Walk4Life Dr Maps – supporting people to walk in their local area

Ade Aboaba, Project Manager, Walk England

ade.aboaba@walkengland.org.uk  

Abstract

Dr Maps is one of a range of tools used by the social enterprise Walk England to provide information aimed at encouraging sedentary people to choose to walk more and improve their fitness. The benefits of physical activity are well evidenced, in terms of health and wellbeing, social factors, economics and the environment. It is also predicted that the collective impact of our inactive lifestyles in the UK is set to continue to have a negative impact on individuals, communities and services.

The maps are clear and visual representations of an area or neighbourhood. Each map illustrates a series of pleasant short walks, and these are ideally distributed to individuals by a health professional from a tear-off pad. Typically these projects are delivered in areas where health inequalities are high.

Figure 1: Walk4Life Dr Maps 3D – Bloomsbury, Camden, London

Research confirms that there is the potential for a lot more walking locally where people live, over relatively short distances. Walking is free, accessible, and most importantly, people seem to believe in its benefits. UK National Statistics (2005) supports this with studies that suggest that 95% of adults in the UK agree that

walking is a good way to stay healthy, and 82% agree it is a good way to lose weight. Despite this, it is still uncommon for people to walk for short local journeys. To address this issue, Walk England has identified through research that there are four main barriers to walking being more prolific an activity. These are:

• Perceived time and distance of the journey • Impaired health status and ability of the individual • The poor nature of the built environment and street quality • Lack of available information

At a national level, walking and its champions are continuing to help people take responsibility for their own health and wellbeing, as well as supporting active travel choices, improving the environment and encouraging social and community connections, thereby increasing individual participation in neighbourhoods.

This paper outlines how the Walk4Life Dr Maps program supports people to overcome the four barriers to walking, and influences long-term attitudes and behaviour about choosing to walk more. It sets the scene by highlighting some of the main concepts and evidence about the environment we have to walk in, how we choose to move through it, and the impact that health professionals have when prescribing and referring people to walking opportunities.

This study makes reference to the early findings of the impact of Dr Maps, and signposts how Walk England will continue to monitor and evaluate this in newly completed projects. This is to be achieved by developing individual case studies and making links to data emerging from the Walk4Life project and the new national website (Walk4Life, 2010).

About the author

Ade Aboaba is a project manager at Walk England and is responsible for delivering the Walk4Life Dr Maps program. Ade has 10 years of experience in regeneration, the built environment and community engagement. More recently, she has been making links with the health and physical activity fields.

Walk4Life Dr Maps – supporting people to walk in their local area

Ade Aboaba, Project Manager, Walk England

Background

Before describing how Walk4Life Dr Maps helps people overcome the key barriers to walking, this section provides the overarching context for developing the maps within communities.

The environment around us

The Government White Paper, ‘Choosing Health’ (2004a), states that:

“The environment we live in, our social networks, our sense of security, socioeconomic circumstances, facilities and resources in our local neighbourhood can

affect individual health.” Figure 2 below shows this with the Health Map (Barton and Grant, 2006), which was created to show the environmental and social determinants of health and wellbeing in relation to public health.

Figure 2: The determinants of health in our cities  

The National Heart Forum (2007) states that:

“There is growing evidence to show that the quality of the environments people experience on a daily basis can have a strong influence on the levels of participation

in physical activity.”

Whilst Dr Maps projects do not result directly in environmental improvement, the process to develop them, alongside communities and health practitioners, brings together the relevant assets and resources already present in an area. In addition, the review of possible routes, and the audit of the final ones chosen, highlights those areas where access and quality is poor and in need of improvement. This information can then be used to support improvements in the local environment, whether for planning, transport or leisure purposes.

Navigating the environment

Studies show that maps and signs (when well designed, clear and consistent) can provide people with information needed when deciding if to walk, where to walk and how long it will take. The level of knowledge we have about our local environment can then influence our levels of confidence in walking to everyday destinations (AIG, 2006).

Maps can be simple and visual representations of an area, and can support people to develop and expand their own mental map of their daily environments. Kevin Lynch (1960) suggests that mental maps are the:

“Generalised mental picture of the exterior physical world that is held be an individual”.

Mental maps gather together our spatial perceptions as well as our feelings and memories about places and the routes we take to get to them. Therefore, our mental map can help us to plan our journey, as well as aiding us to navigate through the environment. Figure 3 shows this author’s mental map of a walking journey from Kennington to Vauxhall Bridge. It focuses on the navigation of busy roads and dark underpasses, which are perceived to be unsafe. In contrast, it also highlights the positive elements of the walk such as colourful shops, nearby events and the River Thames.

