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The Implementation and Outcomes of Exercise Is Medicine on Campus

Wilson, Oliver William Albert; Bhuiyan, Nishat; Papalia, Zack; Bopp, Melissa

Translational Journal of the American College of Sports Medicine: October 15, 2018 - Volume 3 - Issue 20 - p 158–168
doi: 10.1249/TJX.0000000000000071
Original Investigation
Free

Widespread implementation of Exercise Is Medicine® on Campus (EIM-OC) has the potential to address college student physical inactivity; however, limited research has comprehensively assessed how EIM-OC is operationalized at campuses.

Purpose This study aimed to assess EIM-OC implementation and outcomes at various academic institutions.

Methods A survey was developed in consultation with key EIM-OC stakeholders and administered online among EIM-OC representatives. Data collected included institutional information; promotion, education, and healthcare system integration; partnerships; challenges; and goals. Descriptive statistics were used to explore institution characteristics and other variables. Thematic analysis was conducted to identify the dominant themes and subthemes in qualitative data collected from open-ended questions.

Results Forty-one responses were received from a diverse group of academic institutions ranging in size (<10,000 to >50,000 students) and type (public and private). Campus recreation departments, campus health providers, and student organizations/clubs emerged as the most important partners. Student involvement was critical to the success of many EIM-OC programs, with students involved in a range of roles from promotion (n = 20), leadership/organization/planning (n = 18), education (n = 16), implementation (n = 14), and data collection (n = 10). Implementing the physical activity vital sign emerged as a common challenge, with many institutions having no protocol in place for arranging a follow-up between students and physical fitness professionals after referral acceptances, and no protocol existing for referral declinations. Finally, social media was underused, with no social media platforms used by over a third of programs.

Conclusion EIM-OC programs at various institutions experienced similar challenges. This research will serve to inform and improve on the implementation and outcomes of EIM-OC programs and ultimately contribute to helping academic institutions increase the physical activity of students and their local communities.

Department of Kinesiology, Pennsylvania State University, University Park, PA

Address for correspondence: Melissa Bopp, Ph.D., 266 Recreation Building, Department of Kinesiology, Pennsylvania State University, University Park, PA 16802 (E-mail: mjb73@psu.edu).

Oliver Wilson and Nishat Bhuiyan are graduate research assistants at the Department of Kinesiology, Pennsylvania State University.

Dr. Melissa Bopp is an associate professor of Kinesiology at the Pennsylvania State University and director at the Physical Activity and Public Health Laboratory.

Zack Papalia is a graduate student at the Department of Kinesiology, a supervisor at the Center for Fitness and Wellness, and a campus coordinator of Exercise Is Medicine at the Pennsylvania State University.

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INTRODUCTION

College is characterized by the exploration of numerous alternative experiences and is influential in the adoption of an active lifestyle that may continue throughout one’s life (1). Insufficient physical activity (PA) potentially heightens the risk of students developing chronic diseases later in life, whereas regular engagement in PA may help students avoid serious future health and well-being issues (2,3). The high prevalence of physically inactive and insufficiently active individuals in this population is therefore concerning, with evidence suggesting that many students both within the United States (4–7) and internationally (8–14) accumulate insufficient levels of PA to benefit their health.

Universities are ideal settings for Exercise Is Medicine® (EIM), as college is a period during which many individuals develop lifetime health and wellness habits, combined with the availability of experts to facilitate and encourage the development of such habits, i.e., faculty, campus recreation, campus health, students, etc. (15). Exercise Is Medicine On Campus (EIM-OC) is an initiative by the American College of Sports Medicine (ACSM) that aims to foster and promote PA participation on college campuses. Thus, widespread implementation of EIM-OC has the potential for addressing the growing rates of physical inactivity among college students. Between its establishment in 2009 and the year 2015, EIM-OC was adopted by 85 North American institutions (16) and has since grown to 159 campuses in North America, as well as in Africa, Asia, Australasia, and Europe (17). A formative goal of the EIM-OC initiative was to provide universities with an opportunity to learn what other campuses were doing to promote PA and its health benefits (16). However, despite this, a limited number of studies have examined EIM-OC implementation or outcomes (16,18,19).

