Does neighbourhood walkability moderate the effects of mass media communication strategies to promote regular physical activity?

BACKGROUND: Mass media campaigns are widely used in Australia and elsewhere to promote physical activity among adults. Neighbourhood walkability is consistently shown to be associated with walking and total activity. Campaigns may have different effects on individuals living in high and low walkable neighbourhoods. PURPOSE: The purpose of this study is to compare pre- and post-campaign cognitive and behavioural impacts of the Heart Foundation's Find Thirty every day® campaign, in respondents living in high and lower walkable neighbourhoods. METHODS: Pre- and post-campaign cross-sectional survey data were linked with objectively measured neighbourhood walkability. Cognitive and behavioural impacts were assessed using logistic regression stratified by walkability. RESULTS: Cognitive impacts were significantly higher post-campaign and consistently higher in respondents in high compared with lower walkable neighbourhoods. Post campaign sufficient activity was significantly higher and transport walking significantly lower, but only in residents of lower walkable areas. CONCLUSIONS: Cognitive impacts of mass media physical activity campaigns may be enhanced by living in a more walkable neighbourhood.

Would you Find Thirty online? Website use in a Western Australian physical activity campaign.

ISSUE ADDRESSED: Mass media campaigns have used a range of traditional media (television, radio and print) to communicate health messages. In the past decade the Internet has added to these traditional methods with Web 2.0, smart phone technology and interactive media. 'Find Thirty every day(®)', a Western Australia population-wide mass media campaign delivered over 2 years, used a combination of traditional mass media, a website, online resources and banner advertising. The aim of the present study is to describe the use of the Find Thirty every day(®) website during the campaign media activities of May 2008-June 2010. METHODS: Cross-sectional self-reported survey data were collected from a random sample of adults using a computer-assisted telephone interview over the period February-March 2010. Objective online analytical measures of unique visits to the Find Thirty every day(®) website were collected between June 2008 and June 2010. RESULTS: Monthly visitors to the Find Thirty every day(®) website increased from 3193 in 2009 to 4374 in 2010. During the last two media waves (October 2009 and February 2010), site visits were 5388 and 5272 per month, respectively. CONCLUSION: The impact of the Find Thirty every day(®) website was a positive outcome, considering the minimal online presence. SO WHAT? Health communication campaign planners should maximise the potential synergy of traditional mass media and new social media in future campaigns. Accordingly, a multidisciplinary approach that includes communication researchers, experts in information systems and a creative team experienced in online environments will need to be the way forward.

Reliability and validity testing of a single-item physical activity measure.

OBJECTIVE: To develop and test a new single-item physical activity screening tool, suitable for assessing respondents' eligibility for behaviour change interventions. DESIGN: Two single-item assessment tools were developed, one using a "past week" recall period, the other using a "past month" recall period. A quota sampling system was used to recruit 480 adults from across England, Scotland and Wales. Half the sample completed the past-week question and half completed the past-month version. Test-retest reliability was assessed over a 2- to 5-day period. Concurrent validity was assessed using the Global Physical Activity Questionnaire and the UK Active People Survey. All surveys were completed via telephone interviews. RESULTS: Both versions of the single-item instrument demonstrated strong reproducibility (r=0.72-0.82), using Spearman's rank correlation coefficients. The past-week recall question showed strong agreement in the classification of respondents meeting the current physical activity recommendation (kappa=0.63, 95% CI 0.54 to 0.72).Concurrent validity over the past week compared to the Global Physical Activity Questionnaire was modest (r=0.53) and slightly weaker for the past month compared to the Active People Survey (r=0.33-0.48). CONCLUSION: Both versions of the new single-item measure performed as well as other short physical activity tools in terms of reliability and concurrent validity. Criterion validity testing of the single-item measure is recommended to establish its ability to assess objectively measured physical activity levels. In addition, further research to assess the responsiveness of the single-item measure in detecting changes in physical activity will inform its usefulness in programme evaluation.

Advice on exercise from a family physician can help sedentary patients to become active.