Research by Transport for London (TfL) supports the main factors used in developing mental maps, and the Legible London approach and navigational wayfinding systems are based on mental mapping (Transport for London, 2006): “This process of using routes ‘connecting areas’ is one of the key building blocks in

helping people to build their mental maps”. To aid wayfinding, maps often include information on ‘markers’, which are landmarks, key features, and focal points in the environment that people will recognise in their mental maps. Other wayfinding and cognitive studies support the use of maps, alongside other systems, to develop spatial awareness of our environments, and thereby giving us confidence to move through them from place to place along streets.

Figure 3: Mental map – The author’s walk to Vauxhall Bridge, London

The state of the nation

In contemporary society, people are leading ever more inactive lives. The Department of Health (2004b) claims that six out of ten people in the UK are now classified as leading an inactive life, which is putting their health at risk. Changing economies, how we work, how we travel, lifestyle trends and social and cultural values are changing our attitudes and behaviour to how we choose to spend our time and influencing whether we engage in physical activity. On the whole, we are failing to exploit physical activity and walking opportunities in our local environments on a daily basis, for such journeys between home, work, school, play, shopping and socialising. In the UK, diseases such as coronary heart disease, type II diabetes and cancer, which are linked to low levels of physical activity and obesity, and also and chronic depression, are increasing at high rates. The Department of Health (2004b) states that:

“The annual costs of physical inactivity in England are estimated at £8.2billion – including the rising costs of treating chronic diseases such as coronary heart disease

and diabetes. This does not include the contribution of inactivity to obesity – an estimated further £2.5billion cost to the economy each year”.

It is well-known that regular moderate physical activity, defined as lasting for at least twenty minutes, five times a week, can help prevent and manage the medical conditions mentioned above and more. Walking is often described as (Morris and Hardman, 1997):

“The nearest thing to perfect exercise“, and it can easily be built into people’s daily rhythms. This approach is championed at a national and community level in the UK. For example, Be Active, Be Healthy (Department of Health, 2009c) is a national plan to encourage more physical activity, and walking plays a major part in the plan in addition to cycling, swimming and dancing.

‘Prescribing’ walking An NHS White Paper published earlier this year in the UK proposed that £80bn of NHS funding will be given directly to doctor’s surgeries to buy care for patients in their area, getting rid of primary care trusts and strategic health authorities by 2013. This will change the way in which health care is delivered at a local level. However, currently in England, the Primary Care Trusts (PCTs) are still responsible for commissioning and managing primary care services for people in their area based on local needs. There is evidence that shows health practitioners, at the primary care level, are well placed to encourage sedentary patients to be more active. NICE (2006) promotes “brief advice” in primary care (and exercise referral schemes, pedometers and community-based exercise programmes for walking and cycling) and states that

“Primary care practitioners should take the opportunity, whenever possible, to identify inactive adults and advise them to aim for 30 minutes of moderate activity

on 5 days of the week (or more)”. Further NICE recommendations advise health practitioners to talk to patients about their specific needs and capabilities, and where activity could be undertaken locally. Overcoming the Barriers to Walking

An overview

So if walking has so many benefits, why don’t we walk in our local areas more in the UK? Research shows there are a number of barriers to achieving this. It is useful here to consider the barriers in terms of soft ‘image’ factors and hard ‘infrastructure’ factors (Transport for London, 2008). Walk England has also identified from a variety of research studies, that barriers can be gathered under four main categories, shown in Table 1 and Figure 4 below.

1. Perceived speed 2. Lack of information

Image: • Misperception of distance • Misperception of time

Infrastructure: • Lack of consistent wayfinding

systems • Lack of information relating to

time/distance • Too few landmarks/mental focal

markers

Image: • No/lack of knowledge about the

location and links to places Infrastructure:

• Lack of consistent wayfinding systems

• Lack of information relating to time/distance

• Too few landmarks/mental focal points

3. Built environment and street quality

4. Health ability

Image: • Fear of crime e.g. attack,

particularly in the dark • Fear of abduction (children) • Fear of busy roads

Infrastructure: • Poor/lack of lighting • Litter, graffiti, vandalism etc • Noise and air quality (pollution) • Characterless streets and places • Poor maintenance of pavements • Lack of safe places to cross • Slopes, gradients, steps, surfaces

and widths, obstructions etc • Climate and weather

Image: • Misperception of fitness • Lack of knowledge on ease of

walking and its benefits • Lack of assurance and motivation

Infrastructure: • Lack of information relating to

time/distance • Lack of social/led walk groups

and poor social connections

Table 1: Barriers to walking

Walk4Life Dr Maps are designed to overcome some of the soft ‘image’ factors that deter people from walking. Whilst there is no substitute for investing in and improving the quality, accessibility and readability of the built environment, Dr Maps promotes the ‘good’ infrastructure assets already present in neighbourhoods through route selection.

