Step Four: Delivery and Maintenance

K) Train CHAP Volunteers

Once session dates have been confirmed, you can run the training for the CHAP Volunteers. The Local CHAP Coordinator will contact the CHAP Volunteers to confirm the dates of the training sessions.  Participation in both training sessions is mandatory.

Training sessions should allow ample time for questions and hands-on experience with the automated blood pressure measuring device and the Risk Profile Recording Forms. (Appendix 7.3)

Appendices 6.2 and 6.3 are PowerPoint presentations for both training sessions that can be downloaded and modified to best suit the needs of your CHAP Volunteers.

Following the training session, each volunteer must sign a CHAP Volunteer Letter of Understanding (Appendix 6.4) in order to continue to participate.

The topics to be covered during the training sessions include:

  • General background and understanding of cardiovascular health issues.
  • Details on the workings of the CHAP sessions, including a list of all CHAP materials to be handed out to participants.
  • The role of the CHAP Volunteers.
  • The role of the Designated CHAP Health Care Professional (( A ‘Designated CHAP Health Care Professional’ is anyone whose scope of practice includes assessing blood pressure.  This may include a pharmacist, physician, nurse, nurse practitioner or registered practical nurse (RPN).  In other CHAP communities, a public health nurse has filled this role.))
  • CHAP protocols, based on Hypertension Canada’s guidelines.
  • Local resources for health promotion and or community programs.
  • Review of the blood pressure equipment, and all forms and protocols.

All CHAP Volunteers should be familiar with:

  • Participant Sign-in Sheet (Appendix 7.1)
  • Participant Consent Form (Appendix 7.2)
  • Risk Profile Recording Form (Appendix 7.3)
  • Blood Pressure Recording Card (Appendix 7.4)
  • CHAP Session Schedule
  • Resources from the community

Note: It is very important to emphasize in all your dealings with volunteers or potential volunteers that they are not expected to ever provide any medical advice or interpret findings for participants.  They help participants assess their likelihood of developing cardiovascular disease, with standardized equipment and protocols following guidelines from Hypertension Canada.

L) Host CHAP Sessions:

There are several components necessary to ensure CHAP sessions run smoothly and continue to be responsive to the communities’ needs.

At a minimum, at each CHAP session, participants should:

  • Sign the Participant Sign-in Sheet (Appendix 7.1)
  • Complete the Risk Profile Recording Form (Appendix 7.3)
  • Complete the Blood Pressure Recording Card (Appendix 7.4)

As required, participants should:

  • Sign Participant Consent Form (signed at first visit, then annually) (Appendix 7.2)
  • Receive a copy of the CHAP Session Schedule
  • Be offered resources from the community
  • Complete other assessments, if the community is also screening for other risk factors (e.g. Diabetes, falls risks, mental health issues, etc.)

If possible, the CHAP Local Coordinator should try to take some photos to document the sessions for evaluation and future promotion. Be sure to obtain permission from anyone appearing in the photographs (Appendix 2.9).

Health Promotion Resources for CHAP Sessions:

It is important to have health promotion materials that cover all of the modifiable risk factors for heart disease, diabetes, and stroke; this includes physical activity, healthy eating, and smoking cessation. Providing a high number of resources to CHAP participants is not as important as providing a select few that reflect the individual needs of each participant and their personal objectives.

Several National and International Stroke and Hypertension organizations have excellent resources. There are also a number of sources in your community, which may have good materials, including:

  • Local Public Health Unit
  • Local parks and recreation programs
  • Local YWCA/YMCA
  • On-line resources from your local branch offices of the Ontario Heart and Stroke Foundation, Kidney Foundation and Diabetes Association

CHAP Session Set-Up

Each CHAP session location will be set up differently.

See the Figure on the following page for an example.

Each CHAP session should have:  a greeting station, waiting area and blood pressure station.  Local CHAP Coordinators should arrive at each session at least 20-30 minutes early to set up each session.

List of items needed at each session:

Automated Blood Pressure Measuring Device CHAP Forms
Tables Binder/Container for completed forms
Clipboards Duct tape
Name Tags Power bars and extension cords
CHAP Poster Tape to mount Poster
Chairs Sticky notes
Education Materials/Local resources Extra copies of the schedule
Pad of Paper

Depending on  additional screening your CHAP initiative may be including, other equipment may be required; (e.g. a scale, measuring tape, etc.)

As the sessions continue, the Local CHAP Coordinator has to ensure the equipment is in working order  and resources are replenished. Volunteer recruitment should be ongoing as required, and training  should be offered regularly to maintain the quality and standard of the sessions.

M) Manage CHAP data and Evaluate

The blood pressure readings and health information collected at each session must be handled appropriately to ensure privacy and confidentiality. CHAP data should be safeguarded as with any other patient information.    Some CHAP initiatives are directly linked to patients’ medical records at a clinic or pharmacy.  For participants who do not have their data sent directly to their health care provider, it must be stored in a way which safeguards their identity and follows protocols for privacy legislation for their province or territory. (E.g. Ontario’s Personal Health Information Protection Act (PHIPA), https://www.ipc.on.ca/health/your-health-privacy-rights-in-ontario/ ).  Any form or document containing participant information that is not to be kept must be shredded, not put into the garbage.

