The Wray Health Initiative builds exercise facilities and makes fitness fun for people of all ages.
In the rural town of Wray, Colorado a group of concerned citizens and health care providers called the Wray Health Initiative (WHI) became motivated to support resident participation in physical activity. Building a state-of-the-art recreation facility was necessary, but it also needed an infusion of participants. A decade after they had collaborated to build a 24,000 square foot fitness and rehabilitation center, facility use was not what had been expected, so the group kicked into gear and launched a multi-pronged community health outreach program that would create outdoor facilities and help residents find the fun in fitness. With a special emphasis on heart health, WHI built recreation facilities, sponsored contests and hosted public events that would encourage regular exercise in a community context. Three years later, WHI reports significant community health improvements, including three times as many people participating in community- based walking programs and regular use of newly built indoor and outdoor fitness and recreation facilities.
The place:
Wray, Colorado, 170 miles from Denver, sits in a scenic valley beside the banks of the North Fork of the Republican River just 13 miles from the point where Colorado, Kansas and Nebraska meet. A long range of grassy sand hills stretches north of the city. Wray is 90 miles away from any large towns and at least 2.5 hours away from a large medical facility. It is a hilly, rural town with no formal walking paths which makes it difficult for residents to find safe, convenient areas to walk outdoors. The population of 2,187 is predominantly White, with about 5% to 10% Latinos comprising the remainder, according to the 2000 US Census. Average income for residents is under $25,000.
The project:
In the early 1990’s, through donations and foundation grants, community-minded citizens built a 24,000 square foot, state-of-the-art rehabilitation center. The Wray Rehabilitation and Activity Center (WRAC) boasted a walking track, an indoor swimming pool, nautilus equipment and free weights, a racquetball court, physical therapy equipment, and a hot tub and steam room. “It was really something,” says Jennifer Kramer, WHI chairperson. “The citizens of Wray thought it nearly impossible to build a facility of this caliber in our little town.”
The multi-purpose facility was open both to recovering cardiac patients and local residents through memberships. The goal of the WRAC was to provide a facility that all community members could afford to use. Membership costs were intended to be low so that all residents could use it for exercise or physical therapy. But over time it became clear that the WRAC was underutilized. Patients were not following up with rehabilitation instructions from their medical care providers. WHI hoped that by increasing community involvement they could promote health and increase use of WRAC facilities. The group launched a new mission: to improve health in the community by increasing activity levels, conducting health assessments, and encouraging individual physical activity.
After submitting proposals in 1999, WHI received funding of $330,000 over three years from the Rural Health Outreach Project and $140,000 over two years from the Robert Wood Johnson Foundation. Their first step was to hire a coordinator to support patients’ physical activity efforts and continue rehabilitation. Then, the WHI partners conducted an assessment around town to determine need. Through a series of focus groups that included health care providers, com- munity groups, teens, local clubs, and senior citizens, WHI learned straight from residents what the com- munity members wanted to see in their town. Special priority was placed on giving voice to Latino residents, who had historically been underrepresented in com- munity decision-making. With straight-from-the- source information in hand, WHI better understood the community’s perceived barriers to exercise and activity, began to identify specific community needs and used this information to implement community- identified solutions.
To increase opportunities for outdoor activity, WHI built a basketball court, updated playground equipment, enhanced a local walking path, and assisted with financing amenities at the new swimming facility in Wray. All of these physical changes were complemented by efforts to build community awareness, increase social support for physical activity, and make exercise fun. Early on, WHI held a community-wide contest to involve residents in naming the project: “The idea was to begin engaging the community in what we were doing so they’d feel like a part of it right from the beginning,” says Kramer. The WHI provided one-on-one health assessments with over 500 residents. The assessments gave personalized “recipes for success,” including tailored dietary and exercise programs and let participants know how they com- pared to the national averages for flexibility, strength, weight, and osteoporosis. WHI coordinated walking clubs, 5K and 10K runs, a holiday marathon held between Thanksgiving and Christmas, moonlight golf, and a family fitness day to encourage intergenerational activity. The WRAC serves as a community gathering place during the Wray Health Fair, when about 400 to 500 residents visit booths, participate in screenings and learn more about health resources in the community.
Perhaps most popular and successful of all, WHI held a community event in which participants received a free pedometer and were encouraged to log their miles to “walk around the world” as a community. The participants achieved their goal so quickly that they changed the event’s title to WRAY Walks the World, to the Moon and Beyond. Signs were posted around town showing collective progress. This program also engaged over 500 residents by giving them social support, pedometers, and other prizes as they publicly tracked the community’s progress in walking “toward the moon.”
The people: Diverse Partners Collaborate to Build Healthy Environments
Medical providers, city government, and local residents joined together and formed the Wray Health Initiative (WHI). Combinations of federal funding from a Rural Health Outreach grant and support from the Robert Wood Johnson Foundation helped to maintain the effort. The City of Wray, the WRAY Community District Hospital and the Wray Rehabilitation and Activity Center (WRAC) were the three key organizations involved in the initiative.