Figure 4: The key barriers to walking

The four main barriers to walking are evidenced in Walk England’s pilot project in Camden, London with NHS Camden (one of 31 PCTs in London). In this project, Walk England engaged with and talked to sedentary people, a range of community groups and people with pre-existing health conditions to help choose and audit the best walking routes in their own neighbourhoods. The areas chosen included Kentish Town and Kings Cross in London (NHS Camden, 2010) that reflected priority areas.

In order to reduce the perceived barriers to walking, NHS Camden funded Walk England to develop colourful and easy to follow 3D maps showing a series of accessible, safe and attractive short walks of one to two miles and lasting twenty to forty minutes, in urban areas near to or passing doctor’s surgeries.

By talking to target groups, Walk England tailored the maps to help overcome the barriers shown in Figure 4. Routes were often chosen by way of consultation, to reflect a wide range of themes and interests, from social, cultural and leisure activities to the desire for greener spaces and setting personal health challenges.

"The health maps are an ideal way of encouraging people to start walking, with a variety of routes allowing people to discover their local area whilst getting fit and healthy at the same time. The walks are easy to follow and vary in length helping people progress at their own pace. I hope they will encourage people to make the first steps towards a healthier lifestyle, whilst appreciating undiscovered places around their homes.” (Camden Borough Council, 2009) The following sections briefly describe each barrier in more detail and how Dr Maps is addressing them.

Time and distance

Qualitative studies show that the main barriers to walking relate to misperceptions and lack of information regarding distance and time. Without adequate knowledge, people often think it will take longer to walk to a place than it would in actuality. (Transport for London, 2008). This common perception is often worsened by a lack of awareness of local walking geography, and also a lack of sufficient information about the best route to take (AIG, 2007).

To help change perceptions of time and distance required for gaining the benefits discussed, Walk4Life Dr Maps illustrates a selection of interconnecting walks that reflect community themes and destinations from between one to three miles away. In the key, both an indication of time and distance is shown, based on an average walking speed of three miles per hour (typically walks between 20 minutes to one hour) to help counter this barrier. Providing such information can help change perceptions of one’s own speed, which gives people the opportunity to benchmark their walking ability by measuring the time it takes to walk a route.

Figure 5: Dr Maps key showing time and distance

Early evaluation (based on the pilot map project for NHS Camden) shows that the maps were useful in helping to develop a better understanding of local geography related to useful walking routes. A respondent in the pilot project evaluation (Walk England, 2009) stated:

“The map is really useful and will come in handy for people who do not know the area, and could take the shortest routes to get from A to B.”

Continuing research on the impact of Dr Maps related to this barrier could be used to monitor and evaluate:

• Changes in individual mental maps, relating to people’s personal geographies of their local environment before and after using the maps.

• Any changes in perceptions of time and distance and walking time. • Types of journey and how they fit into daily routines.

Health ability We already know that in the UK adults believe walking is a good way to keep healthy, but the Chief Medical Officer (2004) acknowledges that:

“About a third of men and between a third and a half of women do less than 30 minutes of activity per week (that is, are inactive or sedentary)”.

The question to ask from this, is do people feel they do not have the ability to walk for 30 minutes or more, especially those who are inactive? There is a range of international studies that explores the factors that influence people’s self-related and actual health conditions, such as lifestyle, current physical activity levels and access to walking opportunities. A lack of understanding about the actual benefits of walking, related to an individual’s own circumstances, may also be a problem for many people. In a recent Walk England meeting to discuss some of the benefits of walking (Walk England, 2010) one respondent asked:

