· Web viewA descriptive survey design was completed to determine if there were barriers to physical activity for the community of Cold Spring, MN. A convenience sample of 56 Cold

Running head: BARRIERS TO PHYSICAL ACTIVITY 1

Barriers to Physical Activity in the Community of Cold Spring, MN

Marcia Scherer, MS, RN, CNE, PHN, LSN

PSY 627: Multivariate Statistics in the Behavioral Sciences

Presented to Dr. David Stockburger

Missouri State University

Final Statistics Project

August 4, 2011

2BARRIERS TO PHYSICAL ACTIVITY

Abstract

The desire to decrease health care costs due to ramifications of chronic illness secondary to

obesity and a sedentary lifestyle continues to haunt the United States citizens. In a study

completed by the Center for Disease Control (CDC) covering 36 states, physical activity

decreased from 30.5% in 1989 to 25% in 2008 (2010). Under funding through a grant from the

Minnesota legislature, Stearns County Public Health Department continues to assess and

formulate suggestions for towns/cities within the county. The goal of this paper is to determine

barriers to physical activity for a single community, the town of Cold Spring for the public health

department.

A descriptive survey design was completed to determine if there were barriers to physical

activity for the community of Cold Spring, MN. A convenience sample of 56 Cold Spring

residents completed a 10 statement Likert survey tool describing aspects of the community.

The findings suggest that there are no barriers to physical activity in Cold Spring according to

residents surveyed. There was however an inverse correlation found; the older the resident the

tendency to disagree with the 10 statements. The fact remains, physical activity is necessary for a

healthy and productive life.

Keywords: barriers to physical activity, physical inactivity, obesity, Statewide Health

Improvement Program, Minnesota Department of Health, Centers for Disease Control, sedentary

lifestyle


Barriers to Physical Activity in the Community of Cold Spring, MN

Obesity is an increasing phenomenon in the United States (US) while motivation towards

physical activity appears to be dwindling. In a study of 36 states completed by the Center for

Disease Control (CDC), physical activity decreased from 30.5% in 1989 to 25% in 2008 (2010).

In response, the U.S. Department of Health and Human Services released a “National Prevention

Strategy” addressing four areas fundamental to improving health within the nation (2011). Two

of these areas provide direction for states to implement in improving health; “Building Healthy

and Safe Community Environments” and “Empowering People to Make Healthy Choices”

(2011, p. 1). Stearns County Public Health Department has taken this directive seriously and

with funding provided by the Minnesota legislature continues to assess cities/towns within their

jurisdiction. Upon completion of the assessment process, creative ideas for environmental

improvements are suggested to the city/town with potential implementation through state

funding. Taking one such city, Cold Spring, within the county was a directive given by the

director of the public health department. Therefore, the goal of this research project was to

determine if there are community barriers to physical activity for residents of Cold Spring,

Minnesota (MN).

According to the Minnesota Department of Health (MDH) 97 million adults in the U.S.

are overweight or obese (2009). In Minnesota nearly 63% adults are overweight or obese (2009).

Typically obesity is associated with a sedentary lifestyle along with poor eating habits. Are there

environmental changes where people reside that preclude people from being physically active on

a regular basis? Physical inactivity contributes to obesity which in turn leads to chronic illnesses

such as Diabetes Mellitus Type II, hypertension, stroke, cancer, and heart disease. One way to

respond to the increasing incidence of chronic illnesses due to obesity and a sedentary lifestyle is


to encourage physical activity. Healthy People 2020 addresses physical activity by encouraging

communities to increase availability of sidewalks, bike lanes, trails, and parks” for their residents

(U.S. Department of Health and Human Services, 2011, p. 1).

Healthy People 2020 states that to “understand the barriers to and facilitators of physical

activity are important to ensure the effectiveness of interventions and other actions to improve

levels of physical activity” (U. S. Department of Health and Human Services, 2011, p. 2). In

2009 the MDH introduced the Statewide Health Improvement Program (SHIP) where

community health boards and tribal governments could apply for a grant to “prevent obesity in

Minnesota” (Minnesota Department of Health [MDH], 2010, p. 2). Since 2009 the Stearns

County Public Health Department has been utilizing a SHIP grant to identify environmental

needs of cities within the county to increase physical activity towards overall improvement of

resident health (Sherry O’Brien, personal communication, May 20, 2011). O’Brien, Public

Health Nursing Supervisor for Stearns County Public Health Department, requested completion

of a physical assessment for the city of Cold Spring to identify barriers to physical activity and

address community needs for future city planning.

