This was a cross-sectional study using mixed-methods. Audits of HWE programs and survey results from HWE program participants are presented. The study protocol was approved by York University’s Office of Research Ethics (e2014 - 376). The Ottawa Health Sciences Network Research Ethics Board granted an ethics approval exemption for this study.
The HWE program was launched in 2007 in the greater Ottawa area of Ontario, Canada. Community-based exercise facilities, both private and publically-funded, were approached regarding the HWE model. Facilities offering both group and individual exercise sessions (e.g., personal training) are eligible to join HWE. Steps required before a formal HWE agreement was signed included a site visit to ensure the six criteria were met, completion of a HWE training program by the fitness leader(s), and agreement to the Terms and Conditions, which include a statement that the program agrees to be audited for quality purposes.
The HWE program was expanded to other regions in the province of Ontario. In particular, it was also expanded to the greater Toronto area in 2009. Facilities put HWE signs in their reception areas and designate specific classes as HWE.
Auditors were university-level kinesiology students who received HWE program training, and were instructed on the elements of the audit form and its’ application in the field. The auditors sent a standardized email to facility contacts to arrange a site audit of HWE classes (i.e., HWE logo, advertised for clients’ chronic disease). If more than one HWE class was offered per week at a particular site, the auditors evaluated a subsequent class, if the site and exercise leaders were agreeable.
On the day of the audit, the auditors first recorded observations from the reception area of the facility, before introducing themselves to the exercise leaders. Exercise leaders were often not aware the audit would be occurring. The audit evaluated whether the HWE-designated session met program criteria using a standardized checklist (see Additional file 1). Some of the audit questions were asked of the fitness leaders prior to the beginning of the class (see notation in Additional file 1). HWE classes were then observed, as well as post-program interactions between participants and exercise leaders.
A survey was administered to a convenience sample of HWE program participants at the end of the audited classes. Participants were provided three options for completing the survey. They could (1) complete a paper-based format at the end of the class, (2) take the paper-based survey home to complete (they were provided with a pre-paid, self-addressed envelope), or (3) complete the survey online at home (SurveyMonkey, Palo Alto, California, USA). Participants choosing the latter option were provided a sheet with a link to the survey to take home. All audits were completed between October, 2014 and March, 2015.
Sample: sites and participants
At the time of the study, there were 230 facilities formally designated as HWE across Ontario, of which 47 (20.4 %) were in Toronto and 51 (22.2 %) were in Ottawa. A convenience sample of HWE programs offering group exercise classes in the Toronto and Ottawa areas were approached. The facilities were selected if they had signed on to the HWE program at least two months prior, were not a pilot site for the audit checklist, and they had not been informally audited in the last six months. Individual conditioning sessions were excluded.
A convenience sample of HWE class participants were approached to participate in the survey. Auditors attempted to invite all exercise session participants to complete the survey by asking the exercise leader to announce the survey at the end of all audited classes, however this was not possible in all cases (e.g., time didn’t allow, exercise leader declined or forgot, some participants left before the end of the class). Inclusion criteria were being able to read and understand English.
The standardized checklist for the audits (see Additional file 1) was based on the six HWE criteria. The audit form was piloted in October 2014 at several sites in the greater Ottawa area. Both the audit form and participant survey, as described below, were developed by experts in the areas of community programming, exercise training, chronic disease management, and program evaluation.
The participant survey items were investigator-generated. Questions pertained to chronic disease diagnoses and risk factors, how they became aware of the HWE program, their satisfaction with the exercise class, their frequency and duration of participation, as well as some items related to HWE criteria. Response options were primarily multiple-choice or Likert-type scales. Again, the items were piloted at several sites in the greater Ottawa area.
A descriptive examination of audit findings and participant survey responses was performed. Data are reported as means ± standard deviations, unless otherwise noted. Valid percentages were reported when there was missing data (i.e., the denominator was reduced to reflect not the total sample size but the number of valid responses). All data were analyzed using IBM SPSS for Windows (version 23; Chicago, IL, USA).