Bopp et al. (16) examined the effect of holding a series of EIM-OC events over the course of a week at a large U.S. university. Aside from the events enhancing the visibility of the Kinesiology Department, which has potential implications for the recruitment of future Kinesiology undergraduates with a strong interest in fitness/wellness, there were several other findings to come from this study. The involvement of a student club was noted as critical because of club members’ interest, leadership, and reach among the wider student body. An organizational structure overseeing EIM-OC facilitated effective and efficient decision making for planning, programming, logistics, etc. Support from the college dean and the university president was also important in raising the profile of EIM-OC activities within the campus community. EIM was ultimately integrated into the Kinesiology Department’s strategic planning, thus maximizing the likelihood of its future sustainment with this long-term commitment, which has the potential to guide resource and staffing allocation related to EIM-OC. The importance of institutionalizing EIM through partnerships with other campus departments, such as student health, athletics and fitness, campus planning, housing, and sustainability, was also stressed.

In support of the importance of institutionalizing EIM through the formation of partnerships, the establishment of good working relationships between faculty, campus health, campus recreation, and other parties has been identified as critical to the successful implementation of EIM-OC by subsequent studies (18,19). Top-down “buy in” from the university president, and subsequently the directors of the campus health center and campus recreation, aided in the establishment of these relationships (18). Previous research has also highlighted the importance of student involvement to EIM-OC success (16,18,19), from involvement in the design and implementation of activities during an EIM-OC week (16,19) to serving as exercise practitioners enabling the implementation of a referral system for insufficiently active students after the incorporation of PA as a vital sign assessed during university health center baseline checks (18).

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Institutional Struggles

Despite students, faculty, and student affairs (the department responsible for providing services and support to enhance student growth and development) staff standing to benefit from collaboration between faculty and student affairs staff (20), fostering such collaboration is often challenging given the groups’ differing perspectives on student development. Higher education institution departments are commonly perceived to operate in “silos,” stemming from the primarily vertical organization of institutions where different departments and programs work in parallel more focused on promoting internal goals and objectives than on collaborating to accomplish broader institutional purposes (21). Student affairs programs typically have the mission of addressing all students’ needs and are horizontal as they work across, yet have an integrative role in relation to the vertical structures (silos) (22). Identification of desired student outcomes, e.g., to have a healthy physically active student body, creates accountability across departments for achieving outcomes for the entire student body, which necessitates interdepartment collaboration (22). With respect to institutional change, Keeling et al. (22) stress the importance of insuring desired outcomes reflect what should be and not necessarily what has been or what is.

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Summary

There is a need to increase college student PA, and widespread adoption of EIM-OC has the potential to address this problem. In light of the limited preliminary evidence on the implementation and sustained programming of EIM-OC, there is a need to examine the implementation and outcomes of EIM-OC programming in further depth and compare between institutions. Therefore, this study aims to provide a greater understanding to inform and facilitate the implementation of EIM-OC where absent, further improve outcomes where EIM-OC has been implemented and, ultimately, help universities increase PA within the student body and their surrounding communities.

The overarching purpose of this study is to investigate the implementation and outcomes of EIM-OC and identify areas in which improvements can be made with respect to the delivery of EIM-OC.

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METHODS

Procedures and Data Collection

This cross-sectional mixed-methods survey study used Qualtrics software (Provo, UT) to collect data from universities with a registered EIM-OC program using an online questionnaire. The questionnaire was developed in consultation with members of the EIM-OC advisory group who were liaised with via email and telephone. The questionnaire was then distributed via email to EIM-OC representatives of each participating university with the assistance of the ACSM. Upon opening the survey, program representatives were given 1 week to complete the survey before the opportunity to complete the survey expired, although the estimated response time was approximately 20 min.

The Pennsylvania State University Institutional Review Board approved this study. Informed and voluntary consent was implied by representatives electing to continue with the survey after the presentation of the participant information sheet detailing how participant confidentiality and anonymity would be maintained.

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Measures

Measures were original and not derived from previously validated instruments/measures/surveys. Measures assessed one or more aspects of EIM-OC program implementation and outcomes. Response categories are noted below where appropriate.

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Institutional Characteristics

Characteristics information was collected using self-report items on country, and institution size (small <10,000, medium 10,000–25,000, large 25,000–50,0000, and very large >50,000), location (metro, nonmetro, and rural), funding (public vs private), and type (2-year community college, 4-year community college, undergraduate or undergraduate and graduate institutions).

