Effectiveness and cost-effectiveness of a physical activity loyalty scheme for behaviour change maintenance: a cluster randomised controlled trial

Background
Increasing physical activity in the workplace can provide employee physical and mental health benefits, and employer economic benefits through reduced absenteeism and increased productivity. The workplace is an opportune setting to encourage habitual activity. However, there is limited evidence on effective behaviour change interventions that lead to maintained physical activity. This study aims to address this gap and help build the necessary evidence base for effective, and cost-effective, workplace interventions

Methods/design
This cluster randomised control trial will recruit 776 office-based employees from public sector organisations in Belfast and Lisburn city centres, Northern Ireland. Participants will be randomly allocated by cluster to either the Intervention Group or Control Group (waiting list control). The 6-month intervention consists of rewards (retail vouchers, based on similar principles to high street loyalty cards), feedback and other evidence-based behaviour change techniques. Sensors situated in the vicinity of participating workplaces will promote and monitor minutes of physical activity undertaken by participants. Both groups will complete all outcome measures. The primary outcome is steps per day recorded using a pedometer (Yamax Digiwalker CW-701) for 7 consecutive days at baseline, 6, 12 and 18 months. Secondary outcomes include health, mental wellbeing, quality of life, work absenteeism and presenteeism, and use of healthcare resources. Process measures will assess intervention “dose”, website usage, and intervention fidelity. An economic evaluation will be conducted from the National Health Service, employer and retailer perspective using both a cost-utility and cost-effectiveness framework. The inclusion of a discrete choice experiment will further generate values for a cost-benefit analysis. Participant focus groups will explore who the intervention worked for and why, and interviews with retailers will elucidate their views on the sustainability of a public health focused loyalty card scheme.

Discussion
The study is designed to maximise the potential for roll-out in similar settings, by engaging the public sector and business community in designing and delivering the intervention. We have developed a sustainable business model using a ‘points’ based loyalty platform, whereby local businesses ‘sponsor’ the incentive (retail vouchers) in return for increased footfall to their business.

The EU Referendum and the UK Environment: An Expert Review:How has EU membership affected the UK and what might change in the event of a vote to Remain or Leave

This expert review provides a detailed review of the academic evidence on how EU membership has influenced UK policies, systems of decision making and environmental quality. Containing 14 chapters and over 60,000 words, it documents how the EU has affected UK environmental policy and how, in turn, the UK has worked through the EU to shape wider, international thinking. It has been authored by 14 international experts, who have drawn on the findings of over 700 publications to offer an impartial and authoritative assessment of the evidence.

The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil

EMOND, Alan et al. The effectiveness of community-based interventions to improve maternal and infant health in the Northeast of Brazil. Revista Panamericana de Salud Pública/ Pan American Journal of Public Health , v.12, n.2, p.101-110, 2002

Transient simulations for present and last interglacials using a comprehensive coupled climate model CCSM3 (Community Climate System Model 3.0), links to model result files in NetCDF format

Transient simulations are widely used in studying the past climate as they provide better comparison with any exisiting proxy data. However, multi-millennial transient simulations using coupled climate models are usually computationally very expensive. As a result several acceleration techniques are implemented when using numerical simulations to recreate past climate. In this study, we compare the results from transient simulations of the present and the last interglacial with and without acceleration of the orbital forcing, using the comprehensive coupled climate model CCSM3 (Community Climate System Model 3). Our study shows that in low-latitude regions, the simulation of long-term variations in interglacial surface climate is not significantly affected by the use of the acceleration technique (with an acceleration factor of 10) and hence, large-scale model-data comparison of surface variables is not hampered. However, in high-latitude regions where the surface climate has a direct connection to the deep ocean, e.g. in the Southern Ocean or the Nordic Seas, acceleration-induced biases in sea-surface temperature evolution may occur with potential influence on the dynamics of the overlying atmosphere. The data provided here are from both accelerated and non-accelerated runs as decadal mean values.

