Chapter 12Interventions in organisations

and communities

Helping people become more active where they work and live

Chapter 12 aims• consider physical activity promotion and interventions in schools• discuss the role of physical education in exercise promotion and to

evaluate the evidence on specific interventions to change physical activity levels

• evaluate whether physical activity in childhood predicts participation in adulthood

• consider physical activity promotion and interventions in the workplace

• present a rationale for physical activity promotion in the workplace and associated evidence on its effectiveness

• consider physical activity promotion and interventions in the community

• discuss contemporary social psychological approaches to persuasion and attitude change

• highlight a social marketing approach to physical activity promotion• discuss recent initiatives from national governments to promote

physical activity within broader health policy• show how an integration is possible between different levels of

interventions in physical activity.

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12.1. Energy expenditure of children taught in two experimental SPARK conditions and

a control group condition (data from Sallis et al. 1997

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12.2. Energy expenditure of children taught either by classroom or PE teachers during

the SPARK project(data from McKenzie et al. 1997)

12.3. Changes in minutes of walking reported in the Walk in to Work out trial for contemplators

and preparers (Mutrie et al. 2002)

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12.4. Stair-climbing before and after a promotional intervention

(Blamey et al. 1995)

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Key point:

• Schools have a responsibility to teach children about physically active lifestyles and encourage regular activity – but are they doing this as well as they should?

Key point:

• Active commuting offers a regular opportunity to achieve recommended physical activity levels. However, few initiatives that promote active commuting have been evaluated.

Key point:

• Promoting active commuting by walking at least part of the journey may be easier to achieve than promoting cycling.

Key point:

• Mass media campaigns relating to physical activity should have the goal of raising awareness rather than changing behaviour.

Key point:

• Prompting people to use the stairs instead of taking a lift or escalator is an intervention that has support from research reviews and could be implemented in many places.

Key point:

• The emergence of a global strategy for increasing physical activity levels should encourage more governments to put appropriate national strategies in place.

Table 12.4. Principles of ecological approaches to health behaviour change applied to physical activity (based on Sallis & Owen, 1996). (1)

• Multiple dimensions of influence on behaviour – In addition to intra- and inter-personal influences,

ecological models include social, cultural, and physical environments as important influences on health behaviours

• Examples– social ‘acceptance’ of physical activity in different

cultural groups– inhibitory physical environment for physical activity

Table 12.4. Principles of ecological approaches to health behaviour change applied to physical activity (based on Sallis & Owen, 1996). (2)

• Interactions of influences across dimensions – An ecological approach should say how the

different types of determinants will interact to influence health behaviours

• Examples– A research study testing the interaction

between intra-personal beliefs concerning walking and use of a pedestrianised city centre.

Table 12.4. Principles of ecological approaches to health behaviour change applied to physical activity (based on Sallis & Owen, 1996). (3)

• Multiple levels of environmental influences – Ecological models specify levels of influence,

such as different types of environment (e.g., urban, climate)

• Examples– The prevalence of physical activity in places

differing in climate or in the number of inner-city cycle paths

Table 12.4. Principles of ecological approaches to health behaviour change applied to physical activity (based on Sallis & Owen, 1996). (4)

• Environments directly influence behaviours – Ecological models propose that environments

directly influence health behaviours as well as indirectly through other factors such as individual beliefs

• Examples– Physical activity will be directly influenced by

local traffic conditions regardless of intra- or inter-personal differences.

NICE guidance on Promoting and creating

built or natural environments that

encourage and support physical activity

http://www.nice.org.uk/Professor Nanette MutrieChaired this NICE programme development group

Evidence from the Kahn et al systematic review

• Systematic review suggests that there is insufficient evidence that mass media campaigns can increase physical activity– However maybe mass media’s role is more

about awareness raising than actually changing behaviour

• Systematic review suggests sufficient evidence that prompts increase stair use

Box 12.1. Understanding what the consumer wants

• We make the point in the text, when discussing social marketing, that the psychologist may not necessarily be the most expert person for the 'selling' of the community-wide message

• A recent story illustrates this. – A small survey was carried out by a local team of health/exercise

specialists in a health authority 'district' in England. They wanted to find out the type of health interventions that might be appealing to residents on a fairly deprived housing estate on the edge of a town. The 'classic' replies were expected, such as interventions to stop smoking, start exercising, eat more healthily etc. Instead, rather more 'basic' answers were given. The priorities for a 'healthy lifestyle' identified by these residents included 'proper lighting in alleyways' and 'keeping dog shit off the pavements'!

• The need to match the message to the clients is clear to see.

Chapter 12: Conclusions 1• schools are well placed to promote healthy lifestyles, including

physical activity• physical education has the potential to reach large numbers of

children of all backgrounds and abilities• interventions to increase physical activity in or through schools

have met with mixed success or have not been properly evaluated.

• the objectives, content and delivery of health-related exercise in schools are often confused and sometimes PE has failed groups in the promotion of lifetime of physical activity

• in some countries, the workplace has been identified as an important setting for physical activity and health promotion

• there is evidence for the effectiveness of physical activity interventions in the workplace on absenteeism, productivity and reduced health care costs, but effectiveness in increasing physical activity has not been demonstrated

Chapter 12: Conclusions 2• the greatest potential public health impact of physical activity

promotion is likely to come through community interventions• social psychological approaches to attitude change and

persuasion hold considerable promise in the identification of appropriate strategies for community interventions

• principles of social marketing require further application to exercise and physical activity, and in particular note should be taken of the importance of market segmentation and targeted groups

• governments of developed countries have only recently been involved in legislative initiatives in physical activity and this interest has helped to legitimise physical activity as an important health behaviour.

• effective physical activity promotion requires co-ordination across all levels of interventions as described by the ecological model and endorsed by the WHO global strategy