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EIM-OC Program Background

Background information was collected using items on the following: date of EIM-OC registration, EIM-OC recognition-level milestones (noted below), EIM-OC program home (academic department, student health center, campus recreation, student club/organization, and other), EIM-OC program focuses (percentage of effort dedicated to student wellness, staff/faculty wellness, and/or community wellness), whether programs had an EIM-OC ambassador (yes/no), and selection of student leaders and student involvement in EIM-OC program (via separate open-ended questions). With respect to recognition levels, campuses can apply to be recognized as bronze-, silver-, or gold-level EIM-OC programs, which represent the degree of engagement in leading their campuses and communities to become healthier through PA promotion (23).

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Data Collection Methods

Methods of data collection were assessed using items asking whether programs collected information on the following: participation/engagement rates in EIM week/month; participation/engagement rates in other EIM-OC initiatives; student health, fitness, or PA outcomes; faculty/staff health, fitness, or PA outcomes; social media engagement; and an open-ended “other” item.

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PA Awareness Promotion

Promotional methods were assessed using items asking about the use of suggestions outlined in the 2016 EIM-OC Action Guide (24) and an open-ended “other” item.

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Social Media Utilization

Utilization of social media to promote EIM-OC was assessed via self-reported number of “followers” on four popular social media platforms (Facebook, Twitter, Instagram, and Snapchat).

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EIM Educational Activities

EIM educational activities offered were assessed using items asking about the use of ideas outlined in the 2016 EIM-OC Action Guide (24), and an open-ended “other” item.

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EIM-week/month

EIM week or month activities were assessed using a descriptive open-ended item.

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Healthcare System Integration

EIM-OC solution integration into the campus healthcare system was assessed using items asking about the use of idea suggestions outlined in the 2016 EIM-OC Action Guide (24), and an open-ended “other” item.

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Physical Activity Vital Sign

The physical activity vital sign (PAVS) refers to the assessment of moderate to strenuous exercise, and sometimes muscle strengthening exercises, by healthcare providers to assess whether patients are meeting national guidelines (25). Implementation of the PAVS was assessed using items asking about (i) the way(s) in which the healthcare provider assessed whether students were sufficiently or insufficiently active; (ii) the options offered to those identified as at risk, or insufficiently active; (iii) the responsible party, upon acceptance of a referral to a physical fitness professional, for following up and arranging a consultation (student, physical fitness professional, or both); and (iv) the protocol in the instance of referral declination.

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Partner Relations

Relationships with campus and local partners regarding EIM-OC were assessed by presenting a list of potential campus partners and asking representatives to do four things: (i) group campus partners into those they currently worked with, and those they did not currently work with but would like to; (ii) rank partner relationships by most value within groups; (iii) explain why they considered their top ranked partner the most important with an open-ended question; and (iv) in an open-ended question, indicate what had made establishing a relationship with nonpartners impractical and/or unsuccessful.

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Existing Challenges

An open-ended item asked representatives to describe what they considered the greatest challenge currently faced by their EIM-OC program.

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Implementation Challenges

An open-ended item asked representatives to describe what they wish they had known before implementing EIM-OC.

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Collaboration

Collaboration between EIM-OC programs was assessed using an item asking (yes/no) whether the EIM-OC program had collaborated with programs at other academic institutions in any capacity outside of an ACSM conference or EIM-OC week/month. Open-ended items asked about the nature of collaboration among those who responded yes and the types of collaboration they would like to see happen with other EIM-OC programs in the future among those who responded no.

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Goals

Future goals of EIM-OC programs were assessed via an open-ended item asking to describe the EIM-OC program’s 5-year goals.

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Data Analysis

Quantitative data were analyzed using IBM SPSS Statistics Version 24 (IBM, Armonk, NY). Descriptive statistics were used to summarize characteristics and other variables. Thematic analysis was conducted to identify the dominant themes and subthemes in qualitative data collected from open-ended questions (26).

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RESULTS

Sample

Of the 159 representatives to whom the survey was distributed to, 58 responded, representing a response rate of 36.5%. Forty-one responses were included in analyses, as 17 were removed because of incomplete responses. In 10 instances, representatives had merely clicked the survey link, and in the other seven, no qualitative data were provided. Representative quotes are accompanied by the representative’s university size and level of recognition, e.g., small, silver.