Assessment of a city layout yields important information that can improve the health of

its residents. Fenton (2005) points out that the obesity epidemic can be controlled through a

redefinition of obesity to that “of physical inactivity and poor nutrition” (p. S115). By

restructuring communities with accessible and safe sidewalks, bikeways, and parks residents are

more apt to become more physically active. In a report, “F as in Fat: How Obesity Threatens

America’s Future,” funded by the Robert Wood Johnson Foundation, specifically identifies

convenience and security are major factors influencing physical activity of residents in a

community (2011). When residents are more physically active they will have a tendency to be


healthier; which could be the topic of another research project for the community of Cold

Spring!

The purpose of this research project then is to identify barriers within the community of

Cold Spring, MN that prohibit activity among its residents. The question is, “Are there barriers to

physical activity for residents of Cold Spring?” The Stearns Public Health Department is

interested in identifying the barriers to physical activity for this community so improvements can

be made to the city’s structural environment to increase physical activity of its residents. From

this question the null hypothesis is formulated which states, “There are no barriers to physical

activity for residents of Cold Spring.” While the alternative hypothesis is, “There are barriers to

physical activity for residents of Cold Spring.”

Methods

Participants

A convenience sampling of Cold Spring residents was attained. Residents were asked to

complete a paper survey as they entered the grocery store, golf course, bank, hardware store, or

bar. Nursing students introduced themselves and asked each resident for verbal permission

before filling out the short survey. Prior to completing the survey, residents were also asked their

approximate residence location after being shown a map with clear section delineations of the

city; north, south, east, or west (see Appendix A). Residents were given the tool after a brief

introduction to and rationale for the survey, along with residence location within the city limits.

All of the surveys were anonymous. Resident names and addresses were not asked for nor

required for completion of this survey. 56 residents finished the written survey (N=56). This

survey was designed and conducted in part as a request by the Stearns County Public Health

Department and as a follow-up to observations of the city after finishing a “walkability” study.


Instrument

In preparation for development of a Likert scale tool, a walkability survey was completed

for the city. On May 24, 2011 the city was divided into three specific areas and nursing students

in a public health nursing course observed each area that they walked. Sidewalks, lighting, curbs,

aesthetic appeal, crosswalks, parks, benches, bike and walking trails were assessed and

comments made using a walkability survey developed by Health by Design (n.d.). After

reviewing the data collected by the students, the students and I developed a Likert scale.

The Likert scale tool was aimed at identifying and understanding the physical activity needs of

the city's occupants along with identifying environmental barriers for the residents of Cold

Spring. This tool consisted of a ten item four point Likert scale with an additional five

demographic questions (see Appendix B). Demographics asked included gender, age, area within

city, hours of exercise per week, and hours of exercise wished to do per week. There were 10

Likert type statements. The following is an example for scoring of the Likert type responses

Statements Missing Score 1 Score 2 Score 3 Score 41. I live in a physically

active community.No

ResponseStrongly Disagree

Disagree Agree Strongly Agree

After completing the walkability study there were several areas of concern and was

hopeful by completing this survey that residents would give their perspective for safety and other

environmental issues. The walkability study demonstrated easy access to downtown businesses,

the fragrance of flowers, and benches to rest upon. Concerns noted were faded crosswalks,

sidewalks with cracks, heaves, and unevenness, a bridge with only a knee high ledge (safety

concern for curious children), school crossing signs missing, and sidewalks leading to schools

for children who walk to school are non-existent. So, do residents of Cold Spring feel that their

community is safe to walk? Are there barriers to resident physical activity within the city limits?


Results

The results of this study show that there are no barriers to physical activity in the city of

Cold Spring. The null hypothesis is retained, “There are no barriers to physical activity for

residents of Cold Spring.” Further examination of the data leads to this result.

Of the 56 residents, the frequency table (through the histogram below) reveals that 42.9

percent respondents (N=24) were male and 51.7 percent respondents (N=32) were female. This

histogram provides age frequency with a normal distribution curve. The x axis is set for 1 = 18-

24 years, 2 = 25-34 years, 3 = 35-44 years, 4 = 45-54 years, 5 = 55-64 years, and 6 = 65+ years.

Graph 1. Histogram of ages with normal curve distribution.

