Health Promotion Board Health Promotion Toolkit

Community Health Promotion Toolkit A Practical Guide to Planning and Organising Health Promotion Programmes in the Community

www.hpb.gov.sg 1800 223 1313

The Community Health Promotion Toolkit guides community partners to plan and implement programmes to improve the health of their communities.

This Toolkit includes: • tips on planning health promotion programmes for the community • a checklist of recommended community health promotion programmes • information on how the Health Promotion Board can support community health promotion programmes • guidelines on organising health promotion activities The Health Promotion Board (HPB) will be happy to partner you to improve the health of your community. Should you be interested to find out more, please contact us at HPB _HealthyTogether@hpb.gov.sg

Contents Planning for the Community

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Health Promoting Community - Checklist

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Health Promotion in the Community A. Health Promotion Programmes

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• General Public • Seniors • Children, Youth and Parents • Volunteers and Caregivers

B. Health Promoting Touchpoints C. Health Ambassadors D. Constituency Health Promotion Grant Guidelines on: A. Setting up Fitness Corners B. Organising Health Screening C. Serving healthier food at events

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Planning for the Community Residents can learn more about healthy lifestyle through various activities such as talks, workshops, demonstrations and interest groups. To determine which programmes are appealing to the residents and can help to motivate them to adopt a healthier lifestyle, here are some tips for you:

• Know the profile of your residents. For instance, if there are more seniors in your community, you may wish to start by having programmes for them. This will help in prioritising which groups of residents to reach out to.

• Understand the health issues of your residents. For the general public, the health concerns will include unhealthy dietary habits and a lack of regular physical activity. In the case of older adults, they are at higher risk of chronic conditions and should be encouraged to go for regular health screening and follow-up. For more information, you can refer to the National Healthy Survey 2010 at http:// www. moh.gov.sg/content/moh_web/home/Publications/ Reports/2011/national_health_survey2010.html • Know the interest of your residents. If they prefer interactive activities, the health programmes should include more hands-on activities such as games. Informal conversations, general observations and focus group discussions are some ways of finding out the interests of the residents HPB has various tools to assess the needs of your community. Should you be interested to find out more, please contact us at HPB_HealthyTogether @hpb.gov.sg

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Health Promoting Community Checklist Health Promoting Touchpoints* • • • • •

This checklist highlights key initiatives to make healthier choices more accessible in the community.

Health Promoting Community Centres Health Promoting Residents’ Corners Healthier Hawker Centres Fitness Corners Parks

Health Ambassadors • Volunteers to promote and inspire healthy lifestyle in the community

Health Promotion Programmes • Interactive talks (e.g. healthy eating, mental wellbeing) • Experiential workshops (e.g. supermarket tour, parenting workshops) • Regular group activities (e.g. weekly exercise sessions) • Interest groups (e.g. Rummy-O)

* These are some examples of existing community infrastructure which can be used to encourage the adoption of a healthy lifestyle.

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Health Promotion in the Community

The Health Promotion Board (HPB) has developed a wide range of programmes for the community to stay healthy. These programmes are designed to benefit the different age groups.

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A.

Health Promotion Programmes

For General Public Cooking Demonstrations Trainers will share nutrition tips as well as practical knowledge on how to prepare healthier, affordable and tasty meals ideal for the entire family.

Target group: Language: Duration: Cost: Number of participants:

“

General public English, Mandarin or Malay 1 hour - 1 hour 30 mins S$180 per session Minimum 20 persons

The free recipes allow me to cook healthy and delicious meals for my family.

”

- Ms Fatimah, participant of a Cooking Demonstration session

Supermarket Tour The supermarket tour will cover the basics of nutrition – how to read food labels, how to choose healthier products and practical healthier cooking tips.

Target group: Language: Duration: Cost: Number of participants:

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General public English, Mandarin or Malay 1 hour S$6 - S$8 per person About 10 persons

Falls Prevention Talk Falls can result in disability and even death. Falls can often be prevented.

The talk will educate the public about practical steps to prevent falls through medication review, participation in physical activity, vision checks and keeping the home environment safe and clutter-free.

