A review of data sources

for physical activity outcomes

In support of Creating an Active Wales

Publication details / copyright statement

Title: A review of data sources for physical activity outcomes – In support of Creating an Active Wales

Publisher: Public Health Wales NHS Trust

Date: June 2012

ISBN: 978-0-9572759-1-1

Material contained in this document may be reproduced without prior permission

provided it is done so accurately and is not used in a misleading context. Acknowledgement to Public Health Wales NHS Trust to be stated.

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Purpose and summary of Document

This document describes the results of a rapid desk-based study to

identify key sources of data that may be used to generate performance

indicators, measure correlates or measure potential mediators of physical

activity levels in Wales and transport related physical activity.

Acknowledgements

The main authors of this report are:

Eleri Tyler, Public Health Wales

Dinah Roberts, Public Health Wales Observatory

Anne Bath, Public Health Wales Observatory Judith Greenacre, Public Health Wales Observatory

Many thanks to the following for timely discussions and correspondence

contributing to this report (in alphabetical order):

James Ardern Welsh Government

Ana Harries Welsh Local Government Data Unit Rachel Hughes Sport Wales

Meryl James Welsh Government Luned Jones Welsh Government

Ryland Jones Sustrans Nathan Lester Public Health Wales Observatory

Jane Lorimer Sustrans Marianne Mannello Play Wales

Richard Morgan Welsh Government

Jenny Murphy Welsh Local Government Data Unit Gwenda Owen Cyclist Touring Club

Sue Rice Welsh Government Chris Roberts Welsh Government

Henry Small Welsh Government Adrian Smith Welsh Local Government Data Unit

Lucy Teague Welsh Government Jonathan West Public Health Wales

Sue Williams Countryside Council for Wales

Thanks to Kaye Morton, Julie Jones, Ruth Davies and Isabel Puscas for administrative support.

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1 Contents

2 Summary ................................................................................. 4

3 Introduction ............................................................................. 5

3.1 Scope of this review ............................................................... 5

3.2 Health indicators .................................................................... 6

3.3 Creating an Active Wales ......................................................... 7

3.4 Methodology .......................................................................... 8

4 Data review............................................................................ 10

4.1 Data to monitor targets for Creating an Active Wales ................ 10

4.2 Supporting Active Environments theme ................................... 11

4.3 Active Children and Young People theme ................................. 22

4.4 Active Adults theme .............................................................. 30

4.5 Sport for All theme ............................................................... 34

4.6 Equality group data from identified sources ............................. 37

4.7 Benchmarking performance against other countries .................. 39

4.8 Other sources of potential data .............................................. 46

5 Discussion .............................................................................. 47

5.1 Measuring parameters of physical activity ............................... 47

5.2 Data and indicator quality ..................................................... 48

6 Conclusions ............................................................................ 50

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Appendix A: Data sources that could be used for indicators ........ 51

A 1: Active Adults Survey (Sport Wales) ........................................ 51

A 2: Active Young People Survey (Sport Wales) .............................. 52

A 3: Health Behaviour in School-aged Children Study ...................... 54

A 4: Living in Wales Survey .......................................................... 55

A 5: National Survey for Wales ..................................................... 56

A 6: National Travel survey .......................................................... 58

A 7: PE Provision in Welsh School surveys (Sport Wales) ................. 59

A 8: Walking and Cycling Action Plan for Wales 2009 - 2013 ............. 60

A 9: Welsh Health Survey (WHS) .................................................. 61

A 10: Welsh Outdoor Recreation Survey ..................................... 63

A 11: WLGDU: Quality of Life Indicators ..................................... 64

A 12: WLGDU: Gwion database / Local Authority Performance

Indicators ................................................................................... 65

Appendix B: Data sources of interest but not suitable for

indicators .................................................................................... 68

Appendix C: Constructing health indicators ................................. 76

Choosing indicators ...................................................................... 76

Constructing Indicators ................................................................ 76

References .................................................................................. 79

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2 Summary

1. This report describes work commissioned by the Public Health Wales

Physical Activity and Nutrition Networks Wales to undertake a rapid

review of existing data sources that can support the Sport and Physical

Activity action plan Creating an Active Wales.

2. Data sources were identified from searches of published literature,

existing reports, web searches and shared knowledge from others

working in the field

3. A wide variety of data sources have been identified that can be

considered as a basis for outcome measures for the physical activity action plan Creating an Active Wales.

4. Data sources have been divided into two broad groups:

4.1. sources of reasonable quality that are collected across Wales

and could form the basis of indicators to monitor the progress of Creating an active Wales.

4.2. highly relevant data sources that are not collected systematically across Wales.

5. No data source is perfect and all featured in this report have some

data quality issues of relevance to the Creating an Active Wales action plan.

6. Data are available to monitor the two high level targets for Creating an

Active Wales. Further options can be considered in relation to the target for children.

7. There are data to support outcome indicators for each of the four

themes of Creating an Active Wales, although not all sub themes are covered and, for some, available data are of poor quality.

8. More work is needed to assess quality aspects of some data sources if it is intended to use them to construct indicators.

9. Robust indicator construction is a time consuming and complex

process. Constructing indicators for this action plan needs to be properly planned and resourced.

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3 Introduction

This report describes work commissioned by the Public Health Wales

Physical Activity and Nutrition Networks Wales on behalf of Welsh

Government. It involves undertaking a rapid review of existing data

sources that can support the Sport and Physical Activity action plan

Creating an Active Wales1.

3.1 Scope of this review

The aims and objectives of the review are given in the specification document developed by the Physical Activity and Nutrition Networks

Wales.2

3.1.1 Aim of review To conduct a review of all data sources to identify reliable, accurate,

robust and practical measures to inform Creating an Active Wales outcomes.

3.1.2 Objectives

Identify existing sources of credible data that are available at Local

Authority level and/or Local Health Board level relating to the themes in Creating an Active Wales

Identify surveys that will be conducted on a long term basis Identify any gaps in the data

Identify data that would support and enhance our understanding of participation in equality groups

Identify any data that would enable us to benchmark our performance against other UK, EU and International countries.

