Looking forward, the Hawaii Cardiovascular Health Learning and Action Network (LAN) is pursuing grants through organizations like the Robert Wood Johnson Foundation that will allow them to conduct research to map unhealthy behaviors within native Hawaiian communities and to develop new programs for further improving the quality of their health. 
The Play 4 Prevention program has also been successfully introduced in Wyoming and Alaska. In Alaska, Mountain-Pacific partners with NeighborWorks to present the program to older adults and dual eligible groups. Participants help define additional topics that allow them to continue managing their own health. Wyoming adapted Play 4 Prevention to fit their beneficiaries’ needs by creating a train-the-trainer program that is being used in senior centers. This train-the-trainer method has been adopted in five Wyoming communities so far and continues to grow.