Avril Blamey

Walk in to work out: a randomised controlled trial of a self help intervention to promote active commuting

Study objective: To determine if a self help intervention, delivered via written interactive materials (the “Walk in to Work Out” pack), could increase active commuting behaviour (walking and cycling). Design: Randomised controlled trial. The intervention group received the “Walk in to Work Out” pack, which contained written interactive materials based on the transtheoretical model of behaviour change, local information about distances and routes, and safety information. The control group received the pack six months later. Focus groups were also conducted after six months. Setting: Three workplaces in the city of Glasgow, Scotland, UK. Participants: 295 employees who had been identified as thinking about, or doing some irregular, walking or cycling to work. Main results: The intervention group was almost twice as likely to increase walking to work as the control group at six months (odds ratio of 1.93, 95% confidence intervals 1.06 to 3.52). The intervention was not successful at increasing cycling. There were no distance travelled to work, gender, or age influences on the results. Twenty five per cent (95% confidence intervals 17% to 32%) of the intervention group, who received the pack at baseline, were regularly actively commuting at the 12 month follow up. Conclusion: The “Walk in to Work Out” pack was successful in increasing walking but not cycling. The environment for cycling must be improved before cycling will become a popular option.

The Practice and the Theory Lessons from the Application of a Theories of Change Approach

Theory-based evaluation approaches are becoming increasingly popular in the evaluation of comprehensive community initiatives. Such an approach, Theory of Change (ToC), has been used in the external evaluations of two of four Scottish Health Demonstration projects. This article provides an empirically based analysis of the issues raised in the process of articulating a project’s ToC. It then considers the value of the approach in relation to sharpening planning, providing formative feedback, improving performance management, guiding internal and external evaluation, judging impact and reducing problems of attribution. A conclusion is reached that, whilst such approaches are by no means a panacea, they offer one useful framework within which to negotiate a range of evaluation practice decisions.

Changing the individual to promote health-enhancing physical activity: the difficulties of producing evidence and translating it into practice

This paper presents conclusions from recent systematic reviews and highlights individually targeted interventions that are effective at increasing physical activity. It discusses the limitations of currently available evidence, considers what factors lead to these limitations and what barriers exist in terms of implementing the evidence as part of local and national policy and practice. Barriers present themselves in terms of getting evidence into practice and in terms of ensuring that practice informs the evidence base. These barriers include difficulties in conducting systematic reviews, disaggregating knowledge from complex interventions, making local adaptations to existing evidence, the lack of an evaluation culture, ethical and pragmatic difficulties in designing interventions, selecting appropriate outcome measures, poor designs and implementation of evidence and, finally, a recognition that policy making is not only based on the available evidence. New and more integrated approaches to evaluation and to practice are needed.

An evaluation of police reporting of road casualties

Background: Under-reporting of road traffic casualties in police records has been well documented. Objectives: To investigate the extent and nature of possible under-reporting of road traffic casualties in the West of Scotland. Design: A linked database comprising both police data (STATS19) and hospital in-patient records (SMR01) was created. The study period was 1997–2005 inclusive. Contrasting the number of SMR01-identified road casualties that were also recorded (“linked”) in STATS19 records with those that were not (“unlinked”) gives an indication of the extent and types of under-reporting of hospitalized road casualties by the police. Results: 45% of hospital admissions due to road casualties were not reported to (or recorded by) the police. The STATS19 “slight casualties” that were linked to the SMR01 data was the only category that showed an increase in numbers (+4%) over the study period, whereas the numbers of STATS19 KSI (killed or seriously injured—combining fatal and serious casualties) decreased substantially (−38%). Pedal cyclists and motorcyclists were most likely to be missed by police recording. No third-party involvement, older casualties, females, length of stay in hospital (day cases), and earlier year of crash were also significantly associated with under-reporting. Conclusions: A general decline in the completeness of STATS19 is unlikely to have occurred, but there may have been an increasing tendency over time for police officers to report injuries as slight rather than serious. To improve the quality of this information, routine linkage of road casualty data derived from police and hospitalization databases should be considered.

Measuring the tail of the dog that doesn't bark in the night: the case of the national evaluation of Choose Life (the national strategy and action plan to prevent suicide in Scotland)

BackgroundLearning about the impact of public health policy presents significant challenges for evaluators. These include the nebulous and organic nature of interventions ensuing from policy directives, the tension between long-term goals and short-term interventions, the appropriateness of establishing control groups, and the problems of providing an economic perspective. An example of contemporary policy that has recently been subject to evaluation is the first phase of the innovative Scottish strategy for suicide prevention (Choose Life).Discussion and summaryThis paper discusses how challenges, such as those above, were made manifest within this programme. After a brief summary of the overarching approach taken to evaluating the first phase of Choose Life, this paper then offers a set of recommendations for policymakers and evaluators on how learning from a second phase might be augmented. These recommendations are likely to have general resonance across a range of policy evaluations as they move from early planning and implementation to more mature phases.

Using programme theory to strengthen research protocol and intervention design within an RCT of a walking intervention

This article provides a practical example of how to apply a theory-driven approach to research intervention and protocol design. It illustrates how reflection on both intervention theory and programme theory can inform and refine the: implementation of the intervention; research design; specification of research questions and tools; and, identify the contribution each research stage makes in the accumulation of policy-relevant learning. The article presents the logic models, associated theory and learning from the development of a pilot randomized control trial/feasibility study of a walking intervention targeting older adults.

Getting the inactive active: implications for public health policy

Epidemiological data have established that a sedentary lifestyle increases the incidence of at least 17 medical conditions. The evidence is strongest for coronary heart disease. A sedentary lifestyle is now the normal lifestyle for the majority of the populations in developed countries and relapse from regular physical activity is also high. Thus there is clear need for public policy aimed at increasing the physical activity levels in the population. Policy makers have begun to respond to this need and recently Scottish and English plans for increasing physical activity levels in the populations have been published.

Using and generating evidence: policy makers' reflections on commissioning and learning from the Scottish Health Demonstration Projects

This article discusses the gap between rhetoric and reality in evidence-based policy making using data derived from external evaluations of two of Scotlands national Health Demonstration Projects. More specifically, it reports on the extent to which policy makers used evidence to commission the projects, and on the type of evidence that they expected to flow from them to feed into future government strategy. Using primary data, this article confirms that policy decisions are made on the basis of factors that go beyond research evidence and suggests that both policy makers and evaluators would gain from more explicit acknowledgement of what lies beneath the veneer of evidence-based policy making.

Encouraging stair walking

A motivational poster placed at a choice point between escalator and stair use, in a city centre underground station, doubled stair use (fig 1).1 The study also showed that men and boys used the stairs more than women and girls both before and after the poster intervention, but there was …