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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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slide1

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
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
leading contributors to premature death
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

slide4
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

project phases

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

phase i community involvement
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
targeted message and audience

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
target population
Target Population

78% of 55-64 year olds

were insufficiently active

BRFSS 2001

funding sources
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
methodology a basis in theory
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:
campaigns using mass media

Multi-strategycampaign

community interventions & community development

Media

legislative & regulatory

health

professional education

paid

unpaid

Campaigns using mass media

structured, co-ordinated, & multi-faceted

phase ii message development formative research
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)

slide13

TIME

ENERGY

slide16

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
slide17

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

slide18

Reception Processing Response Behavior

behavior beliefs

argument qualityPLACEMENTelaboration normative intentionBEHAVIOR likelihood beliefs to actFREQUENCYcues control beliefs

phase iii campaign and evaluation

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

paid advertising 8 weeks

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

public relations to generate earned media included

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

results earned media

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

slide25

Wheeling Walks

RESULTS—TELEPHONE QUESTIONNAIRES

SELF-REPORT --Baseline to Immediate-post

Percent Increase

14% difference

32%

18%

slide26

Wheeling Walks

RESULTS—POSITIVE STAGE CHANGES

From Baseline precontemplation,contemplation, and preparation

12% difference

62%*

50%

* p< .001)

slide27

Attitude

.33

.13

Walking Status

.31

.15

Treatment

Intention

.11

.42

Control

All paths with coefficients are significant at .01 or better

slide28

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

slide29

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)

slide30

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%

slide31

Wheeling Walks

Group A= Baseline daily walking minutes <=10 minutes

slide32

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
slide33

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

paid advertising 8 weeks1
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

slide38

WV WALKS

RESULTS—TELEPHONE QUESTIONNAIRES

WV WALKS

Baseline to Immediate-post

Percent Increase

12% difference

27%

15%

results earned media1
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

slide40

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

slide41

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.

slide42

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”
assessment of policymakers
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%

walking issues
Walking Issues
  • Morgantown
    • Baseline: Ranked 4th
    • Post Campaign: Ranked 1st
    • P < 0.05 (t-test for differences in proportion means)
  • Huntington
    • Not mentioned
community problem issues
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
slide46

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.

slide47
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.”

slide48

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
slide49

Policy and Environmental / INFRASTRUCTURE changes

Initial STEERING COMMITTEE

PROJECT MODEL

WHEELING WALKS /WV WALKS Task Force

Mass media-based

CAMPAIGN

12-week CHPP