Abstract
The Prescription for Activity (PfA) Task Force developed a 20- to 30-year outcomes-focused road map for transforming the health-care system so that physical activity–based behavior change interventions can become more integral and, as a result, more people can achieve recommended levels of physical activity. What makes the work of the PfA Task Force so promising is its approach to bringing together the already existing efforts across the country—at local, regional, and national levels—and leveraging that expertise on the ground in communities where it’s needed most.
But first, what is the PfA Task Force and how did it create its road map? The PfA Task Force is comprised of volunteer national stakeholders who gathered in 2016 and early 2017 to examine the following questions: How can the health-care industry mobilize people from communities across the United States to achieve recommended levels of physical activity—with a focus on those populations at greatest need? What steps might health care take to pursue the priorities and execute the strategies recommended by leading authorities such as the Physical Activity Guidelines for Americans,
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the American College of Sports Medicine’s Exercise is Medicine,
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the National Physical Activity Plan Healthcare Sector,
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and the US Preventive Services Task Force?
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What steps would be required for clinical care and that which surrounds and supports it to become a force for a cultural shift leading to a healthier, more active US?
The PfA Task Force developed a systems-change map illustrating how to mobilize health care to help more Americans achieve physical activity guidelines, leading to better health outcomes and reductions in health disparities.
The Theory of Change Approach to Strategic Planning
The PfA Task Force used the theory of change (TOC) 5 approach to strategic planning to guide its work. The TOC is an innovative approach to addressing highly complex social or system-level problems. It explains how a long-range goal can be reached through the attainment of a sequence of early and intermediate accomplishments. Full implementation of the TOC approach articulates the assumptions about the change process and details the ways in which the early and intermediate outcomes relate to the achievement of the ultimate outcome.
The PfA Task Force Systems-Change Map
To create the systems-change map,
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the PfA Task Force: Identified the long-term goal or “ultimate outcome”; Developed a pathway of change, including measurable outcomes, that would be necessary “incremental outcomes” or stepping-stones toward achieving the ultimate outcome; Arranged those incremental outcomes into sequences of cause-and-effect; preconditions, the result of which have evolved to represent “chains” of necessary categories of work; Described the stakeholders that might logically be involved, or are already involved, in the pursuit of each precondition within each chain; and Identified approaches, interventions, and other strategies that might be deployed in pursuit of each precondition.
The TOC process begins with determining the “ultimate outcome,” which is depicted in Figure 3.
Theory of change (TOC) process to determine the ultimate outcome.
The achievement of this outcome requires an ongoing focus on health equity with the pursuit of a more physically active America. The belief that every American must have an equal opportunity to achieve his or her best health is fundamentally intertwined. This outcome will be achieved only when environments and opportunities support and empower individuals of all backgrounds to increase their personal level of physical activity. Health equity is not only an outcome of this work but a lens through which the PfA Task Force viewed each of the chains of the map and all of the outcomes that fall within those chains.
The PfA systems-change map features 3 “core paths” Care delivery chain: Prescribing physical activity as a path to enhanced patient outcomes. Community chain: Recruiting communities to make physical activity not only a priority, but also a source of fun, enjoyment, and socialization. Clinic–community integration chain: Building a bridge of trust and collaboration between health-care providers and community resources to encourage physical activity.
These core paths are bolstered by 4 “supporting paths;” Education and training chain: Equipping health-care professionals to be true physical activity advocates. Funding and payment chain: Funding affordable, universal access to physical activity. Informatics chain: Evolving the information architecture underpinning care delivery so physical activity monitoring and counseling become supported and routine for care providers. Communications chain: Creating engaging and targeted messaging that persuades people across all walks of life to see physical activity not only as a health imperative but integral to a life of fulfillment and happiness.
Finally, the systems-change map begins with a series of “sparks” designed to unleash transformation and facilitate the initial outcome in each of the 7 chains just described.
Alignment With Existing Efforts
The members of the PfA Task Force recognized that many initiatives are already underway to support integration of physical activity into the health-care setting. In fact, the leaders of many of these initiatives are members of, or advisors to, the PfA Task Force. As a result, the PfA Task Force aspired to build upon existing efforts and develop a framework and implementation plan to help align and accelerate them.
Key Next Steps
The PfA Task Force identified a series of key next steps to catalyze the tremendous body of work required to implement a change of this magnitude, some of which are already underway. These steps include: Building a highly organized nationwide implementation initiative; Identifying and recruiting individuals and organizations to serve leadership, support, coordination, and implementation functions; Developing an identity for the initiative, as well as a message platform, communication strategy, and awareness-building campaign; Crafting written materials for academic, funding, and other prospective partners, as well as lay audiences, describing the work and vision of the PfA Task Force; Identifying how stakeholders across healthcare and in communities nationwide can answer the Call to Action detailed in this article; and Recruiting the critical stakeholders and gathering the funding and human capital necessary to pursue the most urgent preconditions on the PfA systems-change map.
What’s exciting about the PfA Task Force and its systems-change map is the big picture view that pulls together concepts and expertise from a wide range of industries linked to health care and wellness in an effort to maximize the possibilities for long-term success. The PfA Task Force imagines a new paradigm for physical activity where health-care providers routinely assess physical activity levels, encourage physical activity among their patients, counsel on its necessity, and then refer patients to appropriate community partners based on each patient’s interests and readiness to change. Further, the Task Force envisions a system where the business sector—which includes third-party payers, medical records companies, and employers—work with health-care practitioners and the community to support the achievement of the task outlined on the community chain of the PfA systems-change map. By enlisting the support of experts from areas as diverse as communications, informatics, care delivery, and community initiatives, the PfA Task Force allows the fulfillment of exercise prescriptions to take place outside the clinic walls, in the communities and workplaces where people live their daily lives.
To learn more about the PfA Task Force and its systems-change map, or to read the full White Paper, visit www.prescriptionforactivity.org.