1. Effective planning
With 48% of 75-84 year olds and 71% of 85+ inactive, the older age group isn’t the first demographic that springs to mind when thinking about sport. Even though people aged 75-84 are half as likely to be active as 16-24 year olds, regardless of stage of life, everyone deserves equal opportunities to get active and experience the associated benefits. In a bid to address low physical activity levels associated with later life, along with loneliness and mental wellbeing, London Sport piloted an initiative in two boroughs: Sitting Netball.
Our aim was to help older adults get active in care home environments. By adapting an existing sport, upskilling and providing outreach to those in need; we created an environment that led to more active care home residents, smiling, laughing and having fun. Stakeholder objectives included:
- • Residents - Increase the amount of activity, resulting in: Improved cognitive functioning; Increased physical, social and mental wellbeing
- • Care Homes - Increase in Activity Coordinator confidence to deliver activity sessions, resulting in: Increased amount of activity sessions on offer
- • Local Authorities - Increase in physical and mental wellbeing of residents, resulting in: Less need for health services. Improved relationships with Homes, resulting in: Increased social capital and trust
- • London Sport - Improved relationships with Local Authorities and Homes, resulting in: Better reputation; the creation of a successful scalable delivery model.
2. Effective Insight and customer engagement
Regular, robust monitoring and evaluation was essential to understand if Sitting Netball improved physical, mental and social wellbeing. The research methodology is explained below.
First, we discussed monitoring and evaluation with the staff that would be delivering Sitting Netball (Activity Coordinators) to find out their capacity to, and preferences for collecting data. We discussed what would be feasible to collect, based on the residents’ information processing capabilities. This resulted in the co-design of two registers; one adapted from the Warwick Edinburgh Mental Wellbeing scale with a five point Likert scale and another with yes/no options.
Before the 8-week longitudinal study commenced, Coordinators asked the mental wellbeing questions to provide baseline measurements. Telephone interviews were conducted with each Coordinator after their first and fourth week of delivery to find out how sessions were going, which activities had been popular, if visitors had been involved and to check the status of equipment. After four weeks, coordinators asked the wellbeing questions again to provide a midway measure. Coordinators commented that it was, “Really nice to be able to talk to you, to know someone is interested, it keeps us going, motivating, like a personal trainer”. Staying in regular communication and motivating Coordinators meant residents were likely to get more out of sessions.
From weeks four to eight, we took an ethnographic approach, visiting sessions to chat to residents, generating ‘in the moment’ feedback. After eight weeks, Coordinators took the final wellbeing measure before attending a focus group, along with leads from the respective Local Authorities. Here, they filled out evaluation forms, before conversing for 90-minutes about how they, and their residents, had found Sitting Netball.
Taking a mixed-methods approach provided in-depth and robust evidence to take positive action. We engaged with local authorities, care homes and residents throughout the programme in order to fully represent and learn from all respective experiences.
3. Achievement against objectives
Sitting Netball used the power of sport to engage and bring about positive change in the holistic wellbeing of care home residents. By the end of the programme, 98% of residents were doing at least one physical activity session a week, compared with 62% at the start, resulting in improved functional movement. 66% of residents had an improved mental wellbeing, 79% felt close to other people often or all the time, and the percentage of people feeling optimistic often or all the time more than doubled, from 21% at start to 45% at end.
But why and how were these positive changes created?
Inclusive: Adapted to be inclusive for all, residents could enjoy physical activity in a safe, social environment. Even if residents weren’t playing, they were keeping score, supporting and cheering those who were.
Sociable: A platform for social interaction, resulting in a greater sense of belonging. Residents worked together towards a shared goal, fostering a team spirit, with support, encouragement and bonding through cheering and applause. This shared experience helped spark and sustain conversation and friendships.
Nostalgia: The success of this project was its ability to connect older people with a sport that they knew and identified with from their youth. Residents reminisced about the ‘old days’, stimulating positive nostalgia.
Self-fulfilment: Sitting Netball includes an ‘aim’: to throw a good pass or score a goal; something to focus on, the ball and teammates; and, ultimately, skills to improve. Residents had to think about how to throw the ball or the next sequence, requiring concentration, mental stimulation and an opportunity to keep learning. This resulted in a sense of achievement; boosting their confidence, self-esteem and individual development.
4. Local leadership
A coordinated delivery was achieved via effective relationships with England Netball and Local Authorities.
Local Authorities and Clinical Commissioning Groups: Contributed to shaping the objectives of the programme, then helped us to identify relevant care homes and funding.
Care Homes: We introduced Sitting Netball into 10 care homes across Harrow and Barnet, a number which continues to increase! We were eager to train a workforce that could deliver Sitting Netball to individual requirements, preserving residents’ dignity. Coordinators understood the residents’ needs, having the essential softer skills. They provided the knowledge of the target group whilst we provided the sports context. Care home managers sent Activity Coordinators and carers on the Sitting Netball training which we delivered.
England Netball: Attended training sessions and provided feedback. After the study, the findings were presented to England Netball’s Head of Inclusion and Regional officers. Our thorough evaluation, results and future recommendations has led to their agreement to add Sitting Netball to their portfolio of delivery.
5 & 6. Innovative practice, sustainability and business development
When delivering physical activity interventions, it can be difficult to coordinate an inactive population, a suitable workforce and affordable facilities in the same place. Sitting Netball addresses this by getting inactive residents active in an environment they feel comfortable in. What is more, it is sustainable. By training up Coordinators, offering cascade training and providing equipment, there are no running costs. Sitting Netball has a long-term impact. All care homes involved in the pilot continued delivery after the eight weeks, with some increasing delivery of sessions to two per week.
London Sport is not inherently a delivery organisation. Therefore by England Netball agreeing to take on Sitting Netball, we have ensured its continuation. With our advice, they have set a cost to provide training, equipment and monitoring to care homes in the future, making it economically viable and offering support in the future.
As well as growing in care homes via local authorities, we have had interest from wider charities to deliver the initiative in sheltered housing and leisure centres. We presented the findings at the Margaret Butterworth Care Forum at Kings College London to an audience of dementia specialists. We also shared the findings on our Data and Insight Portal and social media channels as well as progressed in two key areas below.
Sutton Council: Following the pilot in Harrow and Barnet, the next borough chosen to deliver Sitting Netball was Sutton. This is because Sutton Clinical Commissioning Group has Vanguard status, one of only six enhanced health in care home Vanguards in England. Vanguards take a lead on new care models which will act as the blueprints for the NHS moving forward, inspiring the rest of the care system.
Academic Research: We met with a Dementia & Sports Reminiscence, Memory & Nostalgia PhD student. As a netball Superleague player, with a background in statutory social care and the third sector, she is interested in using the initiative as a focus for her research.