Sector activities and lessons learned around initial implementation of the United States national physical activity plan.

BACKGROUND: National plans are increasingly common but infrequently evaluated. The 2010 United States National Physical Activity Plan (NPAP) provided strategies to increase population levels of physical activity. This paper describes (i) the initial accomplishments of the NPAP sector teams, and (ii) results from a process evaluation to determine how the sectors operated, their cross-sector collaboration, challenges encountered, and positive experiences. METHODS: During 2011, a quarterly reporting system was developed to capture sector-level activities. A year-end interview derived more detailed information. Interviews with 12 sector leads were recorded, transcribed verbatim, and analyzed for common themes. RESULTS: The 6 sectors worked on goals from the implementation plan that focused broadly on education, promotion, intervention, policy, collaboration, and evaluation. Through year-end interviews, themes were generated around operations, goal setting, and cross-sector collaboration. Challenges to the NPAP work included lack of funding and time, the need for marketing and promotion, and organizational support. Positive experiences included collaboration, efficiency of work, enhanced community dynamic, and accomplishments toward NPAP goals. CONCLUSIONS: These initial results on the NPAP sector teams can be used as a baseline assessment for future monitoring. The lessons learned may be useful to other practitioners developing evaluations around state- or national-level plans.

In-depth interviews with state public health practitioners on the United States National Physical Activity Plan.

BACKGROUND: The United States National Physical Activity Plan (NPAP; 2010), the country's first national plan for physical activity, provides strategies to increase population-level physical activity to complement the 2008 physical activity guidelines. This study examined state public health practitioner awareness, dissemination, use, challenges, and recommendations for the NPAP. METHODS: In 2011-2012, we interviewed 27 state practitioners from 25 states. Interviews were recorded and transcribed verbatim. Transcripts were coded using a standard protocol, verified and reconciled by an independent coder, and input into qualitative software to facilitate development of common themes. RESULTS: NPAP awareness was high among state practitioners; dissemination to local constituents varied. Development of state-level strategies and goals was the most frequently reported use of the NPAP. Some respondents noted the usefulness of the NPAP for coalitions and local practitioners. Challenges to the plan included implementation cost, complexity, and consistency with other policies. The most frequent recommendation made was to directly link examples of implementation activities to the plan. CONCLUSIONS: These results provide early evidence of NPAP dissemination and use, along with challenges encountered and suggestions for future iterations. Public health is one of eight sectors in the NPAP. Further efforts are needed to understand uptake and use by other sectors, as well as to monitor long-term relevance, progress, and collaboration across sectors.

The U.S. National Physical Activity Plan: dissemination and use by public health practitioners.

BACKGROUND: The 2010 U.S. National Physical Activity Plan contains a comprehensive set of policies, programs, and initiatives to increase physical activity. PURPOSE: To determine the early awareness, use, diffusion, and implementation of the plan among members of the National Society of Physical Activity Practitioners in Public Health. METHODS: The web-based survey was conducted in 2011 and analyzed in 2011-2012. The survey was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and Diffusion of Innovations theory. Of 492 professional members, 291 responded. RESULTS: Overall, 79% reported awareness of the plan, with higher odds among state practitioners compared to other practitioners and among those with state partnerships to address physical activity compared to those without. Among those who were aware (n=230), 15% reported using the plan ≥6 times, whereas 28% had never used it. For those who referred to the plan at least once in their work (n=165), the most commonly reported uses were for brainstorming and discussion (73%); development and implementation of activities (55%); and state-level goal-setting (34%). Related to diffusion principles, many respondents reported that the plan fit their organization's goals (85%) and was easy to understand (81%), yet fewer agreed that changes made after the plan were easy to observe (32%); easy to implement (28%); and low-cost (25%). CONCLUSIONS: This theory-based evaluation found that the National Physical Activity Plan has been broadly disseminated to physical activity practitioners working in public health. Opportunities exist for public health practitioners and others to more fully integrate the plan into their work.

All health is local: state and local planning for physical activity promotion.

CONTEXT: Physical activity is a leading cause of death in the world. Although state and local public health planning is a useful strategy to address noncommunicable disease health concerns such as heart disease, diabetes, cancer, and obesity, physical activity frequently is subsumed in such disease-centric planning efforts. This strategy could dilute broader efforts to promote physical activity, create administrative silos that may be trying to accomplish similar goals, and weaken efforts to more collectively address a variety of noncommunicable diseases. Currently, few stand-alone state plans directed specifically at physical activity exist. The reasons and barriers for this situation are not understood. OBJECTIVE: In 2011, we surveyed public health care practitioners to describe state and local efforts for physical activity planning. DESIGN: Cross-sectional study. SETTING: Survey of physical activity practitioners in the United States. PARTICIPANTS: A total of 227 former or current members of the US National Society of Physical Activity Practitioners in Public Health who completed a survey. RESULTS: Overall, 48.0% of respondents indicated that they were aware of public health plans for physical activity promotion in their state, whereas 36.6% indicated that they did not know. Respondents at the state level more frequently reported awareness of a plan (62.1%) than those with local-level (52.4%) or other job responsibilities (36.0%). A greater proportion of respondents reported that stand-alone physical activity plans existed in their state than actually did exist in the respective states. Integration with the National Physical Activity Plan was least often identified as a moderately or extremely relevant aspect of a state-level physical activity plan, although it was chosen at a high percentage (75.7%). Respondents identified financial support (88.0%) and political will and support (54.6%) most frequently as very or somewhat difficult barriers to moving forward with state-level physical activity plans. CONCLUSIONS: These data suggest that despite efforts to increase development and use of stand-alone physical activity plans, most practitioners rely on existing chronic disease- or obesity-related plans to guide their efforts. Barriers to developing stand-alone physical activity plans must be addressed to develop such plans.