Farmers' Resilience to Climate Change in the Welsh Marshes

Climate change will exacerbate challenges facing food security in the UK. Increasing frequency and intensity of extreme weather events will further impact upon farm systems. At the heart of the impending challenges to UK agricultural production, farmers’ resilience will be tested to new limits. Research into farmers’ resilience to climate change in the UK is distinctly underdeveloped when compared to research in developing and other developed nations. This research gap is addressed through exploration of farmers’ resilience in the Welsh Marches, establishing the role of risk perceptions, local knowledge and adaptive capacity in farmers’ decision-making to limit climate shocks. Further contributions to agricultural geography are made through experimentation of a ‘cultural-behavioural approach’, seeking to revisit the behavioural approach in view of the cultural-turn. The Welsh Marches, situated on the English-Welsh border, has been selected as a focal point due to its agricultural diversity, and known experiences of extreme weather events. A phased mixed methodological approach is adopted. Phase one explores recorded and reported experiences of past extreme weather events in local meteorological records and local newspaper articles. Phase two consists of 115 survey-questionnaires, 15 in-depth semi-structured interviews, and a scenario based focus group with selected farmers from the Welsh Marches. This allows farmers’ resilience to climate change in the past, present and future to be explored. Original contributions to knowledge are made through demonstrating the value of focusing upon the culture of a specific farm community, applying a ‘bottom-up’ approach. The priority given to the weather in farmers’ decision-making is identified to be determined by individual relationships that farmers’ develop with the weather. Yet, a consensus of farmers’ observations has established recognition of considerable changes in the weather over the last 30 years, acknowledging more extremes and seasonal variations. In contrast, perceptions of future climate change are largely varied. Farmers are found to be disengaged with the communication of climate change science, as the global impacts portrayed are distant in time and place from probable impacts that may be experienced locally. Current communication of climate change information has been identified to alienate farmers from the local reality of probable future impacts. Adaptation options and responses to extreme weather and climate change are identified from measures found to be already implemented and considered for the future. A greater need to explore local knowledge and risk perception in relation to farmers’ understanding of future climate challenges is clear. There is a need to conduct comparable research in different farm communities across the UK. Progression into establishing the role of farmers’ resilience in responding effectively to future climate challenges has only just begun.

Understanding Contradictions in Times of Change: A CHAT Analysis in an Art Museum

Thesis (Ph.D.)--University of Washington, 2016-08

Long-term community responses to droughts in the early modern period: the case study of Terrassa, Spain

New challenges posed by global environmental change have motivated scholars to pay growing attention to historical long-term strategies to deal with climate extremes. We aim to understand long-term trends in community responses to cope with droughts, to explain how many preindustrial societies coevolved with local hydro-climatic dynamics and coped with climate extremes over time. The specific goals of this work are: (1) to analyze how local communities experienced droughts over long periods of time and (2) to document the spectrum of recorded community responses to drought. Our research covers over one century (1605-1710) of responses to drought in the community of Terrassa, Barcelona, Spain. Data were collected through archival research. We reviewed and coded 2076 village council minutes. Our results show that the local community adopted a mixture of symbolic, institutional, and infrastructural responses to drought and that drought-related decisions varied through time. We discuss adaptation strategies on the basis of the distinct physical signals of drought propagation and the role of nonclimatic historical factors, such as warfare and public debt, in shaping responses. We conclude that long-term perspectives on premodern history and comparable empirical studies are fundamental to advance our understanding of past social responses to hydro-climatic extremes.

Nature-based solutions to climate change mitigation and adaptation in urban areas: perspectives on indicators, knowledge gaps, barriers, and opportunities for action

Nature-based solutions promoting green and blue urban areas have significant potential to decrease the vulnerability and enhance the resilience of cities in light of climatic change. They can thereby help to mitigate climate change-induced impacts and serve as proactive adaptation options for municipalities. We explore the various contexts in which nature-based solutions are relevant for climate mitigation and adaptation in urban areas, identify indicators for assessing the effectiveness of nature-based solutions and related knowledge gaps. In addition, we explore existing barriers and potential opportunities for increasing the scale and effectiveness of nature-based solution implementation. The results were derived from an inter- and transdisciplinary workshop with experts from research, municipalities, policy, and society. As an outcome of the workshop discussions and building on existing evidence, we highlight three main needs for future science and policy agendas when dealing with nature-based solutions: (i) produce stronger evidence on nature-based solutions for climate change adaptation and mitigation and raise awareness by increasing implementation; (ii) adapt for governance challenges in implementing nature-based solutions by using reflexive approaches, which implies bringing together new networks of society, nature-based solution ambassadors, and practitioners; (iii) consider socio-environmental justice and social cohesion when implementing nature-based solutions by using integrated governance approaches that take into account an integrative and transdisciplinary participation of diverse actors. Taking these needs into account, nature-based solutions can serve as climate mitigation and adaptation tools that produce additional cobenefits for societal well-being, thereby serving as strong investment options for sustainable urban planning.

