Chapter 19: Chapter 19: Community Level Intervention Community Level Intervention StrategiesStrategies

Community strategies typically include a Community strategies typically include a number of institutions, organizations, and number of institutions, organizations, and groups to deliver a variety of interventionsgroups to deliver a variety of interventions

Target ________________ rather than Target ________________ rather than

individual behavior change individual behavior change

Primary distinction between individual, Primary distinction between individual, group, and community interventions is …group, and community interventions is …

Community Level InterventionsCommunity Level Interventions

Karen Glanz (1997) provided an outline of the Karen Glanz (1997) provided an outline of the benefit and breadth of community level benefit and breadth of community level interventions interventions Community-level models suggest strategies and Community-level models suggest strategies and

initiatives that are planned and led by initiatives that are planned and led by organizations and institutions whose missions are organizations and institutions whose missions are to protect and improve health: schools, worksites, to protect and improve health: schools, worksites, health care settings, community groups, and health care settings, community groups, and governmental agencies. Other institutions for governmental agencies. Other institutions for whom health enhancement is not a central mission, whom health enhancement is not a central mission, such as the mass media, also play a critical role. such as the mass media, also play a critical role.

Community Level InterventionsCommunity Level Interventions

An aggregate of people who share An aggregate of people who share ______________________________________________________________________

Shared institutions include: local hospitals, Shared institutions include: local hospitals, recreation centers, worksites, faith-based recreation centers, worksites, faith-based institutions, and schoolsinstitutions, and schools

Refers to the locality of an aggregate of people, Refers to the locality of an aggregate of people, groups or institutionsgroups or institutions

Informal social norms, belief systems, Informal social norms, belief systems, interdependent groups, and attachmentsinterdependent groups, and attachments

Community DefinedCommunity Defined

There is practicality in developing and There is practicality in developing and implementing physical activity implementing physical activity interventions at the community level interventions at the community level A community-based intervention should A community-based intervention should

increase ________________________ increase ________________________ invested into health promotion because of invested into health promotion because of the inter-group relationships, shared the inter-group relationships, shared values, and a common attachment within values, and a common attachment within the communitythe community

Why Focus on Communities?Why Focus on Communities?

Community programs for the promotion Community programs for the promotion of physical activityof physical activity

4 primary sections: 4 primary sections: Site-based interventionsSite-based interventions Community-wide and policy interventionsCommunity-wide and policy interventions Mass media interventionsMass media interventions The Centers for Disease Control and The Centers for Disease Control and

Prevention guidelines for community-based Prevention guidelines for community-based physical activity interventions. physical activity interventions.

Community InterventionsCommunity Interventions

Elementary, middle, and high schools Elementary, middle, and high schools have traditionally offered physical have traditionally offered physical education classeseducation classes

Schools are offering fewer, and shorter Schools are offering fewer, and shorter duration, physical education classes and duration, physical education classes and have even eliminated them completely is have even eliminated them completely is some casessome cases

Site-Based Interventions: SchoolsSite-Based Interventions: Schools

Two Areas of Focus:Two Areas of Focus: Increasing physical activity Increasing physical activity

____________________________________________________________ Increasing Increasing

____________________________________________ Stone and associates (1998) examined Stone and associates (1998) examined

the effectiveness of 14 school the effectiveness of 14 school interventions interventions

Site-Based Interventions: SchoolsSite-Based Interventions: Schools

Stone and associates found:Stone and associates found: Interventions were often successful at Interventions were often successful at

improving knowledge and attitudes improving knowledge and attitudes towards physical activitytowards physical activity

Interventions were typically successful at Interventions were typically successful at increasing physical activity increasing physical activity ________________________________________________________

Interventions were often unsuccessful at Interventions were often unsuccessful at increasing _________________________increasing _________________________

Site-Based Interventions: SchoolsSite-Based Interventions: Schools

The Child and Adolescent Trial for The Child and Adolescent Trial for Cardiovascular Health Cardiovascular Health (CATCH) (CATCH)

96 elementary schools in California, Louisiana, 96 elementary schools in California, Louisiana, Minnesota, and Texas Minnesota, and Texas

CATCH targeted increasing physical activity CATCH targeted increasing physical activity during physical education classes and outside of during physical education classes and outside of school timeschool time

Based on ________________________ and Based on ________________________ and organizational change strategies organizational change strategies

Site-Based Interventions: SchoolsSite-Based Interventions: Schools

33rdrd grade year grade year 5-week curriculum 5-week curriculum Policy interventions such as the provision of Policy interventions such as the provision of

space, equipment and supervision during space, equipment and supervision during non-school hours non-school hours

Policy and curricula in physical education Policy and curricula in physical education classes were also introducedclasses were also introduced

