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Beyond Wheeling Walks : Enhanced planning, environment, and policy components

Beyond Wheeling Walks : Enhanced planning, environment, and policy components. Bill Reger-Nash, EdD, WVU Prevention Research Center Linda Cooper, MSW, LCSW Adrian Bauman, MD, PhD Kenneth J Simon, EdD Kevin M. Leyden, PhD. PRESENTATION OUTLINE. Background

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Beyond Wheeling Walks : Enhanced planning, environment, and policy components

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  1. Beyond Wheeling Walks: Enhanced planning, environment, and policy components Bill Reger-Nash, EdD, WVU Prevention Research Center Linda Cooper, MSW, LCSW Adrian Bauman, MD, PhD Kenneth J Simon, EdD Kevin M. Leyden, PhD

  2. PRESENTATION OUTLINE • Background • Community capacity building • Formative research and message development • Pilot testing of the targeted ads • Program implementation and evaluation • Results • Policy and environment change

  3. Leading Contributors to Premature Death Physical Inactivity/Diet 350,000 Tobacco 435,000 Alcohol 85,000 Microbial Agents 75,000 Toxic Agents 55,000 Motor Vehicles 43,354 Firearms 28,663 Mokdad JAMA, 2005

  4. West Virginia has one of the very highest rates of total CVD deaths in U.S. (per 100,000) US WV MN HI 386.6 436.8 322.0 306.6 BRFSS, 2000

  5. Wheeling Walks PROJECT PHASES Phase I --1999-2001 PARTICIPATORY PLANNING Phase II --2000-2001 -MESSAGE DEVELOPMENT - PREPARATION for CAMPAIGN Phase III --2001-2002 CAMPAIGN and EVALUATION PhaseIV --2002 > On-going POLICY & ENVIRONMENT

  6. Establish initial community Steering Committee /Advisory Board 12-week Participatory Planning program Pursue grant sources Select media producers Develop protocols Identify staff and consultants PHASE I – Community Involvement

  7. Wheeling Walks Targeted Message and Audience • a targeted public health physical activity message: • 30 minutes or more of • moderate-intensity walking • almost every day. • to a targeted audience: • Insufficiently active • adults, ages 50-65, • in a West Virginia community

  8. Target Population 78% of 55-64 year olds were insufficiently active BRFSS 2001

  9. Robert Wood Johnson Foundation West Virginia Bureau for Public Health Benedum Foundation Ohio Valley Medical Center Wheeling Hospital WesBanco Bank Corp Wheeling Walks Funding Sources

  10. METHODOLOGY - a basis in theory: • Social Ecological Approach • Participatory Planning • McGuire Communication Model • Elaboration Likelihood • Theory of Planned Behavior • Transtheoretical Model • Social Marketing • A BRIEF REVIEW:

  11. Multi-strategycampaign community interventions & community development Media legislative & regulatory health professional education paid unpaid Campaigns using mass media structured, co-ordinated, & multi-faceted

  12. PHASE II –Message Development(Formative Research) -- An Elicitation Survey to identify salient psychosocial factors about moderate-intensity walking. (30 people) -- A Quantitative Survey to identify which psychosocial factors differentiate regular walkers and insufficiently active. (300 people) -- A Qualitative Pretesting of ad storyboards to guide final ad production. (80 people)

  13. TIME ENERGY

  14. TV ad : Woman

  15. Print ad: man

  16. PHASE III –Campaign and Evaluation Wheeling Walks • 8-WEEK Mass media-based CAMPAIGN • MONTH 5 Public relations BOOSTER • CANCELLED due to Sept 11, 2001 • MONTH 11 BOOSTER Campaign • EVALUATION at: - Baseline • - Immediate Post • - 6 Months Post • - 12 months Post

  17. RECEPTION Exposure to and awareness of message PROCESSING Receive, comprehend, and think about message RESPONSE Current beliefs altered, new ones remembered, and behavior changed McGuire Cascade of the sequential stages of message delivery essential to behavior change

  18. Reception Processing Response Behavior behavior beliefs argument qualityPLACEMENTelaboration normative intentionBEHAVIOR likelihood beliefs to actFREQUENCYcues control beliefs

