Promoting health through physical activity: Collaborative leadership between a community health center and the YWCA

Lack of access to safe, affordable exercise is a key factor impeding low-income inner city residents adopting healthier lifestyles. Community health center administrators can offer patients access to physical activity through collaborating with local physical fitness facilities. Our health center purchased 3 YWCA institutional memberships, allowing up to 12 patients to exercise simultaneously. Clinicians completed an exercise release form and patient identification card for the YWCA. YWCA administrators provided guidance to staff on issues related to diversity, and staff offered a brief initial patient orientation. Through prospective analysis of 24 months of adult patient exercise, retrospective chart review of HbA1c changes of patients with diabetes, and in-depth interviews with health center and YWCA staff, we found that: 1060 patients (including 112 with diabetes) made 14,276 exercise visits in 24 months. A higher proportion of health center exercisers were female (66% vs 60%) and were Hispanic (56% vs 43%). Among these patients with diabetes, 27% had 24 or more visits and their overall average HbA1c fell 1%. Patients with diabetes who had between 12 and 23 visits (17%) experienced a 0.9% HbA1c reduction. While the partnering organizations had similar missions, administrators faced conflicts presented by the process of bringing together differing cultures and expectations. Additional challenges developed from offering open access, while ensuring that low-income, deconditioned patients understood how to become active, responsible facility users. Crucial to the success of this collaboration was the YWCA leadership's commitment to addressing cultural humility. Developing strategies to meet the needs of this newly participating low-income urban population required the YWCA to develop new language capacities and hire a more diverse staff. Moreover, the partnership had to grapple with the unique challenges of success by modifying the parameters of the program when the sheer volume of participating health center patients threatened to overwhelm it.