Jennifer Kramer, a cardiac re-habilitation nurse and assistant director of nurses serves as chairperson for WHI. Revae Parker, currently community services director for the City of Wray, was director of WRAC and served on the committee when the initiative began. A doctor committed to physical activity and nutrition and a senior citizen representing the com- munity were also instrumental. The entire process from writing the grant to implementation was a collaborative effort. To get residents excited and involved in the effort, WHI sought community input from the beginning. From the outset, people knew what role they would play and shared a common vision for achieving their goals.
The Results: Healthy Change in Local Environments
Three years since the WHI launched its efforts to improve community health by increasing activity levels, the group reports significant improvements. Three times as many people now participate in community- based walking programs. Regular use of both indoor and outdoor fitness and recreation facilities has remained steady. The group has documented change with individual health assessments and rehabilitation success stories—including a diabetic man who lost 30 pounds and got his diabetes under control within six months. WHI also reports cultural changes in the community that support health. One example is the fact that two local restaurants became non-smoking facilities through WHI advocacy efforts. And now the local grocery store features the WHI logo, a symbol that has become synonymous with health, on heart- healthy items. In addition, a local business gives employees an extra 15 minutes during their breaks if they use the time to exercise and a large employer, the Oil & Gas Exploration Company, created a policy allowing employees to use work time to work out. Meanwhile, the local trust, the Kitzmiller-Bales Trust, donated $10,000 for pedometers for community members.
Data illustrating that physical activity improves cardiovascular health is robust. The Wray results are in line with available research strongly suggesting that improving access to exercise facilities and encouraging activity through community-wide campaigns can increase activity levels and promote fitness among community residents. A review of the published literature conducted by Humpel et al. in 2002 concluded that “the availability of, and access to, cycle ways, footpaths, health clubs, and swimming pools were found to be associated with physical activity.”1 Linenger et al. (despite noted limitations in the study design) found improvements in fitness among military personnel when new equipment was added to a gym, a women’s fitness center was opened and when policies allowed for release time for physical activity.2 Based on a systematic review of published evidence, the Task Force on Community Preventive Services finds support for strongly recommending the “creation of, or enhanced access to, places for physical activity combined with informational outreach activities” to increase physical activity.3 The Task Force indicates that successful interventions include “creating walking trails, building exercise facilities, or providing access to nearby facilities” and that “many of these programs...offer health behavior education, risk factor screening, referrals to physicians...and support or buddy systems.”4
Wisdom From Experience:
Kramer strongly advises others to “start out with a collaborative group to get buy-in from a broader part of the community. Pick out stakeholders from the beginning so that you know what problems people face.” She also adds that “this program had a profession- al evaluator, who helped guide the activities by gathering data through surveys and focus groups, and the information taught partners a lot about what was working and what wasn’t. Don’t duplicate existing efforts: we tried hard to improve existing things, and if we identified things that weren’t there, then we worked to create and sustain those.” And most of all, says Kramer, “make activity fun!”
Looking Ahead:
Although initial efforts were well funded and quite successful, WHI has found, not surprisingly, that grant funding comes and goes. Without continued funding, it became impossible to pay the coordinator who was instrumental in conducting individual health assessments, identifying community members at high risk of heart attacks and providing cardiac patients with appropriate referrals and support to continue rehabilitation. Community members find it difficult to pay for the services provided by the WRAC, so the WHI continues to explore reimbursement options that will allow for the provision of preventive services and make such services affordable to the community.
Despite these challenges, the multifaceted efforts WHI launched have resulted in a changed culture among Wray residents and new norms among local employers and businesses. Furthermore, their work lays an important foundation for future collaboration between major community-serving organizations. With momentum from the WHI and matching funds from Colorado’s Department of Transportation and the City of Wray, a core group of residents and stakeholders from the initial WHI are now working to build a new walking trail through Wray.
The new structures are also enduring assets to the community. The infrastructure changes, including the playground, basketball court, swimming pool, and updated walking path are all tangible results that continue to serve the community and provide support for physical activity among all Wray residents.
Program Contact:
Jennifer Kramer, RN
Wray Health Initiative Chairperson Phone: 970.332.2245
Email: jennifer.kramer@bannerhealth.com
Endnotes:
- Humpel N, Owen N, Leslie E. Environmental Factors Associated with Adults’ Participation in Physical Activity. Am J Prev Med. 2002;22(3):188-196.
- Linenger JM, Chesson C, Nice S. Physical Fitness gains Following Simple Environmental Change. Am J Prev Med. 1991;7(5):298-310.
- Recommendations to Increase Physical Activity in Communities. Task Force on Community Preventive Services, Am J Prev Med. 2002;22(4S)67-73
- Recommendations to Increase Physical Activity in Communities. Task Force on Community Preventive Services, Am J Prev Med. 2002;22(4S)67-73.