Way2Go! Social marketing for girls' active transportation to school.

Active transportation to school (ATS) is a recognized way to increase physical activity (PA). However, girls and young women do not regularly use ATS despite the many documented physical, mental, and community health benefits. Social Marketing (SM) may provide a framework for understanding girls' perspectives of and experience with ATS and inform messages for use in a public health marketing campaign. Focus groups with 79 girls between the ages of 7 and 15 were conducted in Spring 2017 in Victoria, Canada. Transcripts and poster data were initially categorized using the '4Ps' from social marking (Product, Price, Place and Promotion). Participant groups were segmented into three age categories for designing tailored messaging. Thematic analysis revealed elementary school aged participants identified health and fun while middle school participants valued socializing and helping the environment as reasons for engaging in ATS. For secondary school students, ATS was seen as a way to become more independent. All three highlighted fun and enjoyment as important benefits of ATS, and suggested positive and lighthearted messaging. Segmenting into different audiences highlighted how campaign segmentation would resonate with different audiences based on core values and beliefs. Further segmentation of the audience could result in different core values and beliefs held by diverse groups.

A feasibility randomized trial of an identity-based physical activity intervention among university students.

INTRODUCTION:  Exercise identity has considerable evidence as a correlate of physical activity (PA), but almost no research has focused on intervention. Theory suggests identity may be formed through indirect means of motivated behaviour change over time or through direct targeting of identity related antecedents. Using a parallel, single blind design, the purpose of this study was to explore the feasibility (recruitment, retention, and satisfaction) of these two types of interventions (indirect, direct) to increase exercise identity and subsequent PA. METHODS:  Participants between the ages of 18-25 who were not meeting PA guidelines were recruited from the University of Victoria, and randomized at a 1:1 ratio to an indirect or direct intervention group. The indirect intervention group received information on the benefits of PA and behaviour change techniques such as planning. The direct intervention group received the same information, with the addition of identity-specific information. Intervention materials were delivered bi-weekly for 6 weeks. Feasibility and participant satisfaction at the study end-point were assessed using mixed methods, and both PA change and exercise identity change were assessed via self-report. RESULTS:  Twenty participants were randomized to the direct or indirect intervention group (10 each), with 18 participants completing full study protocol. The recruitment rate was 26% and retention was 90%. Mean scores from the satisfaction survey (five-point scale) were high for both groups (indirect M = 2.69, SD = 0.62; direct M = 2.83, SD = 0.40). Both intervention groups increased their PA (η2 = 0.25), and exercise identity levels (η2 = 0.43) across six weeks. DISCUSSION:  High feasibility ratings, both through retention, and survey and interview data show that the study could be extended to a full-scale RCT. Modifications to recruitment including oversampling to account for low recruitment rates may be useful. No adverse events were reported.

Understanding Physical Activity Motivation and Behavior Through Self-Determination and Servant Leadership Theories in a Feasibility Study.

Despite its well-established benefits, physical activity engagement is low in the adult population; evidence suggests that this is especially a concern for women >60 years. The purpose of this mixed methods study was to explore the feasibility of a 6-week randomized control trial of self-determination theory-based dance and walking programs for older women. Primary outcomes were feasibility measures: recruitment, retention, and satisfaction. Secondary outcomes included self-reported physical activity, behavioral regulations, and psychological needs. Thirty-five women completed the study (M = 62.8 ± 4.8 years), representing 39% recruitment and 95% retention rate. Both programs were highly attended. Exploratory effect sizes for secondary measures were promising. Emergent themes highlighted the importance of servant leadership concepts in the group setting for motivating physical activity. Our findings provide support for expanding this trial to a full-scale study.

"Layers of translation" - evidence literacy in public health practice: a qualitative secondary analysis.