Target group: Language: Duration: Cost: Number of participants:

General public English, Mandarin or Malay 1 hour Free 20 to 200 persons

Osteoporosis Prevention Workshop Osteoporosis can lead to fractures in later years. The impact of such fractures can be devastating as it often results in disability or even death.

Healthy nutrition and regular exercise can help to prevent osteoporosis.

Through fun and engaging activities, workshop participants will pick up useful nutrition tips and exercises to build strong bones.

Target group:

Language: Duration: Cost: Number of participants:

All adults. Highly recommended for women aged 45 years and above English, Mandarin or Malay 2 hours Free 30 to 100 persons

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For Seniors Community Health Screening The risk of developing chronic diseases, certain cancers and functional decline increases with age. Regular screening will detect such conditions early and allow for timely treatment to prevent serious complications.

This programme will screen for: • Chronic diseases (obesity, high blood pressure, high blood cholesterol and diabetes) • Cancers (breast, cervical and colorectal cancers) • Functional decline (vision, oral health, physical function, mood, continence and hearing) On-site counselling will be available for residents with abnormal screening results. Appropriate healthcare professionals may also be on-site to provide one-stop follow-up for residents attending the functional screening.

Target group:

Language: Duration:

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Chronic Disease Screening: 40 years and above Cancer Screening: 50 years and above Functional Screening: 60 years and above English, Mandarin or Malay Chronic disease screening: 15-20 minutes per person Cancer screening: 15-20 minutes per person Functional screening: 30 minutes per person

Cost:

Chronic disease screening: - S$8 subsidy for eligible persons Cancer screening: - Pap smear (Cervical Cancer) $15 per person - Mammogram (Breast Cancer) S$50 per person - Faecal Immunochemical Test (FIT) kit (Colorectal Cancer) S$5 per person Functional screening: - S$5 per person on weekends S$2 per person on weekdays

Number of participants:

25 to 150 persons, depending on the type of health screening

Wellness Circuit The Wellness Circuit is a holistic activity-based programme where participants will learn more about Mental Wellness, Healthy Eating and Physical Activity and be equipped with the knowledge to improve their overall health and wellbeing.

Target group: Language: Duration: Cost: Number of participants:

Adults 50 years and above English, Mandarin or Malay 1.5 to 2 hours Free 18 to 36 persons

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Mental First Aid Kit (MFAK) The programme aims to optimise the mental wellbeing of participants through interactive and experiential activities. There are 2 modules.

Module 1: Nurture Your Mind* (NYM) To empower seniors to optimise their mental wellbeing, this Module will include 3 sessions of workshops and 4 sessions of Mentalympics (games such as Bingo and Rummy-O which stimulate cognitive function).

Participants who have completed the NYM module will be invited to a graduation ceremony.

Module 2: Stimulate Your Mind* (SYM) To equip participants with practical skills and knowledge to keep themselves cognitively stimulated and optimise cognitive function, this Module will be conducted over 5 sessions and will focus on memory, reasoning and speed of processing information. *Modules can be run separately.

Target group: Language: Duration:

Adults 50 years and above English, Mandarin or Malay NYM: Once a week for 7 consecutive weeks with 3 hours for each workshop and 2 hours for each Matalympics session SYM: Once a week for 5 consecutive weeks with 1.5 hours for each session Cost: Free Number of participants: 30 to 40 persons

“

I have learnt about reasoning, how to remember things better and how to solve problems using techniques such as classification and speed of processing.

”

- Mr Lum, participant of the “Mental First Aid Kit” programme

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For Children, Youth and Parents Healthier Child, Brighter Future Workshops Healthy children and teenagers will grow up to become healthy young adults. Establishing a healthy lifestyle from young will put them in good stead for better health outcomes later in life. The range of interactive workshops aims to nurture the health and well being of the young aged 3 to 12 years old.

Target Group : Language : Duration : Cost: Number of participants:

“

Children, Youth and Parents English, Mandarin or Malay 1 to 3 hours per workshop Free 20 to 30 persons

What benefited me the most is learning about the choice of food that I give to my kids...and how to manage my temper when handling my kids.