OBJECTIVES: To test the effectiveness, in the setting of primary health care, of verbal advice on exercise from a family physician (FP) combined with supporting written information. DESIGN: A controlled trial with subjects allocated to a control group or one of two intervention groups using a balanced design based on day of the week. SETTING: Ten general practices in Perth, Western Australia. SUBJECTS: All sedentary patients consulting an FP. INTERVENTION: Verbal advice on exercise from the FP and a pamphlet on exercise mailed to the patient's home address within 2 days of his/her visit to the doctor. MAIN OUTCOME MEASURE: Level of physical activity at follow-up. RESULTS: 6,351 adult patients attending an FP practice completed a screening questionnaire, and 763 sedentary adults were recruited to the project. The response to follow-up, via a postal survey at 1, 6, and 12 months after the index consultation was 70%, 60%, and 57%, respectively. At 1 month a subsample of the control and intervention subjects were contacted for a telephone interview to verify self-reported levels of activity (n = 136). Treating all nonresponders as sedentary, at 1 month significantly more subjects in the combined intervention groups reported doing some physical activity (40%) compared with the control group (31%). Similarly, at 6 months, 30% of the control group and 38% of the combined intervention groups were "now active." There was very little change at follow-up at 12 months (31% control and 36% intervention groups, respectively). CONCLUSION: A simple intervention aimed at the promotion of physical activity to sedentary patients in general practice can help reduce inactivity.

Tailored advice on exercise--does it make a difference?

OBJECTIVE: A controlled trial to compare the effectiveness of verbal advice from a family physician (FP) combined with either "standard" or "tailored" written information on physical activity in increasing the levels of physical activity in sedentary patients. DESIGN: Sedentary patients (n = 763) were recruited through ten family practices and allocated to a control group or one of two intervention groups. Brief advice on physical activity was given by the FP during the consultation and either a standard or tailored pamphlet was mailed to the home address of patients assigned to the intervention groups within two days of their visit to the FP. RESULTS: The response to follow-up, via a postal survey at one, six, and twelve months after the index consultation was 70%, 60%, and 57%, respectively. Treating all nonresponders as sedentary, the results revealed that although more tailored subjects reported some physical activity at each follow-up compared with the standard group, these differences were not significant. Furthermore, there was no significant difference in movement across the stages of readiness to exercise at follow-up between subjects in the tailored group who received material targeting their current stage (precontemplation or contemplation) and the standard group who received generic material that addressed both stages. CONCLUSION: These findings do not concur with the results from previous research in the areas of nutrition and smoking cessation where additional benefits were seen with a tailored intervention. Future research on the application of the principles of "tailoring" to the promotion of physical activity should focus on identifying which, if any, physical, social, psychological or environmental variables should be addressed to produce improved outcomes over and above the effects of well designed generic materials.

Understanding how people process health information: a comparison of tailored and nontailored weight-loss materials.

Health information tailored to meet individuals' unique needs has been shown to be more effective than generic information in promoting risk-reducing behavior changes. To explore mechanisms underlying tailoring's effectiveness, this study randomly assigned 198 overweight adults to receive weight-loss materials that were (a) tailored to the individual, (b) in an American Heart Association (AHA) brochure, or (c) AHA-content formatted to look like tailored materials. Participants who received tailored materials had more positive thoughts about the materials, positive personal connections to the materials, positive self-assessment thoughts, and positive thoughts indicating behavioral intention than those who received either of the untailored materials. The tailoring of health information can significantly improve the chances the information will be thoughtfully considered and can stimulate prebehavioral changes such as self-assessment and intention.

Stage of readiness to exercise in ethnically diverse women: a U.S. survey.

PURPOSE: To assess stage of readiness to exercise and readiness to be physically active in a national survey of women aged 40 yr and over from various racial/ethnic groups (the U.S. Women's Determinants Study). METHOD: The prevalence of each stage was determined and compared across race/ethnicity. In addition, the level of misclassification between self-report of stage of readiness to exercise/be physically active and self-reported participation in specific exercise behavior was evaluated. RESULTS: Data were collected from a total of 2912 U.S. women via telephone survey over a 1-yr period (black 26%, American Indians/Alaskan Natives 25%, Hispanics 23%, and whites 26%). Over half the total sample was staged as currently undertaking regular exercise (maintenance stage, 55%), 25% indicated they were in precontemplation, and 15% were in contemplation stage. Few women were in preparation and action stages. There were statistically significant differences between the minority groups. Specifically, black women (OR 0.53, 95% 0.31-0.91) were less likely to be in the active stages (e.g., preparation, action, maintenance) than Hispanics and Alaskan Native/American Native women, and this was true after controlling for important sociodemographic and health variables (age, education, BMI, and smoking). The additional analysis of a modified stage question developed to assess readiness to be more physically active (150 min.wk(-1)) may have provided inflated results (82% in maintenance), possibly due to the complexity of the questions. The level of misclassification between measures ranged from 5 to 20%. CONCLUSION: These results have important implications for the use of stage of change measures with populations of older ethnically diverse women particularly and the popularity of modifying stage questions to reflect "lifestyle" or moderate-intensity physical activity.

Effects of tailored, personalized and general health messages on physical activity.

