Trevor Shilton

The effectiveness of a physical activity intervention for seniors

Purpose. To determine whether a tailored, 6-month, neighborhood-based, physical activity intervention for people aged 65 to 74 years could increase their total physical activity levels and to identify factors associated with physical activity times. Design. A longitudinal, prospective, intervention study. Setting. Perth, Western Australia. Subjects. A total of 573 older adults, recruited from 30 intervention (n = 260) and 30 control (n = 313) neighborhoods. Initial response rates were 74% (260/352) in the intervention group and 82% (313/382) in the control group, which provided the 573 adults for participation in the study. A total of 413 participants (177 and 236 in the intervention and control groups, respectively) completed the program. Intervention. A neighborhood-based physical activity intervention. Measures. A self-reported questionnaire administered at three time points. Physical activity levels were measured using the International Physical Activity Questionnaire. Personal and demographic information, including perceived financial struggle and proximity to friends, were collected. Analysis. Descriptive statistics, repeated measures analysis of variance, and generalized estimating equations (GEE). Results. The intervention resulted in a significant increase in total average physical activity times of 2.25 hours per week (p < .001). The GEE analysis confirmed significant increases in physical activity from baseline to midpoint (p = .002) and to postintervention (p = .031). Perception of financial struggle (p = .020) was positively associated with physical activity time spent by participants, whereas having no friends or acquaintances living nearby (p = .037) had a significant negative correlation. The main limitation of this study was the restricted duration of the intervention. Conclusion. The program was successful in increasing weekly mean time for physical activity in seniors and in identifying factors that affect their commitment to physical activities.

Advocacy for physical activity-from to influence

Advocacy is an evolving and underdeveloped element of public health practice. Historically, it was used to describe activities undertaken by persons on behalf of the poor, the sick or oppressed. In the seventies, led by tobacco control advocates such as Pertschuk in the United States, Gray in Australia and Daube in the United Kingdom, public health advocacy became more focused on structural and policy change. Since the Ottawa Charter (WHO, 1986), the health promotion movement has embraced a broader view of the role of advocacy. The public health community now see advocacy as social action primarily aimed at effecting changes in legislation, policy and environments that support healthy living. Advocacy is defined by the World Health Organization as a combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or programme (WHO, 1995). This paper describes a model for understanding and mobilising physical activity advocacy. It outlines a three step process: 1. Gathering and translating the most pertinent physical activity evidence. Why advocate for physical activity? 2. Developing from the evidence, a physical activity advocacy agenda and articulating a plan (or plans) of key actions that will increase population levels of physical activity. What should be advocated? 3. Implementing a mix of advocacy strategies to influence and mobilise support for the physical activity agenda. How should advocacy be implemented?

Effects of Find Thirty every day® Cross-Sectional Findings From a Western Australian Population-Wide Mass Media Campaign, 2008-2010

Background. Internationally, over the last four decades large-scale mass media campaigns have been delivered to promote physical activity and its associated health benefits. In 2002-2005, the first Western Australian statewide adult physical activity campaign Find Thirty. It’s Not a Big Exercise was launched. In 2007, a new iteration of the campaign was proposed with new objectives, executions, and tag line Find Thirty every day®. Purpose. This article reports on the population-level effects of the Find Thirty every day® campaign from 2008 to 2010, with a focus on changes in awareness, intention, and physical activity. Methods. Evaluation of the campaign involved pre- and posttest serial cross-sectional surveys. Baseline data were collected in May 2008, and subsequent surveys in 2009 and 2010. Samples sizes were as follows: baseline (n = 972), first follow-up (n = 938), and second follow-up (n = 937). Data were derived from self-reported responses to a random-sample computer-assisted telephone interview. Results. Total awareness increased from 30.4% at baseline to 48.5% at second follow-up. Total awareness was higher in women and low socioeconomic status adults. Intention was 21.0%, double that reported at baseline. There were positive significant changes from baseline to first follow-up across all four categories: walking, moderate, vigorous, and total physical activity. There also were positive significant changes for self-reported walking from baseline to second follow-up. Conclusion. Find Thirty every day® resulted in an increase in awareness, intention, walking, vigorous intensity, and total level of physical activity in priority target groups. Campaign effects should be further examined by subgroups to identify the most receptive population segments.