“What’s the point of walking a mile anyway?” Walk4Life Dr Maps are mainly distributed in a healthcare environment, commonly by doctors, practice nurses, health care assistants, health trainers and walk leaders, to encourage sedentary people to walk more as part of their daily routine. The maps are available in A4 landscape tear-off pads (and are also made available at libraries and community/social centres, when relevant), which typically sit on a health professional’s desk for easy access. In this context, a discussion then can be had with the patient or service user about the relevance of walking related to specific medical conditions, alongside giving reassurance that walking short distances can be achieved and is beneficial. Where possible, the routes pass surgeries, other health venues and places to undertake other forms of physical activity (such as health check points, outdoor gyms, sports and community centres, swimming pools and schools), for people to take advantage of. Routes pass through local and familiar places to encourage a sense of familiarity and confidence. In some cases, walk leaders in led walks can reinforce the map’s messages and encourage people to undertake the routes themselves independently of the group. Early evaluation has captured qualitative views about self-rated health relevance of the maps, but further work must be done to measure the quantitative impact on health and fitness ability. A respondent in the pilot project evaluation stated:

“My disabled husband has also been using the map to increase walking as part of rehabilitation.”

Continuing research into Dr Maps in overcoming people’s perceptions of health ability may consider monitoring and evaluating:

• Self-rated health/fitness ability. • Actual fitness ability – perhaps using the Rockport 1 Mile Fitness Test.

• Changes in walking and physical activity levels. • Links to walking choices at a neighbourhood level (see environmental and

street quality section below). • Links to socio-demographic data, where possible.

Environmental and street quality Other major barriers to walking are the quality of the built and street environment, a lack of pleasant places to walk through, and not knowing where the best routes are within neighbourhoods. Environmental quality also has a large affect on safety concerns (for example, fear of crime, abduction and traffic). Adults in the UK mostly think their local environments are good. 72% of adults feel their local streets are safe and 74% say that their local area is a pleasant place to walk. However, this reduces significantly in deprived neighbourhoods, with satisfaction levels reducing to 55% and 57% respectively (National Statistics, 2005), which may be because the environment is less attractive and ‘walkable’. There are various elements that make up the outdoor environment, which have an impact on health and wellbeing. The Sustainable Development Commission (2008) summarise these as: “Natural spaces, air pollution, road traffic, noise, floods, climate, accessibility, safety

and incivilities, mixed land-use and street design”. From this author’s experience, Walk England would add to this summary, with specific relation to walking in terms of the following:

• Accessibility e.g. widths, crossings, kerbs and steps, cross slopes and gradients, surfaces.

• Urban design e.g. character, quality, design of routes and places. • Maintenance of pavements and shared surfaces.

Walk4Life Dr Maps often details routes in deprived areas where health inequalities are high, and where it may be harder to find pleasant and useful routes. Walk England consults with local communities about where people already enjoy walking, and audits the routes selected for risks. Through evaluation, Walk England has found the most effective maps use a 3D base to emphasise appealing markers in the environment, such as green spaces, pleasant streets, focal community/social points, places of interest and cultural, social and educational hubs. This also includes underground stations and a selection of public toilets and cafés, which all help to place markers in users’ minds, as well as being welcome rest points. Key buildings and structures are developed in more graphic detail to aid navigation through the environment.

Where funding is limited, the same approach can be used with a less costly 2D map base – for example Open Street Map (2010). This method has been used in some Dr Maps projects, but is yet to be fully evaluated.

Figure 6: Highlighting attractive features of the neighbourhood

The maps are bold and uncluttered to give people confidence in information about where to go. Where possible, the routes take the walker off main busy roads, in some cases offering new views of the local neighbourhood, which helps to expand personal mental maps of the area and walking geography. Early evaluations clearly demonstrate the success of the maps in providing a resource to present appealing routes in the environment. The main objectives of the maps is to result in and sustain more walking locally and improve physical activity levels; however there is anecdotal evidence that the maps have different purposes depending on the target group. One of the doctors in a surgery in Camden that is covered by a map is using it to help him find houses for house calls – and walking there instead of driving! “I sometimes use it over the weekend – it enables me to walk a more interesting way.”

“The map looked really appealing, very clear to see where you are going and points

of interest.”

“I stuck the map up at work, and it has really encouraged female colleagues to walk more.”

- Comments from respondents in pilot project evaluation Some ideas for further research into the efficacy of Dr Maps in overcoming some of the issues for people regarding walking in the built environment could include:

• Understanding walking choices and geographies e.g. through mental mapping and ethnographic studies.

• Ascertaining neighbourhood health assets from a community perspective. • Looking for links between environmental quality of routes and frequency of

usage. Lack of information People are often unaware of the best places to walk in their locality, and can be deterred from trying to walk if they aren’t sure of the way. Maps provide a solution to this problem, and particular particularly Dr Maps, which are designed to be used by non-map readers and show attractive routes through safe and pleasant green spaces and interesting built environments. The Legible London initiative aims to make London easier to navigate. AIG’s research (2008) has shown that:

“Navigational strategies used by pedestrians include a mix of planning (often with maps) and doing (walking along deciphering the street and looking for markers)”.

