Walking and Walkability: Is Wayfinding a Missing Link? Implications for Public Health Practice

Demonstration Projects to Test Built Environment Changes: A Systematic Review

CONTEXT

Built environment interventions (pedestrian/bicycle infrastructure and enhanced access) mitigate barriers to physical activity by making the healthy choice the default choice. Demonstration projects (eg, temporary pedestrian lanes or sidewalks marked with tape) are used to test these interventions before making permanent changes. However, it is unknown whether demonstration projects lead to desired built environment changes.

OBJECTIVE

To systematically review the literature to determine outcomes and overall public health impacts of demonstration projects and whether they lead to permanent changes to the built environment.

DESIGN

Systematic review, conducted from March to September 2022 by searching PubMed and EBSCOhost for peer-reviewed literature and Google for gray (non-peer-reviewed) literature. Inclusion criteria were policy, systems, or environmental interventions; temporary implementation; and presence of evaluation data. Exclusion criteria were individual/interpersonal-level interventions, permanent implementation, and absence of evaluation data. Two authors coded for inclusion/exclusion and resolved discrepancies, coded a portion of included sources and resolved discrepancies, refined coding guide definitions, and coded remaining sources.

MAIN OUTCOME MEASURES

Data were extracted based on the expanded RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework, which incorporates constructs of the Implementation Outcomes Framework (acceptability, appropriateness, feasibility).

RESULTS

Gray (N = 23) and peer-reviewed (N = 1) sources describing unique demonstration projects (N = 31) met inclusion criteria. Projects tested built environment interventions including traffic calming measures, crosswalks, bike lanes, intersection design, and trails. Sources primarily reported effectiveness (typically improved safety), maintenance, acceptability, and appropriateness. Most sources did not report projects leading to permanent changes to the built environment.

CONCLUSIONS

Based on inconsistent reporting of key outcomes (number of community members reached, changes to physical activity levels), overall impacts are unknown. Most demonstration projects captured community members' feedback, which was typically positive, but it is unknown whether feedback led to long-term changes. We recommend providing improved demonstration project guidance for practitioners to facilitate robust data collection, including suggested evaluation methods and tools.

The spatial configuration of local climate zones reveals effects on wayfinding in human walking

The importance of easy wayfinding in complex urban settings has been recognized in spatial planning. Empirical measurement and explicit representation of wayfinding, however, have been limited in deciding spatial configurations. Our study proposed and tested an approach to improving wayfinding by incorporating spatial analysis of urban forms in the Guangdong-Hong Kong-Macau Great Bay Area in China. Wayfinding was measured by an indicator of intelligibility using spatial design network analysis. Urban spatial configurations were quantified using landscape metrics to describe the spatial layouts of local climate zones (LCZs) as standardized urban forms. The statistical analysis demonstrated the significant associations between urban spatial configurations and wayfinding. These findings suggested, to improve wayfinding, 1) dispersing LCZ 1 (compact high-rise) and LCZ 2 (compact mid-rise) and 2) agglomerating LCZ 3 (compact low-rise), LCZ 5 (open mid-rise), LCZ 6 (open low-rise), and LCZ 9 (sparsely built). To our knowledge, this study is the first to incorporate the LCZ classification system into the wayfinding field, clearly providing empirically-supported solutions for dispersing and agglomerating spatial configurations. Our findings also provide insights for human-centered spatial planning by spatial co-development at local, urban, and regional levels.

Design and evaluation of radiation disaster prevention map based on evacuation behavior

An effective disaster prevention map ensures public safety and efficient evacuation during emergencies. Emergency evacuation information design in Taiwan is in its nascent stages. This study focuses on individuals' understanding, behavior, and decision-making during disaster prevention to devise suitable disaster prevention map norms. We examined the Emergency Planning Zone's existing disaster prevention methods and surveyed the community to understand their disaster prevention concepts and needs. We conducted two experiments: the first tested the comprehension of existing disaster prevention maps and identified their issues, while the second evaluated a redesigned map based on Experiment 1's findings. We discovered that all age groups agree on needing accurate, fast information and diverse evacuation route options. Experiment 1 revealed disproportionate assembly point icons on the existing map, leading to navigation difficulties. The map also failed to mark landmarks, road names, and blocked intersections accurately. The redesigned map in Experiment 2 addressed these issues, showing that improving map information design aids recognition and memory, and bridges wayfinding behavior gaps in people with different spatial abilities. We suggest marking evacuation routes on maps, placing corresponding signs on-site, and locating assembly points near landmarks for easier navigation.

Wayfinding Information Syntheses: A Study of Wayfinding Efficiency and Behavior in Complex Outdoor Institutional Environment

OBJECTIVE

This research aims to investigate the effectiveness of wayfinding information (destination reference images) in real-time complex environmental settings through the syntheses of mobile and static information sources. This investigation will help in improving the wayfinding information design for complex institutional environments which will enhance the environmental legibility.

BACKGROUND

Complex environments are challenging for wayfinding efficiency. Identification of the location and orientation are considered to be important for wayfinding efficiency. This study investigated the user behavior in synthesizing the wayfinding information for identifying the users' location and orientation in a complex environment.

METHOD

Twenty-five university students have participated in the desktop-based virtual reality experiment. Five experimental conditions were developed for the assessment of wayfinding efficiency and users' preferred information sources.

RESULTS

Reference images of destinations with user-matched angles were found more effective than the building's facade images. Participants synthesized the mobile wayfinding information with real environmental information to identify their location and orientation. Real environment information (road intersections and shape of the road) and mobile information (reference images of building facades) were found influential in the identification of the user's location and orientation.