Can the impact on health of a government policy designed to create more liveable neighbourhoods be evaluated? An overview of the RESIDential Environment Project.

There is growing interest in the impact of community design on the health of residents. In 1998, the Western Australian Government began a trial of new subdivision design codes (i.e. Liveable Neighbourhoods Community Design Code) aimed at creating pedestrian-friendly neighbourhoods to increase walking, cycling and public transport use. The trial provided a unique opportunity for a natural experiment to evaluate the impact of a government planning policy on residents. Nevertheless, evaluations of this kind present a number of methodological challenges in obtaining the highest quality evidence possible. This paper describes the RESIDential Environment Projects study design and discusses how various methodological challenges were overcome.

Consumers' responses to front-of-pack labels that vary by interpretive content

Previous research has shown that front-of-pack labels (FoPLs) can assist people to make healthier food choices if they are easy to understand and people are motivated to use them. There is some evidence that FoPLs providing an assessment of a foods health value (evaluative FoPLs) are easier to use than those providing only numerical information on nutrients (reductive FoPLs). Recently, a new evaluative FoPL (the Health Star Rating (HSR)) has been introduced to Australia and New Zealand. The HSR features a summary indicator, differentiating it from many other FoPLs being used around the world. The aim of this study was to understand how consumers of all ages use and make sense of reductive FoPLs and evaluative FoPLs including evaluative FoPLs with and without summary indicators. Ten focus groups were conducted in Perth, Western Australia with adults (n = 50) and children aged 10-17 years (n = 35) to explore reactions to one reductive FoPL (the Daily Intake Guide), an existing evaluative FoPL (multiple traffic lights), and a new evaluative FoPL (the HSR). Participants preferred the evaluative FoPLs over the reductive FoPL, with the strongest preference being for the FoPL with the summary indicator (HSR). Discussions revealed the cognitive strategies used when interpreting each FoPL (e.g., using cut offs, heuristics, and the process of elimination), which differed according to FoPL format. Most participants reported being motivated to use the evaluative FoPLs (particularly the HSR) to make choices about foods consumed as part of regular daily meals, but not for discretionary foods consumed as snacks or deserts. The findings provide further evidence of the potential utility of evaluative FoPLs in supporting healthy food choices and can assist policy makers in selecting between alternative FoPL formats.

Health promotion competencies: providing a road map for health promotion to assume a prominent role in global health

Understanding of health and its determinants is rapidly expanding and changing. The emergence of chronic diseases as the leading cause of global disease burden and improved understanding of social determinants of health has brought greater focus to the role of prevention in health. The IUHPE has shown outstanding leadership through the Galway Consensus Statement. Its three recommendations appropriately focus on stimulating dialogue, developing global consensus and communicating the results to key stakeholders. The IUHPE can further enhance progress of the statement by developing participative processes to ensure engagement and ownership by its members. The Galway Consensus Statement can be used to advance professional standards in global health promotion by: (1) providing a common language by which health promotion and its meaning can be communicated to others; (2) providing a framework for building capacity in the health promotion workforce and in the health workforce in general; (3) providing international consensus for consistency in university health promotion courses; (4) providing a framework for credentialing in health promotion; (5) better informing health promotion engagement with other significant workforce sectors and advancing partnership as a key way of working. A vital further application of the Galway Consensus Statement is to inform advocacy. Advocacy is vital to ensure health promotion is better resourced and prioritized by policy makers. Advocacy and communication are vital tools to highlight the evidence, establish the policy fit and infrastructure requirements of health promotion, and present health promotion solutions based on evidence of effectiveness.