Markers here can translate to signage, landmarks, public art, lighting, urban design and even sound and smell, in addition to community and social focal points (see the previous section, Environmental and street quality). The Dr Maps project identifies ‘markers’ and highlights them on the maps through detailed 3D drawings to assist with navigation, and to give people confidence that they are in the right place. Walk4Life Dr Maps attempts to use clear mapping to provide the information people need to help them choose to walk. Continuing research of Dr Maps could monitor and evaluate:

• When maps are used, how often and for how long. • Increases in walking daily/weekly. • Changes in route knowledge, and maybe willingness to experiment. • Confidence to walk in different and/unknown areas.

Moving Forwards Gaining a better understanding of the impact of Dr Maps The Walk4Life project, in particular the new portal – www.walk4life.info - and ongoing qualitative and quantitative monitoring and evaluation by Walk England, will give insights into the impact of promoting and prescribing walking. The following section gives an overview of the two main opportunities for ongoing research. Walk4Life is part of the Change4Life movement, a marketing plan from the Department of Heath in response to the rise in obesity, which has been set up to encourage families and adults to eat well, move more and live longer in the UK. Walk4Life is all about helping people move, and evidence shows that walking is an effective way to start. As part of Walk4Life, Walk England has delivered and will maintain a new website that went live on 13th September 2010, supported by strategic and local partners with a remit surrounding walking. The website is designed for the public, and it provides a place to:

• Look for somewhere to walk. • Create walks. • Record walking activity. • Track progress (e.g. keep track of where and when the walks were, miles

completed and changes in fitness). Walk England expects the website to grow, populated by everyday walking routes in local neighbourhoods, and there are now over 2000 uploaded on the website across the country. Additional functionality will be developed to:

• Allow people to create and join groups. • Set or sign up to challenges. • Record fitness levels using the Rockport 1 Mile Fitness Test.

Figure 7:www.walk4life.info

The website offers the opportunity to collate data to increase understanding of the impact of walking promotion on levels of physical activity and health in communities. To make best use of the data, Walk England are working closely with the School of Sport, Exercise and Health Sciences at Loughborough University to study a number of areas, based on data from the website. All the routes shown on the Walk4Life Dr Maps projects are present and available to download from the new website, which gives the opportunity to explore the relationship between online and paper resources.

Case studies Since the Camden Dr Maps Pilot in 2008, Walk England has now recently completed three other map projects in Camden and Tower Hamlets in London and Tewkesbury in Gloucestershire.

W4L Dr Maps Project Coverage No. of routes

No. of paper maps

Camden, London phase one1

Pilot areas – Bloomsbury, Kentish Town, Kings Cross, Royal Free Hospital

13 4, 3D (13 routes)

Camden, London phase two

All the borough – focus on priority areas (incl. Kilburn and Somers Town)

43 3, 3D (10 routes)

Tower Hamlets, London Borough wide – 8 Local Area Partnership (LAP) areas

45 8, 2D (25 routes)

Tewkesbury, Gloucestershire

All of town – focus on five priority neighbourhoods

25 5, 3D (25 routes)

Gloucestershire County wide - initially in key areas and market towns

60 (for website launch)

-

Table 2: Dr Maps projects to date

It is important for Walk England, together with their partners, to continue to monitor, evaluate and understand the impact of the Walk4Life Dr Maps on supporting sedentary people to walk more. Based on previous evaluation (Camden phase one), feedback from recent meetings with health professionals and ideas emerging from this paper, Walk England will:

• Focus on health and wellbeing case study development, with regard to conditions such as diabetes, heart disease, COPD and mental illness.

• Engage and work through doctors’ surgeries and other health/community places via Doctors, Health Care Assistants, Practice Nurses, Health Trainers and Healthy Lifestyle Managers.

• Develop individual case studies through one-to-one sessions and focus groups.

• Try and measure changes in physical activity levels and fitness. • Assess how the maps help people to overcome the perceived barriers to

walking. • Make links with Walk4Life website data, activity logs, mile fitness tests and

Loughborough research

The list is not exhaustive, but gives a flavour of Walk England’s approach to evaluation over the next year. We look forward to presenting emerging findings at Walk21s conference in 2011 in Canada, including presenting details of emerging data sets from the Walk4Life website.

                                                                                                                 

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