Beyond Wheeling Walks : Enhanced planning, environment, and policy components

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Bill Reger-Nash, Ed.D. WVU Community Medicine CDC —April 13, 2006 Beyond Wheeling Walks: Enhanced planning, environment, and policy components Bill Reger-Nash, EdD, WVU Prevention Research Center Linda Cooper, MSW, LCSW Adrian Bauman, MD, PhD Kenneth J Simon, EdD Kevin M. Leyden, PhD

description

Beyond Wheeling Walks : Enhanced planning, environment, and policy components. Bill Reger-Nash, EdD, WVU Prevention Research Center Linda Cooper, MSW, LCSW Adrian Bauman, MD, PhD Kenneth J Simon, EdD Kevin M. Leyden, PhD. PRESENTATION OUTLINE. Background - PowerPoint PPT Presentation

Transcript of Beyond Wheeling Walks : Enhanced planning, environment, and policy components

Page 1: Beyond  Wheeling Walks : Enhanced planning, environment, and policy components

Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Beyond Wheeling Walks:Enhanced planning, environment, and policy components

Bill Reger-Nash, EdD, WVU Prevention Research Center Linda Cooper, MSW, LCSW Adrian Bauman, MD, PhDKenneth J Simon, EdD Kevin M. Leyden, PhD

Page 2: Beyond  Wheeling Walks : Enhanced planning, environment, and policy components

Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PRESENTATION OUTLINE

Background Community capacity building Formative research and message development Pilot testing of the targeted ads Program implementation and evaluation Results Policy and environment change

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Leading Contributors to Premature Death

Physical Inactivity/Diet 350,000Tobacco 435,000Alcohol 85,000Microbial Agents 75,000Toxic Agents 55,000Motor Vehicles 43,354 Firearms 28,663

Mokdad JAMA, 2005

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

West Virginia has

one of the very highest rates of total CVD deaths in U.S.

(per 100,000)

US WV MN HI

386.6 436.8 322.0 306.6

BRFSS, 2000

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PROJECT PHASES

Phase I --1999-2001 PARTICIPATORY PLANNING

Phase II --2000-2001 - MESSAGE DEVELOPMENT - PREPARATION for CAMPAIGN

Phase III --2001-2002 CAMPAIGN and EVALUATION Phase IV --2002 >

On-going POLICY & ENVIRONMENT

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PHASE I – Community Involvement

• Establish initial community Steering Committee /Advisory Board

• 12-week Participatory

Planning program

• Pursue grant sources

• Select media producers

• Develop protocols

• Identify staff and consultants

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Targeted Message and Audience

• a targeted public health physical activity message: 30 minutes or more of

moderate-intensity walking almost every day.

• to a targeted audience:

Insufficiently active adults, ages 50-65,

in a West Virginia community

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Target Population

78% of 55-64 year olds

were insufficiently active

BRFSS 2001

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Funding Sources

• Robert Wood Johnson Foundation

• West Virginia Bureau for Public Health

• Benedum Foundation

• Ohio Valley Medical Center

• Wheeling Hospital

• WesBanco Bank Corp

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

• Social Ecological Approach• Participatory Planning

• McGuire Communication Model

• Elaboration Likelihood

• Theory of Planned Behavior

• Transtheoretical Model

• Social Marketing •A BRIEF REVIEW:

METHODOLOGY - a basis in theory:

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Campaigns using mass media structured, co-ordinated, & multi-faceted

Multi-strategy campaign

legislative & regulatory

Media

paid unpaid

health professional education

community interventions & community development

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PHASE II –Message Development(Formative Research)

-- An Elicitation Survey to identify salient psychosocial factors about moderate-intensity walking. (30 people)

-- A Quantitative Survey to identify which psychosocial factors differentiate regular walkers and insufficiently active. (300 people)

-- A Qualitative Pretesting of ad storyboards to guide final ad production. (80 people)

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

TIME

ENERGY

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

TV ad : Woman

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Print ad: man

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Wheeling WalksPHASE III –Campaign and Evaluation

•8-WEEK Mass media-based CAMPAIGN

•MONTH 5 Public relations BOOSTERCANCELLED due to Sept 11, 2001

•MONTH 11 BOOSTER Campaign

•EVALUATION at: - Baseline - Immediate Post - 6 Months Post

- 12 months Post

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PROCESSINGReceive,

comprehend, andthink about message

RECEPTIONExposure to and

awareness of message

RESPONSECurrent beliefs altered, new ones remembered, and behavior changed

McGuire Cascade of

the sequential stages of message delivery

essential to behavior change

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Reception Processing Response Behavior

behaviorbeliefs

argument qualityPLACEMENT

elaboration normative intention BEHAVIOR likelihood beliefs to act FREQUENCY

cues control beliefs

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PHASE III –Campaign and Evaluation

