Community wide interventions for increasing physical activity

Background Multi-strategic community wide interventions for physical activity are increasingly popular but their ability to achieve population level improvements is unknown. Objectives To evaluate the effects of community wide, multi-strategic interventions upon population levels of physical activity. Search methods We searched the Cochrane Public Health Group Segment of the Cochrane Register of Studies,The Cochrane Library, MEDLINE, MEDLINE in Process, EMBASE, CINAHL, LILACS, PsycINFO, ASSIA, the British Nursing Index, Chinese CNKI databases, EPPI Centre (DoPHER, TRoPHI), ERIC, HMIC, Sociological Abstracts, SPORTDiscus, Transport Database and Web of Science (Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index). We also scanned websites of the EU Platform on Diet, Physical Activity and Health; Health-Evidence.org; the International Union for Health Promotion and Education; the NIHR Coordinating Centre for Health Technology (NCCHTA); the US Centre for Disease Control and Prevention (CDC) and NICE and SIGN guidelines. Reference lists of all relevant systematic reviews, guidelines and primary studies were searched and we contacted experts in the field. The searches were updated to 16 January 2014, unrestricted by language or publication status. Selection criteria Cluster randomised controlled trials, randomised controlled trials, quasi-experimental designs which used a control population for comparison, interrupted time-series studies, and prospective controlled cohort studies were included. Only studies with a minimum six-month follow up from the start of the intervention to measurement of outcomes were included. Community wide interventions had to comprise at least two broad strategies aimed at physical activity for the whole population. Studies which randomised individuals from the same community were excluded. Data collection and analysis At least two review authors independently extracted the data and assessed the risk of bias. Each study was assessed for the setting, the number of included components and their intensity. The primary outcome measures were grouped according to whether they were dichotomous (per cent physically active, per cent physically active during leisure time, and per cent physically inactive) or continuous (leisure time physical activity time (time spent)), walking (time spent), energy expenditure (as metabolic equivalents or METS)). For dichotomous measures we calculated the unadjusted and adjusted risk difference, and the unadjusted and adjusted relative risk. For continuous measures we calculated percentage change from baseline, unadjusted and adjusted. Main results After the selection process had been completed, 33 studies were included. A total of 267 communities were included in the review (populations between 500 and 1.9 million). Of the included studies, 25 were set in high income countries and eight were in low income countries. The interventions varied by the number of strategies included and their intensity. Almost all of the interventions included a component of building partnerships with local governments or non-governmental organisations (NGOs) (29 studies). None of the studies provided results by socio-economic disadvantage or other markers of equity. However, of those included studies undertaken in high income countries, 14 studies were described as being provided to deprived, disadvantaged or low socio-economic communities. Nineteen studies were identified as having a high risk of bias, 10 studies were unclear, and four studies had a low risk of bias. Selection bias was a major concern with these studies, with only five studies using randomisation to allocate communities. Four studies were judged as being at low risk of selection bias although 19 studies were considered to have an unclear risk of bias. Twelve studies had a high risk of detection bias, 13 an unclear risk and four a low risk of bias. Generally, the better designed studies showed no improvement in the primary outcome measure of physical activity at a population level. All four of the newly included, and judged to be at low risk of bias, studies (conducted in Japan, United Kingdom and USA) used randomisation to allocate the intervention to the communities. Three studies used a cluster randomised design and one study used a stepped wedge design. The approach to measuring the primary outcome of physical activity was better in these four studies than in many of the earlier studies. One study obtained objective population representative measurements of physical activity by accelerometers, while the remaining three low-risk studies used validated self-reported measures. The study using accelerometry, conducted in low income, high crime communities of USA, emphasised social marketing, partnership with police and environmental improvements. No change in