Understanding the personal, social and environmental impact upon physical activity of the ‘Devon Active Villages’ programme Emma Solomon (PhD researcher) CSLT PhD Researcher Seminar, June 28 th 2011, Exeter, UK Physical activity and health

The ‘Devon Active Villages’ programme Research partner: Active Devon Aim: to support rural village communities to provide sustainable opportunities for sports and physical activity participation. £1 million programme (funded by Sport England & Devon County Council). The programme will work by: 1.Identifying what opportunities each local community wants 2.Providing support to “kick start” activities 3.Supporting people within their communities to sustain the opportunities

‘Devon Active Villages’ timeline Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Phase 1 Phase 2 Phase 3 Phase 4 Engagement 35 villages Phase 1 Phase 2 Phase 3 Phase 4 12 week activities 35 villages

Physical activity research In England in 2008, 32% of women and 39% of men aged years reported doing sufficient physical activity to meet the guidelines. (HSE, 2008) Community level physical activity interventions are considered a public health priority. (Bauman & Owen, 1999) In addition to personal and social factors, environmental factors are important to understanding and monitoring the factors that enable or inhibit physical activity. (Sallis et al., 2008) Creating more ‘activity-friendly’ environments holds promise for improving population-wide physical activity. (King & Sallis, 2009)

Evaluating physical activity programmes Little is known about the effectiveness of community level interventions designed to improve physical activity participation. Evaluations of physical activity interventions are necessary to further the theoretical understanding of what makes interventions successful. Lack of rigorous evaluations of public health interventions. (Wanless, 2004) Randomised controlled trials (RCTs) are considered to be the gold standard method of evaluating interventions but are often not plausible. (Des Jarlais et al., 2004) Cross-sectional and quasi-experimental designs are more common.

Stepped wedge randomised trial designs An intervention is deployed in a randomised sequence until all eligible communities have received the intervention. This study design is beneficial when: 1.It is believed that the intervention will do more good than harm. 2.An intervention cannot be delivered concurrently to all units. Advantages: 1. Still an experiment 2. Individuals/clusters (villages) act as their own controls. Disadvantages: 1.Longer trial duration and large amount of data collection. 2.Greater chance of contamination in the control group.

Research Design and Methodology Baseline (22 Villages) Intervention (22 Villages) Intervention (22 Villages) Intervention (22 Villages) Intervention (22 Villages) Baseline (36 Villages) Control (36 Villages) Intervention (36 Villages) Intervention (36 Villages) Intervention (36 Villages) Baseline (35 Villages) Control (35 Villages) Control (35 Villages) Intervention (35 Villages) Intervention (35 Villages) Baseline (35 Villages) Control (35 Villages) Control (35 Villages) Control (35 Villages) Intervention (35 Villages) Stage 1 Stage 2 Stage 3 Stage 4 Stage 5

Data collection time points Stage 1 Baseline Survey Stage 2 Survey Stage 3 Survey Stage 4 Survey Stage 5 Survey

How many people do we need to survey? To detect an increase in physical activity from 25% to 30% at the 5% significance level we would need to sample n subjects from each of the 128 villages at each stage: For 80% power: need 10 subjects from each of the villages (6400 subjects altogether) For 90% power: need 13 subjects from each of the villages (8320 subjects altogether)

What we will measure General participant characteristics (age, height, weight etc.) Health and physical activity behaviour Awareness of Active Villages and other programmes Physical activity attitudes and intentions Neighbourhood characteristics

What we hope to find Primary outcome: Increased physical activity in intervention groups compared to controls Secondary outcomes: Improved attitudes towards physical activity High awareness and participation of the programme Increased sense of social support within the community Environment more facilitative of physical activity Understand how the programme has impacted on the community, and discover what types of individuals take part in the activities.