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Institutional Characteristic Information

Thirty-seven academic institutions were located in the United States, three in Canada, and one was located in New Zealand. Institutions ranged in size from small (<10,000) to very large (>50,000) and were predominantly nonrural, public, and 4-year undergraduate and graduate universities (Table 1).

TABLE 1

TABLE 1

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EIM-OC Program Background

The majority of institutions had registered for EIM-OC in the preceding 2 years and housed their EIM-OC program in an academic department, most of which reported as Kinesiology. Twelve institutions reported being recognized at the gold level, 7 at the silver level, and 15 at the bronze level, which is fairly representative of the proportion of institutions recognized at each level in 2017 (27). Less than half of institutions reported having an EIM certified ambassador (Table 1).

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Program Focus

On average, the greatest reported effort was dedicated to student wellness (M = 61.98%, SD = 24.57%), followed by faculty/staff (M = 22.43%, SD = 17.05%), and community wellness (M = 15.59%, SD = 20.11%). Most programs (n = 27) dedicated the majority of their efforts to student wellness, seven programs dedicated equal attention to student and faculty and staff-wellness, and community wellness was the main focus of three programs. No effort was dedicated to faculty/staff wellness or community wellness by eight and 11 programs, respectively.

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Student Representative Selection and Involvement

Forty-one representatives responded to questions regarding student representative selection and involvement. Many student leaders came from a student club or organization (n = 25), with such students tending to hold leadership positions within their respective clubs. Faculty members were often involved in student representative selection (n = 12). One campus recreation housed program selected their representative from students working within their department, whereas a small number of programs involved graduate students (n = 4). A newly established bronze program indicated that they were in the process of building a student leadership team, who will “be selected from different departments on campus (Student Health, Recreation and the Department of Kinesiology and Health).”

With regard to student involvement, six newly established programs had yet to establish students’ roles. Among other programs, promotion of activities/events (n = 22), leadership/organization/planning (n = 19), education (n = 17), implementation (n = 15), and data collection (n = 11) emerged as themes. The following was a representative response:

Student involvement is a critical piece to the success of EIM-OC. They are the advocates, leaders, and motivators. Students have led EIM-OC Month of October events such as fitness challenges, our Homecoming 5K, walking routes on campus, assist with the development and implementation of both student and employee wellness PA initiatives, collect data, and make proposals and present to our board and others the results (small, silver).

Another representative’s response demonstrated the extent to which some programs allowed students to be involved, indicating that students were involved in “goal setting; PA promotion event development, organization, and running; EIM-OC month organization; social media coordination, website development” (large). By contrast, other programs indicated that students had well-defined roles, with one representative commenting, “There is little student involvement in the promotion, EIM week, and data collection. We rely on students to help educate and work with EIM referrals from our student health services/counseling department on campus” (large, gold). This contrast demonstrates students are involved in many aspects of some programs and heavily involved in very specific aspects of others.

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Data Collection Methods

Four institutions reported collecting no data on their EIM-OC efforts. Among other institutions, participation/engagement rates in EIM-OC week/month (n = 19), participation/engagement rates in other EIM-OC initiatives (n = 23), student health, fitness, or PA outcomes (n = 18) were the most common types of data collection and used by most programs. Although less common, faculty/staff health, fitness, or PA outcomes (n = 12), as well as social media engagement (n = 14), were also commonly used data collection methods. Data collection method frequencies along with representative quotes are displayed in Table 2.

TABLE 2

TABLE 2

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PA Awareness Promotion Methods

PA awareness promotion methods are summarized in Table 2. One institution reported using no promotion methods. Participation in local health/wellness fair(s) (n = 26) and marketing and promotion at the beginning of each semester (n = 21) were methods used by most. Some institutions (n = 8) described using other methods, and the dominant emergent themes were partnering with other organizations (n = 3) and holding PA events (n = 3).

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Social Media Utilization

Thirty-three representatives responded to the social media question. Less than half had Facebook pages (n = 13), whereas even fewer had Twitter (n = 10), Instagram (n = 10), or Snapchat (n = 3) accounts. For the most part, the followership of social media platforms was relatively low (Table 3). Many programs reported no (n = 11) or very little (i.e., one account, n = 8) social media presence. Under half reported using multiple platforms, with seven programs having two accounts, five having three, and four having four.

