Published on March 20, 2014
Healthy Town, healthier people? An investigation into changes in knowledge, attitudes and behaviour in healthy living in a ‘Healthy Town’ intervention in England. ‘[Tewkesbury’s] like abroad’. Diane Crone, Professor, Exercise Science, University of Gloucestershire. Co-authors: James, D.V.B., O’Connell-Gallagher, N., Mahoney, M. and Gidlow, C.
Introduction • Increasing concern regarding the public health of the nation in the UK • Range of programmes and interventions but little impact on population based health and behaviour change • National initiative – Health Towns • £30 million, 9 ‘healthy towns’ - complex community interventions
Public health campaign • Change4Life – family focus • Hints and programmers • TV advertisements – Weight management – Healthy eating – Alcohol awareness
Healthy towns Programme • 9 Healthy Towns • Tewkesbury Town (18000 people) • £2.2 million project over 2 ¼ years (Nov ‘08 – March ‘11).
Healthy Town Intervention P A promotion Healthy Food Research Transport
Research/evaluation questions 1. Changes (pre-during-post) in knowledge, attitudes and behaviour, and factors associated with any change (through longitudinal household survey of adults) 2. Engagement with individual interventions, and description of those engaging (through intervention attendance lists) 3. Experiences of CMI! (through interviews and focus groups focusing on families, young people and children).
Research Question 1 and Method • RQ1: Changes (pre-during-post) in knowledge, attitudes and behaviour, and factors associated with any change (through longitudinal household survey of adults) • Method • Community Survey (June 2009/June 2010/April 2011) • Demographic data , e.g. age, gender, post code, employment status, etc. • Outcome measure data included: • Attitude, knowledge and behaviour in relation to the three areas (PA, food, transport). • Self reported data on wellbeing, • 8000 homes, postal survey
Results – Food Choices • Changes in knowledge of recommendations of portions of fruit and vegetables per day (31.7% of the aligned sample had improved their knowledge) • Changes in the consumption of portions of fruit and vegetables per day (30.5% of the aligned sample had improved their consumption).
Results – Physical Activity • Changes in behaviour in two areas; – physical activity, per day (in minutes) (41.6% of the aligned sample had improved the amount of physical activity per day) – spending (minutes) outside per day (44.6% of the aligned sample had improved the amount of minutes spent outside).
Transport Cycle signs that include length of time and distance walking and cycling
Findings - Transport • Change in attitudes to cycling (perceptions that Tewkesbury is suitable for cycling improved in 41.9% of the sample). • Changes in perceptions that Tewkesbury has accessible Public Transport • Change in the perceptions of the importance of choice of transport for health and wellbeing (33.53%).
Findings – Life satisfaction • Perception of personal satisfaction with life as a whole improved in 40.1% of the aligned sample • Associations found for gender where females were significantly more likely to improve their perception of personal satisfaction with life as a whole.
RQ 2 and Method • RQ2: Engagement with individual interventions, and description of those engaging (through intervention attendance lists) • Method • Individual Intervention Evaluation: • Demographic data (age, post code [place of residence/ward], gender, etc) • Outcome measures, e.g. attendance and adherence.
Findings from RQ 2 • Total n=6139 attendances, with 3413 (62.9%) used in the final analysis • Largest proportion of attendances children (5-17 years) and adults (30–49 years) • More female than males (57.2% vs 37.4%) • All five wards represented but attendances from two most deprived wards were the highest (21.6% and 20.6%). • Total attendances by theme – environment and transport 51.8%, – physical activity 26.0%, – food theme 6.8%
RQ 3 and Method • RQ3: Experiences of CMI! (through interviews and focus groups focusing on families, young people and children). • Method: • Focus groups and interviews (n=16) with ‘discreet communities’ including: • Family's – one from each ward (n=5) • Young people - local youth club (n=1) • Children (primary (y6) and secondary (y7) (n=2) • Undertaken during Jan 2010 (pre intervention) and Jan 2011 (post(ish) intervention).
Findings - summary • an increased awareness of the brand and of the project: ‘I see it as encouragement to change to healthy, instead of unhealthy.’ ‘[town’s] people coming together and doing exercise’. • changes in behaviour and attitude: ‘I can certainly see it [the town] becoming healthier, because I do think attitudes change over time; people are becoming more aware,…more people will be turning to walking and cycling’.
Findings - summary • increase in opportunities and health benefits: • physical activity: ‘one thing we’ve found is having walked backwards and forwards to school, we have actually found ourselves being happier.’ • food choices: ‘It means like eating and being in a healthy lifestyle.’ • active transport: ‘there is a giant bike shed at my school where you could fit at least 100 bikes in .... probably a couple of hundred. It is pretty good.’
Conclusions • Evidence of change in physical activity, time spent outside, consumption of fruit and vegetables, and behaviour regarding the use of the car. • Knowledge of recommendations for fruit and vegetables improved • Participants had positive experiences of living in Tewkesbury during the intervention period • Residents in the five wards attended the interventions in all three theme areas.
Complexities - a researchers observations • Multifaceted intervention • Postal survey… • Measure/assess change in 18,000 people • Capturing ‘broad range’ of lived experiences • Partnership working • Budget…. £2.2m – but £50K for evaluation • Policital climate during and at end….
CMI! has demonstrated that: • Large complex interventions: – Potential to engage communities, including those from deprived areas, – Facilitate improvements in health related behaviour, knowledge and perceptions of life satisfaction. • Further information (Evaluation Report and Exec Summary) can be found at: http://insight.glos.ac.uk/academicschools/dse/research/Pa ges/Tewkesbury-LivingfortheFuture.aspx
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