1. A telephone survey questionnaire of 1,472 residents --Baseline --Immediately post-intervention -- 6 months post-intervention --12 months post-intervention

2. Earned media

3. Environmental and Policy Change

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PAID ADVERTISING - 8 weeks Gross

Rating

# Points

-- Two 30-second television ads 683 5,100

-- Two 60-second radio ads 1,988 3,450

-- Two 1/8 page newspaper ads 28

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PUBLIC RELATIONS to generate Earned Media included:

WEEK 1--campaign KICK-OFF press conference

WEEK 3--press conference with physicians

WEEK 4--a mid-campaign progress report press event

WEEK 6--1st Mayor’s Fitness Cup –noon-time walk

WEEK 7--Intergenerational Walk

WEEK 8--campaign finale press conference

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

RESULTS –EARNED MEDIA

76 -- TV news stories

48 -- Radio news stories

49 -- Newspaper articles (23--Front Page)

107 -- TV / Radio interviews / promotions

2 -- USA Today article w/ pix

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

RESULTS—TELEPHONE QUESTIONNAIRESSELF-REPORT --Baseline to Immediate-post

Percent Increase

32%

14% difference

Wheeling Walks

18%

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

RESULTS—POSITIVE STAGE CHANGES

From Baseline precontemplation, contemplation, and preparation

62%*

50%

* p< .001)

12% difference

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Treatment

Attitude

Control

IntentionWalking Status

.13

.11

.33

.42

.31 .15

All paths with coefficients are significant at .01 or better

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Best “Predicted” Model, Chi-square[3] = 39.73; p < .00001

Treatment

Control Beliefs

IntentionWalking Status

.18 .57

.15

All paths with coefficients are significant at .01 or better

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

4-week Media BOOSTER --11th month

--334 TV ads (30-second)

--95 Radio ads (60-second)

--6 1/8-page Newspaper ads

--Public Relations events

-Kick-Off Press Conference

-Celebrity visitor (Adrian Bauman)

-2nd Annual Mayor’s Fitness Cup

-Closing celebration

--Weekly columns by PI (BRN)

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

RESULTS—TELEPHONE QUESTIONNAIRES

Immediate 12-mos Post Post

Knew about campaign------------ 90% 89%Saw TV ads--------------------------- 77% 93%Heard Radio ads-------------------- 33% 36%Saw or heard news stories------ 81% 83%Heard about campaign: at worksite------------------------ 5% 5% via faith-based programs----- 4% 4% via speakers--------------------- 4% 5%

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Group A= Baseline daily walking minutes <=10 minutes

0

10

20

30

40

50

60

70

80

90

100

0 3 6 9 12

Months from baseline

Wee

kly

wal

kin

g ti

me-

in m

edia

n m

inu

tes Least Active at Baseline

Wheeling Walks

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PHASE IV – POLICY and ENVIRONMENT

Process Outcomes:

• Mayor designated Walkable Wheeling Task Force, Monthly meetings since 2001, Trails Master Plan now approved by City Council 03/06

•  Develop walking opportunities in the community

o       Upgrade and connect trails (DOT added trails , city exercised eminent domain in December 2005)

o       Adding rest rooms and telephones

o       Improve overall safety & aesthetics

o       Plan for an urban state park

•  Engaged city, county, and state agencies: streets, highways,

recreation department, schools, parks, planning

            

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Nov 99 Feb 01 Feb 02 (n=32) (n=33) (n=29)

Mean [sd] Mean [sd] Mean [sd]

Commitment 4.10 [0.75] 4.27 [0.78] 4.66 [0.48] * #Enjoyment 4.47 [0.73] 4.38 [0.75] 4.66 [0.55]Confidence 4.16 [0.79] 4.36 [0.90] 4.66 [0.55] *Shared Purpose 4.25 [0.72] 4.44 [0.62] 4.69 [0.54] *Contribution Valued 4.20 [0.85] 4.52 [0.57] 4 55 [0.78]Trust 4.28 [0.58] 4.45 [0.79] 4.72 [0.45] *

Data were analyzed as pairwise independent comparisons of means; significance was set at p<0.01 due to multiple testing.