TABLE 3

TABLE 3

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EIM Educational Activities

Five institutions reported offering no educational activities. Among the other institutions, EIM month or week activities were the most common (n = 22), followed by educational classes (n = 19), hosting educational EIM presentations and/or workshops (n = 18), integration of units on EIM into the curriculum (n = 16), educating health care professionals on EIM and how the EIM solution can be implemented in their practice (n = 14), and safety education (n = 5) (Table 2). Four institutions selected “other,” examples of which included “community presentations” (small, silver) and “other programming activities done during the year” (large).

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EIM-Week/Month Events and Activities

Twenty-five representatives responded to the question regarding EIM-OC week/month, with one reporting organizing no events or activities. Of the remaining institutions, offering exercise classes and/or workshops (n = 12), hosting a walk or run (n = 7), and hosting or participating in health and wellness fairs (n = 6) were the most common. Other types of events and activities, along with representative quotes, are displayed in Table 2.

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Health Care System Integration

Thirty-eight representatives responded to the question regarding how the EIM-OC solution was integrated into their academic institution’s campus health care system. Seventeen indicated that the EIM-OC solution was not integrated in any way. Among the other respondents, the development of campus resources and programs that can receive referrals from health care providers was the most common response (n = 17), followed by a referral system from health care providers to on-campus PA resources and programs (n = 16), whereas 10 indicated that the PAVS was assessed at every patient visit and 7 reported having provided health care providers with customized exercise prescription pads.

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PAVS

Thirty-four representatives responded to the PAVS questions. As depicted in Figure 1, many programs had yet to implement the PAVS, both electronic and paper methods were used to assess the PAVS, and follow-up responsibility varied between programs. In addition, both students and physicians conducted PAVS assessment (Table 4). Only two programs, both of which had been recognized as gold for at least 2 years, indicated that they had a protocol in place for referral declination, with both providing students with educational materials in such instances.

Figure 1

Figure 1

TABLE 4

TABLE 4

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Partner Relations

Current Partners

Thirty-five representatives responded to the question regarding relationships with campus and local partners that they currently work with and ranked them in order of importance (Fig. 2a), 33 of which provided descriptions of why they ranked their top partner as the most important. Among those who ranked campus health provider as their top partner (n = 12), the most common emergent themes were general assistance with the planning and implementation of EIM events and activities, being a source of referrals, and having the most interactions with students. Along similar lines, among those who ranked campus recreation as their top partner (n = 8), the most common emergent themes were providing the main fitness facilities on campus, general assistance with the planning and implementation of EIM events and activities, and having the most interactions with students. A response that was representative of the majority of those who ranked campus health provider or campus recreation as their top partner was, “Student Health and Recreation have the most interactions with students on campus. These two areas also have the most appropriate means and available resources to create behavior change around physical activity.” Another representative response was “Campus Recreation offers the majority of opportunities to exercise on our campus. They also have marketing platforms and a specific connection to students.”

Figure 2

Figure 2

Among those who ranked student clubs/organizations as their top partner (n = 8), the most common emergent themes from the descriptions were general assistance with the planning and implementation of EIM events and activities and spreading the message of EIM. A representative response was, “The student clubs are important as they serve as the volunteers needed to put the events on.”

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Prospective Partners

Thirty-five representatives responded to the question regarding relationships with campus and local partners that they do not currently work with but would like to (Fig. 2b). Thirty-one representatives provided descriptions of what made establishing a working relationship with these partners impractical, and 17 provided descriptions of what made establishing a working relationship with these partners unsuccessful. Among those ranking the communications and marketing/media department as their top prospective partner (n = 7), a lack of resources, and the EIM-OC program still being in infancy or early stages were the most common themes. One representative commented, “Money is likely needed to get their services.” Among those ranking local (nonacademic institution) health providers as the top prospective partner (n = 8), the major themes were the academic institution not having a campus health center and the EIM-OC program still being in infancy or early stages. Among those ranking their campus health provider as the top prospective partner (n = 6), the key themes were lack of time and resources. Representative responses included “Time, we decided to focus on programming and then later will focus on the healthcare aspect of EIM-OC as a vital sign,” and “Campus health services are so understaffed, they are unable to take on any new case initiatives.”