Physical inactivity is a major public health problem. Patient education programs and materials that are customized to address the unique needs and concerns of specific patients have shown promise in changing a range of health related behavior, although findings to date for physical activity have been equivocal. In this study a randomized controlled trial was conducted among 272 adult primary care patients to compare the effectiveness of tailored, personalized and general health messages, and usual medical care in promoting leisure time physical activity (LTA) and physical activities of daily living (PADLs). Patients in the tailored group were more likely to increase PADLs than were patients in the personalized, general and control groups (65% vs. 46% vs. 56% vs. 54%) and less likely to being doing fewer PADLs at follow-up (18% vs. 38% vs. 38% vs. 38%; chi 2 = 12.2, df = 6, p = 0.056). There were no significant differences for LTAs. To help maximize the effectiveness of future tailored interventions on physical activity, studies should seek to identify the social, psychological and environmental variables that are most important to include in tailored materials.

Developments in National Physical Activity Policy: an international review and recommendations towards better practice.

Physical activity (PA) is increasingly considered an important public health issue and as such requires the development of good public health policy. This paper provides a summary of the literature on policy development and defines what a policy on PA may usefully comprise. The results of an international review of national level PA policies, using a defined set of criteria, are reported. Considerable similarities were found in the methods and approaches to policy development on PA across countries, with most adopting an intersectoral approach, with consultation and partnership between sectors occurring at a high level of government. The need for action across the lifespan is recognised, as is the need for multiple strategies across a variety of settings. A review of Australian PA policy found that, after promising strategic developments through Active Australia in the late 1990s, PA policy and the role of the federal health sector has become less clear, with PA policy existing now only as a component part integrated into other chronic disease prevention policy initiatives. Recommendations towards better practice in policy making are made with particular reference to developing a clearly defined integrated national PA policy in the Australian context.

How does physician advice influence patient behavior? Evidence for a priming effect.

OBJECTIVE: To explore a potential "priming effect" of physician advice on patient responses to behavioral change interventions. DESIGN: Randomized controlled trial with a 3-month follow-up. SETTING: Four community-based group family medicine clinics in southeastern Missouri. PARTICIPANTS: Adult patients (N = 915). INTERVENTIONS: Printed educational materials designed to encourage patients to quit smoking, eat less fat, and increase physical activity. MAIN OUTCOME MEASURES: Recall, rating, and use of the educational materials; changes in smoking behavior, dietary fat consumption, and physical activity. RESULTS: Patients who received physician advice to quit smoking, eat less fat, or get more exercise prior to receiving intervention materials on the same topic were more likely to remember the materials, show them to others, and perceive the materials as applying to them specifically. They were also more likely to report trying to quit smoking (odds ratio [OR] = 1.54, 95% confidence interval [CI] = 0.95-2.40), quitting for at least 24 hours (OR = 1.85, 95% CI = 1.02-3.34), and making some changes in diet (OR = 1.35, 95% CI = 1.00-1.84) and physical activity (OR = 1.51, 95% CI = 0.95-2.40). CONCLUSIONS: Findings support an integrated model of disease prevention in which physician advice is a catalyst for change and is supported by a coordinated system of information and activities that can provide the depth of detail and individualization necessary for sustained behavioral change.

Are tailored health education materials always more effective than non-tailored materials?

While promising, the evidence in support of tailored health communication has not been overwhelming. One explanation is that tailored materials may be far superior to non-tailored materials in some cases, but only slightly better, no different or less effective in others. In this study, 198 overweight adults were randomly assigned to receive either tailored or non-tailored weight loss materials. Participants' cognitive, affective and behavioral responses to the materials were measured at an immediate and 1 month follow-up. Analyses compared those who received tailored materials to those who received non-tailored materials that were--by chance alone--either a good fit, moderate fit or poor fit, based on the match between behavioral characteristics of the participant and content of the non-tailored materials. Findings showed that good-fitting non-tailored materials performed as well or better than tailored materials for several cognitive, affective and behavioral outcomes. However, moderate- and poor-fitting non-tailored materials were consistently inferior to both approaches. The art and science of creating tailored health communication programs is still evolving. Data from this study suggest present approaches to tailoring are more effective than non-tailored materials in most, but not all cases. Specific recommendations are made describing ways to refine tailoring methods to maximize the effectiveness of this approach.

Beliefs and behaviour of general practitioners regarding promotion of physical activity.