The mean (4.21) and median (4) age then corresponds to ages 45-54 years. The mode is

represented by group 6, age 65+ years. The range is groups 1-6 with ages ranging from 18 years

to 65+ years.

What parts of the city do these residents call home? A good portion of the respondents

live in the North section (N=20) while the second largest group hails from the East (N=18).


North East South West05

10152025

Respondents

Respondents

Graph 2. Respondent area of residence

Treating the ten statements as ordinal data, percentages for responses are calculated.

Statement No Response

Strongly Disagree

Disagree

Agree Strongly Agree

PercentageAgree/Strongly

Agree1. I live in a physically active community.

0 1 2 43 10 95%

2. I have somewhere I can exercise in Cold Spring.

0 0 3 36 17 95%

3. I would exercise more if I had someone to exercise with.

1 4 15 28 8 64%

4. I know of outdoor trails in Cold Spring.

0 3 19 27 7 61%

5. My community is bicycle friendly.

1 1 15 30 9 70%

6. There are enough sidewalks in Cold Spring.

0 2 12 32 10 75%

7. Sidewalks are well-kept throughout the year.

1 2 9 36 8 79%

8. If I lived close to the school I would allow my children to walk.

1 2 5 38 10 86%

9. My neighborhood is well-lit at night.

0 2 12 33 9 75%

10. I feel safe in my neighborhood

0 1 0 35 20 98%

Table 1. Percentage respondents strongly agree/agree


This table demonstrates that respondents agree with the statements. Further delineation is

necessary to determine if there are effects or barriers that influence physical activity by residents.

Statements in the tool were then scored using the following scale; missing = no response,

1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree. A new variable was

transformed and called, totalstatements, by adding up the scores for each of the respondents for

all 10 statements. The larger the score for the respondent, the more apt the respondent was to

agree with the statements while the smaller the score the less likely. The maximum number a

respondent could achieve is 40 (4 being strongly agree x 10 statements). Further basic statistical

analysis resulted in the following table:

N Minimum Maximum Mean Std. Deviation

Gender 56 1 2 1.57 .499

Age 56 1 6 4.21 1.569

Area 56 1 4 2.25 1.100

Hrs of Ex 56 1 4 2.98 1.000

Wish Hrs 56 1 4 3.34 .920

State 1 56 1 4 3.11 .528

State 2 56 2 4 3.27 .556

State 3 56 0 4 2.68 .876

State 4 56 1 4 2.66 .793

State 5 56 0 4 2.80 .796

State 6 56 1 4 2.89 .731

State 7 56 0 4 2.86 .773

State 8 56 0 4 2.95 .773

State 9 56 1 4 2.86 .724

State 10 56 3 4 3.36 .483

Totalstatements 56 15.00 36.00 29.4286 3.75552

Valid N (listwise) 56

Table 2. Descriptive Statistics for each variable

Utilizing Analysis of Variance (ANOVA) to determine if there are barriers to physical

activity becomes easier when using the transformed variable, totalstatements. Using the variables

of gender, age, area, hours of exercise, and totalstatements in an ANOVA test, two-tailed, the


significance levels are all greater than alpha of 0.05. The “Sig.” levels are as follows; gender

0.345, age 0.732, area 0.669, and hours of exercise 0.245. Thus, the null hypothesis is retained

along with the alternative as effects were not found.

The response variable, totalstatements, was then correlated with gender, age, area, and

hours of exercise. There was a direct positive correlation between hours of exercise and

totalstatements at 0.302 with alpha at the 0.05, two-tailed (see Table 4). Could it be that residents

of Cold Spring feel safe and do not feel there are barriers to physical activity in their city?

Gender Age Area Hrs of Ex Totalstatements

Gender Pearson Correlation 1 -.159 .066 -.088 -.065

Sig. (2-tailed) .241 .628 .517 .634

N 56 56 56 56 56

Age Pearson Correlation -.159 1 -.032 .107 -.047

Sig. (2-tailed) .241 .817 .433 .732

N 56 56 56 56 56

Area Pearson Correlation .066 -.032 1 .087 .238

Sig. (2-tailed) .628 .817 .525 .078

N 56 56 56 56 56

Hrs of Ex Pearson Correlation -.088 .107 .087 1 .302*

Sig. (2-tailed) .517 .433 .525 .024

N 56 56 56 56 56

Totalstatements Pearson Correlation -.065 -.047 .238 .302* 1

Sig. (2-tailed) .634 .732 .078 .024

N 56 56 56 56 56

*. Correlation is significant at the 0.05 level (2-tailed).

