Bringing Micro to the Macro: How Citizen Science Data Enrich Geospatial Visualizations to Advance Health Equity.

Social and spatial contexts affect health, and understanding nuances of context is key to informing successful interventions for health equity. Layering mixed methods and mixed scale data sources to visualize patterns of health outcomes facilitates analysis of both broad trends and person-level experiences across time and space. We used micro-scale citizen scientist-collected data from four Bay Area communities along with aggregate epidemiologic and population-level data sets to illustrate barriers to, and facilitators of, physical activity in low-income aging adults. These data integrations highlight the synergistic value added by combining data sources, and what might be missed by relying on either a micro- or macro-level data source alone. Mixed methods and granularity data integration can generate a deeper understanding of environmental context, which in turn can inform more relevant and attainable community, advocacy, and policy improvements.

Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping.

Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.

Improving lifestyle behaviors is a complex task. Interventions to support such change often have multiple components, making their evaluation difficult. Within the context of an intervention trial delivered at senior public housing sites and designed to increase physical activity among ethno-racially diverse aging adults, we assessed the utility of a novel method, called Ripple Effects Mapping (REM), in identifying useful information for additional refinement of the interventions being studied. We facilitated REM sessions across 6 study sites. Using this method, we were able to uncover useful information, including expected and unexpected outcomes of the interventions from the perspective of the participants themselves. We also learned about participants' own challenges and solutions to problems they encountered during the intervention period, and how these kinds of interventions can be further revised to be most helpful in other settings and with similar populations. Thus, these types of participant-centered methods are feasible and can complement more traditional, investigator-driven evaluation efforts, particularly for complex interventions or those with multiple components. They can also inform scientists about the outcomes most valued by participants, how those outcomes came about, and how future interventions can enhance and sustain healthy behavior change over time.

Testing the effectiveness of community-engaged citizen science to promote physical activity, foster healthier neighborhood environments, and advance health equity in vulnerable communities: The Steps for Change randomized controlled trial design and methods.

While low-income midlife and older adults are disproportionately affected by non-communicable diseases that can be alleviated by regular physical activity, few physical activity programs have been developed specifically with their needs in mind. Those programs that are available typically do not address the recognized local environmental factors that can impact physical activity. The specific aim of the Steps for Change cluster-randomized controlled trial is to compare systematically the initial (one-year) and sustained (two-year) multi-level impacts of an evidence-based person-level physical activity intervention (Active Living Every Day [ALED] and age-relevant health education information), versus the ALED program in combination with a novel neighborhood-level citizen science intervention called Our Voice. The study sample (N = 300) consists of insufficiently active adults ages 40 years and over living in or around affordable senior public housing settings. Major study assessments occur at baseline, 12, and 24 months. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of physical activity, assessed via validated self-report measures supported by accelerometry, and physical function and well-being variables. Additional intervention impacts are assessed at 24 months. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. TRIAL REGISTRATION: clinicaltrial.gov Identifier = NCT03041415.