Anticipated issues There are many factors that make this study quite complex: 7 districts (different local councils) Different local delivery partners Significantly different levels of deprivation Population/pop. density of the villages The effect of weather and seasons Reporting bias in the intervention group Contamination of the control group

Response rates 6400 surveys sent out in March 2011 Overall response rate = 37.7% (2412 responses) East Devon = 40.5% Mid Devon = 38.4% North Devon = 34% South Hams = 34.1% Teignbridge = 36.9% Torridge = 40.8% West Devon = 38.9% At least 10 responses per village: Lowest = 11 (22%) Highest = 31 (62%)

Participant characteristics 49.9% = normal weight (below 25 kg/m 2 ) 36.3% = overweight ( kg/m 2 ) 13.8% = obese (over 30 kg/m 2 ) Average age: 58 years Gender:63% females, 37% males

Education and occupation Age at leaving full time education: 16 and under = 37.6% years = 25.8% 19+ years = 36.6% Occupational activity: Not employed = 49.9% (unemployed, retired, student)

Health & long-term disabilities Self rated health: 14.4% Excellent 33.6% Very good 34.0% Good 13.7% Fair 4.3% Poor Long-term illness or disability: 28.7% Yes 71.3% No

Village Life Time living in local area: Mean = 18.5 years (SD = 17.3 years) Range = 1 month to 91 years Opinion on the local area: +2 (most favorable), 0 (neutral), -2 (least favorable) Mean = 0.18 (SD = 0.61)

Local facilities

Use of recreational facilities in the last month / last 12 months (within and outside of the local area) Walking routes/footpaths

Campaign awareness 1 in 5 people had heard of a local physical activity campaign 6.7% of people reported participating in events as part of any campaign 0.3% named Devon Active Villages (8 participants) unprompted 5% of participants had heard of the Devon Active Villages programme when asked 6.7% of these individuals reported participating in events as part of Devon Active Villages Some people (2%) confused Devon Active Villages with a different theatre campaign

Physical activity levels MalesFemales Met PA recommendations52.1%53.2%70.4%63.1%56%39.3% Exceeded 4 hours sitting per day 61.6%51.5%45.7%43.3%53%67.7% % reporting meeting PA guidelines by education leaving age: 16 or under: 45.8% years: 55.8% 19+ years: 58.7%

Intentions toward Physical Activity 27.0% - Unlikely to ever do more activity 40.7% - Intend to do more activity in the next month 16.7% - Intend to do more PA in the next six months 2.3% - Intend to do more PA, but not in the next six months 13.3% - Don’t know

Motivation, confidence and commitment to Physical Activity

Activity habits, social norms, and village supportiveness Physical activity habit: Mean: 0.58, SD: 1.03 PA Social norms: Mean: 0.17, SD: 0.79 Village supportiveness of PA: Mean: 0.03, SD: 0.87 (+ 2: most favorable response, 0: neutral, -2: least favorable response)

Thank you – any questions? Research presented here was conducted during an ESRC Studentship under its Capacity Building Clusters Award (RES ) in partnership with Active Devon. For more information about this project and the work of the Centre for Sport, Leisure and Tourism research, see Emma Solomon,

References Bauman, A. and Owen, N. (1999). Physical activity of adult Australians: epidemiological evidence and potential strategies for health gain. J Sci Med Sport, 2(1), Cook, T.D. and Campbell, D.T. (1979). Quasi-experimentation: Design and analysis issues for field settings Boston, MA: Houghton Mifflin Company. Des Jarlais, D.C. Lyles, C. et al. (2004). Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. American Journal of Public Health 94(3): Habicht, J.P., Victora, C.G. et al. (1999). Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol, 28(1): King, A.C. and Sallis, J.F. (2009). Why and how to improve physical activity promotion: Lessons from behavioral science and related fields. Preventive Medicine, 49(4): Roth, M. (2009). Self-reported physical activity in adults. Health Survey for England 2008, Volume 1: Physical activity and fitness. R. Craig, J. Mindell and V. Hirani. London, National Centre for Social Research: Rychetnik, L., Frommer, M., Hawe, P. and Shiell, A. (2002). Criteria for evaluating evidence on public health interventions. Journal of Epidemiology and Community Health, 56: 119–127. Sallis, J.F., Owen, N., Fisher, E.B. (2008). Ecological models of health behavior. See Ref. 39, pp. 464–85 Wanless, D. (2004). Securing good health for the whole population: final report. London: HM Treasury.