Exploring a public health perspective on pedestrian planning.

A pedestrian plan is a public document that explains a community's vision and goals for future pedestrian activity. This study explored whether involvement by public health professionals in the development of pedestrian plans was associated with certain characteristics of the plan (vision, goals, identified programs, and evaluation). This study identified, collected, and analyzed content of all pedestrian plans in North Carolina through 2008. Among the 46 plans, 39% reported involvement by public health professionals in their development. Overall, 72% of pedestrian plans included a vision statement; health was mentioned four times and quality of life was mentioned five times. Slightly more than half (52%) of the plans included goals to improve public health. Plans that involved public health professionals more often included the type of physical activity, safety, or education program. Only 22% of all pedestrian plans included a proposal to evaluate their implementation. Plans that included public health professionals were less likely to include an evaluation proposal (11%) compared with those that did not involve public health professionals (21%). Public health professionals are encouraged to seek involvement in the pedestrian planning process, particularly in the areas of health program development, implementation, and evaluation.

Planning for pedestrians and bicyclists: results from a statewide municipal survey.

BACKGROUND: We surveyed North Carolina (NC) municipalities to document the presence of municipal walking- and bicycling-related projects, programs, and policies; to describe whether prevalence of these elements differed if recommended in a plan; and to characterize differences between urban and rural municipalities. METHODS: We surveyed all municipalities with ≥ 5000 persons (n = 121) and sampled municipalities with < 5000 persons (216/420), with a response rate of 54% (183/337). Responses were weighted to account for the sampling design. RESULTS: From a list provided, staff reported on their municipality's use of walking- and bicycling-related elements (8 infrastructure projects, 9 programs, and 14 policies). The most commonly reported were projects on sidewalks (53%), streetscape improvements (51%), bicycle/walking paths (40%); programs for cultural/recreational/health (25%), general promotional activities (24%), Safe Routes to School (24%), and law enforcement (24%); and policies on maintenance (64%), new facility construction (57%), and restricted automobile speed or access (45%). Nearly all projects, programs, or policies reported were more likely if included in a plan and more prevalent in urban than rural municipalities. CONCLUSION: These results provide cross-sectional support that plans facilitate the implementation of walking and bicycling elements, and that rural municipalities plan and implement these elements less often than urban municipalities.

Barriers to municipal planning for pedestrians and bicyclists in North Carolina.

BACKGROUND: The Guide to Community Preventive Services recommends implementing community- and street-scale urban design, as well as land use policies and practices, to promote walking and bicycling. To better understand barriers to municipal walking and bicycling projects and policies, we surveyed municipal staff in North Carolina. METHODS: We surveyed all 121 municipalities with at least 5,000 persons, and 62% responded. We also surveyed 216 of 420 municipalities with less than 5,000 persons, and 50% responded. The municipal staff member most knowledgeable about walking and bicycling planning was asked to complete the survey. Responses were weighted to account for the sampling design, to reflect prevalence estimates for all North Carolina municipalities. RESULTS: Common barriers to walking and bicycling projects and policies were selected from a 14-item list. For walking, barriers included lack of funding (93% of responding municipalities), other infrastructure priorities (79%), automobile infrastructure priorities (66%), and staffing challenges (65%). For bicycling, barriers included lack of funding (94% of responding municipalities), other infrastructure priorities (79%), automobile infrastructure priorities (73%), issues were not high priorities for the municipality (68%), staffing challenges (68%), and insufficient support from residents (63%). Barriers generally were more prevalent among rural municipalities than among urban municipalities (9 of 14 barriers for walking and 5 of 14 for bicycling; P < .10). LIMITATIONS: The study relied on 1 respondent to report for a municipality. Additionally, job titles of respondents varied with municipality size. CONCLUSIONS: Health professionals and multidisciplinary partners can assist in overcoming the common local- and state-level barriers to walking and bicycle projects and policies that are reported by North Carolina municipalities.

Pedestrian and bicycle planning in rural communities: tools for active living.

Pedestrian and bicycle planning has traditionally been viewed from an urban design perspective, rather than a rural or regional planning perspective. This study examined the prevalence and quality of pedestrian and bicycle plans in North Carolina according to geography, regional planning, and sociodemographics. Plan prevalence was lower, but plan quality tended to be higher, in rural areas compared with urban areas. Correlations between plan prevalence and active commuting were strongest in lower-income rural areas. By engaging in the planning process, rural residents and other stakeholders can support active living.

Planning for Pedestrians and Bicyclists: Results From a Statewide Municipal Survey.

BACKGROUND: We surveyed North Carolina (NC) municipalities to document the presence of municipal walking- and bicycling-related projects, programs, and policies; to describe whether prevalence of these elements differed if recommended in a plan; and to characterize differences between urban and rural municipalities. METHODS: We surveyed all municipalities with ≥ 5000 persons (n = 121) and sampled municipalities with < 5000 persons (216/420), with a response rate of 54% (183/337). Responses were weighted to account for the sampling design. RESULTS: From a list provided, staff reported on their municipality's use of walking- and bicycling-related elements (8 infrastructure projects, 9 programs, and 14 policies). The most commonly reported were projects on sidewalks (53%), streetscape improvements (51%), bicycle/walking paths (40%); programs for cultural/recreational/health (25%), general promotional activities (24%), Safe Routes to School (24%), and law enforcement (24%); and policies on maintenance (64%), new facility construction (57%), and restricted automobile speed or access (45%). Nearly all projects, programs, or policies reported were more likely if included in a plan and more prevalent in urban than rural municipalities. CONCLUSION: These results provide cross-sectional support that plans facilitate the implementation of walking and bicycling elements, and that rural municipalities plan and implement these elements less often than urban municipalities.