To assess current practice, perceived desirable practice and barriers related to the promotion of physical activity in general practice, a questionnaire was developed and distributed to all 1228 general practitioners in Perth. From these, 789 valid returns were received (71 per cent response). The mean age of the respondents was 45 years, 69 per cent were male, 52 per cent had postgraduate qualifications and 73 per cent were in full-time practice. General practitioners most frequently asked patients about their current level of physical activity and discussed physical activity programs when seeing patients with symptoms of conditions that could benefit from exercise, rather than asking all patients, new patients or patients previously seen. Walking specifically for fitness was the activity most likely to be recommended. General practitioners felt more able to offer general advice than specific advice on physical activity. Lack of time was reported most frequently as a barrier to the promotion of physical activity (47 per cent), followed by insufficient educational materials (29 per cent), and preference of patients for drug treatment (27 per cent). There were significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by general practitioners. Future strategies should aim to increase the frequency of advice to patients with specific health conditions.

How can and do Australian doctors promote physical activity?

BACKGROUND: Physical inactivity is recognized as an important public health issue. Yet little is known about doctors' knowledge, attitude, skills, and resources specifically relating to the promotion of physical activity. Our survey assessed the current practice, perceived desirable practice, confidence, and barriers related to the promotion of physical activity in family practice. METHODS: A questionnaire was developed and distributed to all 1,228 family practitioners in Perth, Western Australia. RESULTS: We received a 71% response (n = 789). Family practitioners are most likely to recommend walking to sedentary adults to improve fitness and they are aware of the major barriers to patients participating in physical activity. Doctors are less confident at providing specific advice on exercise and may require further skills, knowledge, and experience. Although they promote exercise to patients through verbal advice in the consultation, few use written materials or referral systems. CONCLUSIONS: There are significant differences between self-reports of current practice and perceived desirable practice in the promotion of physical activity by doctors. Future strategies need to address the self-efficacy of family physicians and involve resources of proven effectiveness. The potential of referral systems for supporting efforts to increase physical activity by Australians should be explored.

Understanding the effects of printed health education materials: which features lead to which outcomes?

Printed health education materials (HEMs) are widely used to increase awareness and knowledge, change attitudes and beliefs, and help individuals adopt and maintain healthy lifestyle behaviors. While much of the contemporary research and development of persuasive communication is based on McGuire's input/output model, to date few studies have compared the impact of a large set of inputs across a comprehensive set of the 12 outputs. We examined the effects of printed HEMs on weight loss on the cognitive, affective, and behavioral responses of 198 overweight adults. Participants were recruited via a newspaper advertisement and were randomly assigned to review one of three HEMs. Participants were interviewed and asked to complete a series of questionnaires both before and after viewing the HEMs. Regression analyses were conducted to identify the input characteristics associated with success at each of the output steps. The results revealed attractiveness, encouragement, level of information, and application to one's life were significantly associated with early steps (attention, liking, and understanding) as well as some of the mediating steps (recalling, keeping, and rereading HEMs). Later steps, such as intention to change behavior and show others, were associated with readiness to change, self-efficacy, and perceived application to one's life. Behavior change was more likely for those who received tailored materials and those who had higher self-efficacy. These results provide useful direction for the use of computers in tailoring the content of HEMs and the development of effective communication of health information on weight loss.

Promoting physical activity in general practice: a controlled trial of written advice and information materials.

OBJECTIVE: To investigate the impact of a simple written prescription for physical activity given by a general practitioner and the effect of supplementing this with mailed information materials about physical activity. METHODS: A controlled trial was conducted in 27 general practices in New South Wales, Australia. Subjects were sequential routine care patients between 25 and 65 years old. Controls (n = 386) were recruited first, and intervention subjects two weeks later. Intervention subjects were randomised to receive a prescription only (n = 380) or a prescription plus a mailed booklet (n = 376). Self reported physical activity levels were measured by interview at baseline, 6-10 weeks, and seven to eight months. RESULTS: By intention to treat, the average changes in minutes of total physical activity did not differ significantly between the groups. Inactive people in the prescription plus supplementary booklet group were significantly more likely than controls to report an increase in their physical activity by at least 60 min/week after 6-10 weeks (odds ratio 1.58, 95% confidence interval 1.06 to 2.35). No significant short term improvements in self reported activity were shown in the prescription only group. In the supplemented group, the proportion reporting an increase in physical activity to 3,344 kJ/week at 6-10 weeks was not significant, and neither intervention group showed significant increases in any of the outcome measures at seven to eight months by intention to treat. Treatment received analysis showed greater improvements in intervention groups, especially the prescription plus booklet group, in which the odds of inactive people in this group reporting increased activity became significant at seven to eight months. CONCLUSIONS: A prescription for physical activity from a general practitioner, supplemented by additional written materials, can lead to modest short term improvements in self reported physical activity levels among inactive patients. A prescription alone was found not to be effective.