Site-Based Interventions: SchoolsSite-Based Interventions: Schools

44thth and 5 and 5thth grade years grade years 12-week curriculum 12-week curriculum Policy components were sustained Policy components were sustained

The CATCH project resulted in positive changes in The CATCH project resulted in positive changes in physical activity through the 3 years of the studyphysical activity through the 3 years of the study

The __________________ increase in physical The __________________ increase in physical

activity was still present 3 years lateractivity was still present 3 years later

Site-Based Interventions: SchoolsSite-Based Interventions: Schools

Worksites have also been targeted Worksites have also been targeted environments for physical activity environments for physical activity programsprograms

Expert narrative reviews of literature Expert narrative reviews of literature provided ____________________ provided ____________________ effectiveness of these programseffectiveness of these programs

Site-Based Interventions: WorksitesSite-Based Interventions: Worksites

Dishman and associates (1998) conducted a meta-Dishman and associates (1998) conducted a meta-analysis on 26 studies examining worksite interventionsanalysis on 26 studies examining worksite interventions The __________________ was coded as either The __________________ was coded as either

behavior modification, cognitive behavior behavior modification, cognitive behavior modification, health education, health risk modification, health education, health risk appraisal, exercise prescription, or a combination of appraisal, exercise prescription, or a combination of strategies. strategies.

______________________ was coded as face-to-face, ______________________ was coded as face-to-face, mediated (indirectly through print or telephone), or mediated (indirectly through print or telephone), or a combination of the two, while location was coded a combination of the two, while location was coded as on or off-site. as on or off-site.

Site-Based Interventions: WorksitesSite-Based Interventions: Worksites

The results of the meta-analysis revealed a The results of the meta-analysis revealed a small positive effect for worksite physical small positive effect for worksite physical activity interventionsactivity interventions

The size of this effect was not significantly The size of this effect was not significantly different from zerodifferent from zero

______________________ to the size of effect ______________________ to the size of effect based on any of the moderatorsbased on any of the moderators

Based upon this meta-analysis it was concluded Based upon this meta-analysis it was concluded that worksite physical activity interventions that worksite physical activity interventions ____________________________________________

Site-Based Interventions: WorksitesSite-Based Interventions: Worksites

Simons-Morton and colleagues (1998) Simons-Morton and colleagues (1998) provided a review of health care setting provided a review of health care setting physical activity interventions. physical activity interventions. ______________________________________: Physical activity : Physical activity

promotion for apparently healthy promotion for apparently healthy individualsindividuals

______________________________________: Physical activity : Physical activity promotion for individuals with promotion for individuals with cardiovascular diseasecardiovascular disease

Site-Based Interventions: Health Care Site-Based Interventions: Health Care SettingsSettings

12 12 primary preventionprimary prevention studies studies Based on patient counseling Based on patient counseling No interventions included structured physical No interventions included structured physical

activity programs activity programs Half were based on an underlying theoryHalf were based on an underlying theory 75 % implemented by doctors while nurses or other 75 % implemented by doctors while nurses or other

health professionals administered the remaining health professionals administered the remaining interventions.interventions.

The results of these studies were The results of these studies were __________________________________________________________________________

Effects __________________________Effects __________________________

Site-Based Interventions: Health Care Site-Based Interventions: Health Care SettingsSettings

Secondary Prevention studiesSecondary Prevention studies Simons-Morton et al. (1998) identified 24 Simons-Morton et al. (1998) identified 24

studies of physical activity interventions studies of physical activity interventions for patients with cardiovascular diseasefor patients with cardiovascular disease

________________________ reported ________________________ reported

significant changes in physical activity or significant changes in physical activity or fitness. fitness.

Site-Based Interventions: Health Care Site-Based Interventions: Health Care SettingsSettings

Secondary Prevention Studies (cont.)Secondary Prevention Studies (cont.) In studies that used an intervention that targeted In studies that used an intervention that targeted

many risk behaviors (including inactivity), about many risk behaviors (including inactivity), about half were effective in changing physical activityhalf were effective in changing physical activity

Based upon the review interventions that Based upon the review interventions that included supervised exercise with behavior included supervised exercise with behavior modification techniques or the provision of home modification techniques or the provision of home equipment were most often effective (i.e., 75% of equipment were most often effective (i.e., 75% of the studies)the studies)

Site-Based Interventions: Health Care Site-Based Interventions: Health Care SettingsSettings

King and collaborators (1995) provided an King and collaborators (1995) provided an excellent description of legislative, policy, and excellent description of legislative, policy, and environmental approaches to increase physical environmental approaches to increase physical activity in communities. activity in communities.