- Ms Siti, participant of a “Healthier Child, Brighter Future” workshop

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For Volunteers and Caregivers Falls Prevention Workshop This is a train-the-trainer programme targeted at volunteers, staff of community organisations as well as caregivers. It is designed to train individuals on how to effectively communicate the message of falls prevention and empower caregivers to identify risk factors at home.

Target group: Language: Duration: Cost: Number of participants:

Volunteers, staff of community organisations and caregivers of elderly English, Mandarin or Malay 2 to 3 hours Free 15 to 30 persons

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B.

Health Promoting Touchpoints

Health Promoting Community Centres (HPCC) A Health Promoting Community Centre/Club aims to empower the residents of all ages to lead a healthy lifestyle through the following features: a) Health-related programmes and courses b) Support from Health Ambassadors c) Conducive environment Health Promotion Programmes HPB will co-plan with the HPCC to organise a wide range of health-related programmes to cater to the different needs of the residents.

Health Ambassadors Health Ambassadors promote healthy living within the community and encourage the residents to lead a healthier lifestyle. Once volunteers are recruited as Health Ambassadors, HPB will equip them with the necessary knowledge and skills before they are deployed to the HPCC to promote healthy lifestyle at events or other platforms such as health interest groups*.

Conducive Environment HPB will work with the CCs to enhance the existing facilities to promote a healthy lifestyle. For example: a) An Interactive Health Corner with Body Mass Index (BMI) machine and educational activities with health messages b) Visual cues (e.g. floor stickers) and banners with health messages c) Brochure stands with health education resources d) Consultation for eateries in the CC to provide healthier choices *Please refer to page 14 for more details.

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Health Promoting Residents’ Corners (HPRC) A Health Promoting Residents’ Corner is a dedicated RC that will empower residents of all ages to lead a healthy lifestyle through a combination of health promotion programmes, support from Health Ambassadors as well as a conducive physical environment to support healthy living.

Health Promotion Programmes HPB will co-plan with the HPRC to organise more health promotion programmes to cater to the different needs of the residents living around the RC. In so doing, the HPRC offers residents convenient access to such programmes.

Health Ambassadors Health Ambassadors promote healthy living within the community and encourage the residents to lead a healthier lifestyle. Trained Health Ambassadors will be deployed to the HPRC to promote healthy lifestyle at events or other platforms such as health interest groups*.

Conducive Physical Environment HPB will provide visual cues (e.g. wall stickers) and banners with health messages, and brochure stands with health education resources to encourage the adoption of healthier lifestyles. *Please refer to page 14 for more details.

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Healthier Hawker/Coffee Shop Programme About 60% of Singaporeans eat out at hawker centres, food courts and coffee shop stalls at least four times per week*. To enable Singaporeans to eat healthily, the “Healthier Hawker Programme” and “Healthier Coffee Shop Programme” were introduced. Participating hawker centres and coffee shops offer healthier choices such as wholegrain noodles, brown rice, healthier oil and salt. Calorie counts of the food sold are also clearly indicated on the menu boards to help comsumers make healthier choices. *National Nutrition Survey 2010

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C.

Health Ambassador Programme

Under this programme, volunteers will be equipped with the knowledge on health topics such as weight management and chronic diseases – (e.g. high blood pressure, diabetes) as well as effective communication and mentoring skills to promote healthy lifestyles. Upon completion of the training, Health Ambassadors will reach out and inspire people to lead a healthy lifestyle through their social networks, events and daily interactions with others in the community.

Target group:

Volunteers who are: a) Committed to leading a healthy lifestyle b) Passionate about inspiring others to lead a healthy lifestyle c) Committed to reach out to others through HPB’s activities

Training:

Health Ambassadors will be required to complete 3 training modules over 12 hours as well as an assessment prior to deployment in the community.

Volunteer Hours:

12 hours

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D.

Constituency Health Promotion (CHP) Grant

How does the Grant work?

The CHP Grant will be administered on a co-funding basis. HPB will fund S$5 for every S$1 the constituency contributes towards their health promotion initiatives.

How much is the Grant?

HPB will fund a maximum of S$10,000 per constituency per year. However, depending on the merit of the proposal, a larger grant amount may be granted on a case-by-case basis*.

What can the Grant be used for?