the seven-day average daily minutes of moderate to vigorous physical activity was observed during the two years of operation. Some program level effect was observed with more people walking in the intervention community, however this result was not evident in the whole community. Similarly, the two studies conducted in the United Kingdom (one in rural villages and the other in urban London; both using communication, partnership and environmental strategies) found no improvement in the mean levels of energy expenditure per person per week, measured from one to four years from baseline. None of the three low risk studies reporting a dichotomous outcome of physical activity found improvements associated with the intervention. Overall, there was a noticeable absence of reporting of benefit in physical activity for community wide interventions in the included studies. However, as a group, the interventions undertaken in China appeared to have the greatest possibility of success with high participation rates reported. Reporting bias was evident with two studies failing to report physical activity measured at follow up. No adverse events were reported.The data pertaining to cost and sustainability of the interventions were limited and varied. Authors' conclusions Although numerous studies have been undertaken, there is a noticeable inconsistency of the findings in the available studies and this is confounded by serious methodological issues within the included studies. The body of evidence in this review does not support the hypothesis that the multi-component community wide interventions studied effectively increased physical activity for the population, although some studies with environmental components observed more people walking. Plain language summary Community wide interventions for increasing physical activity Not having enough physical activity leads to poorer health. Regular physical activity can reduce the risk of chronic disease and improve one's health and wellbeing. The lack of physical activity is a common and in some cases a growing health problem. To address this, 33 studies have used improvement activities directed at communities, using more than one approach in a single program. When we first looked at the available research in 2011 we observed that there was a lack of good studies which could show whether this approach was beneficial or not. Some studies claimed that community wide programs improved physical activities and other studies did not. In this update we found four new studies that were of good quality; however none of these four studies increased physical activity levels for the population. Some studies reported program level effects such as observing more people walking, however the population level of physical activity had not increased. This review found that community wide interventions are very difficult to undertake, and it appears that they usually fail to provide a measurable benefit in physical activity for a population. It is apparent that many of the interventions failed to reach a substantial portion of the community, and we speculate that some single strategies included in the combination may lack individual effectiveness. Laički sažetak Intervencije u zajednici za povećanje tjelesne aktivnosti Nedostatna tjelesna aktivnost povezana je s lošijim zdravljem.Redovita tjelesna aktivnost može umanjiti rizik od kroničnih bolesti te poboljšati zdravlje i kvalitetu života pojedinca.Manjak tjelesne aktivnosti čest je problem, a učestalost tog problema se povećava.Cochrane sustavni pregled je analizirao 33 studije koje su istražile programe za povećanje tjelesne aktivnosti u zajednici, u kojima se koristilo više od jednog pristupa.Kad su prvi put pregledani dokazi iz istraživanja koja su bila dostupna 2011. godine, utvrđeno je da nema dovoljno dobrih studija koje bi mogle pokazati je li takav pristup koristan ili ne.Primjerice, neke studije tvrde da programi za povećanje tjelesne aktivnosti u zajednici poboljšavaju tjelesnu aktivnost pojedinaca u zajednici, a druge studije tvrde suprotno.U ovom obnovljenom sustavnom pregledu pronađene su 4 nove studije koje su bile visoke kvalitete, ail nijedna od tih studija nije pokazala da je istraživana intervencija dovela do povećanja tjelesne aktivnosti u zajednici.Neke su studije opisale učinak na način da je opisano da je uočeno da više ljudi u zajednici hoda, međutim, ukupna razina tjelesne aktivnosti u promatranoj populaciji nije se povećala.Ovaj sustavni pregled je utvrdio da je intervencije za povećanje tjelesne aktivnosti u zajednici teško provesti i čini se da one obično ne uspijevaju u svojoj namjeri da na mjerljiv način povećaju tjelesnu aktivnost u populaciji.Čini se da mnoge intervencije nisu uspjele doseći veći broj stanovnika u zajednici pa se može smatrati da neke od strategija uključene u analizirane kombinacije nisu zasebno učinkovite.