3.1.3 Comment & clarification

The terms reliable, accurate, robust and practical are not defined in the specification document. Requirements for the review include the

statement (p4) that:

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„Once the data has been identified it will be used to open a discussion on

the development of high level performance indicators…to incorporate the following elements

Be measurable at local authority level on a long term basis Be evidence based – by impacting on these indicators we will impact

on the target‟.

The review report is expected to list all data sources available, including:

„What they can tell us about the themes or participation levels in a variety of physical activity opportunities in specific groups in specific geographical

areas. This should include reference to validity, limitations and, where applicable, proxy measures‟ (p4-5).

(Appendix A gives details of sources that potentially could be used to develop indicators in support of Creating an Active Wales as they are /

were collected regularly and could give a reasonably consistent picture across Wales. Appendix B gives details of data sources that are highly

relevant are either not collected regularly or could not be used to build up

a consistent all Wales picture).

3.2 Health indicators

The required elements of well constructed health indicators are well described3,4,5,6,7 (see Appendix C). It is recognised that indicator

development work is time consuming and requires specific expertise if done properly. A separate work package is being discussed with Public

Health Wales to develop a set of public health indicators that will feed into health outcome and performance management systems being developed

by Welsh Government for NHS Wales. To undertake detailed study of the reliability and validity of potential indicators relating to physical activity

will be time consuming and lies beyond the remit of this review. It would

be possible for potential indicators to be considered as part of the further work in this area now under discussion between Welsh Government and

Public Health Wales, if any are deemed sufficiently valid and reliable to take forward.

As a first step, this review has focused on the availability of data and metadata in relation to the key themes of Creating an Active Wales.

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3.3 Creating an Active Wales

3.3.1 Aims

The Sport and Physical Activity action plan Creating an Active Wales1 aims

to support individuals in Wales to undertake regular physical activity. The

action plan encompasses the following strategic aims:

Supporting Active Environments Active Children and Young People

Active Adults Sport for All.

3.3.2 Targets and indicators

Two high level targets have been identified for physical activity, one for adults and another for children, that involve getting everyone to do „one

day more‟ of regular physical activity.

Adults: Shift the average point of activity from 2.4 to 3.4 days

activity per week by 2020 Children: Shift the average point of activity for 11 to 16 year olds

from 3.9 to 4.9 days activity per week by 2020.

The targets will be measured through the Welsh Health Survey (Appendix A 9:) and Health Behaviour in School-aged Children Study (Appendix A

3:).

In addition to monitoring the overall targets, the following key indicators will be tracked to ensure participation rates are increasing across the

whole population. Group Data monitored

Gender Male and female participation rates

Age Participation rates of children aged 7-11; Adults aged 55+

Socio-economic classification

Managerial and professional, routine and manual, never worked and long-term unemployed

Other equality groups Current national surveys do not give detail on participation in many groups. Consideration is to be given to ways of identifying other data sources to track

progress

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3.4 Methodology

3.4.1 Definitions and selection criteria for data sources

Data sources were included in the review if they met at least some of the following credibility criteria:

They were in the public domain

They contained information that, on face validity, appeared relevant to the aims and themes of Creating an active Wales

They were systematically and/or regularly collected At least basic details of data collection methods were available

They were available at a relevant population or area level

Evaluation of data validity and reliability was available.

Given the diverse nature of available information sources and the variable quality of information about data collection methods, these credibility

criteria were taken as a guide rather than rigidly applied as inclusion criteria.

Long term surveys were defined as those where there was a history

and/or an intention to repeat the survey. Ad hoc surveys were not covered in as much detail.

3.4.2 Identification and selection of data sources

It is recognised that physical activity data needs to include the complete spectrum of physical activity from active occupations, active living, play,

active recreation and sport data. Due to the time pressure on this rapid desk based study, the sources and surveys covered were those deemed

appropriate by Welsh Government, Public Health Wales Physical Activity and Nutrition Networks Wales and the Public Health Wales Observatory

staff.

A literature search was undertaken using Medline. Search terms included

physical activity; exercise; sport; survey; Wales.

Twenty people were contacted (see acknowledgements), asking them to

identify and give information on any surveys or data sources that they use or had used to measure correlates or potential mediators of physical

activity levels in Wales.

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A further search of core databases, national level surveys, specialist

websites and other grey literature was undertaken to identify further relevant data, common issues, gaps in data, comparative data and

surveys in other countries.

3.4.3 Evaluation of data quality Although detailed evaluation of indicator or data quality was beyond the

scope of this review, comment is made where possible on the relative strengths and weaknesses of individual data sources. These comments

are made on the basis of being:

Self evident to reviewers

Published with the data source Evident from the results of separate published reviews of physical

activity instruments.

In January 2011, when the literature review was complete but before final publication of this report, a further significant paper was published by

Biddle et al8, as part of Project ALPHA (see above). This paper reviews self reported physical activity instruments in young people for population

surveillance. The final text of this report has been amended to include significant findings of this new paper.

3.4.4 Presentation of information The results of the review of data have been structured according to the

four themes of the action plan. Where one data source covers more than one area, this has been cross referenced. Sources have been assigned

according to the theme considered the most relevant. To prevent unnecessary duplication, information about individual data sources has

been collated into two appendices.

Appendix A includes details of relevant data sources of reasonable data quality that are collected across Wales and could form the basis of

indicators to monitor the progress of Creating an active Wales. Appendix B included details of highly relevant data sources but that are not

collected in a way that allows development of all Wales indicators.

Data is described in relation to each theme, together with comment on

the validity or reliability of potential indicators based on these data, where this is available from published sources (for example, recent work arising

from project ALPHA9) or where issues are self evident in the light of published best practice in indicator development. The potential for

indicator development is summarised at the end of each theme.

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4 Data review

4.1 Data to monitor targets for Creating an Active Wales

4.1.1 Adults target: Shift the average point of activity from 2.4 to 3.4 days activity per week by 2020

Creating an Active Wales has already identified that this target will be

monitored using data from the Welsh Health Survey (Appendix A 9:). This is a rolling annual Welsh Government self completed questionnaire on the

health and health related lifestyle of a representative sample of adults and children in around 10,000 households each year. The WHS includes

questions on the number of days in the previous week that adults took part in 30 minutes or more or light, moderate or strenuous activity. The

survey is large and the question is likely to be valid and reliable at all Wales and local authority level. Any subanalyses at local authority level

are likely to be problematic. It is likely that this data source can be used to monitor this target, although further technical work will be needed to

confirm this and to test reliability with smaller groups such as gender or ethnic group, if required. (Where sample sizes are small, reliability can be

improved by considering 2 or 3 consecutive years together).