Results from Australia’s 2014 Report Card on Physical Activity for Children and Youth

BACKGROUND Like many other countries, Australia is facing an inactivity epidemic. The purpose of the Australian 2014 Physical Activity Report Card initiative was to assess the behaviors, settings, and sources of influences and strategies and investments associated with the physical activity levels of Australian children and youth. METHODS A Research Working Group (RWG) drawn from experts around Australia collaborated to determine key indicators, assess available datasets, and the metrics which should be used to inform grades for each indicator and factors to consider when weighting the data. The RWG then met to evaluate the synthesized data to assign a grade to each indicator. RESULTS Overall Physical Activity Levels were assigned a grade of D-. Other physical activity behaviors were also graded as less than average (D to D-), while Organized Sport and Physical Activity Participation was assigned a grade of B-. The nation performed better for settings and sources of influence and Government Strategies and Investments (A- to a C). Four incompletes were assigned due to a lack of representative quality data. CONCLUSIONS Evidence suggests that physical activity levels of Australian children remain very low, despite moderately supportive social, environmental and regulatory environments. There are clear gaps in the research which need to be filled and consistent data collection methods need to be put into place.

Employers’ views on the promotion of workplace health and wellbeing: a qualitative study

BackgroundThe evidence surrounding the value of workplace health promotion in positively influencing employees’ health and wellbeing via changes to their health behaviours is growing. The aim of the study was to explore employers’ views on the promotion of workplace health and wellbeing and the factors affecting these views.MethodsUsing a qualitative phenomenological approach, 10 focus groups were conducted with employers selected from a range of industries and geographical locations within Western Australia. The total sample size was 79.ResultsThree factors were identified: employers’ conceptualization of workplace health and wellbeing; employers’ descriptions of (un)healthy workers and perceptions surrounding the importance of healthy workers; and employers’ beliefs around the role the workplace should play in influencing health.ConclusionsProgress may be viable in promoting health and wellbeing if a multifaceted approach is employed taking into account the complex factors influencing employers’ views. This could include an education campaign providing information about what constitutes health and wellbeing beyond the scope of occupational health and safety paradigms along with information on the benefits of workplace health and wellbeing aligned with perceptions relating to healthy and unhealthy workers.

Physical Activity and Nutrition Program for Seniors (PANS) Process Evaluation

Issue addressed. The Physical Activity and Nutrition Program for Seniors (PANS) program aimed to increase levels of physical activity and improve the diet of insufficiently active community-based seniors aged 60 to 70 years using a range of strategies. Comprehensive process evaluation was used to determine the suitability and appropriateness of the resources and effectiveness of the strategies. Method. Process evaluation data (qualitative and quantitative) were collected on the program strategies and resources throughout, and at the conclusion of the intervention period. Results. The program strategies/resources were found to be relevant to the population, assisting participants to increase their level of physical activity and improve their diet. Participants reported that the program resources were suitable for their age-group (84%), encouraged them to think about physical activity (78%), and nutrition (70%). Participants reported that they used the pedometer (91%) and recorded daily steps (78%). Moreover, the provision of group guides facilitated individuals to set and achieve personal goals. Conclusion. The PANS strategies and resources were appropriate, which supported the seniors in identifying, establishing, and achieving their physical activity and nutrition goals. Minor refinements of the program were recommended based on the findings.

Effectiveness of a Home-Based Postal and Telephone Physical Activity and Nutrition Pilot Program for Seniors

Objective. To evaluate the effectiveness of a 12-week home-based postal and telephone physical activity and nutrition pilot program for seniors. Methods. The program was delivered by mailed material and telephone calls. The main intervention consisted of a booklet tailored for seniors containing information on dietary guidelines, recommended physical activity levels, and goal setting. Dietary and walking activity outcomes were collected via a self-administered postal questionnaire pre- and postintervention and analysed using linear mixed regressions. Of the 270 seniors recruited, half were randomly selected for the program while others served as the control group. Results. The program elicited favourable responses. Postintervention walking for exercise/recreation showed an average gain of 27 minutes per week for the participants in contrast to an average drop of 5 minutes for the controls (P < .01). Little change was evident in errand walking for both groups. The intervention group (n = 114) demonstrated a significant increase in fibre intake (P < .01) but no reduction in fat intake (P > .05) compared to controls (n = 134). Conclusions. The participants became more aware of their health and wellbeing after the pilot program, which was successful in increasing time spent walking for recreation and improving fibre intake.