  19. Wheeling Walks PHASE III –Campaign andEvaluation 1. A telephone survey questionnaire of 1,472 residents --Baseline --Immediately post-intervention -- 6 months post-intervention --12 months post-intervention 2. Earned media 3. Environmental and Policy Change

  20. Wheeling Walks PAID ADVERTISING - 8 weeks Gross Rating #Points -- Two 30-second television ads6835,100 -- Two 60-second radio ads1,9883,450 -- Two 1/8 page newspaper ads28

  21. Wheeling Walks PUBLIC RELATIONSto generate Earned Media included: WEEK 1--campaign KICK-OFF press conference WEEK 3--press conference with physicians WEEK 4--a mid-campaign progress report press event WEEK 6--1st Mayor’s Fitness Cup –noon-time walk WEEK 7--Intergenerational Walk WEEK 8--campaign finale press conference

  22. Wheeling Walks RESULTS –EARNED MEDIA 76 -- TV news stories 48 -- Radio news stories 49 -- Newspaper articles (23--Front Page) 107 -- TV / Radio interviews / promotions 2 -- USA Today article w/ pix

  23. Wheeling Walks

  24. Wheeling Walks RESULTS—TELEPHONE QUESTIONNAIRES SELF-REPORT --Baseline to Immediate-post Percent Increase 14% difference 32% 18%

  25. Wheeling Walks RESULTS—POSITIVE STAGE CHANGES From Baseline precontemplation,contemplation, and preparation 12% difference 62%* 50% * p< .001)

  26. Attitude .33 .13 Walking Status .31 .15 Treatment Intention .11 .42 Control All paths with coefficients are significant at .01 or better

  27. Best “Predicted” Model, Chi-square[3] = 39.73; p < .00001 Walking Status .15 Treatment Intention .18 .57 Control Beliefs All paths with coefficients are significant at .01 or better

  28. Wheeling Walks 4-week Media BOOSTER --11th month --334 TV ads (30-second) --95 Radio ads (60-second) --6 1/8-page Newspaper ads --Public Relations events -Kick-Off Press Conference -Celebrity visitor (Adrian Bauman) -2nd Annual Mayor’s Fitness Cup -Closing celebration --Weekly columns by PI (BRN)

  29. Wheeling Walks RESULTS—TELEPHONE QUESTIONNAIRES Immediate 12-mos PostPost Knew about campaign------------ 90% 89% Saw TV ads--------------------------- 77% 93% Heard Radio ads-------------------- 33% 36% Saw or heard news stories------ 81% 83% Heard about campaign: at worksite------------------------ 5% 5% via faith-based programs----- 4% 4% via speakers--------------------- 4% 5%

  30. Wheeling Walks Group A= Baseline daily walking minutes <=10 minutes

  31. PHASE IV – POLICY and ENVIRONMENT • Process Outcomes: • Mayor designated Walkable Wheeling Task Force, Monthly meetings since 2001, Trails Master Plan now approved by City Council 03/06 • Develop walking opportunities in the community • o       Upgrade and connect trails (DOT added trails ,city exercised eminent domain in December 2005) • o       Adding rest rooms and telephones • o       Improve overall safety & aesthetics • o       Plan for an urban state park • Engaged city, county, and state agencies: streets, highways, • recreation department, schools, parks, planning

  32. Assessment of SOCIAL CAPITAL Walkable Wheeling Task Force members Nov 99 Feb 01 Feb 02 (n=32) (n=33) (n=29) Mean [sd] Mean [sd] Mean [sd] Commitment 4.10 [0.75] 4.27 [0.78] 4.66 [0.48] * # Enjoyment 4.47 [0.73] 4.38 [0.75] 4.66 [0.55] Confidence 4.16 [0.79] 4.36 [0.90] 4.66 [0.55] * Shared Purpose 4.25 [0.72] 4.44 [0.62] 4.69 [0.54] * Contribution Valued 4.20 [0.85] 4.52 [0.57] 4 55 [0.78] Trust 4.28 [0.58] 4.45 [0.79] 4.72 [0.45] * Data were analyzed as pairwise independent comparisons of means; significance was set at p<0.01 due to multiple testing. *p<0.01 comparing 1999 to 2002 # p<0.01 “Commitment” comparing 2001 to 2002