*p<0.01 comparing 1999 to 2002 # p<0.01 “Commitment” comparing 2001 to 2002

Assessment of SOCIAL CAPITALWalkable Wheeling Task Force members

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Differences / modifications to

WV WALKS

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Weekly column

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

PAID ADVERTISING - 8 weeks Wheeling WV

Walks WALKS

--Two 30-second television ads 683 356 Gross Rating Points 5,100 3,016

--Two 60-second radio ads 1,988 1,763 Gross Rating Points 3,450 1,876

--Two 1/8-page newspaper ads 28 39

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

0%

10%

20%

30%

40%

North-Central WV Comparison

WV WALKS

RESULTS—TELEPHONE QUESTIONNAIRESBaseline to Immediate-post

Percent Increase

27%

15%

12% difference

WV WALKS

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

RESULTS –EARNED MEDIA

Wheeling WV

Walks WALKS

76 77 -- TV news stories

48 27 -- Radio news stories

49 40 -- Newspaper articles (23--Front Page)

107 1,241 -- TV / Radio interviews / promotions

2 -- USA Today article w/ pix

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Annual cost Per month per per Intervention changed changed

person person

Project Active Lifestyle change $205.80 $17.50 Structured exercise $591.72 $49.31

Wheeling Walks Wheeling only $38.47 $3.20 TV media market $19.00 $1.58

WV WALKS $18.27 $1.52

Cost comparison of Wheeling Walks, WV WALKS, and Project Active

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Wheeling Walks

a. Total campaign cost $120,000

b. Total media area population 418,000

c. Total ages 50-65 (18.6%) / 40-65 (27%) 77,748

d. Target Population (insufficiently active) (58% / 60% )* 45,094

e. Exposed to campaign message (target population) (92% / 82%)* 41,486

f. Cost per individual exposed to message (a/e) $ 2.89

Cost per month (f/12) $ .24

g. Individuals self-report changed (14% / 12% of d.)* 6,313

h. Cost per changed person (a/g) $ 19.00

i. Cost per month ( h/12) $ 1.58

*Percent derived from intervention surveys.

Basis of calculations

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

POLICY and ENVIRONMENTProcess Outcomes in Morgantown:

• Work in concert with City and University via WV WALKS Community Advisory Board

• Diverting large industrial truck traffic from downtown

• Develop walking opportunities in the community

      -  Upgrade and connect trails

     -  Adding new and paving sidewalks ($150k per year)

- Developing community walking league

• Coordinated study (Zande Engineering) to make WVU-HSC campus more walkable

• Physicians writing “prescriptions for walking”             

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Assessment of Policymakers• Mail survey to assess whether WV Walks intervention focused on changing

the attitudes and behavior of the public can also affect policymakers

• Survey mailed to all municipal elected officials, appointed heads of departments, and all individuals appointed to serve on government boards/commissions (133 in Morgantown and 120 in Huntington )

• Response rates

PRE POST

Morgantown n=76 57.1% n=58 43.4%

Huntington n-38 31.7% n=34 29.3%

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Walking Issues

• Morgantown– Baseline: Ranked 4th– Post Campaign: Ranked 1st

– P < 0.05 (t-test for differences in proportion means)

• Huntington– Not mentioned

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Community Problem IssuesMorgantown – Lack of Pedestrian Walkways, Crosswalks and

Sidewalks – Poorly Planned Development and Sprawl– Traffic Congestion

Huntington– Underage Drinking– Drug and Alcohol Abuse– Crime

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

Environment and policy changes have great potential to influence human behavior. They can impact and sustain change in entire populations for a small financial investment.

 O’Donnell MP. Am J Health Promot. 1989;2(2):5.

BUT HOW DO WE DO THIS?

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

WORLD HEALTH ORGANIZATION1st International Conference on Health Promotion

November 21, 1986Ottawa, CANADA

OTTAWA CHARTER FOR HEALTH PROMOTION“Health promotion is the process of enabling

people to increase control over, and to improve, their health…People cannot achieve their fullest health potential unless they are able to take control of those things which determine their health.”

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

• Health / other sectors participating together in PA campaigns

• Organized efforts, sequenced, adequately resourced

• Over arching theme consistency, brand

• Targeted Message

• Exposure, Exposure, Exposure

• Policy makers are community members

• Timetable of media, other components

• Sub-themes or audience segments

• Well evaluated at all levels

Lessons Learned

Page 49: Beyond  Wheeling Walks : Enhanced planning, environment, and policy components

Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

12-week CHPP

Mass media-based

CAMPAIGN

WHEELING WALKS /WV WALKS Task Force

Initial STEERING COMMITTEE

Policy and Environmental / INFRASTRUCTURE changes

PROJECT MODEL

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

ExercisePrevention

of CHD

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006

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Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006