The Grant can be used primarily for • initiatives targeting the different age groups in the following priority areas: – obesity prevention (nutrition & physical activity) – mental health – tobacco control – chronic disease management – cancer screening • infrastructure transformation to facilitate healthy living in the constituency • incentives to encourage residents to embrace healthy lifestyles and participate in appropriate health promoting initiatives

Who can apply for the Grant?

The Grant is open to all the constituencies in Singapore.

What is the period of the Grant?

The Grant is open for application from April each year and the Grant has to be utilised by end of March the following year

How is the Grant disbursed?

Upon approval of the grant proposal, the Grant may be disbursed partially every quarterly for activities that have been conducted and/or items purchased. All submissions for reimbursement have to be completed by end of March the following year.

The total amount disbursed will be based on the approved budget or actual expenditure, whichever is lower.

*Additional amounts may also be granted on a co-funding basis where HPB will fund S$5 for every S$1 the constituency contributes towards their health promotion initiatives

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Guidelines On Setting Up Health Promoting Infrastructure & Community Events The following set of guidelines will help you: A. set up and maintain fitness corners B. organise health screening activities C. provide healthier food at events

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A.

Guidelines On Set Up And Maintenance Of Fitness Corners

Physical activity not only helps one to look and feel good, it also gives one more energy to enjoy a healthy life. 150 minutes of physical activity every week will help one to reduce the risk of heart disease, stroke and chronic diseases such as diabetes and high blood pressure. The following provides guidelines1 on setting up and maintaining the Fitness Corners in the community.

1. Design & Maintenance •

For safety, fitness corners should be designed for individuals aged 12 years and above. There should be a signage to inform the public of the age recommendation and safety measures.

•

Ensure the flooring surface provides sufficient shoe-grip to prevent falls and is made of a material that is able to cushion falls.

•

Carry out regular checks for damage caused by wear and tear and vandalism as faulty equipment will increase the risk of injury and falls.

2. Sequencing of Equipment •

Place equipment in the sequence shown below and include designated areas for warm-up and cool-down/flexibility exercises.

•

Ensure there is smooth transition of exercises beginning with warm-up, followed by strength exercises, aerobic/cardio exercises and ending with cool-down/flexibility exercises.

Area 1

Area 2

Warm-Up/Cool-down Stations:

Strength Stations ◆: - Chest Press - Leg Press - Seated Row - Leg Curl - Shoulder Press - Crunches/Sit-Up

- Open Space with signages (for PAR-Q* and stretching exercises)

* PAR-Q stands for Physical Activity Readiness Questionnaire ◆

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Please see pages 18 to 19 for details.

Area 3 Aerobic/Cardio Stations: - Elliptical Trainer - Stepper - Stationary Bike - Hand Ergometer

3. Installation of Signages •

Install the Physical Activity Readiness Questionnaire (PAR-Q)* signage at a visible area of the fitness corner to help users decide their readiness for physical activity.

•

Install instructional/educational signage for each exercise equipment and include information on: – proper technique on use of the equipment – range-of-motion – number of repetitions and sets – highlight muscle groups used – intensity scale

•

Provide instructions and information in different languages.

4. Recommended Outdoor Fitness Equipment Strength Equipment • Use of equipment should involve major muscle groups: legs, hips, back, abdomen, chest, shoulders and arms (e.g. 1 to 6).

• If cost and space are constraints, the equipment should at least include upper body, lower body and core exercises.

1) Chest Press – Chest and Arms

2) Leg Press – Legs and Hips

2) Seated Row – Back and Arms

*Please refer to http://www.hpb.gov.sg/parq for details to be included on the PAR-Q signage

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4) Leg Curl – Legs

5) Shoulder Press – Shoulders and Arms

6) Crunches/Sits-ups – Abdominals

Aerobic/ Cardio Equipment Elliptical

Stepper

Stationary Bike

Hand Ergometer

1 The information above is based on recommendations by the Health Promotion Board’s (HPB) Physical Activity Centre of Excellence, in consultation with the National Physical Activity Consensus Group.

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B.

Guidelines On Organising Health Screening In The Community

Health screening helps a person find out if he/she has a particular disease even though there may be no obvious symptoms or signs. This is done with simple tests or physical examinations. Early detection, followed by treatment can result in better health outcomes and less risks of complications. The following are guidelines1 on how to organise health screening in the community.