CONCLUSIONS

The study suggested a need for thorough investigation regarding the users' wayfinding behavior with different types of environmental information. Future studies have been recommended to investigate other complex institutional environments with larger sample groups for enhancing environmental legibility and institutional efficiency.

The Impact of a Dementia-Friendly Garden Design on People With Dementia in a Residential Aged Care Facility: A Case Study

BACKGROUND

There is a paucity of evidence on the efficacy of garden design based on dementia-friendly environment (DFE) characteristics on the level of agitation, apathy, and engagement of people with dementia in residential aged care facilities (RACFs).

OBJECTIVE

To investigate the effect of a garden improved according to DFE characteristics on agitation, apathy, and engagement of people with dementia in one RACF.

METHODS

A case study design with a mixed-method approach was used.

RESULTS

There was no significant improvement in the level of participants' agitation following visits to the improved garden, χ²(2) = 5.167, p = .076. A high level of engagement was found in participants during the intervention (Week 1-1, p < .01; Week 1-2, p < .01; Week 2, p < .01; Week 3, p < .05; and Week 4, p < .05) when compared to before intervention (Week 0). A higher level of apathy was found in participants at Week 0 when compared to during the intervention (Week 1-1, p < .05; Week 1-2, p < .01; Week 2, p < .05; Week 3, p < .01; and Week 4, p < .01). Five themes emerged from participant interviews: the presence of sensory-provoking elements in the garden, meaningful engagement in the garden, accessibility of the garden, garden impacts, and garden experiences that demonstrated the effectiveness of the garden.

CONCLUSIONS

The garden promoted engagement and decreased apathy of people with dementia living in the RACF with the researcher's partial facilitation of the intervention sessions. The qualitative findings indicated the effectiveness of the garden in reducing agitation.

Getting to Know a Place: Built Environment Walkability and Children's Spatial Representation of Their Home-School (h-s) Route

The literature on environmental walkability to date has mainly focused on walking and related health outcomes. While previous studies suggest associations between walking and spatial knowledge, the associations between environmental walkability and spatial knowledge is yet to be explored. The current study addresses this lacuna in research by exploring children’s mental representations of their home-school (h–s) route, vis-à-vis objectively measured environmental attributes along the actual routes. Ninety-two children aged 10–12 years old (5th and 6th graders) drew sketch maps depicting their h–s route and drew the actual route on a neighborhood map, in addition to completing a brief survey. h–s routes went through Geographic Information Systems (GIS) analysis, yielding an en-route walkability index and its components. Children in traditional neighborhoods outperformed in the route’s orientation and structure, but not in the richness of the drawn maps. The orientation and structure of the drawn routes was related to objectively measured walkability, density, street connectivity and commercial land-uses along h–s routes. These associations remained significant among children who walked to school, but not among those who were driven to school. These findings highlight the importance of urban form and school travel mode in acquiring navigation skills and getting to know one’s neighborhood.

Associations between Physical Activity and Cognitive Functioning among Middle-Aged and Older Adults

OBJECTIVES

To describe aerobic physical activity among middle-aged and older adults by their self-reported cognitive decline and their receipt of informal care for declines in cognitive functioning and most common type of physical activity.

DESIGN

Cross-sectional study using data from the 2011 Behavioral Risk Factor Surveillance System.

SETTING

Landline and cellular telephone survey.

PARTICIPANTS

93,082 respondents aged 45 years and older from 21 US states in 2011.

MEASUREMENTS

Subjective cognitive decline (SCD) was defined as experiencing confusion or memory loss that was happening more often or getting worse during the past 12 months. Regular care was defined as always, usually, or sometimes receiving care from family or friends because of SCD. Using the 2008 Physical Activity Guidelines for Americans, respondents were classified as being inactive, insufficiently active, or sufficiently active based on their reported aerobic exercise. We calculated weighted proportions and used chi-square tests for differences across categories by SCD status and receipt of care. We estimated the prevalence ratio (PR) for being inactive, insufficiently active, and sufficiently active using separate log-binomial regression models, adjusting for covariates.

RESULTS

12.3% of respondents reported SCD and 23.1% of those with SCD received regular care. 29.6% (95%CI: 28.9-30.4) of respondents without SCD were inactive compared to 37.1% (95%CI: 34.7-39.5) of those with SCD who did not receive regular care and 50.2% (95%CI: 45.2-55.1) of those with SCD who received regular care. 52.4% (95%CI: 51.6-53.2) of respondents without SCD were sufficiently active compared to 46.4% (95%CI: 43.8-49.0) of respondents with SCD and received no regular care and 30.6% (95%CI: 26.1-35.6) of respondents with SCD who received regular care. After adjusting for demographic and health status differences, people receiving regular care for SCD had a significantly lower prevalence of meeting aerobic guidelines compared to people without SCD (PR=0.80, 95%CI: 0.69-0.93, p=0.005). The most prevalent physical activity was walking for adults aged ≥ 45 years old (41-52%) regardless of SCD status or receipt of care.

CONCLUSION

Overall, the prevalence of inactivity was high, especially among people with SCD. These findings suggest a need to increase activity among middle-aged and older adults, particularly those with SCD who receive care. Examining ways to increase walking, potentially by involving informal caregivers, could be a promising way for people with SCD to reduce inactivity and gain the health benefits associated with meeting physical activity guidelines.