CHAP Session Blood Pressure Protocol Protocol (Appendix 4.4)

The public health nurse /Designated CHAP Health Care Professional, (( A ‘Designated CHAP Health Care Professional’ is anyone whose scope of practice includes assessing blood pressure.  This may include a pharmacist, physician, nurse, nurse practitioner or registered practical nurse (RPN).  In other CHAP communities, a public health nurse has filled this role.)) Local CHAP Coordinator and all CHAP Volunteers should be well versed on the protocol.  Referring physicians and pharmacists should have been given an opportunity to review the protocol.

The Designated CHAP Health Care Professional (( A ‘Designated CHAP Health Care Professional’ is anyone whose scope of practice includes assessing blood pressure.  This may include a pharmacist, physician, nurse, nurse practitioner or registered practical nurse (RPN).  In other CHAP communities, a public health nurse has filled this role.)) must be available throughout the sessions and during the volunteer training sessions so that they can be reached for cases requiring referrals or for general questions.

Evaluation:

 Continuous Program Evaluation is a systematic, step-by-step process where you collect information about your program in order to make decisions about ways to improve it.

A list of activities and tools to conduct a local program evaluation of your community’s CHAP sessions are provided in this section and Appendix 8.  It may be helpful for the Local CHAP Coordinator to develop program evaluation objectives specific to the community.

Program Evaluation minimal data collected:

  1. Metrics of the CHAP sessions
  2. CHAP Volunteers’ Feedback Questionnaire.
  • CHAP Community Engagement.
  1. Participating physician or pharmacist survey.
  2. Metrics of CHAP sessions:

As a minimum, the following statistics should be recorded at every session, starting at the very first CHAP session:

  • Number of CHAP sessions held;
  • Total number of blood pressure assessments conducted;
  • Total number of unique participants;
  • Average number of visits per participant over a standard period (i.e. 6 months)
  • Number of times a Designated CHAP Health Care Professional,(( A ‘Designated CHAP Health Care Professional’ is anyone whose scope of practice includes assessing blood pressure.  This may include a pharmacist, physician, nurse, nurse practitioner or registered practical nurse (RPN).  In other CHAP communities, a public health nurse has filled this role.)) physician or pharmacist was consulted following the Blood Pressure Recommendation Protocol;

Any anecdotal information from CHAP participants or other health care providers also gives valuable context to how CHAP is working in the local community.

  1. CHAP Volunteer Feedback (See Appendix 8.1.)

This provides volunteers with an opportunity to give input and ideas about the CHAP sessions;  to enhance both their experience as a volunteer and the program itself.

It is recommended that CHAP Volunteers complete a feedback questionnaire every 6 to 12 months; and at least once per year.

If there is an abrupt increase in volunteer turnover, it may be necessary to have volunteers complete the questionnaire more often.

Note: It is also very important to thank and acknowledge the CHAP Volunteers.  Present each Volunteer with a certificate thanking them for their participation, and at least once a year, plan a thank you dinner/luncheon to acknowledge their invaluable contribution to CHAP.    See Appendix 2.12,  CHAP Volunteer Appreciation Certificate.

  • CHAP Community Engagement (See Appendix 8.2)

This provides a snapshot of the overall impact of CHAP in the community.  The Local CHAP Coordinator should complete this form with assistance from the Local Lead Organization, if necessary.  A copy of this information should be passed on to CHAP Central, care of: Dr. Lisa Dolovich lisa.dolovich@utoronto.ca , Dr. Janusz Kaczorowski , janusz.kaczorowski@umontreal.ca   or Dr. Gina Agarwal  agarg@mcmaster.ca .

  1. Participating Physician or Pharmacist Surveys (See Appendix 8.3, 8.4);

Local health care providers including physicians, pharmacists, nurses, Family Health Teams, Community Health Centres and nurse practitioners are the foundation for implementing CHAP in your community.  The Local Lead Organization and Local CHAP Coordinator can benefit from valuable insight about how the sessions are run, and how to best recruit participants.   It is suggested these surveys are distributed once a year.

Knowledge Transfer

After you complete your evaluation, sharing your successes and challenges with other CHAP communities will enrich the knowledge and learnings for everyone.  As we pool our experiences, it will be easier to expand CHAP to more and more people.  Please consider sharing any evaluation findings with CHAP Central, care of one of the Principal Investigators:

Dr. Lisa Dolovich lisa.dolovich@utoronto.ca , Dr. Janusz Kaczorowski , janusz.kaczorowski@umontreal.ca   or Dr. Gina Agarwal  agarg@mcmaster.ca  

Additional Program Evaluation Resources: