Background Ethnic minorities and lower-income adults have among the highest rates of obesity and lowest levels of regular physical activity (PA). The Positive Action for Today's Health (PATH) trial compares three communities that are randomly assigned to different levels of an environmental intervention to improve safety and access for walking in low income communities. Design and setting Three communities matched on census tract information (crime, PA, ethnic minorities, and income) were randomized to receive either: an intervention that combines a police-patrolled-walking program with social marketing strategies to promote PA, a police-patrolled-walking only intervention, or no-walking intervention (general health education only). Measures include PA (7-day accelerometer estimates), body composition, blood pressure, psychosocial measures, and perceptions of safety and access for PA at baseline, 6, 12, 18, and 24 months. Intervention The police-patrolled walking plus social marketing intervention targets increasing safety (training community leaders as walking captains, hiring off-duty police officers to patrol the walking trail, and containing stray dogs), increasing access for PA (marking a walking route), and utilizes a social marketing campaign that targets psychosocial and environmental mediators for increasing PA. Main hypotheses/outcomes It is hypothesized that the police-patrolled walking plus social marketing intervention will result in greater increases in moderate-to-vigorous PA as compared to the police-patrolled-walking only or the general health intervention after 12 months and that this effect will be maintained at 18 and 24 months. Conclusions Implications of this community-based trial are discussed.
BackgroundThis study describes the development of a social marketing campaign for increasing walking in a low income, high crime community as part of the Positive Action for Today’s Health (PATH) trial.MethodsFocus groups were conducted with 52 African American adults (ages 18 to 65 yrs), from two underserved communities to develop themes for a social marketing campaign to promote walking. Participants responded to questions concerning social marketing principles related to product, price, place, promotion, and positioning for increasing neighbourhood walking.ResultsFocus group data informed the development of the campaign objectives that were derived from the “5 Ps” to promote physical and mental health, social connectedness, safety, and confidence in walking regularly. Focus group themes indicated that physical and mental health benefits of walking were important motivators. Walking for social reasons was also important for overcoming barriers to walking. Police support from trusted officers while walking was also essential to promoting safety for walking. Print materials were developed by the steering committee, with a 12-month calendar and door hangers delivered to residents’ homes to invite them to walk. Pride Stride walks empowered community walkers to serve as peer leaders for special walking events to engage new walkers.ConclusionsEssential elements for developing culturally tailored social marketing interventions for promoting walking in underserved communities are outlined for future researchers.
Spreading Community Accelerators through Learning and Evaluation (SCALE) was a Robert Wood Johnson Foundation funded initiative from 2015–2017 to build capability of 24 community coalitions to advance health, wellbeing, and equity. The SCALE theory of change had three components: develop leadership capability, build relationships within and between communities, and create an inter-community system to spread promising ideas. The theory was operationalized through training academies, coaching, and peer-to-peer learning that explicitly addressed equity and systems change. In this paper, we describe how SCALE facilitated community transformation related to Collaborating for Equity and Justice (CEJ) principles one, three, four, and six. We conducted a multiple case study approach with two community coalitions including site visits, interviews, and observation to illuminate underlying mechanisms of change by exploring how and why change occurs. Skid Row Women worked with women experiencing homelessness in Los Angeles to address diabetes and food systems. Healthy Livable Communities of Cattaraugus County used a portfolio of projects to create system changes to improve population health and increase access to services for people with disabilities in rural New York state. Through our analysis, we describe how two coalitions used SCALE tools for collaborative coalition processes such as aim setting, relationship building, and shared decision making with community residents. Our findings suggest that advancing CEJ principles requires self-reflection and courage; new ways of being in relationship; learning from failure; productive conflict to explicitly address power, racism, and other forms of oppression; and methods to test systems improvement ideas.
This article presents an overview of the history of prevention science from its conceptual foundations and definitions through its development as a well-established and extremely productive discipline. Effective approaches for program dissemination and evaluation are presented. Other topics covered include the relationships between risk and resiliency, prevention versus promotion, and program implementation versus program innovation. Current efforts in assessing cost-effectiveness, the cultural relevancy of prevention programs, and the role of prevention science in informing public policy are explored. Examples of effective prevention and promotion programs are included throughout the article.
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