  33. Differences / modifications to WV WALKS

  34. Weekly column

  35. PAID ADVERTISING - 8 weeks WheelingWV WalksWALKS --Two 30-second television ads683 356 Gross Rating Points5,100 3,016 --Two 60-second radio ads1,988 1,763 Gross Rating Points 3,450 1,876 --Two 1/8-page newspaper ads28 39

  36. WV WALKS RESULTS—TELEPHONE QUESTIONNAIRES WV WALKS Baseline to Immediate-post Percent Increase 12% difference 27% 15%

  37. RESULTS –EARNED MEDIA Wheeling WV WalksWALKS 76 77 -- TV news stories 48 27 -- Radio news stories 49 40 -- Newspaper articles (23--Front Page) 107 1,241 -- TV / Radio interviews / promotions 2 -- USA Today article w/ pix

  38. Cost comparison of Wheeling Walks, WV WALKS,and Project Active Annual cost Per month per per Interventionchanged changed person person Project Active Lifestyle change $205.80 $17.50 Structured exercise $591.72 $49.31 Wheeling Walks Wheeling only $38.47 $3.20 TV media market $19.00 $1.58 WV WALKS $18.27 $1.52

  39. Basis of calculations Wheeling Walks a. Total campaign cost $120,000 b. Total media area population 418,000 c. Total ages 50-65 (18.6%) / 40-65 (27%) 77,748 d. Target Population (insufficiently active) (58% / 60% )* 45,094 e. Exposed to campaign message (target population) (92% / 82%)* 41,486 f. Cost per individual exposed to message (a/e)$ 2.89 Cost per month (f/12) $ .24 g. Individuals self-report changed (14% / 12% of d.)* 6,313 h.Cost per changed person(a/g)$ 19.00 i. Cost per month ( h/12)$ 1.58 *Percent derived from intervention surveys.

  40. POLICY and ENVIRONMENT • Process Outcomes in Morgantown: • Work in concert with City and University via • WV WALKS Community Advisory Board • Diverting large industrial truck traffic from downtown • Develop walking opportunities in the community •       -  Upgrade and connect trails •      -  Adding new and paving sidewalks ($150k per year) • - Developing community walking league • Coordinated study (Zande Engineering) to make WVU-HSC • campus more walkable • Physicians writing “prescriptions for walking”

  41. Assessment of Policymakers • Mail survey to assess whether WV Walks intervention focused on changing the attitudes and behavior of the public can also affect policymakers • Survey mailed to all municipal elected officials, appointed heads of departments, and all individuals appointed to serve on government boards/commissions (133 in Morgantown and 120 in Huntington ) • Response rates PREPOST Morgantown n=76 57.1% n=58 43.4% Huntington n-38 31.7% n=34 29.3%

  42. Walking Issues • Morgantown • Baseline: Ranked 4th • Post Campaign: Ranked 1st • P < 0.05 (t-test for differences in proportion means) • Huntington • Not mentioned

  43. Community Problem Issues Morgantown • Lack of Pedestrian Walkways, Crosswalks and Sidewalks • Poorly Planned Development and Sprawl • Traffic Congestion Huntington • Underage Drinking • Drug and Alcohol Abuse • Crime

  44. Environment and policy changes have great potential to influence human behavior. They can impact and sustain change in entire populations for a small financial investment. BUT HOW DO WE DO THIS? O’Donnell MP. Am J Health Promot. 1989;2(2):5.

  45. WORLD HEALTH ORGANIZATION1st International Conference on Health PromotionNovember 21, 1986Ottawa, CANADA OTTAWA CHARTER FOR HEALTH PROMOTION “Health promotion is the process of enabling people to increase control over, and to improve, their health…People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health.”

  46. Lessons Learned • Health / other sectors participating together in PA campaigns • Organized efforts, sequenced, adequately resourced • Over arching theme consistency, brand • Targeted Message • Exposure, Exposure, Exposure • Policy makers are community members • Timetable of media, other components • Sub-themes or audience segments • Well evaluated at all levels

  47. Policy and Environmental / INFRASTRUCTURE changes Initial STEERING COMMITTEE PROJECT MODEL WHEELING WALKS /WV WALKS Task Force Mass media-based CAMPAIGN 12-week CHPP

  48. ExercisePreventionof CHD

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