4.1.2 Children: Shift the average point of activity for 11 to 16 year olds from 3.9 to 4.9 days activity per week by 2020.

Creating an Active Wales has already identified that this target will be monitored using data from the Health Behaviour in School-aged Children

Study (Appendix A 3:)

The Health Behaviour of School Children (HBSC) survey is a 4 yearly pan European / international self reported survey, examining a variety of

lifestyle factors including physical activity in children aged 11 to 15 (Appendix A 3:)10,11 It includes data on the frequency of activity (number

of days active in previous week) and the intensity and duration of activity (hours outside of school doing strenuous activity).

Because of use in other countries, international comparisons are possible with this data source.

The HBSC captures data on the number of days respondents have achieved at least 60 minutes of moderate activity (in and out of school),

using a modified version of items developed by Prochaska and

colleagues12 with some objective validation published based on studies using US subjects. The measure is also used elsewhere, such as the Teen

Health Survey, and received support from the majority of the Project ALPHA expert group.8

11

The survey includes 4500 respondents in Wales so that results are only reported at national level.

The HBSC has limitations but is a well used measurement instrument that

is suitable for monitoring progress towards this target. The Sport Wales Active young People Survey focuses on participation in sport rather than

overall levels of activity and so would not be valid for this target.

An alternative to be explored alongside the HBSC survey is responses of children up to age 15 in the Welsh Health Survey (approximately 3000

children per year, although not all are in the age group covered by the target). Further work is needed to explore this possibility in greater detail.

4.2 Supporting Active Environments theme

Creating an Active Wales states that the “overall aim here is to support

the development of and access to well designed and maintained built environments and natural environments across both urban and rural

communities”. The Plan lists environmental factors that are associated with physical activity, as follows:

Proximity of local services to people and attractive environments which are perceived to be safe

Streets designed to encourage physical activity Traffic reduction and calming measures

Well designed, user friendly walking and cycling routes, which also consider the needs of disabled people

Cycle facilities such as racks, showers and lockers; and accessibility

and design / position of stairwells Access to well designed and maintained green spaces such as parks

Access to a variety of environments for play.

Note:

As part of project ALPHA, the European Commission is expected to publish shortly the results work package 5 that includes work on

geographical information systems and perceptions of environments. This may suggest additional indicators that could inform various

environmental factors associated with this theme of Creating an Active Wales.

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4.2.1 Proximity of local services to people and attractive environments which are perceived to be safe

4.2.1.1 National Survey for Wales

A pilot for the new substantial National Survey for Wales (Appendix A 5:) was undertaken in 2008/2009 with the main survey due to run

continuously from 2011 and involving face to face and individual questionnaires at 13,000 households across Wales. Technical information

is available to allow detailed assessment of indicator reliability and validity. There is scope to influence questions to be included in future

survey rounds. Pilot questionnaires include items on proximity to natural green spaces, footpaths and cycle paths. Personal questions will allow

breakdown of responses by age, gender and ethnicity, as well as linking

to some broader determinants of health, although sample size may mean that results at Local Authority level will be less reliable.

Some of the items from the National Survey of Wales are likely to feed into Quality of Life indicators collated by the Welsh Local Government

Data Unit.

4.2.1.2 Living in Wales Survey

The Living in Wales Survey (Appendix A 4:) was carried out annually from 2004 to 2008 and was a large survey involving face to face interviews and

individual questionnaires at 12,000 addresses across Wales. Technical information is available to allow detailed assessment of indicator reliability

and validity. The survey asked questions on usage, access and satisfaction with sports and leisure facilities, although topics covered

varied from year to year.

4.2.1.3 Quality of Life Indicators (WLGDU)

The 2009 Quality of Life indicator handbook (Appendix A 11:) is compiled by the Welsh Local Government Data Unit. The handbook includes „quality

of life indicators‟ that are used by Local Authorities for their community plans. These include:

Personal impressions of safety whilst out walking during the day or after dark

Walking proximity to key services and

Area of parks and green spaces per 1,000 head of population.

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Indicators data are drawn from various other surveys, including Living in

Wales (now ceased).

The validity, reliability and consistency over time of the Quality of Life

Indicators are dependent on the quality of the underlying survey instruments. Analysis may need to be by multiple rather than single

years, because of small sample sizes at local authority level.

4.2.1.4 Mentro Allan

Mentro Allan13 (Appendix B) is supported by the Big Lottery Fund and a national partnership of organisations. It funds a collection of projects in

Wales, each for up to four years. The programme targets specific groups that are generally less active than the wider population and works to

increase the physical activity levels of its target group, making best use of natural outdoor environment close to where people live. Mentro Allan

collects information on evidence of effectiveness from participants and project coordinators through participatory action research. Inspection of

the website and published evaluation reports of several projects does not suggest that this will be a source of valid and reliable indicators at

national or local authority level across Wales, although it is noted that a number of projects have worked with groups highlighted for special action

in Creating an Active Wales.

The best potential source of data for an indicator for „supporting active environments‟ is likely to be the National Survey for Wales, although back data is not available for trend analysis and confirmation is needed that

relevant questions will be retained in future surveys. The sample size may be large enough for analysis at local authority level. The data gives a

subjective assessment of proximity to green spaces and could be prone to bias.

An objective measure of amount of green space is theoretically possible through local authority data that measures amount of green space and

parks, but differences in data collection methods between local authorities are not quantified and there is potential for considerable variation in methods of measurement or reporting. The green space mapping toolkit

(section 4.2.7) will allow greater consistency. The usefulness of this data source to support an all Wales indicator needs further study.

Although data are not sufficiently robust to provide national indicators, Mentro Allan data information may provide useful insights into use of

active environments by groups highlighted as requiring special attention.

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4.2.2 Streets designed to encourage physical activity

In 2009, the National Obesity Observatory reported on physical activity

surveillance in England and noted a paucity of data relating to

„walkability.‟14

Local Authority Performance Indicators (Appendix A 12:) includes data on

“the percentage of total lengths of rights of way that are easy to use by

members of the public” but it is known that only a small percentage of

rights of way are included in local authority surveys and that most public

rights of way lie beyond a street environment.