Table 3. Correlations between gender, age, area, hours of exercise and totalstatements

Further investigation with each individual statement correlated separately with gender,

age, area, and hours of exercise did show some areas of correlation. There were no significant

correlations between gender, age, area, and hours of exercise with statements 1, 3, 4, 5, 6, 7, and

9. Statement 2, “I have somewhere I can exercise in Cold Spring” correlated with hours of

exercise at 0.336 at a 0.05 alpha level, two-tailed. Statement 8, “If I lived close to the school I


would allow my children to walk” correlated with hours of exercise at 0.281 at a 0.05 alpha level,

two-tailed. Does this mean that parents feel that the environment such as crosswalks. traffic lights,

and sidewalks are sufficient to allow their children to walk to school? Statement 10, “I feel safe in

my neighborhood” correlated also with hours of exercise at 0.277 at a 0.05 alpha level, two-tailed.

By taking a closer look at each specific statement, some correlations became more apparent. Do

these statistical analyses present the true feelings of Cold Spring residents?

Discussion

The results depict a convenience sampling of Cold Spring residents who, for the most

part, feel there aren’t barriers to physical activity in their city. This sentiment is seen in

correlations with hours of exercise. ANOVA analysis reflects this opinion of the residents.

Residents surveyed tend to exercise or know of a place to exercise in Cold Spring. This is a

surprise as hiking and biking trails are difficult to find.

When completing the walkability survey there were several environmental concerns

when walking through all areas of the city. Portions of sidewalks were uneven, had cracks, and

in general disrepair. Crosswalks were faded and some intersections in the downtown area did not

have pedestrian crossing signals. One bridge had a ledge that was knee high level, making it easy

for a child to topple over and into the small creek. There were no signs leading to walking or

biking trails within the city. Maybe residents of the city have knowledge of where the parks and

trails are located. The city was aesthetically pleasing with benches to rest on and the fragrance of

flowers a pleasing scent. Walking all of the streets during the day felt safe. It might have been

different at night however; the walkability study was conducted during the day.


The majority, 98% of residents surveyed feel safe in Cold Spring. This reflects then on

why 95% feel they live in a physically active community. If residents feel safe then they are

more apt to walk, jog, or bike in their community.

29% of the respondents felt that the community is not bicycle friendly while 39% report

no knowledge of trail locations in the city. While further investigation revealed no barriers to

physical activity, this might be worth further exploration through a different study. How are bike

and walking trails communicated to residents; pamphlets or signage? Where can residents find

this information?

Correlation testing provides further assurance that residents are exercising without

environmental barriers in the community of Cold Spring. Residents of Cold Spring, through the

convenience sampling are physically active.

Limitations

The convenience sample was fairly small with 56 respondents. The larger the sample size

the less error. Having closer to 100 respondents would maybe give more of a chance for hitting

effects when doing an ANOVA analysis. The size was small due to residential requirements and

only completing one 8 hour day of soliciting respondents.

The survey could have been written differently with more choices on the Likert scale

rather than four; strongly disagree, disagree, agree, strongly agree. A fifth point in the middle, no

opinion, would have been incorporated. This gives the tool more dimensions on the continuum

by adding another point on the scale. This point was intentionally left out due to the tendency for

respondents on any survey to head for the middle point on a Likert scale as it is easier and less

thought provoking to answer, no opinion.

Implications/Conclusion


Reporting back to the Stearns County Public Health Department will include that an

environment that is resident friendly for physical activity makes for a healthy community.

Residents feel that there are currently no barriers to physical activity in their community. There

is a small portion of residents that are unaware of bike and walking trails. I would suggest that

pamphlets or street signage be available for residents to get to the trails within the city.

Encourage Cold Spring city council to increase bicycle lanes so residents could bike to work

more often which increases exercise and decreases pollution. Cold Spring is a beautiful city with

a healthy environment.


Appendix A

City of Cold Spring (four sections)


Appendix B

Physical Activity Questionnaire


The Stearns County Public Health Department is planning to take measures to enhance and promote physical activity within the community of Cold Spring. Completion of this survey will help us in determining where and how improvements can be made within the community of Cold Spring.Directions for each section of the survey are provided at the beginning of each section.