BACKGROUND: Strengthening public health systems has been a concern in Canada in the wake of public health emergencies. In one Canadian province, British Columbia, a high priority has been placed on the role of evidence to guide decision making; however, there are numerous challenges to using evidence in practice. The National Collaborating Centre for Methods and Tools therefore developed the Evidence Informed Public Health Framework (EIPH), a seven step guide to assist public health practitioners to use evidence in practice. We used this framework to examine the evidence literacy of public health practitioners in BC. METHODS: We conducted a secondary analysis of two separate qualitative studies on the public health renewal process in which the use and understanding of evidence were key interview questions. Using constant comparative analysis, we analyzed the evidence-related data, mapping it to the categories of the EIPH framework. RESULTS: Participants require both data and evidence for multiple purposes in their daily work; data may be more important to them than research evidence. They are keen to provide evidence-based programs in which research evidence is balanced with community knowledge and local data. Practitioners recognise appraisal as an important step in using evidence, but the type of evidence most often used in daily practice does not easily lend itself to established methods for appraising research evidence. In the synthesis stage of the EIPH process, synthesized evidence in the form of systematic reviews and practice guidelines is emphasized. Participants, however, need to synthesize across the multiple forms of evidence they use and see the need for more skill and resources to help them develop skill in this type of synthesis. CONCLUSIONS: Public health practitioners demonstrated a good level of evidence literacy, particularly at the collective level in the organization. The EIPH framework provides helpful guidance in how to use research evidence in practice, but it lacks support on appraising and synthesizing across the various types of evidence that practitioners consider essential in their practice. We can better support practitioners by appreciating the range of evidence they use and value and by creating tools that help them to do this.

Wayfinding the Live 5-2-1-0 Initiative-At the Intersection between Systems Thinking and Community-Based Childhood Obesity Prevention.

Childhood obesity is complex and requires a 'systems approach' that collectively engages across multiple community settings. Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) has implemented Live 5-2-1-0-a multi-sector, multi-component childhood obesity prevention initiative informed by systems thinking and participatory research via an innovative knowledge translation (KT) model (RE-FRAME). This paper describes the protocol for implementing and evaluating RE-FRAME in two 'existing' (>2 years of implementation) and two 'new' Live 5-2-1-0 communities to understand how to facilitate and sustain systems/community-level change. In this mixed-methods study, RE-FRAME was implemented via online resources, webinars, a backbone organization (SCOPE) coordinating the initiative, and a linking system supporting KT. Qualitative and quantitative data were collected using surveys and stakeholder interviews, analyzed using thematic analysis and descriptive statistics, respectively. Existing communities described the consistency of Live 5-2-1-0 and extensive local partnerships/champions as catalysts for synergistic community-wide action; new communities felt that the simplicity of the message combined with the transfer of experiential learning would inform their own strategies and policies/programs to broadly disseminate Live 5-2-1-0. RE-FRAME effectively guided the refinement of the initiative and provided a framework upon which evaluation results described how to implement a community-based systems approach to childhood obesity prevention.

Creating a collective impact on childhood obesity: Lessons from the SCOPE initiative.

OBJECTIVES: We describe the processes used in SCOPE, a community-based participatory research (CBPR) initiative, to achieve multisectoral engagement and collective action to prevent childhood obesity. PARTICIPANTS: SCOPE engages representatives from various sectors (local government, health, schools, recreation, local media, early childhood, community services) who influence the environments in which children live, learn and play. SETTING: SCOPE has been implemented in three communities in British Columbia (BC). INTERVENTION: SCOPE (www.live5210.ca) is a multi-setting, multi-component initiative designed to enhance a community's capacity to create and deliver localized solutions to promote healthy weights among children. SCOPE, in partnership with a local organization, engages multiple stakeholders who plan and implement actions framed by a common evidence-based health message ('Live 5-2-1-0'). SCOPE's central team in Vancouver, BC facilitates alignment with provincial initiatives, knowledge translation and exchange (KTE) within and across communities, and the collection, analysis and reporting of shared data. OUTCOMES: Best practice processes that have emerged from SCOPE's experience align with the principles of CBPR and the five conditions of Collective Impact - a common agenda, mutually reinforcing action, continuous communication, a backbone organization and shared measurement. SCOPE has achieved sustainable practice change framed by a common agenda ('Live 5-2-1-0') leading to mutually reinforcing cross-sectoral action. CONCLUSION: A multi-pronged community-led childhood obesity prevention initiative can be achieved using CBPR principles and attending to the conditions for achieving collective impact.

Implementation of school based physical activity interventions: a systematic review.