1. Recommended Tests for Community-based Health Screening Who should be screened?

Individuals aged 18 years and above

Individuals aged 40 years and above

What is the screening for?

What are the recommended screening tests?

How often should the screening tests be carried out?

Obesity

• Body Mass Index (BMI) • Waist circumference

Once every year

Hypertension (High blood pressure)

• Blood pressure measurement

Once every two years or more frequently as advised by the doctor.

• Fasting blood Diabetes mellitus glucose 2 (High blood glucose)

Once every three years or more frequently as advised by the doctor

Hyperlipidaemia (High blood cholesterol)

• Fasting lipids3

Individuals aged 50 years and above

Colorectal cancer

• Faecal immunochemical test (to test for blood in stools)

Once a year

Individuals aged 60 years and above

Functional Decline

• Questionnairebased and simple checks (no blood taking)

Once a year

1 The

information is based on recommendations by the Screening Test Review Committee, comprising representatives from the Academy of Medicine, Singapore (AMS) and the Health Promotion Board (HPB).

2 When screening for diabetes mellitus, fasting venous blood glucose should be used. Finger-prick tests (using Glucometer) are used to monitor blood glucose level for diabetic patients. It should not be used for screening.

3 For lipid screening, a fasting venous sample should be collected. Finger-prick tests do not provide a full lipid profile or panel which includes total cholesterol, triglycerides, high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C).

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Additional Tests for Women Once every three years

Women aged 25-69 years, who have had sexual intercourse

Cervical cancer

• Pap smear

Women aged 50-69 years

Breast cancer

• Mammogram Once every two years

2. Post-screening Follow-up •

Ensure that there is appropriate follow-up after the screening (e.g. encourage residents with abnormal results to see a doctor for medical follow-up).

Screening Results Normal

Action for individuals Continue to go for regular screening at the recommended frequency because screening only detects health conditions that are present at the time of screening.

If any signs or symptoms develop after screening, please see a doctor as soon as possible and do not wait for the next screening appointment.

Abnormal

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Follow-up with a doctor immediately. Early treatment and good control of disease can result in better outcomes and prevent or delay serious complications.

C.

Guidelines On Providing Healthier Food At Community Events

It is common to provide food at community events. The following provides guidelines on how to select healthier food at community events.

1. Healthier Food Products It is recommended that community organisations consider the following when distributing food products at community events or in goodie bags: •

make fruits and plain water the default food choice for goodie bags

•

choose food products with the Healthier Choice Symbol (HCS). These are generally lower in fat, salt and sugar, and some are higher in dietary fibre and calcium compared to similar products within the same food category

Please refer to the following URL for a comprehensive list of products with the Healthier Choice Symbol: http://www.hpb.gov.sg/hpb/pro/pro0402a.asp

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2. Healthier Catering When catering for receptions, it is recommended that the following guidelines be followed: General guidelines • Ask the caterer for their healthier menu. You may refer to the Health Promotion Board’s (HPB) list of caterers1 offering the healthier menu • From this menu, ensure that half of the total items ordered have the Healthier Choice Symbol • Request for reduced fat, oil, salt and sugar in the food items ordered Food Items • If a rice or noodles item is required, opt for brown rice and whole-grain noodles respectively • Offer sufficient vegetables by ensuring that at least 1 out of every 5 items is a vegetable-based dish • Limit deep-fried food to 1 out of every 5 items2 • Choose mixed fresh fruits for dessert as far as possible. If other desserts are preferred, limit high-fat desserts (e.g. chendol) and pastries to 1 out of every 5 items2 Beverages • Always request for plain water as one of the beverages • Request for low-fat milk instead of creamer and serve it separately from the beverages

Please refer to the following URL for a list of caterers offering the healthier menu: http://www.hpb.gov.sg/HOPPortal/health-article/2772 1 All the caterers listed meet HPB’s guidelines for healthier catering by having at least half of the dishes prepared with less oil, salt and sugar and more fruit and vegetables.

2 If 10 items are catered, there should only be 2 items which are either deep fried or with high fat content such as dessert/pastries.

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