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Existing Challenges

Thirty-three representatives provided descriptions of what they consider to be the greatest challenge faced by their EIM-OC program. The most common emergent themes among these descriptions were lack of time (n = 10), lack of student involvement (n = 10), difficulty building or lack of relationships with campus partners (n = 8), lack of resources (n = 7), lack of funding (n = 8), difficulty implementing the PAVS (n = 6), and lack of awareness (n = 2). One representative described the biggest challenge as follows:

Sustainability of the program. Our campus has over 34,000 students, and the majority do not meet the current recommended guidelines around PA. We struggle to meet the demand of students currently being referred to a fitness professional. The majority of our referrals come from the counseling center, but soon the health center will be referring any student not meeting the recommended guidelines and how do we meet the demand with our current structure/manpower (large, gold).

Another response that was representative of many institutions was as follows:

There are so many organizations working on wellness on our large campus that they do not see the need to discuss nor implement a program such as EIM as the MAIN program on campus. The Rec Sports people have their own; academics have their programs, and the community has a strong presence through the hospital. Getting everyone on the same page has been difficult (large, bronze).

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Implementation Challenges

Twenty-two representatives responded to the question regarding what they wish they had known before implementing EIM-OC. The major emergent theme was being aware of how difficult it would be to get buy in into the EIM solution from others, in particular student representatives and health care providers.

With respect to student involvement, five representatives made comments regarding student-related struggles, such as wishing they knew “how best to provide leadership and hold students accountable” (small, silver), and “we knew it would be tough to get students involved, but didn’t realize how tough” (small, bronze). Moreover, one expressed they “didn’t realize how reluctant students and faculty are to actually create change” (small, bronze). However, a representative from a large, silver university expressed that they wish they had known the benefits of alignment with the student club, as it provides students with greater autonomy in running aspects of an EIM-OC program.

Regarding health care providers, four commented that they wish they had been aware of how hard PAVS implementation would be. “How hard it would be to get doctors at the student health center to see [the PAVS] as important and worth their time” (large, bronze) and “How to convince the physician to play a more active role in embracing [the PAVS]” (medium, gold) are representative of such desires.

Several other representatives made brief comments along the lines that they wish they had been aware “that it is such a monumental task” (large, bronze), and “how much work it would be!” (medium). One representative responded that they wished they had known “…that everyone thinks EIM-OC is a great idea and they want to be a part of it … and do nothing to help … show up during the week of EIM-OC … and tell you what you should have done…” (small).

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Collaboration

Seven representatives reported collaboration with another academic institution, namely, interuniversity challenges (n = 2) and information sharing (n = 3). Twenty-four representatives provided a description of the type of collaboration they would value. Excluding the two who were unsure, the main themes to emerge pertained to idea sharing (n = 14) and interuniversity challenges (n = 7). With respect to idea sharing, several (n = 3) expressed the desire of sharing information regarding the implementation of the PAVS, whereas regional conferences were identified as a good avenue for collaboration (n = 2).

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Goals

Thirty-three representatives described their program’s 5-year goal. Three indicated they had no goals. Among the remaining representatives, the most frequently cited goal was the implementation, or improvement, of the PAVS (n = 11). Of these, referral by physicians was a particular focus of many programs (n = 7). Other commonly reported goals included increasing student involvement in the leadership and delivery of EIM (n = 7) and increasing awareness of EIM (n = 6). Less common goals mentioned by multiple representatives included integrating EIM into the curriculum (n = 2), increasing student PA levels (n = 2), reaching faculty and staff (n = 3), improving data collection (n = 2), and establishing a speaker series (n = 2).

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DISCUSSION

To the authors’ knowledge, this is the first study to examine the focus of EIM-OC programs. Although programs’ efforts were predominantly focused on student wellness, some dedicated a considerable amount of their efforts to faculty/staff and community wellness. It would appear that there is an opportunity for many programs to enhance their contribution to faculty/staff and community wellness, and involving students in the latter would provide them with increased opportunities to gain practical experience in the public health field.

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Student Involvement

Student involvement emerged as a vital component of many EIM-OC programs, similar to previous findings (16,18,19). Consistent with prior findings (16,19), it was found that many student leaders were affiliated with a student club or organization and held leadership positions within their respective clubs. Student representatives were involved in a broad range of capacities, including promotion, planning, education, implementation, and to a lesser extent data collection. The level of student involvement varied between institutions, but it appears that many programs would not be able to function without student involvement. Student involvement also emerged in the questions pertaining to challenges, wishes, and goals. Challenges revolved around difficulty getting students involved and providing students with leadership, while increasing student involvement was a relatively common 5-year goal.