_________________refers to formal legal structures _________________refers to formal legal structures at the local, state, or federal levels of government. at the local, state, or federal levels of government.

____________is the formal or informal rules that ____________is the formal or informal rules that provide structure to a governing organization. provide structure to a governing organization.

________________________ involve providing, for ________________________ involve providing, for example, bike paths and facilities with exercise to example, bike paths and facilities with exercise to communitycommunity

Community-wide and Policy InterventionsCommunity-wide and Policy Interventions

The Navel Community Project in California The Navel Community Project in California Three groups: an intervention community, a control Three groups: an intervention community, a control

community, and a Navy-wide sample community, and a Navy-wide sample Cardiovascular fitness was assessed before and after Cardiovascular fitness was assessed before and after

the 1-year intervention period the 1-year intervention period The environmental and policy strategies used focused The environmental and policy strategies used focused

on physical activity and healthy eatingon physical activity and healthy eating

Community-wide and Policy InterventionsCommunity-wide and Policy Interventions

Policy strategies:Policy strategies: _____________________ the community _____________________ the community

recreation center was openrecreation center was open Communications between superiors and Communications between superiors and

subordinates ___________________ that subordinates ___________________ that all members of the base should be involved all members of the base should be involved in regular exercisein regular exercise

Include fruits and vegetables at all snack Include fruits and vegetables at all snack shops on the Naval base was implemented shops on the Naval base was implemented

Community-wide and Policy InterventionsCommunity-wide and Policy Interventions

Environmental changes:Environmental changes: New exercise equipment was purchased for New exercise equipment was purchased for

the gymnasia the gymnasia A women-only fitness center was opened on A women-only fitness center was opened on

the basethe base 1.5 mile running routes were marked out 1.5 mile running routes were marked out

around the basearound the base The organization of athletic events and The organization of athletic events and

jogging clubsjogging clubs

Community-wide and Policy InterventionsCommunity-wide and Policy Interventions

The intervention had a number of positive The intervention had a number of positive benefits for participants who experienced benefits for participants who experienced the environmental change conditionthe environmental change condition

They completed a 1.5-mile run 18 seconds They completed a 1.5-mile run 18 seconds faster following the interventionfaster following the intervention

A reduced failure rate during the physical A reduced failure rate during the physical testing (12.4% pre-test down to 5.1% testing (12.4% pre-test down to 5.1% post-intervention)post-intervention)

Community-wide and Policy InterventionsCommunity-wide and Policy Interventions

Did not gain body fat while participants in Did not gain body fat while participants in both control conditions showed significant both control conditions showed significant increases in percent body fat increases in percent body fat

Although the number of sedentary Although the number of sedentary individuals (<2000 kcal of activity) individuals (<2000 kcal of activity) increased in all groups, the increase was increased in all groups, the increase was at a lower rate in the intervention group at a lower rate in the intervention group (about 3%) when compared to the control (about 3%) when compared to the control conditions (about 7%).conditions (about 7%).

Community-wide and Policy InterventionsCommunity-wide and Policy Interventions

Perhaps the most important finding of the Perhaps the most important finding of the study was the extent of the impact for the study was the extent of the impact for the interventionintervention

______________________ of the population ______________________ of the population were positively influenced by the intervention were positively influenced by the intervention strategy thereby providing support for the strategy thereby providing support for the King et al. (1995) hypothesis that both King et al. (1995) hypothesis that both environmental and policy approaches are environmental and policy approaches are effective for increasing physical activityeffective for increasing physical activity

Community-wide And Policy InterventionsCommunity-wide And Policy Interventions

Mass media is often associated with Mass media is often associated with television, radio, and newspapers, but may television, radio, and newspapers, but may also included the use of telephones, internet also included the use of telephones, internet technology, and postal servicestechnology, and postal services

Mass Media InterventionsMass Media Interventions

Mass Media Interventions Mass Media Interventions ExampleExample

• Marcus et al. (1998) ___________________ motivationally tailored PA intervention.

• Based on ________________________• Sedentary subjects in Two groups:

– Stage matched self-help booklet– Standard self-help booklet (action oriented)

• Both treatments worked. The stage-matched was more effective (increase from 5.5 min to 151 min of PA per week)

___________ report to summarize ___________ report to summarize recommendations for encouraging physical recommendations for encouraging physical activity in young peopleactivity in young people

The recommendations focused on school and The recommendations focused on school and general community programs but most are general community programs but most are valuable for, and can be generalized to, any valuable for, and can be generalized to, any type of community-based interventiontype of community-based intervention

See See table 17-1 in text booktable 17-1 in text book

Recommendations For Community Recommendations For Community Programs To Promote Physical ActivityPrograms To Promote Physical Activity