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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
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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
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
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
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
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
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
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
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Target Population
78% of 55-64 year olds
were insufficiently active
BRFSS 2001
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
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:
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
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)
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
TIME
ENERGY
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
TV ad : Woman
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Print ad: man
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
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
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
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
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
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
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
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Wheeling Walks
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%
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
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
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
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
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
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
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
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
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Differences / modifications to
WV WALKS
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Weekly column
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
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
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
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
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
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”
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%
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
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
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?
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.”
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
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
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
ExercisePrevention
of CHD
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006
Bill Reger-Nash, Ed.D. WVU Community MedicineCDC —April 13, 2006