Due to time constraints, this facilitator of physical activity was not

discussed further with the various planning authorities in Wales.

4.2.3 Traffic reduction and calming measures

The Safe Routes in Communities Programme (Appendix B) replaced the Safe Routes to Schools initiative in 2008. The grant programme is funded

by Welsh Government and aims to improve accessibility and safety, and encourage walking and cycling within communities. Safe Routes in

Communities funds various capital works, including:

Crossings

Traffic calming measures Cycle paths

Footpaths Secure cycle facilities (including stands and CCTV), lockers and

changing facilities.15

Some evaluation of Safe Routes to Schools and Safe Routes in Communities is linked to capital funding of improvements. However

evaluation is not standardised, validated or followed-up to measure sustained changes in walking or cycling behaviour. Indicators such as

percentage of schools with safe „walk-to school‟ routes are not currently

available and funded projects are linked only to specific local authorities so that a systematic picture across Wales is not available.

No suitable data sources have been identified to act as a basis for an

indicator for ‟streets designed to encourage physical activity‟

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4.2.4 Stats19 data on pedestrian injuries in Wales

These statistics refer to casualties resulting from personal injury accidents on public roads reported to the police and forwarded to the Welsh

Government. A summary is published by Welsh Government as an annual statistical bulletin16 that can identify pedestrian and cyclist casualties and

gives a range of information about the age of casualties, location and time of accidents, weather conditions, etc. Data is only reported at all Wales

level. Information on casualties could be a valid outcome measure for

traffic reduction and calming measures but is not a valid higher level outcome measure for levels of physical activity. Further work is needed to

assess data quality before this data source is considered further.

4.2.5 Well designed, user friendly walking and cycling routes, which also consider the needs of disabled people

A recent peer reviewed systematic review of interventions to promote

cycling17 reflected the need for more evidence in this area and concluded that:

Community-wide promotional activities and improving infrastructure for cycling have the potential to increase cycling by modest amounts, but

further controlled evaluative studies incorporating more precise measures are required, particularly in areas without an established cycling culture.

Clear definitions of „well designed‟ and „user friendly‟ are required in order to fully assess suitability of indicators to monitor this factor. In relation to

public rights of way, the Countryside Commission for Wales describes good quality routes as being:

In excellent condition and easy to use Accurately described

Well publicised and easy to find out about.18

No robust data sources have been identified to act as a basis for an indicator

for „traffic reduction and calming measures.‟ Safe routes in Communities „data can provide some insights into developing traffic calming schemes but data are not standardised across Wales. Stats 19 data could be considered

as a provisional indicator for this sub theme but this should be preceded by

further assessment of data quality.

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4.2.5.1 Gwion data base (WLGDU): pathways and cycle routes

The Gwion database developed by the Welsh Local Government Data Unit

contains a variety of performance indicators based on data collected in

relation to specific local authority responsibilities (Appendix A 12:). This

includes data collected by individual local authorities on the percentage of

total length of rights of way that are easy to use by members of the

public. Data is available by local authority area and for all Wales.

However, the indicator is expressed as a percentage of length of rights of

way surveyed, which does not take account of the total length of rights of

way within the LA area (less than 2,000km of pathway was surveyed in

2009/10; the Countryside Commission for Wales estimates that there are

over 33,000km of public rights of way in Wales18). The indicator considers

access but would not be a valid measure of physical activity or usage of

pathways. Further details are also required to assess comparability of

definitions and measurements between local authorities before this could

be considered further as a potential indicator.

During the 2005-6 PI consultation process by the Data Unit for a new

performance measurement framework, two other indicators were considered, namely:

TH6 Percentage increase in total length of safe cycle routes

TH7 Percentage target school year population who have completed road

safety/cycle training

TH6 data were collected in 2005-06 whereas TH7 was not taken forward

into the framework and data on this have never been collected. Results from the 2006-7 consultation indicated that authorities did not find TH6

data useful. The indicator was subsequently dropped from the set and there are no plans to re-introduce it.

4.2.5.2 Sustrans data

Sustrans is a major sustainable transport charity in the UK that aims to

address transport challenges through:

• Creating public spaces enabling more people to walk and cycle

• Bringing about travel behaviour change • Influencing government policy19.

As well as developing the National Cycle Network, Sustrans is a collaborator on Safe Routes to Schools, Safe Routes to Stations, Home

Zones (liveable neighbourhoods), and other practical initiatives.

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Sustrans hold data from evaluations and monitoring of a variety of their

projects, as described below and have their own research and evaluation team20. Technical reports giving detailed accounts of evaluation

methodologies and indicator metadata are not immediately available from the Sustrans website. Considerable further technical details are required

before conclusions of data validity and reliability can be formed.

1. Sustrans' Route User Monitoring Report (Appendix B) is the major

product of all of Sustrans' National Cycle Network research and monitoring activities.19 Annual reports have been published since 2001

(available on the Sustrans website from 2004). Annual cycling and walking route activity is modelled from manual counts over 4 day

surveys. Survey data captures age, gender, ethnicity, employment status, travel behaviour, journey purpose, and physical activity in the

last 7 days, self reported health status, and future levels of walking and cycling. The methodology for route user monitoring is reported as

standardised across projects though survey data is not believed to

have been validated against objective measures such as accelerometry or fitness. Data are only given at UK level. Discussions with individuals

at Sustrans noted that extrapolations from these data in relation to Wales are usually considered as 10% of the total since 10% of the

National Cycle Network is geographically located in Wales but this does not allow population based rates to be inferred for cycle route usage

(data is based on usage not populations; the population of Wales comprises only 5% of the UK population).

2. Sustrans hold some data in relation to specific Connect2 projects in Wales (Merthyr Tydfil and Parc Bryn Bach in Tredegar). However, the

limited sample size of Welsh data and the evident selection biases of respondents mean that it would be difficult to extrapolate these data

as valid and reliable indicators of cycling and walking route usage by all Welsh residents.