Several practical implications arise from these findings. Aside from challenges, it was clear that student involvement offered numerous benefits including, but not limited to, provision of student perspectives, and the ability for faculty or staff members to delegate tasks and responsibilities. Student involvement may help provide fresh ideas because of the inherent high turnover rate, although this may come at the expense of continuity in the absence of strong leadership and a stable framework. In addition, selection of students from a limited pool, such as those affiliated with a club or working with a department, may be restrictive in obtaining a diverse range of opinions because of shared viewpoints.

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Data Collection/Promotion/Education EIM-Week/Month Events and Activities

To the authors’ knowledge, this is the first independent assessment of the methods by which EIM-OC programs collect data, promote PA awareness, and offer EIM educational activities. With regard to data collection, a majority of universities collected data on participation rates in EIM week, month, and/or other EIM-OC initiatives, similar to previously reported data collection methods (16,18). As participation rates at EIM week, month and, other initiatives can be seen as a measure of engagement with the campus community, it may be worthwhile requiring the collection of data regarding participation rates as a requirement in the EIM-OC recognition program to motivate institutions to increase or maintain their efforts in this aspect.

Several institutions reported collecting data on health, fitness, or PA outcomes; however, how this information was being used was not assessed in the current study. Given that the overall goal of EIM-OC is to promote PA and improve the health and well-being of the campus community, it was unclear how institutions that are not collecting data on these outcomes are assessing progress toward this goal. Lynn et al. (18) reported PA outcomes to demonstrate the success of their PAVS implementation at their institution; however, whether this information was collected before, or helpful during, the implementation process was not discussed. Future research is needed to determine the utility of collecting these data in helping EIM PA promotion efforts on campus, establishing PA as a part of health care provider visits, or implementing PAVS. Lastly, EIM-OC programs may want to consider sharing aggregate health, fitness, or PA outcomes with other institutions as a form of an interuniversity challenge in improving these outcomes through EIM efforts. Providing a template of data or outcomes would also be helpful to provide consistency in data collection among institutions and allow interinstitution comparisons.

A large number of institutions reported using the PA awareness promotion methods and offering the educational activities outlined in the 2016 EIM-OC Action Guide. Including more specific examples of these ideas in the Action Guide may be useful to institutions. In addition, as far as the authors are aware, this is the first study to report descriptions of EIM-OC week and/or month events and activities, and results may provide guidance to newly established EIM-OC programs. However, it may be more helpful for EIM-OC programs to share this information with one another.

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Social Media

Findings suggest that, despite a third of representatives reporting collecting social media engagement data, social media platforms are largely underused. It is currently unclear whether even the platforms with the greatest followership will be receiving a return on the investment of time dedicated to promotion via these platforms. That is not to say that social media platforms do not represent a good medium through which to disseminate the EIM-OC message, especially given the high prevalence of social media usage, but rather that programs may need to better utilize such platforms to justify the investment of time. Wilson et al. (28) previously explored the reach of a social media campaign to promote active travel behaviors at a university campus and showed potential for using Facebook and Twitter to reach some followers and provide motivation and promotion of regular PA. However, challenges in engaging a larger portion of the campus community were noted, and further research is needed to determine how social media can be used effectively to engage and communicate with students, faculty/staff, and the broader community. Further analytics, for example, measuring the reach of promotional messages shared via social media and their relationship with attendance at the event promoted, may be useful in assessing the effectiveness of social media campaigns. With respect to students, greater student involvement may help enhance student-focused messaging and lead to higher reach among other students.

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Partner Relations

It was clear that campus health, campus recreation, and student clubs/organizations were the most important current partners. All were valued for their general assistance with planning and implementation, but each appeared to offer their own distinct contributions to EIM-OC. Both campus recreation and campus health providers were perceived to have the greatest student interactions. Campus recreation also provides the main exercise facilities, whereas campus health providers were a source of referrals. Student clubs/organizations were valued because of their capacity to promote the EIM-OC message. In line with the findings of Bopp et al. (16), results suggest that there is still room for improvement with respect to the establishment of relations with other institutional partners, such as campus planning, housing, and sustainability.

