Evaluation of the implementation of an intervention to improve the street environment and promote walking for transport in deprived neighbourhoods

Cultural Tailoring and Targeting of Messages: A Systematic Literature Review

Cultural targeting and tailoring are different, yet they remain intertwined in the literature inhibiting theory development and limiting the possibility of determining their effects. This preregistered systematic literature review describes these constructs and provides a framework for cultural tailoring with evidence from a review of 63 studies, published from 2010 to 2020, to characterize the processes, elements, and theories used in the existing literature. The results show that 86% of studies self-defined as cultural tailoring, but coding revealed relatively few tailoring studies (25%) with 31% including both tailoring and targeting elements. Most studies used outreach and consultation as processes for tailoring or targeting with participatory approaches used in a fifth of the studies. Surface-level features of message content were commonly used to tailor or target with deep-cultural-values found in only a quarter of the studies. We argue from theories of communication accommodation and persuasion that cultural tailoring or targeting may provide gains in attention, recall, or source evaluation.

Increasing physical activity in the community setting

Physical activity (PA) is beneficial for both mental and physical health, yet many individuals do not meet PA recommendations. There are a multitude of approaches to increase levels of PA and the role of the community is one area of growing interest. This review discusses the community environment as well as programs within the community and their influence on PA levels. Despite some research limitations, there are clear factors associated with community-based PA. Strategies that improve the built environment along with community-based programs have shown success, although differences between the characteristics of communities can mean strategies to promote PA are not universally effective. Additional research is needed on effective strategies that can be tailored to the characteristics of the community to increase PA. Further, public health interventions and policies should consider the role of the community when aiming to increase PA levels.

Socio-Ecological Natural Experiment with Randomized Controlled Trial to Promote Active Commuting to Work: Process Evaluation, Behavioral Impacts, and Changes in the Use and Quality of Walking and Cycling Paths

Active commuting to work (ACW) has beneficial effects on health, traffic, and climate. However, more robust evidence is needed on how to promote ACW. This paper reports the findings of a multilevel natural experiment with a randomized controlled trial in 16 Finnish workplaces. In Phase 1, 11 workplaces (1823 employees) from Area 1 were exposed to environmental improvements in walking and cycling paths. In Phase 2, five more workplaces (826 employees) were recruited from Area 2 and all workplaces were randomized into experimental group (EXP) promoting ACW with social and behavioral strategies and comparison group (COM) participating only in data collection. Process and impact evaluation with questionnaires, travel diaries, accelerometers, traffic calculations, and auditing were conducted. Statistics included Wilcoxon Signed Ranks Test, Mann-Whitney U-test, and after-before differences with 95% confidence intervals (95% CI). After Phase 1, positive change was seen in the self-reported number of days, which the employees intended to cycle part of their journey to work in the following week (p = 0.001). After Phase 2, intervention effect was observed in the proportion of employees, who reported willingness to increase walking (8.7%; 95% CI 1.8 to 15.6) and cycling (5.5%; 2.2 to 8.8) and opportunity to cycle part of their journey to work (5.9%; 2.1 to 9.7). To conclude, the intervention facilitated employees’ motivation for ACW, which is the first step towards behavior change.

Community perceptions of the implementation and impact of an intervention to improve the neighbourhood physical environment to promote walking for transport: a qualitative study

BACKGROUND

Using community engagement approaches to develop and deliver interventions targeting small-scale physical environmental improvements in neighbourhoods is a potential strategy for increasing walking for transport. This study aimed to qualitatively assess community perceptions of the implementation and impact of the Fitter for Walking (FFW) intervention, which encouraged communities to work together to improve the street environment on local routes and promote walking for transport.

METHODS

From 155 FFW community projects, nineteen were selected to take part in a focus group/interview using specified criteria: geographical area; level of community involvement; intervention activities; and project progress. Participants were invited to take part via the project coordinator or lead member of the community group. A written guide was used to initiate and direct discussions through key topics. Deductive and inductive approaches were used to analyse the data and identify key themes relating to the barriers and facilitators for implementation and the perceived impact of the intervention.

RESULTS

Fourteen focus groups and five interviews were conducted with 86 community members. Themes were identified in relation to barriers (poor area reputation and regeneration areas; engaging the local community; and working with local authorities) and facilitators (provision of a coordinator/facilitator; strong local partnerships; and using a range of communication and engagement activities) for programme implementation. Participants perceived the main impacts to be improved physical and social environments. Increases in walking for transport were rarely specifically commented on, but participants did report increased street use.

CONCLUSIONS

Community perspectives provided important insights into the barriers and facilitators for the implementation of the FFW intervention and its' potential impacts. Using community engagement approaches can lead to perceived improvements in the physical and social environment resulting in increased street use, which may lead to increases in walking for transport in the longer-term. Recommendations are provided for researchers, practitioners and policy makers in planning and delivering future interventions. Future research should determine optimal implementation strategies, investigate the relative importance of improving physical environments, social environments and using individual behaviour change strategies, and determine how physical and social environments interact to maximise intervention impact on walking for transport.

From Delivery to Adoption of Physical Activity Guidelines: Realist Synthesis

BACKGROUND

Evidence-based guidelines published by health authorities for the promotion of health-enhancing physical activity (PA), continue to be implemented unsuccessfully and demonstrate a gap between evidence and policies. This review synthesizes evidence on factors influencing delivery, adoption and implementation of PA promotion guidelines within different policy sectors (e.g., health, transport, urban planning, sport, education).

METHODS

Published literature was initially searched using PubMed, EBSCO, Google Scholar and continued through an iterative snowball technique. The literature review spanned the period 2002-2017. The realist synthesis approach was adopted to review the content of 39 included studies. An initial programme theory with a four-step chain from evidence emersion to implementation of guidelines was tested.

RESULTS

The synthesis furthers our understanding of the link between PA guidelines delivery and the actions of professionals responsible for implementation within health services, school departments and municipalities. The main mechanisms identified for guidance implementation were scientific legitimation, enforcement, feasibility, familiarity with concepts and PA habits. Threats emerged to the successful implementation of PA guidelines at national/local jurisdictional levels.

CONCLUSIONS

The way PA guidelines are developed may influence their adoption by policy-makers and professionals. Useful lessons emerged that may inform synergies between policymaking and professional practices, promoting win-win multisectoral strategies.