Changing times, changing stories: generational differences in climate change perspectives from four remote indigenous communities in Subarctic Alaska

Indigenous Arctic and Subarctic communities currently are facing a myriad of social and environmental changes. In response to these changes, studies concerning indigenous knowledge (IK) and climate change vulnerability, resiliency, and adaptation have increased dramatically in recent years. Risks to lives and livelihoods are often the focus of adaptation research; however, the cultural dimensions of climate change are equally important because cultural dimensions inform perceptions of risk. Furthermore, many Arctic and Subarctic IK climate change studies document observations of change and knowledge of the elders and older generations in a community, but few include the perspectives of the younger population. These observations by elders and older generations form a historical baseline record of weather and climate observations in these regions. However, many indigenous Arctic and Subarctic communities are composed of primarily younger residents. We focused on the differences in the cultural dimensions of climate change found between young adults and elders. We outlined the findings from interviews conducted in four indigenous communities in Subarctic Alaska. The findings revealed that (1) intergenerational observations of change were common among interview participants in all four communities, (2) older generations observed more overall change than younger generations interviewed by us, and (3) how change was perceived varied between generations. We defined “observations” as the specific examples of environmental and weather change that were described, whereas “perceptions” referred to the manner in which these observations of change were understood and contextualized by the interview participants. Understanding the differences in generational observations and perceptions of change are key issues in the development of climate change adaptation strategies.

Community owned solutions: identifying local best practices for social-ecological sustainability

Policies and actions that come from higher scale structures, such as international bodies and national governments, are not always compatible with the realities and perspectives of smaller scale units including indigenous communities. Yet, it is at this local social-ecological scale that mechanisms and solutions for dealing with unpredictability and change can be increasingly seen emerging from across the world. Although there is a large body of knowledge specifying the conditions necessary to promote local governance of natural resources, there is a parallel need to develop practical methods for operationalizing the evaluation of local social-ecological systems. In this paper, we report on a systemic, participatory, and visual approach for engaging local communities in an exploration of their own social-ecological system. Working with indigenous communities of the North Rupununi, Guyana, this involved using participatory video and photography within a system viability framework to enable local participants to analyze their own situation by defining indicators of successful strategies that were meaningful to them. Participatory multicriteria analysis was then used to arrive at a short list of best practice strategies. We present six best practices and show how they are intimately linked through the themes of indigenous knowledge, local governance and values, and partnerships and networks. We highlight how developing shared narratives of community owned solutions can help communities to plan governance and management of land and resource systems, while reinforcing sustainable practices by discussing and showcasing them within communities, and by engendering a sense of pride in local solutions.

Evaluation of Tottenham Thinking Space Pilot: Final Report. Research Report 11.

This reports summarises research that began in March 2014 and was completed in October 2015 by an experienced inter-disciplinary research team from the Centre for Social Justice and Change and Psycho-Social Research Group, School of Social Sciences, the University of East London (UEL) and included Dr Yang Li from the Centre for Geo-Information Studies, UEL, for the first phase of the study. Tottenham ‘Thinking Space’ (TTS) was a pilot therapeutic initiative based in local communities and delivered by the Tavistock & Portman NHS Foundation Trust and funded by the London Borough of Haringey Directorate of Public Health. TTS aimed to improve mental health and enable and empower local communities. TTS was situated within a mental health agenda that was integral to Haringey’s Health and Wellbeing Strategy 2012-2015 and aimed to encourage people to help themselves and each other and develop confident communities. On the one hand TTS was well-suited to this agenda, but, on the other, participants were resistant to, and were trying to free themselves from labelling that implied ‘mental health difficulties’. A total of 243 meetings were held and 351 people attended 1,716 times. The majority of participants attended four times or less, and 33 people attended between 5 and 10 times and 39 people attended over 10 times. Attending a small number of times does not necessarily mean that the attendee was not helped. Attendees reflected the ethnic diversity of Tottenham; 29 different ethnic groups attended. The opportunity to meet with people from different cultural backgrounds in a safe space was highly valued by attendees. Similarly, participants valued the wide age range represented and felt that they benefited from listening to inter-generational experiences. The majority of participants were women (72%) and they were instrumental in initiating further Thinking Spaces, topic specific meetings, the summer programme of activities for mothers and young children and training to meet their needs. The community development worker had a key role in implementing the initiative and sustaining its growth throughout the pilot period. We observed that TTS attracted those whose life experiences were marked by personal struggle and trauma. Many participants felt safe enough to disclose mental health difficulties (85% of those who completed a questionnaire). Participants also came seeking a stronger sense of community in their local area. Key features of the meetings are that they are democratic, non-judgemental, respectful, and focussed on encouraging everyone to listen and to try to understand. We found that the therapeutic method was put in place by high quality facilitators and health and personal outcomes for participants were consistent with those predicted by the underpinning psychoanalytical and systemic theories. Outcomes included a reduction in anxieties and improved personal and social functioning; approximately two thirds of those who completed a questionnaire felt better understood, felt more motivated and more hopeful for the future. The overwhelming majority of survey respondents also felt good about contributing to their community, said that they were more able to cooperate with others and accepting of other cultures, and had made new friends. Participants typically had a better understanding of their current situation and how to take positive action; of those who completed a questionnaire, over half felt more confident to seek support for a personal issue and to contact services. Members of TTS supported each other and instilled hope and build community-mindedness that reduced social isolation.