OBJECTIVE: Implementation science is an emerging area in physical activity (PA) research. We sought to establish the current state of the evidence related to implementation of school-based PA models to explore 1) the relationship between implementation and health outcomes, and 2) factors that influence implementation. METHODS: We searched 7 electronic databases (1995-2014) and included controlled studies of school-based PA programmes for healthy youth (6-18 y) measuring at least one physical health-related outcome. For objective 1, studies linked implementation level to student-level health outcome(s). For objective 2, studies reported factors associated with implementation. RESULTS: There was substantial variability in how health outcomes and implementation were assessed. Few studies linked implementation and health outcomes (n=15 interventions). Most (11/15) reported a positive relationship between implementation and at least one health outcome. Implementation factors were reported in 29 interventions. Of 22 unique categories, time was the most prevalent influencing factor followed by resource availability/quality and supportive school climate. CONCLUSIONS: Implementation evaluation supports scale-up of effective school-based PA interventions and thus population-level change. Our review serves as a call to action to 1) address the link between implementation and outcome within the school-based PA literature and 2) improve and standardize definitions and measurement of implementation.

A cross-cultural comparison of body composition, physical fitness and physical activity between regional samples of Canadian and English children and adolescents.

OBJECTIVES: Cross-cultural comparisons in children's body composition, health-related fitness and physical activity (PA) are rare due to a shortage of comparable data, but such comparisons may help avert worrying global prevalence in childhood obesity, and declining fitness and PA. METHODS: We drew samples of Canadian and English children (10 years, n=1630, 50% boys) and adolescents (15 years, n=1406, 56% boys) from three separate, regional studies that conducted comparable school-based assessments (2006-2011). For each age-sex group, we assessed between-country differences for body composition (mass, height, BMI, waist circumference), cardiorespiratory fitness (CRF; 20 m shuttle run test), strength (handgrip) and self-reported PA. We used multiple regression to investigate whether between-country differences in fitness were explained by body composition and PA. RESULTS: At any age, Canadian boys and girls were taller, heavier, and had greater BMIs and waist circumferences. English children had higher CRF than Canadians, which was explained by differences in body composition and PA. Canadian children were significantly stronger, partly due to greater body size. There were no between-country differences in adolescent boys. Canadian adolescent girls reported more PA than their English counterparts, but neither PA nor body size explained why Canadian adolescent girls had greater CRF or strength. CONCLUSION: Future cross-cultural studies of PA should include indices of growth and fitness to better understand the relationship between intricate differences in PA and health outcomes.

Unleashing physical activity: an observational study of park use, dog walking, and physical activity.

BACKGROUND: Walking has been identified as a low resourced yet effective means of achieving physical activity levels required for optimal health. From studies conducted around the world, we know that dog owners walk more than nondog owners. However, this evidence is largely self-reported which may not accurately reflect dog-owners' behaviors. METHOD: To address this concern, we systematically observed the use of 6 different public parks in Victoria, British Columbia during fair and inclement weather. Using a modified version of the SOPARC tool, we documented visitors' types of physical activity, and the presence or absence of dogs. The Physical Activity Resource Assessment was used to consider park features, amenities, and incivilities. RESULTS: More people without dogs (73%) visited the parks than those with dogs (27%), largely because of attendance at the multiuse sport parks during the summer months. Despite the opportunities to engage in multiple sports, most people used the parks to walk. However, when inclement weather struck, dog owners continued visiting parks and sustained their walking practices significantly more than nondog owners. CONCLUSION: Our observational snapshot of park use supports earlier work that dogs serve as a motivational support for their owners' walking practices through fair and foul weather.

Navigating through translational research: a social marketing compass.

When prominent health issues are chronic, rooted in complex behaviors, and influenced by cognitive, behavioral, social, cultural, economical, and environmental variables, layered and coordinated interventions are needed. Finding solutions that are valid, reliable, and transferable represents a daunting task for researchers. We know that converting science into action is critical for advancing health, but we have failed to appropriately disseminate evidenced-informed research to practitioners. The purpose of this article is to suggest that a social marketing framework can be the compass down this road less traveled in academic research. An experience developing an evaluation toolkit is described as an example of applying social marketing strategies to knowledge translation.

Using participatory research to challenge the status quo for women's cardiovascular health.