Community environment education centers : Facilitating community created ecoscapes

This study focuses on designing a community environment education center (CEEC) for Chillingham, as a hub for community transition to sustainability, redressing social fragmentation, youth unemployment, a high eco-footprint and economic rural decline due to globalisation. The ecologically sustainable development framework was delivered by integrating environment education and community development through project-based experiential learning. The development of Chillingham Community Centre involved case study research and incorporated participatory design charrettes, transformative learning, eco-positive development and community-public-private partnerships. This process evolved from community strategic planning in a small rural village buffering world heritage rainforests impacted by a rapidly expanding urban conurbation on Australia’s east coast. This community space encompasses socio-environmental flows connecting people to each other and the ecoscape to grow natural capital, community cohesion and empower eco-governance. Modelling passive solar design, on-site renewable energy/water/nutrient cycling, community garden/market and environment education programs sowed the seeds for a green local economy, demonstrating community capacity to participate in transition to sustainability. A small rural community can demonstrate to other communities that a CEEC enables people to meet their socio-environmental and economic needs locally and sustainably. The ecologically sustainable solution is holistic, all settlements need to be richly biodiverse, locally specific and globally wise.

Relocating a flood-affected community : good planning or good politics?

Problem, research strategy and findings: On January 10, 2011, the town of Grantham, Queensland (Australia), was inundated with a flash flood in which 12 of the town's 370 residents drowned. The overall damage bill in Queensland was AUD∃2.38 billion (USD∃2.4 billion) with 35 deaths, and more than three-quarters of the state was declared a flood disaster zone. In this study, we focus on the unusual and even rare decision to relocate Grantham in March 2011. The Lockyer Valley Regional Council (LVRC) acquired a 377-hectare (932-acre) site to enable a voluntary swap of equivalent-sized lots. In addition, planning regulations were set aside to streamline the relocation of a portion of the town. We review the natural hazard literature as it relates to community relocation, state and local government documents related to Grantham, and reports and newspaper articles related to the flood. We also analyze data from interviews with key stakeholders. We document the process of community relocation, assess the relocation process in Grantham against best practice, examine whether the process of community relocation can be upscaled and if the Grantham relocation is an example of good planning or good politics. Takeaway for practice: Our study reveals two key messages for practice. Community relocation (albeit a small one) is possible, and the process can be done quickly; some Grantham residents moved into their new, relocated homes in December 2012, just 11 months after the flood. Moreover, the role of existing planning regulations can be a hindrance to quick action; political leadership, particularly at the local level, is key to implementing the relocation.

Evolution of the docklands food hub : a design-led innovation approach to food sovereignty through local food systems

Access to nutritious, safe and culturally appropriate food is a basic human right (Mechlem, 2004). Food sovereignty defines this right through the empowerment of the people to redefine food and agricultural systems, and through ecologically sustainable production methods. At the heart of the food sovereignty movement are the interests of producers, distributors and consumers, rather than the interests of markets and corporations, which dominate the current globalized food system (Hinrichs, 2003). Food sovereignty challenges designers to enable people to innovate the food system. We are yet to develop economically viable solutions for scaling projects and providing citizens, governments and business with tools to develop and promote projects to innovate food systems and promote food sovereignty (Meroni, 2011; Murray, Caulier-Grice and Mulgan, 2010). This article examines how a design-led approach to innovation can assist in the development of new business models and ventures for local food systems: this is presented through an emerging field of research ‘Design-Led Food Communities’. Design-Led Food Communities enables citizens, governments and business to innovate local food projects through the application of design. This article reports on the case study of the Docklands Food Hub Project in Melbourne, Australia. Preliminary findings demonstrate valued outcomes, but also a deficiency in the design process to generate food solutions collaboratively between government, business and citizens.

Translating Management Storylines: developing a visual strategy to communicate science to stakeholder community, a case for Mackay, QLD

This project developed a visual strategy and graphic outcomes to communicate the results of a scientific collaborative project to the Mackay community. During 2013 and 2014 a team from CSIRO engaged with the community in Mackay to collaboratively develop a set of strategies to improve the management of the Great Barrier Reef. The result of this work was a 300+ page scientific report that needed to be translated and summarised to the general community. The aim of this project was to strategically synthesise information contained in the report and to design and produce an outcome to be distributed to the participant community. By working with the CISRO researchers, an action toolkit was developed, with twelve cards and a booklet. Each card represented the story behind a certain local management issue and the actions that the participants suggested should be taken in order to improve management of The Reef. During the design synthesis it was identified that for all management issues there was a reference to the need to develop some sort of "educational campaign" to the area. That was then translated as an underlying action to support all other actions proposed in the toolkit.

Community engagement or community conversation?: Boomtown, a large-scale regional, outdoor community theatrical event

On the 18th of July 2013, three hundred local members of Gladstone, Queensland erupted into song and dance performing the fraught history of their community harbourside through tug boat ballets, taiko drumming, German bell ringing and BMX bike riding. Over 17,500 people attended the four performances of Boomtown, a Queensland Music Festival event. This was the largest regional, outdoor community-engaged musical performance staged in Australia. The narrative moved beyond the dominant, pejorative view of Gladstone as an industrial town to include the community members’ sense of purpose and aspirations. It was a celebratory, contentious and ambitious project that sought to disrupt the traditional conventions of performance-making through working in artistically democratic ways. This article explores the potential for Australian Community Engaged Arts (CEA) projects such as Boomtown to democratically engage community members and co-create culturally meaningful work within a community. Research into CEA projects rarely consider how the often delicate conversations between practitioners and the community work. The complex processes of finding and co-writing the narrative, casting, and rehearsing Boomtown are discussed with reference to artistic director/dramaturge Sean Mee’s innovative approaches. Boomtown began with and concluded with community conversations. Skilful negotiation ensured congruence between the townspeople’s stories and the “community story” presented on stage, abrogating potential problems of narrative ownership. To supplement the research, twenty-one personal interviews were undertaken with Gladstone community members invested in the production before, during and after the project: performers, audience members and local professionals. The stories shared and emphasised in the theatricalised story were based on propitious, meaningful, local stories from lived experiences rather than preconceived, trivial or tokenistic matters, and were underpinned by a consensus formed on what was in the best interests of the majority of community members. Boomtown exposed hidden issues in the community and gave voice to thoughts, feelings and concerns which triggered not just engagement, but honest conversation within the community.