3. The „Bike It‟ project (Appendix B) managed by Sustrans on behalf of

Welsh Government only holds data for individual projects so again no national picture emerges. „Bike It‟ projects cover 36 schools currently,

located in Conwy, Cardiff and Neath Port Talbot. The evaluations of the projects do include survey data on levels of cycling pre- and post

project implementation and other data such as counts of bikes in the bike sheds.

To note:

Sustrans comment that there could be better links with local authorities in

relation to planning and monitoring of travel schemes. For example, Sustrans suggest that:

18

Local authorities should be required to report on participation in

National Standards Cycle Training, Bikeability. They suggest commissioning intercept surveys on walking routes but acknowledge

difficulties in obtaining significant participation in such surveys. Welsh Government look at evaluations of English cycling

demonstration towns. Other possible sources to collect data are the sustainable travel

centres and regional travel plan co-ordinators. For the latter they advise investigating the use of a tool such as iTrace

(http://www.itrace.org.uk) to facilitate the process. Local Authorities should be more involved or give greater recognition

to major funded projects undertaken by non statutory organisations that are funded by Welsh Government, such as Bike it or Mentro Allan.

4.2.5.3 National Survey of Wales

The National Survey of Wales pilot questionnaire (Appendix A 5:) asked the question:

Do you live within a ten minute walk of a footpath or cycle path?

But this gave no idea of the degree to which routes are well designed or

user friendly. There is scope to influence questions asked in future

surveys.

Various data sources are available to support an indicator on „well

designed and user friendly walking and cycling routes that consider the needs of disabled people‟, but none are ideal for this purpose. Sustrans

route user monitoring data are highly relevant and include metrics of cycleway use (the presumed desired outcome of this theme) as well as details of special groups including disability. However, the lack of

validation checks, together with the fact that all Wales figures are only available through extrapolation of UK results mean that the data are

potentially of limited validity and reliability. Local Government data on access to rights of way is also relevant but again, data quality is not assured, given the potential lack of

standardisation of technique between local authorities and the very small length of footpaths actually surveyed annually.

The National Survey of Wales data describe proximity to foot and cycle paths but this is not an indicator of design quality or user friendliness.

A gap exists of good quality data to describe this theme of the action plan.

http://www.itrace.org.uk/

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4.2.6 Cycle facilities such as racks, showers and lockers; and accessibility and design/position of stairwells

No relevant indicator data was readily identified. There may be scope to

utilise measures used in the Small Workplace Health Award, the Corporate Health Standard or Workboost Wales but this was not carried

out within the scope of this project.

4.2.7 Access to well designed and maintained green spaces such as parks

4.2.7.1 Greenspace mapping toolkit

The Countryside Council for Wales have developed a greenspace mapping

toolkit21 including definitions, standards, measurement and reporting techniques (http://www.ccw.gov.uk/about-ccw/newsroom/press-

releases/green-space-toolkit.aspx?lang=en). It is thought that this is used by around 80% of Local Authorities to map green spaces in their

area. Each Local Authority has used the toolkit in a slightly different way and, although there is probably a reasonable coverage of green space

mapping across Wales, the maps cannot be aggregated to provide an

overall map of Wales. Work to allow mapping at an all-Wales level is currently under development. With greater standardisation, this could be

a valuable instrument to improve the quality of metadata for indicators relating to green spaces in Wales. If used in this way, it is not clear

where the data would be stored, but it is assumed this could be with the Local Government Data Unit.

4.2.7.2 Welsh Outdoor Recreation Survey

The Welsh Outdoor Recreation Survey has been commissioned jointly by

Countryside Council for Wales and Forestry Commission Wales (Appendix A 10:). It measures participation in outdoor recreation among residents in

Wales, measured through over six thousand telephone interviews, stratified by the six spatial plan areas. Measures include use of the

outdoors; places visited, including woodlands; motivations for using the outdoors; barriers to visiting the outdoors; the „latent demand‟ for

outdoor recreation.

The survey was undertaken in 2008/09 and it is intended to repeat every

three years. The survey was undertaken by Ipsos MORI and it is

No suitable data sources have been identified to act as a basis for an

indicator for ‟cycle facilities and well designed stairwells‟

http://www.ccw.gov.uk/about-ccw/newsroom/press-releases/green-space-toolkit.aspx?lang=enhttp://www.ccw.gov.uk/about-ccw/newsroom/press-releases/green-space-toolkit.aspx?lang=en

20

therefore likely that extensive metadata information will become available

on which to base further assessment of validity and reliability of indicators based on survey data. Information is collected on various equality groups

but sample size is probably insufficient to allow detailed breakdown of these factors.

4.2.7.3 Other data sources

The Quality of Life Indicators from the Data Unit (Appendix A 11:)

include a measure of area of parks and green spaces per 1,000 head of population. However, data for this measure are not

currently available. The National Survey of Wales pilot (Appendix A 5:) `included the

question Do you live within a ten minute walk of a natural green space?

4.2.8 Access to a variety of environments for play

Various data on environments for play have been collected in the past

but only data on free use of swimming pools are currently active.

National performance indicators for Welsh Local Authorities (NAWPI)

are set by the National Assembly for Wales as part of the performance measurement framework. Indicators are intended to provide a

comprehensive, balanced and comparable picture of performance and its likelihood to improve for local authorities. Data is held by the Welsh

Local Government Data Unit.22 NAWPI used to include reporting on the number of playgrounds per thousand children under 12 and on their

quality. Although national definitions were developed, it is not clear

how consistently these were applied across Wales.

Various data sources are available on which to base potential indicators to monitor access to well designed green spaces.

The greenspace mapping tool can support a standardised approach to measuring greenspace across local authorities. This is collated by the

Welsh Local Government Data Unit. However, improvements to these measures lie with local government and are beyond the direct control of

health services. The outdoor recreation survey can give an indication of use of green spaces

as it collects data on outdoor spaces visited. The survey also asks about barriers to use which could give insights into green space design issues.

However, the survey data are reported by spatial plan rather than local authority area. The survey metadata should be published soon and will

allow further assessment of indicator quality.

21

Other active local authority information held by the WLGDU includes a

number of measures arising from the collection of data in association with the Free Swimming Initiative, including all swims (paid and free)

for children 16 years and under (Appendix A 12:). Again, it is not clear how consistently standard definitions were applied across Wales.