With respect to prospective partners, communications and marketing departments and both campus and noncampus health providers emerged as the most sought after partners. The main barrier to working with communications and marketing departments appeared to be a lack of resources, i.e., money, on the part of EIM-OC programs. Similarly, a lack of resources was a primary barrier for working with health providers, but in this case it was lack of resources on the part of the health provider as opposed to the EIM-OC program. Other barriers to working with health providers included academic institutions not having a campus health provider, demonstrating the unique barriers encountered by some institutions, as well as being a newly established EIM-OC program. With respect to the latter, given the importance of healthcare providers to the EIM-OC mission, further insight into successful programs on how to establish a positive working relationship that benefits both parties would be of great value to EIM-OC programs in their infancy. Educational strategies (e.g., webinars) or peer institution mentoring could help campuses struggling with this, learn from campuses that have been successful.

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Health Care System Integration

It is somewhat concerning that a large number of EIM-OC programs had not integrated EIM-OC solution into their institution’s campus health care system. In addition, disparate responses were received with respect to health care system integration and PAVS assessment, raising questions as to whether respondents were biased or inaccurate. Moreover, whether PAVS is actually assessed at every visit is questionable (29). At present, implementation of the PAVS is required for gold-level recognition by the ACSM (23). However, it is apparent from the findings of this study that PAVS implementation was a source of frustration for many programs. Furthermore, even when implemented, the existing protocols and procedures of many programs suggest that it may be largely ineffective, as of the 34 representatives to respond to the PAVS question, only two programs recognized as gold had implemented what one would consider a “gold standard” PAVS protocol.

Given these findings, it is perhaps worth considering whether having the PAVS as a requirement for gold-level recognition is truly beneficial, as programs may not be taking the necessary steps to implement the PAVS effectively, rather they may be doing this to “check the box” and be recognized at the highest level. The findings of the study would suggest it could be worth revisiting the standard of PAVS implementation as a requirement for gold recognition within a more comprehensive framework to consider the many programmatic elements that indicate a successful EIM-OC program. Requiring universities to report statistics regarding referrals and follow-ups from referrals would advance the understanding of how to best implement the PAVS and provide a foundation for a more data-driven gold-level recognition, along with showing that programs perform at high standards in a broader range of areas relevant to EIM-OC.

Our findings clearly indicate that further research into the challenges associated with the PAVS is warranted and would enable programs to implement the PAVS without creating any tension with their health care partners, in particular physicians, which appears to be taking place at present. An understanding of what ideal PAVS implementation would consist of from a physician’s perspective remains largely unknown in the context of college health care services and is worth exploring in future studies. Lastly, a greater understanding of the effectiveness of consultations provided upon referral is needed, given the considerable variation in these consultations among programs. The scope of the current study did not allow for a full investigation into the full range of issues associated with PAVS implementation and assessment; however, these findings provide a foundation for potential avenues of investigation.

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Collaboration

Findings suggest that there was not a great level of collaboration but that collaboration would be welcomed. It appears that interuniversity challenges and idea sharing, both of which already take place between a small number of institutions, were the two primary forms of desired collaboration. Guidelines for best practices in implementation and data collection, perhaps based on university size and structure/resourcing, may also prove beneficial. It may be worth considering disseminating the contact details of each EIM-OC program’s representative, along with details of each program’s area of expertise and their social media platforms could facilitate collaboration. National challenges between universities of matching size and recognition status could foster friendly competition.

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CONCLUSION

In summary, student involvement was paramount to a successful EIM-OC program, as were working relationships with campus recreation and campus healthcare provider. Social media appears to an area in which many programs could improve, whereas effective PAVS systems and procedures were largely absent. Finally, there is a desire for greater collaboration between programs. Future researchers should consider further examination of the implementation and development of effective PAVS systems and procedures and the establishment, fostering, and maintenance of relationships with EIM-OC partners.

No funding supported the research reported in this publication. The authors thank Dr. Carena Winters (EIM-OC Chair) for her advice developing the survey, ACSM employees Lisa Dudeck and Jennifer Pesarchick for their assistance distributing the survey, and EIM-OC representatives who took the time to respond to the survey. None of the authors have a conflict of interest related to the present study. The results of the present study do not constitute endorsement by the ACSM.

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