A social licence to operate: Corporate social responsibility, local communities and the constitution of global production networks

This article contributes to the theorization of the role of informal regulation (undertaken by leading firms) in the ongoing organization of global production networks. It does so through a qualitative case study of BHP Billiton's Ravensthorpe Nickel Operation (RNO) in the rural Shire of Ravensthorpe in Western Australia. This less tangible, and to date under-researched, dimension of global production networks is foregrounded through a focus on the corporate social responsibility strategy implemented by RNO in the service of achieving and/or demonstrating a broader ‘social licence to operate’. This ‘licence’ functions – beyond the corporation – as a legitimated and legitimating multi-scalar mechanism through which to gain and maintain access to mineral resources and thus to establish viable and ongoing global production networks. Further, this informal regulation is shown to shape social relations and qualities of place conducive to competitive global mineral extraction and to facilitate the positioning of local communities and places in mineral global production networks.

Identifying opportunity spaces for design research in South America: Working with grassroots and community groups

As design research continues to gain momentum in South America, design researchers and practitioners in the region have begun to consider how to the field may address regionally-specific issues, including on-going political struggles. By bringing approaches such as Participatory Design and Adversarial Design that consider political aspects of design, local researchers have explored various forms that these two approaches could take that are tailored to the needs and values of different communities across the region. This paper focuses on identifying opportunities for developing design research projects in community-based and grassroots-oriented contexts. The paper presents the findings of our study about the understanding and experience of design researchers and experts who have been working closely with community groups and grassroots organisations in South America. Five themes emerged, highlighting opportunities and challenges related to positioning contemporary design research in the region, integration of adversarial perspectives into design processes, leveraging local obstacles through creativity, and the potential of building capacity within community groups and grassroots organisations for sustainability and autonomy.

Guaiac versus immunochemical tests: Faecal occult blood test screening for colorectal cancer in a rural community

Objective: To describe patient participation and clinical performance in a colorectal cancer (CRC) screening program utilising faecal occult blood test (FOBT). Methods: A community-based intervention was conducted in a small, rural community in north Queensland, 2000/01. One of two FOBT kits – guaiac (Hemoccult-ll) or immunochemical (Inform) – was assigned by general practice and mailed to participants (3,358 patients aged 50–74 years listed with the local practices). Results: Overall participation in FOBT screening was 36.3%. Participation was higher with the immunochemical kit than the guaiac kit (OR=1.9, 95% Cl 1.6-2.2). Women were more likely to comply with testing than men (OR=1.4, 95% Cl 1.2-1.7), and people in their 60s were less likely to participate than those 70–74 years (OR=0.8, 95% Cl 0.6-0.9). The positivity rate was higher for the immunochemical (9.5%) than the guaiac (3.9%) test (χ2=9.2, p=0.002), with positive predictive values for cancer or adenoma of advanced pathology of 37.8% (95% Cl 28.1–48.6) for !nform and 40.0% (95% Cl 16.8–68.7) for Hemoccult-ll. Colonoscopy follow-up was 94.8% with a medical complication rate of 2–3%. Conclusions: An immunochemical FOBT enhanced participation. Higher positivity rates for this kit did not translate into higher false-positive rates, and both test types resulted in a high yield of neoplasia. Implications: In addition to type of FOBT, the ultimate success of a population-based screening program for CRC using FOBT will depend on appropriate education of health professionals and the public as well as significant investment in medical infrastructure for colonoscopy follow-up.