These data reflect free use of local authority swimming pools, but not private swimming facilities. Valid or reliable population based rates of

swimming cannot be established as numerators reflect number of swims rather than number of individuals and there is no clear

denominator data for facility based activities. Trends in numbers of swims can be described but will be influenced by demographic

changes as well as changes in levels of swimming activity.

Further data available in previous years from the WLGDU includes playable space provision (multi use games areas / wheeled play

areas); fixed equipment playgrounds; community based play

provision; local authority based play provision and holiday play schemes. These data have not been collated at an all-Wales level

since 2004-5.

The Audit Commission developed a library of local Performance Indicators (PIs) developed by local authorities in addition to those set

for the National Performance Framework23. Ideally, local indicators would allow comparison with others. This library was designed to help

authorities to do this and share good practice. The library is now closed. Local PIs housed in the Audit Commission‟s library include:

LIB037 the number of playgrounds and play areas provided by the council per 1000 children under 12

LIB038 the number of sports pitches available to the public per 1000 population.

The Children and Families (Wales) Measure 2010 includes

requirements for local authorities to assess the sufficiency of play opportunities in its area for children. Regulations and guidance for play

sufficiency audits are not currently available. It is hoped that, when implemented, these audits will provide data on availability and access

to quality of play provision.

Playwork Wales is the National Centre for Playwork Education and Training in Wales. Melyn Consulting Ltd was commissioned by

Playwork Wales to undertake research to gather information about the nature and needs of the playwork workforce across Wales however

this gives no information on actual numbers of playworkers. There are ten regional play association projects covering Wales

(Appendix B). These projects have each completed exercises mapping and auditing play provision in each Local Authority area - a first

attempt to bring together and compare current local priorities in play

22

provision. Play Wales is currently examining these data to ascertain

the exact measures available. Early indications show that there are figures across all areas for playable space provision; fixed equipment

playgrounds; community based play provision; local authority based play provision and holiday play schemes. The collation of data

however is not standardised as it was conducted by each play association project independently. The implementation phase of ten

regional strategic play projects funded by Big Lottery Child's Play programme is currently ongoing and will be evaluated in some form.

Play Wales suggested possible indicators of active play could include the extent Local Authorities use given tools, namely Design for Play

and Managing Risk in Play Provision-an Implementation Guide in planning their play provision. The use of these tools would help

demonstrate a commitment to meet indicators of quality, rather than just quantity. Play Wales indicated that regulations and guidance for

play sufficiency audits were not currently available but hoped that

when implemented these would provide data not just on availability but on access to and quality of play provision.

Play Wales highlighted some key information gaps:

o Quality of play opportunities

o Attitudinal and environmental constraints on children‟s access to play opportunities

o Children and young people‟s views of play provision o Compilation of regional baseline audits to present an all Wales

review.

4.3 Active Children and Young People theme

The action plan suggests a number of interventions for increasing physical

activity levels in children, particularly in relation to:

School based activity

Although there have been various attempts to collect data that would be relevant to the theme of a variety of environments for play, none of the data

have been robust and several are now discontinued. Play sufficiency audits provide a new opportunity to collect better quality data in this area, but will

depend on cooperation to develop standardised approaches between local authorities in Wales. Play Wales have already started work in this area and health services could support efforts in this area.

23

Extracurricular activity

Active travel.

4.3.1 School based activity

The Creating an Active Wales action plan envisages a Wales where:

“Activity is at the centre of the school ethos and physical literacy is as

important as numeracy and language”

One of the WHO global strategies on diet and health output indicators is:

“Percentage of schools offering a minimum of one hour of physical activity daily”24

Sport Wales25 hold a variety of data relating to their different programmes to improve sports based physical activity in schools,

including:

The Active Young People Survey The PE provision survey

Data associated with the PE and School Sport (PESS) programme Dragon Sport

5x 60.

4.3.1.1 The Active Young People Survey

The Active Young People survey (Appendix A 2:) collects data on participation in curricular sports during the last academic year and could

be used as indicators of progress towards achieving the aims of Creating an Active Wales.

4.3.1.2 PE Provision survey

Sport Wales conducts a Physical Education (PE) Provision survey every

two years. The survey collates types of activity provided during lessons, number of minutes per week provided for PE and numbers of staff and

facilities associated with PE (Appendix A 7:).

The survey has been running for over 10 years and is intended to provide

trend data to monitor progress and identify gaps in school PE provision. All maintained schools, excluding special schools, are asked to take part

in the survey every two years. The survey is completed by PE Coordinators in primary schools and Heads of PE in secondary schools.

The survey covers:

24

Time made available for PE in the curriculum Extracurricular time provided by teachers Sports and activities offered in PE and as extracurricular activities Teachers' opinions on the resources, delivery and support for PE Sports facilities available to schools and perceptions about their quality Provision and take up of examination PE.

No detailed methodology, data or reports from the survey are currently available from the Sport Wales website, and these would be needed to

comment further on survey quality and stratification of results. Further work in this area is required but is beyond the scope of this review.

4.3.1.3 PESS

The PE and School Sport (PESS) Project was set up by Sport Wales in

2000 as a result of a task force report outlining the key actions required to improve standards of PE in schools (Appendix B). PESS collates the

number of continuing professional development (CPD) opportunities provided by each Local Authority and data on perceived needs for PE

training from the workforce. The data may be better viewed as a needs assessment tool as the number of CPD opportunities provided is not

necessarily a valid measure of improved quality of PE sessions delivered in schools.25

Sport Wales hold data on the PESS programme from two sources:

PESS Coordinators access a web interface to input data on a termly

basis on the number of CPD opportunities provided by each Local Authority. The data can be stratified by Local Authority and region.

There are also PESS Continuing Professional Development (CPD)

Surveys, used principally to assess in which areas and by which means professional development is needed within PE. From 2004, a

survey has been established to investigate teachers‟ perceptions about the initial training they received for Physical Education (PE)

and their confidence in teaching various aspects of PE and their CPD needs. The last data collection for this occurred in 2008.

4.3.1.4 Dragon Sport

Dragon Sport has been running for nearly ten years and is a Sport Wales initiative funded by the National Lottery, designed to offer 7-11 year olds

fun and enjoyable sporting opportunities25 (Appendix B).