Cardiovascular health research has been dominated by medical and patriarchal paradigms, minimizing a broader perspective of causes of disease. Socioeconomic status as a risk for cardiovascular disease is well established by research, yet these findings have had little influence. Participatory research (PR) that frames mixed method research has potential to bring contextualized clinically relevant findings into program planning and policy-making arenas toward developing meaningful health and social policies relevant to primary prevention. In this article we provide an overview of a PR program that included two quantitative and one qualitative studies and then we discuss lessons learned. The PR process we found was empowering for lone mothers, and transformative for lone mothers and researchers. Further, PR as an approach to research opened spaces in practice and policy-making arenas to raise upstream issues relevant to the health of low income lone mothers. We conclude that while PR is an effective approach to social determinants research, as a time-intensive endeavor, and one that does not easily align with research tradition, researchers must consider the strengths and drawbacks of PR when planning to implement such an approach.

Developing and evaluating a relevant and feasible instrument for measuring health literacy of Canadian high school students.

Health literacy has come to play a critical role in health education and promotion, yet it is poorly understood in adolescents and few measurement tools exist. Standardized instruments to measure health literacy in adults assume it to be a derivative of general literacy. This paper reports on the development and the early-stage validation of a health literacy tool for high school students that measured skills to understand and evaluate health information. A systematic process was used to develop, score and validate items. Questionnaire data were collected from 275, primarily 10th grade students in three secondary schools in Vancouver, Canada that reflected variation in demographic profile. Forty-eight percent were male, and 69.1% spoke a language other than English. Bivariate correlations between background variables and the domain and overall health literacy scores were calculated. A regression model was developed using 15 explanatory variables. The R(2) value was 0.567. Key findings were that lower scores were achieved by males, students speaking a second language other than English, those who immigrated to Canada at a later age and those who skipped school more often. Unlike in general literacy where the family factors of mother's education and family affluence both played significant roles, these two factors failed to predict the health literacy of our school-aged sample. The most significant contributions of this work include the creation of an instrument for measuring adolescent health literacy and further emphasizing the distinction between health literacy and general literacy.

High school health curriculum and health literacy: Canadian student voices.

This study explores the relevance of health literacy, and its development through a health curriculum, as a necessary but insufficient component to facilitate healthy living among adolescents through comprehensive school health models. This paper presents qualitative findings from focus groups with students (N = 33) in four schools toward the end of their experience in a health class that focused on topics related to healthy living, healthy relationships, health information and decision-making. Students reported mostly negative experiences citing repetitive course content, routinely delivered by teachers and passively received by students. As well, students described their experiences of using health information sources beyond the classroom, such as the media. The findings suggest that the curriculum, and particularly its implementation, have had limited effect on health literacy: students' abilities to access, understand, communicate and evaluate health information. The paper concludes with recommendations for improving health education.

A social ecological conceptual framework for understanding adolescent health literacy in the health education classroom.

With the rising concern over chronic health conditions and their prevention and management, health literacy is emerging as an important public health issue. As with the development of other forms of literacy, the ability for students to be able to access, understand, evaluate and communicate health information is a skill best developed during their years of public schooling. Health education curricula offer one approach to develop health literacy, yet little is known about its influence on neither students nor their experiences within an educational context. In this article, we describe our experience applying a social ecological model to investigating the implementation of a health education curriculum in four high schools in British Columbia, Canada. We used the model to guide a conceptual understanding of health literacy, develop research questions, select data collection strategies, and interpret the findings. Reflections and recommendations for using the model are offered.

SARS wars: an examination of the quantity and construction of health information in the news media.

The media have the power to sway public perception of health issues by choosing what to publish and the context in which to present information. The media may influence an individual's tendency to overestimate the risk of some health issues while underestimating the risk of others, ultimately influencing health choices. Although some research has been conducted to examine the number of articles on selected health topics, little research has examined how the messages are constructed. The purpose of this article is to describe an examination of the construction of news reports on health topics using aspects of the social amplification of risk model and the elaboration likelihood model of persuasion for theoretical direction. One hundred news media reports (print, radio, television, and Internet) were analyzed in terms of message repetition, context, source, and grammar. Results showed that health topics were more often discussed in terms of risk, by credible sources using strong language. This content analysis provides an empirical starting point for future research into how such health news may influence consumer's perceptions of health topics.