Burning questions: Exploring the impact of a natural disaster on community pharmacies

Background The past decade has seen a rapid change in the climate system with an increased risk of extreme weather events. On and following the 3rd of January 2013, Tasmania experienced three catastrophic bushfires, which led to the evacuation of several communities, the loss of many properties, and a financial cost of approximately AUD$80 million. Objective To explore the impacts of the 2012/2013 Tasmanian bushfires on community pharmacies. Method Qualitative research methods were undertaken, employing semi-structured telephone interviews with a purposive sample of seven Tasmanian pharmacists. The interviews were recorded and transcribed, and two different methods were used to analyse the text. The first method utilised Leximancer® text analytics software to provide a birds-eye view of the conceptual structure of the text. The second method involved manual, open and axial coding, conducted independently by the two researchers for inter-rater reliability, to identify key themes in the discourse. Results Two main themes were identified - ‘people’ and ‘supply’ - from which six key concepts were derived. The six concepts were ‘patients’, ‘pharmacists’, ‘local doctor’, ‘pharmacy operations’, ‘disaster management planning’, and ‘emergency supply regulation’. Conclusion This study identified challenges faced by community pharmacists during Tasmanian bushfires. Interviewees highlighted the need for both the Tasmanian State Government and the Australian Federal Government to recognise the important primary care role that community pharmacists play during natural disasters, and therefore involve pharmacists in disaster management planning. They called for greater support and guidance for community pharmacists from regulatory and other government bodies during these events. Their comments highlighted the need for a review of Tasmania’s 3-day emergency supply regulation that allows pharmacists to provide a three-day supply of a patient’s medication without a doctor’s prescription in an emergency situation.

Understanding local processes: Contemplating franchisation

Increasing, there is growing acknowledgement of the importance of franchising within all modern global economies. Despite this, little is understood with regards the actual impact of franchising on local economies. This research aims to reframe the contribution of franchising by considering the process of franchisation. This study employed a mixed-method approach, utilizing critical realism to facilitate an outcomes-based explanation of firm survival. The focus of the study was upon generative mechanisms that were assumed to give rise to particular events from which (pizza) firm survival was enhanced vis-à-vis all other community members. A database of 2440 firms (or in excess of 21,000 company years) combined with archival records, interviews and the researcher’s observations provided the researcher with access to the nature of interaction occurring between firms. It was found that the survival of local firms was influenced positively by the day-to-day actions of franchise operators. However, it is argued that to understand how any such advantage my fall to local independent firms, we need too better appreciate the multitude of local processes related to such industries. This research re-examines several ecological concepts with the view of enabling a clearer investigation of underlying local processes. It also represents an authentic autecological approach to the study of firms.

Re-imagining public journalism for community radio news-gathering

This paper explores the use of public journalism within a community radio news context. It argues that, the central tenets of the public journalism movement can help to frame, more adequately, a news gathering and production approach Tailored to the needs of community media. . Community radio stations generally enjoy strong relationships with their listeners and play an important role in the formation of the community itself (Lowrey et al., 2008). This paper argues that such strong community ties, in conjunction with public journalism news gathering approaches give community radio stations a strong opportunity to produce relevant, local news sourced driven by their listeners. In this regard ,this paper examines a particular case of public journalism used within the The Wire, a national, daily current affairs program broadcast on community radio. In the case study examined here ,public journalism informed story production that were designed to better meet the needs of community radio stations and their audiences.

The impact of the public library as a creative place in the community: A contextual review

This review examines recent literature on the public library as a creative place and the ways in which socio-cultural impact is being measured in assessments of cultural value. Inputs such as funding and staffing are frequently measured against outputs such as visitor numbers and lending frequencies, but qualitative measures (outcomes and impacts) are minimal in the literature because of the lack of persuasive evaluative frameworks and the difficulty of designing and facilitating the evaluations at local and national levels. Nevertheless, when combined with data about outputs and outcomes, the impact on individuals and their communities can be measured effectively and reported persuasively (Poll 2012, p.124). This contextual review provides an overview of current thinking about public libraries and creative spaces with particular attention paid to the rise of so-called makerspaces and Fab Labs. This includes discussion on the types of creative activities that are occurring in the public library context, and an outline of the rhetoric and reality of the public library as a community space. These outlines are reconsidered in a discussion of the evaluative frameworks that have been employed by libraries in the past, followed by an account of some prominent creative spaces that have been formally evaluated. The existence of creative spaces in public libraries is in a state of constant flux, and the development and redevelopment of evaluative frameworks will ensure that published reports will continue to appear throughout 2015 and beyond. This review provides a brief snapshot of the state of the field as it is in the first quarter of 2015.