Liaising closely with schools and community sports clubs, Dragon Sport

both broadens the sporting interests of children who already take part in sport and encourages children who currently lack such opportunities

25

outside of their school PE lessons to become involved in a variety of

organised sporting activities. Children are introduced to coaching, skill development and appropriate competition using versions of the adult

game, modified to meet their needs and skill levels. Current sports included are rugby, athletics, cricket, football, hockey, netball, tennis and

golf.

Dragon Sport activity in Local Authority Schools and community settings is captured on an academic termly basis. The Dragon Sport data is linked

to each Local Authority Partnership Agreements (LAPA) core programme targets. Information collated refers to participation of 7-11 year olds that

are active through Dragon Sport activity.

The Sport Wales website states that an evaluation of Dragon Sport is underway and will report soon. This will be useful in assessing further the

potential for this source of activity based data to be used to assess progress with the Creating an Active Wales action plan.

4.3.1.5 5x60

This is another Sport Wales programme designed to work with senior

schools to increase participation in sport in pupils both in and beyond the school environment (Appendix B). Participation data in 5x60 activity in

each secondary school is collated and the data is linked to each Local Authority‟s LAPA core programme targets. The participation data

collected refers to the 11- 16 age group in secondary schools.25 The Sport

Wales website states that an evaluation of 5x60 has been undertaken and will report soon. This will be useful in assessing further the potential for

this source of activity based data to be used to assess progress with the Creating an Active Wales action plan.

Physical activity in the school environment can be described from a

number of sources, although again, none are ideal. The PE provision survey is very relevant but further details are needed of

data quality before judgements can be made on suitability for indicator development. Dragon Sport and 5x60 surveys also appear relevant but

again, data quality needs further assessment. Both initiatives have apparently recently been evaluated, which should prove helpful in this regard.

The Active Young People‟s survey offers the best potential for good quality indicator development but most of the questions are not relevant as they

relate to extracurricular sport rather than physical activity within the school setting. The HBSC survey and the WHS includes general questions on physical

activity but these are not specific to the school environment

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4.3.2 Extracurricular activity

4.3.2.1 Active Young People Survey

The Active Young People Survey (Appendix A 2:) includes questions on

participation in extracurricular sports:

Frequency and duration of participation in extracurricular sports and

sports clubs outside of school Percentage of senior school children attending a leisure centre

Swimming ability in all respondents Primary school pupils‟ use of recreational facilities such as skateparks

etc.

4.3.2.2 The Health Behaviour of School Children (HBSC) survey

Questions included in the HBSC survey (Appendix A 3:) are relevant to all

three areas identified under the theme of active children and young people of Creating an Active Wales. Of relevance to extracurricular

physical activity levels in children are questions on:

Frequency of activity – number of days active in previous week Intensity and duration of activity - hours outside of school doing strenuous activity (make you out of breath or sweat)

Sedentary behaviour - hours a day watching TV in free time

Data is collected 4 yearly and is available at all Wales level only.

4.3.2.3 Swimming data

The Welsh Local Government Data Unit holds data on the number of

swims in relation to the free swimming initiative (Gwion database, Appendix A 12:).

An evaluation of the FSI by Sports Wales in 200826 does hold some information over and above that held by the WLGDU. This has been

collated from surveys of target groups, Local Authority managers and

officers, pool managers and disability support officers, for those under 16, the evaluation highlights that structured activities rather than „splash‟

sessions where young people have more freedom to choose how much activity they do in the pool may lead to increases in actual levels of

physical activity. The evaluation notes:

“The longer term impact of more structured developmental approaches

could be far more significant over time in terms of changing behaviour and offering long term sustainable physical activity opportunities than

unstructured „splash‟ sessions and the effectiveness of the FSI should not

27

be judged, therefore simply in terms of the numbers which have

participated. The type and quality of the experience they have is also important.”

The Free Swimming initiative is evolving to include more non-aquatic structured activities and a new measure of number of hours of sport

delivered in relation to the initiative will be collated by the WLGDU from October 2010.

4.3.3 Active travel in children

Various surveys and monitoring reports and programmes include data relevant to active travel in children.

4.3.3.1 National Survey for Wales / Living in Wales

The National Survey for Wales pilot (Appendix A 5:) included responses

from children aged 11 to 16 and asked:

Do you live within a six/ten minute walk of a natural green space?

Do you live within a ten minute walk of a footpath or cycle path?

Variations of these questions were also asked in the preceding Living in

Wales survey (Appendix A 4:) and are referred to in the monitoring report for the Walking and Cycling Action Plan (Appendix A 8:).

There is scope to influence future questions to be included in future rounds of the National Survey for Wales.

Indicators of extracurricular physical activity in children could be based on

either the Active Young People‟s survey or the HBSC. Use of swimming pools appears to be over represented among types of

sport, probably because local authority pool use is not hidden. It measures use of facilities rather than levels of swimming activity, and in this respect,

the survey data from the Active Young People‟s survey are more helpful as they describe levels of swimming ability as a proxy for physical activity through swimming.

Dragon Sport and 5x60 may be able to provide a better picture of the

range of sports and physical activities undertaken by children and these are not collected through HBSC or the Active Young People‟s surveys.

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4.3.3.2 Active Young People Survey

The Active Young People Survey (Appendix A 2:) retains a question on

active travel. The 2009 survey contained queries measuring frequency of walking or cycling to school. However, whereas previous surveys captured

„usual mode of transport to school‟ and duration of the journey, the 2009

survey did not capture duration of walking or cycling to school. (Discussions with the data manager at Sport Wales suggested that this

information could be readily captured if considered useful). These data feed into the monitoring target for the Walking and Cycling Action Plan

(Appendix A 8:).

4.3.3.3 Walking and Cycling Action Plan

The Statistical Directorate of the Welsh Government produced a monitoring report for the Walking and Cycling Action Plan in 2010

(Appendix A 8:). This uses two indicators to monitor walking and cycling to school, namely:

Percentage of children in Wales (5-16) whose main mode of travel to school is walking: data (only available at all Wales level) is taken

from the National Travel Survey (Appendix A 6:) Percentage of children who cycle to school in Wales: data taken

from the Children & Young People‟s Sports and Physical Activity Participation Surveys, now replaced by the Active Young People

Survey (Appendix A 2:).