Our Landscape, Ourselves: Integrating Process and Traditional food Principles for Wellbeing + Resilience in the Swinomish Tribal Community

Thesis (Master's)--University of Washington, 2016-08

Evaluating a School Community Linked Physical Activity Intervention Programme: a Multi-level Analysis.

Previous research has highlighted the importance of positive physical activity (PA) behaviors during childhood to promote sustained active lifestyles throughout the lifespan (Telama et al. 2005; 2014). It is in this context that the role of schools and teachers in facilitating PA education is promoted. Research suggests that teachers play an important role in the attitudes of children towards PA (Figley 1985) and schools may be an efficient vehicle for PA provision and promotion (McGinnis, Kanner and DeGraw, 1991; Wechsler, Deveraux, Davis and Collins, 2000). Yet despite consensus that schools represent an ideal setting from which to ‘reach’ young people (Department of Health and Human Services, UK, 2012) there remains conceptual (e.g. multi-component intervention) and methodological (e.g. duration, intensity, family involvement) ambiguity regarding the mechanisms of change claimed by PA intervention programmes. This may, in part, contribute to research findings that suggest that PA interventions have had limited impact on children’s overall activity levels and thereby limited impact in reducing children’s metabolic health (Metcalf, Henley & Wilkin, 2012). A marked criticism of the health promotion field has been the focus on behavioural change while failing to acknowledge the impact of context in influencing health outcomes (Golden & Earp, 2011). For years, the trans-theoretical model of behaviour change has been ‘the dominant model for health behaviour change’ (Armitage, 2009); this model focusses primarily on the individual and the psychology of the change process. Arguably, this model is limited by the individual’s decision-making ability and degree of self-efficacy in order to achieve sustained behavioural change and does not take account of external factors that may hinder their ability to realise change. Similar to the trans-theoretical model, socio-ecological models identify the individual at the focal point of change but also emphasises the importance of connecting multiple impacting variables, in particular, the connections between the social environment, the physical environment and public policy in facilitating behavioural change (REF). In this research, a social-ecological framework was used to connect the ways a PA intervention programme had an impact (or not) on participants, and to make explicit the foundational features of the programme that facilitated positive change. In this study, we examined the evaluation of a multi-agency approach to a PA intervention programme which aimed to increase physical activity, and awareness of the importance of physical activity to key stage 2 (age 7-12) pupils in three UK primary schools. The agencies involved were the local health authority, a community based charitable organisation, a local health administrative agency, and the city school district. In examining the impact of the intervention, we adopted a process evaluation model in order to better understand the mechanisms and context that facilitated change. Therefore, the aim of this evaluation was to describe the provision, process and impact of the intervention by 1) assessing changes in physical activity levels 2) assessing changes in the student’s attitudes towards physical activity, 3) examining student’s perceptions of the child size fitness equipment in school and their likelihood of using the equipment outside of school and 4) exploring staff perceptions, specifically the challenges and benefits, of facilitating equipment based exercise sessions in the school environment. Methodology, Methods, Research Instruments or Sources Used Evaluation of the intervention was designed as a matched-control study and was undertaken over a seven-month period. The school-based intervention involved 3 intervention schools (n =436; 224 boys) and one control school (n=123; 70 boys) in a low socioeconomic and multicultural urban setting. The PA intervention was separated into two phases: a motivation DVD and 10 days of circuit based exercise sessions (Phase 1) followed by a maintenance phase (Phase 2) that incorporated a PA reward program and the use of specialist kid’s gym equipment located at each school for a period of 4 wk. Outcome measures were measured at baseline (January) and endpoint (July; end of academic school year) using reliable and valid self-report measures. The children’s attitudes towards PA were assessed using the Children’s Attitudes towards Physical Activity (CATPA) questionnaire. The Physical Activity Questionnaire for Children (PAQ-C), a 7-day recall questionnaire, was used to assess PA levels over a school week. A standardised test battery (Fitnessgram®) was used to assess cardiovascular fitness, body composition, muscular strength and endurance, and flexibility. After the 4 wk period, similar kid’s equipment was available for general access at local community facilities. The control school did not receive any of the interventions. All physical fitness tests and PA questionnaires were administered and collected prior to the start of the intervention (January) and following the intervention period (July) by an independent evaluation team. Evaluation testing took place at the individual schools over 2-3 consecutive days (depending on the number of children to be tested at the school). Staff (n=19) and student perceptions (n = 436) of the child sized fitness equipment were assessed via questionnaires post-intervention. Students completed a questionnaire to assess enjoyment, usage, ease of use and equipment assess and usage in the community. A questionnaire assessed staff perceptions on the delivery of the exercise sessions, classroom engagement and student perceptions. Conclusions, Expected Outcomes or Findings Findings showed that both the intervention (16.4%) and control groups increased their PAQ-C score by post-intervention (p < 0.05); with the intervention (17.8%) and control (21.3%) boys showing the greatest increase in physical activity levels. At post-intervention, there was a 5.5% decline in the intervention girls’ attitudes toward PA in the aesthetic subdomains (p = 0.009); whereas the control boys had an increase in positive attitudes in the health domain (p = 0.003). No significant differences in attitudes towards physical activity were observed in any other domain for either group at post-intervention (p > 0.05). The results of the equipment questionnaire, 96% of the children stated they enjoyed using the equipment and would like to use the equipment again in the future; however at post-intervention only 27% reported using the equipment outside of school in the last 7 days. Students identified the ski walker (34%) and cycle (32%) as their favorite pieces of equipment; with the single joint exercises such as leg extension and bicep/tricep machine (<3%) as their least favorite. Key themes from staff were that the equipment sessions were enjoyable, a novel activity, children felt very grown-up, and the activity was linked to a real fitness experience. They also expressed the need for more support to deliver the sessions and more time required for each session. Findings from this study suggest that a more integrated approach within the various agencies is required, particularly more support to increase teachers pedagogical content knowledge in physical activity instruction which is age appropriate. Future recommendations for successful implementation include sufficient time period for all students to access and engage with the equipment; increased access and marketing of facilities to parents within the local community, and professional teacher support strategies to facilitate the exercise sessions.

