Chapter 19: Community Level Intervention Strategies

1. Chapter 19: Community Level Intervention Strategies

2. Community Level Interventions • Community strategies typically include a number of institutions, organizations, and groups to deliver a variety of interventions • Target ________________ rather than individual behavior change • Primary distinction between individual, group, and community interventions is …

3. Community Level Interventions • Karen Glanz (1997) provided an outline of the benefit and breadth of community level interventions • Community-level models suggest strategies and initiatives that are planned and led by organizations and institutions whose missions are to protect and improve health: schools, worksites, health care settings, community groups, and governmental agencies. Other institutions for whom health enhancement is not a central mission, such as the mass media, also play a critical role.

4. Community Defined • An aggregate of people who share ___________________________________ • Shared institutions include: local hospitals, recreation centers, worksites, faith-based institutions, and schools • Refers to the locality of an aggregate of people, groups or institutions • Informal social norms, belief systems, interdependent groups, and attachments

5. Why Focus on Communities? • There is practicality in developing and implementing physical activity interventions at the community level • A community-based intervention should increase ________________________ invested into health promotion because of the inter-group relationships, shared values, and a common attachment within the community

6. Community Interventions • Community programs for the promotion of physical activity • 4 primary sections: • Site-based interventions • Community-wide and policy interventions • Mass media interventions • The Centers for Disease Control and Prevention guidelines for community-based physical activity interventions.

7. Site-Based Interventions: Schools • Elementary, middle, and high schools have traditionally offered physical education classes • Schools are offering fewer, and shorter duration, physical education classes and have even eliminated them completely is some cases

8. Site-Based Interventions: Schools • Two Areas of Focus: • Increasing physical activity ______________________________ • Increasing ______________________ • Stone and associates (1998) examined the effectiveness of 14 school interventions

9. Site-Based Interventions: Schools • Stone and associates found: • Interventions were often successful at improving knowledge and attitudes towards physical activity • Interventions were typically successful at increasing physical activity ____________________________ • Interventions were often unsuccessful at increasing _________________________

10. Site-Based Interventions: Schools • The Child and Adolescent Trial for Cardiovascular Health (CATCH) • 96 elementary schools in California, Louisiana, Minnesota, and Texas • CATCH targeted increasing physical activity during physical education classes and outside of school time • Based on ________________________ and organizational change strategies

11. Site-Based Interventions: Schools • 3rd grade year • 5-week curriculum • Policy interventions such as the provision of space, equipment and supervision during non-school hours • Policy and curricula in physical education classes were also introduced

12. Site-Based Interventions: Schools • 4th and 5th grade years • 12-week curriculum • Policy components were sustained • The CATCH project resulted in positive changes in physical activity through the 3 years of the study • The __________________ increase in physical activity was still present 3 years later

13. Site-Based Interventions: Worksites • Worksites have also been targeted environments for physical activity programs • Expert narrative reviews of literature provided ____________________ effectiveness of these programs

14. Site-Based Interventions: Worksites • Dishman and associates (1998) conducted a meta-analysis on 26 studies examining worksite interventions • The __________________ was coded as either behavior modification, cognitive behavior modification, health education, health risk appraisal, exercise prescription, or a combination of strategies. • ______________________ was coded as face-to-face, mediated (indirectly through print or telephone), or a combination of the two, while location was coded as on or off-site.

15. Site-Based Interventions: Worksites • The results of the meta-analysis revealed a small positive effect for worksite physical activity interventions • The size of this effect was not significantly different from zero • ______________________ to the size of effect based on any of the moderators • Based upon this meta-analysis it was concluded that worksite physical activity interventions ______________________

16. Site-Based Interventions: Health Care Settings • Simons-Morton and colleagues (1998) provided a review of health care setting physical activity interventions. • ___________________: Physical activity promotion for apparently healthy individuals • ___________________: Physical activity promotion for individuals with cardiovascular disease

17. Site-Based Interventions: Health Care Settings • 12 primary prevention studies • Based on patient counseling • No interventions included structured physical activity programs • Half were based on an underlying theory • 75 % implemented by doctors while nurses or other health professionals administered the remaining interventions. • The results of these studies were _____________________________________ • Effects __________________________

18. Site-Based Interventions: Health Care Settings • Secondary Prevention studies • Simons-Morton et al. (1998) identified 24 studies of physical activity interventions for patients with cardiovascular disease • ________________________ reported significant changes in physical activity or fitness.

19. Site-Based Interventions: Health Care Settings Secondary Prevention Studies (cont.) • In studies that used an intervention that targeted many risk behaviors (including inactivity), about half were effective in changing physical activity • Based upon the review interventions that included supervised exercise with behavior modification techniques or the provision of home equipment were most often effective (i.e., 75% of the studies)

20. Community-wide and Policy Interventions • King and collaborators (1995) provided an excellent description of legislative, policy, and environmental approaches to increase physical activity in communities. • _________________refers to formal legal structures at the local, state, or federal levels of government. • ____________is the formal or informal rules that provide structure to a governing organization. • ________________________ involve providing, for example, bike paths and facilities with exercise to community

21. Community-wide and Policy Interventions • The Navel Community Project in California • Three groups: an intervention community, a control community, and a Navy-wide sample • Cardiovascular fitness was assessed before and after the 1-year intervention period • The environmental and policy strategies used focused on physical activity and healthy eating

22. Community-wide and Policy Interventions • Policy strategies: • _____________________ the community recreation center was open • Communications between superiors and subordinates ___________________ that all members of the base should be involved in regular exercise • Include fruits and vegetables at all snack shops on the Naval base was implemented

23. Community-wide and Policy Interventions • Environmental changes: • New exercise equipment was purchased for the gymnasia • A women-only fitness center was opened on the base • 1.5 mile running routes were marked out around the base • The organization of athletic events and jogging clubs

24. Community-wide and Policy Interventions • The intervention had a number of positive benefits for participants who experienced the environmental change condition • They completed a 1.5-mile run 18 seconds faster following the intervention • A reduced failure rate during the physical testing (12.4% pre-test down to 5.1% post-intervention)

25. Community-wide and Policy Interventions • Did not gain body fat while participants in both control conditions showed significant increases in percent body fat • Although the number of sedentary individuals (<2000 kcal of activity) increased in all groups, the increase was at a lower rate in the intervention group (about 3%) when compared to the control conditions (about 7%).

26. Community-wide And Policy Interventions • Perhaps the most important finding of the study was the extent of the impact for the intervention • ______________________ of the population were positively influenced by the intervention strategy thereby providing support for the King et al. (1995) hypothesis that both environmental and policy approaches are effective for increasing physical activity

27. Mass Media Interventions • Mass media is often associated with television, radio, and newspapers, but may also included the use of telephones, internet technology, and postal services

28. Mass Media Interventions Example • Marcus et al. (1998) ___________________ motivationally tailored PA intervention. • Based on ________________________ • Sedentary subjects in Two groups: • Stage matched self-help booklet • Standard self-help booklet (action oriented) • Both treatments worked. The stage-matched was more effective (increase from 5.5 min to 151 min of PA per week)

29. Recommendations For Community Programs To Promote Physical Activity • ___________ report to summarize recommendations for encouraging physical activity in young people • The recommendations focused on school and general community programs but most are valuable for, and can be generalized to, any type of community-based intervention • See table 17-1 in text book