Please mark your answer with an X in the space provided.

1) Gender _____ Male_____ Female

2) Age _____ 18 – 24_____ 25 – 34_____ 35 – 44_____ 45 – 54_____ 55 – 64_____ 65 and older

3) What area of Cold Spring do you live in? (See map)_____ North (pink)_____ South (orange)_____ East (yellow)_____ West (green)

4) How many hours do you exercise each week? _____ Less than 1 hour_____ 1 – 2 hours_____ 3 – 4 hours_____ 5 or more hours

5) How many hours would you like to exercise each week?_____ Less than 1 hour_____ 1 – 2 hours_____ 3 – 4 hours_____ 5 or more hours

Please check 1 box for each question. All questions relate to the community of Cold Spring.


References

Strongly Disagree Disagree Agree Strongly

Agree1. I live in a physically active

community.1 2 3 4

2. I have somewhere I can exercise in Cold Spring.

3. I would exercise more if I had someone to exercise with.

4. I know of outdoor trails in Cold Spring.

5. My community is bicycle-friendly.

6. There are enough sidewalks in Cold Spring.

7. Sidewalks are well-kept throughout the year (clean, shoveled, and salted).

8. If I lived close to the school I would allow my children to walk.

9. My neighborhood is well-lit at night.

10. I feel safe in my neighborhood.


Center for Disease Control. (2010). Physical activity statistics. Retrieved from

http://www.cdc.nccdphp/dhpa/physical/stats/leisure_time.htm.

Fenton, M. (2005). Battling America’s epidemic of physical inactivity: Building more walkable,

livable communities. Journal of Nutrition Education Behavior, 37, S115-S120.

Health By Design. (n.d.). How walkable is your neighborhood? Retrieved from

http://www.healthbydesignonline.org/documents/WalkabilitySurvey_HbD.pdf.

Levi, J., Segal, L., Laurent, R., & Kohn, D. (2011). F as in fat: How obesity threatens America’s

future. Retreived from

http://healthyamericans.org/assets/files/TFAH2011FasInFat10.pdf.

Minnesota Department of Health. (2009, December). Minnesota Department of Health fact

sheet: Overweight and obesity. Retrieved from

http://www.health.state.mn.us/divs/hpcd/chp/cdrr/obesity/pdfdocs/obesityfactsheet12200

9updated.pdf.

Minnesota Department of Health. (2011, April). Statewide Health Improvement Program

(SHIP). Retrieved from http://www.health.state.mn.us/healthreform/ship/index.html.

Minnesota Department of Health. (2010, November). Statewide Health Improvement Program

(SHIP) request for proposals, grants to community health boards and tribal governments.

Retrieved from http://www.health.state.mn.us/healthreform/ship/rfp/index.html.

Stearns County Human Services Board. (2011, March). SHIP grantee fact sheet. Retrieved from

http://www.health.state.mn.us/healthreform/ship/about/legislativereport.html.

U.S. Department of Health and Human Services. (2011, June). Healthy People 2020: Physical

activity overview. Retrieved from

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=33.

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=33

http://www.health.state.mn.us/healthreform/ship/about/legislativereport.html

http://www.health.state.mn.us/healthreform/ship/rfp/index.html

http://www.health.state.mn.us/healthreform/ship/index.html

http://www.health.state.mn.us/divs/hpcd/chp/cdrr/obesity/pdfdocs/obesityfactsheet122009updated.pdf

http://www.health.state.mn.us/divs/hpcd/chp/cdrr/obesity/pdfdocs/obesityfactsheet122009updated.pdf

http://healthyamericans.org/assets/files/TFAH2011FasInFat10.pdf

http://www.healthbydesignonline.org/documents/WalkabilitySurvey_HbD.pdf

http://www.cdc.nccdphp/dhpa/physical/stats/leisure_time.htm


U.S. Department of Health and Human Services. (2011, June, 16). Obama administration

releases national prevention strategy. Retrieved from

http://finance.yahoo.com.news/Obama-Administration-Releases-bw-2621446715.html?

x=0

http://finance.yahoo.com.news/Obama-Administration-Releases-bw-2621446715.html?x=0

http://finance.yahoo.com.news/Obama-Administration-Releases-bw-2621446715.html?x=0

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· Web viewA descriptive survey design was completed to determine if there were barriers to physical activity for the community of Cold Spring, MN. A convenience sample of 56 Cold