Predicting bee community responses to land-use changes: Effects of geographic and taxonomic biases

Land-use change and intensification threaten bee populations worldwide, imperilling pollination services. Global models are needed to better characterise, project, and mitigate bees' responses to these human impacts. The available data are, however, geographically and taxonomically unrepresentative; most data are from North America and Western Europe, overrepresenting bumblebees and raising concerns that model results may not be generalizable to other regions and taxa. To assess whether the geographic and taxonomic biases of data could undermine effectiveness of models for conservation policy, we have collated from the published literature a global dataset of bee diversity at sites facing land-use change and intensification, and assess whether bee responses to these pressures vary across 11 regions (Western, Northern, Eastern and Southern Europe; North, Central and South America; Australia and New Zealand; South East Asia; Middle and Southern Africa) and between bumblebees and other bees. Our analyses highlight strong regionally-based responses of total abundance, species richness and Simpson's diversity to land use, caused by variation in the sensitivity of species and potentially in the nature of threats. These results suggest that global extrapolation of models based on geographically and taxonomically restricted data may underestimate the true uncertainty, increasing the risk of ecological surprises.

Beckton Sustainable Living Initiative, Working Paper 4.

This working paper reflects the authors’ involvement with a civic engagement project funded by the University of East London’s (UEL) Institute for Civic Engagement. It was a collaborative initiative between the Centre for Social Justice and Change, School of Social Sciences, and UEL’s Sustainability Research Institute. The initiative commenced in November 2015 and was completed in July 2016. The civic engagement project is part of an ongoing sustainable living project in Beckton. Situated in the hinterland of UEL’s Docklands campus in the London Borough of Newham this initiative provided an opportunity to work with communities local to UEL. Our involvement in a civic engagement initiative raised issues about what our role as students representing a University might involve, how we may contribute rather than replicate or duplicate ongoing local activities, and what additional skills we could bring to make a positive contribution. Our project was about taking practical actions; by completing a communal garden in a local park and distributing water-saving devices to enable households to reduce their expenditure and contribute towards sustainable living. Research findings informed these practical actions and we were able to use our knowledge concerning environmental sustainability and research in discussions with residents and local agencies. Our experience also raised issues about how best to do research that can be used to inform and facilitate social action. This is particularly challenging in local communities which are ethnically diverse and culturally fragmented. This working paper describes our experiences and reflections.