Out of the mainstream: low-income, lone mothers' life experiences and perspectives on heart health.

Cardiovascular disease remains a health issue in North America, particularly for marginalized citizens. Although lifestyle issues and behavioral risk reduction continue to dominate prevention initiatives, an emerging literature suggests that contextual factors such as poverty and social exclusion also influence health. Using group and personal interviews (N = 38), this research explored the social and economic contexts shaping heart health-related experiences from the perspectives of low-income, lone mothers. The transcripts were analyzed using McKinlay and Marceau's upstream-midstream-downstream framework. The overriding pattern characterizing lone mothers' discussions was that the women felt out of the mainstream of everyday life. They lacked the resources and power to effect change, particularly regarding heart health behaviors that were not perceived to be a priority compared to more pressing survival issues. Results are discussed in terms of concepts from the population health and social determinants literature, concluding with policy implications for enhancing health while living in poverty.

Stages of change in adolescents: an examination of self-efficacy, decisional balance, and reasons for relapse.

PURPOSE: The purpose of this study was to test selected constructs of the transtheoretical model (TTM) of behavior change in relation to exercise behavior with an adolescent sample. A further purpose was to examine reasons why adolescents stop physical activity and to relate these to stages of exercise change. METHODS: Participants were 15 to 17 year old students at a private high school (N = 327). Participants completed a questionnaire consisting of an exercise measure, measures of the TTM variables, and an open-ended question that asked if they used to exercise in the past but currently did not, why they had stopped. The TTM data were analyzed using ANOVA F-tests with post-hoc Scheffe tests. To evaluate the ability of the TTM variables to discriminate between stages of exercise behavior, standard discriminant function analyses were performed. Open-ended answers to the relapse question were themed according to a model which categorizes barriers preventing youth's participation in recreational activities as infrastructural, superstructural, and procedural. The relationship of perceived barriers to stage of behavior change was assessed using cross-tabulation and chi-square analyses. RESULTS: Moderate support for the TTM constructs were found, with the strongest discriminator between stages being strenuous exercise, and self-efficacy being the most supported construct. Infrastructural, superstructural, and procedural barriers were all evident. CONCLUSION: Over 30% of previously active adolescents in this study reported barriers precluding extracurricular physical activity. Interventions should target the most often cited reasons for relapse: time and limits relating to the nature of the adolescent self.

Evaluating the participatory process in a community-based heart health project.

This paper presents the evaluation of a participatory research process used in a community-based heart health project, the British Columbia Heart Health Demonstration Project. The project utilized both a population heart health approach and a community mobilization model for taking action on heart health. A participatory evaluation plan was selected to: allow for participation in decision-making, incorporate the community perspective, enhance utilization of data, increase skills and capacities at the community level and enhance the responsiveness of the project team to emerging issues. Six elements common to participatory research were synthesized from the literature and rating scales were developed. Project participants across three project levels (investigative team, community project management committee members, community and provincial project coordinators) were asked to rate each of the elements and then explain their ratings during a focus group interview. Ratings were averaged and plotted on a 'sextagram' to illustrate the extent of participation in the research project. Patterns and themes that emerged from the transcripts and fieldnotes, regarding issues that influenced each rating, were categorized according to the framework of participatory research. Ratings and descriptions of participation on each element varied across project levels. The ratings of participation for the elements of sustainability and resource mobilization were uniformly low reflecting the large dependence on external funds. Participants involved at the community level perceived a greater level of participation in the identification of need and definition of goals and activities. Critical issues identified were related to the predominance of the external funding source, the imposition of funding agency guidelines on the communities, the amount of guidance by experts and the data collection methods. The analysis highlighted the responsiveness of the project to feedback over time and increases in the capacity of communities over time. Critical issues in the evaluation of participation were: differentiating stakeholder participation in program activities from research activities, variations in the meaning of community and participation among interviewees, the complexity of evaluating the extent of participation in a multi-level project and the evolution of participation over a 5 year time span. A definitive conclusion about the level of participation was elusive, however, the methodology afforded a contextual understanding of the assessments of participation and of participation itself and provides a foundation for evaluating and improving future participatory research initiatives.