Discussion with individuals involved in monitoring the Walking and Cycling

Action Plan suggest that these indicators are the ones for which suitably

robust data continues to be collected. The possibility of including additional questions to the National Survey for Wales in relation to

walking and cycling is currently under consideration.

The full report also discusses some other measures which may be of

interest and are available from national datasets, namely for children:

Percentage of children (5-15) who own or can use a bicycle

(National Travel Survey).

4.3.3.4 Performance Indicator Library

The Local Performance Indicator Library held by the Audit Commission and the Improvement and Development Agency (now closed)23 includes

the following „quality approved indicators‟ relating to active travel by children and young people.

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LIB008 percentage of primary school children aged 5 and over

who are covered by an adopted school travel plan

LIB009 primary school pupils‟ main mode of travel to and from

school

LIB010 secondary school pupils main mode of travel to and

from school.

LIB011 percentage of primary school children aged 5 and over

receiving road safety advice during the year.

To note: The last indicator echoes the suggestion from Sustrans that Local

Authorities should be required to report on participation in National Standards Cycle Training and Bikeability.

4.3.3.5 Other programme data

The Safe Routes to Schools and Safe Routes in Communities

projects (Appendix B) provide capital grants for improvement programmes. Local Authorities report back on the impact of the

interventions that are funded but evaluation and monitoring of schemes is not standardised. The development of standard

instruments for the monitoring and evaluation of improvement

schemes is currently under review.

Data on usage of the National Cycle Network is held by Sustrans (Appendix B) is currently relatively ad-hoc. Also it is known that

many Local Authorities have automatic counters on cycle routes though it is not known how extensively. It is also not clear how

comparable any available data might be.

It may be possible to review data from projects such as Eco Schools or the Healthy Schools National Quality Award in the future.

30

4.4 Active Adults theme

The Creating an active Wales action plan notes that evidence suggests

that successful interventions in adults can be delivered through community or workplace settings. This section considers data sources on:

Recreation

Active travel Adults at risk.

4.4.1 Recreation

4.4.1.1 The Walking and Cycling Action Plan

The Walking and Cycling Action Plan (Appendix A 8:) uses two indicators

to monitor walking and cycling for recreation that are based on data from the Active Adults survey (Appendix A 1:), namely;

Percentage of adults in Wales to walk over 2 miles in the past 4 weeks (Sport Wales Active Adults Survey)

Percentage of adults in Wales undertaking any cycling in the past 4 weeks (Sport Wales Active Adults Survey).

There are a variety of data sources describing active travel by children. Pragmatically, the best ones to use are those adopted

by the Walking and Cycling Action Plan for Wales, namely:

Percentage of children in Wales (5-16) whose main mode of

travel to school is walking: data (only available at all Wales

level) is taken from the National Travel Survey (Appendix A 6:)

Percentage of children who cycle to school in Wales: data

taken from the Children & Young People‟s Sports and Physical Activity Participation Surveys, now replaced by the Active

Young People Survey (Appendix A 2:).

31

Sport Wales are researching use of market segmentation data (Experian)

in partnership with Active Adults Survey data. This can be used to target groups with sports opportunities of particular interest to them.

4.4.1.2 The Welsh Outdoor Recreation survey

The Welsh Outdoor Recreation survey (Appendix A 10:) includes

information on intensity and duration of particular activities during respondents‟ most recent visit to the outdoors. It investigates latent

demand for different types of activity and barriers to turning latent demand into action.

4.4.1.3 Active Adults Survey

This is described further in the next section as it focuses on the contribution of sport to physical activity rather than general levels of

recreational physical activity. The survey does however ask about participation levels in a range of (sports and) physical recreation

activities.

4.4.1.4 Let’s Walk Cymru (LWC)

Let‟s Walk Cymru (Appendix B) is a Wales-wide initiative developed in

partnership with Sport Wales, the Welsh Government and Countryside

Council for Wales. It is tasked with increasing the number of people participating in walking as a regular activity27.

The overall focus of LWC is to provide information about walking in Wales, specifically related to health walk programmes. Monitoring is carried out

as part of the conditions of funding from Welsh Government to ensure that LWC funded projects target appropriate populations, according to

their objectives and LWC criteria. LWC funded projects are expected to collect and submit quantitative data via data returns. Inspection of the

website and published evaluation reports of several projects does not suggest that this will be a source of valid and reliable indicators at

national or local authority level across Wales.

4.4.1.5 Other data

Projects such as the Coastal Access Improvement Programme (CAIP) and the Wales Coast Path Project are not believed to have any monitoring

data as of yet. The CAIP project does include work to improve access for

32

groups with disabilities but usage is not currently monitored. The

Connections and Paths project is not currently operational.

In terms of the Rights of Way Improvement Plan (ROWIP) the only

indicator of relevance is that outlined by the Welsh Local Government Data Unit (Appendix A 12:) i.e. percentage of total length of rights of

way which are easy to use by members of the public. Come Outside involved two projects in South East Wales and would thus not have data

at a national level.

Previous references to data sources that also provide support to data to

achieve active adults include:

Section 5.4 - Well designed, user friendly walking and cycling routes, which also consider the needs of disabled people

Section 5.5 - Cycle facilities such as racks, showers and lockers; and accessibility and design/position of stairwells

Section 5.6 - Access to well designed and maintained green spaces

such as parks.

4.4.2 Travel to work

The Statistical Directorate of Welsh Government monitoring report for the Walking and Cycling Action Plan (Appendix A 8:), includes the

following indicators in relation to travel to work:

o Percentage of adults in Wales whose main mode of travel to work is walking (Labour Force Survey)

o Percentage of adults in Wales whose main mode of travel to work is cycling (Labour Force Survey).

The National Survey of Wales pilot questionnaire (Appendix A 5:) asked a question about mode of travel to work, following on from similar

questions asked in the predecessor Living in Wales survey (Appendix A 4:).

The Audit Commission and the Improvement and Development Agency

Performance Indicators23 includes the following indicator:

Active recreation in adults is a broad area and indicators can be based on a number of data sources. The indicators identified by the Walking and Cycling

Action Plan are also general indicators of adult recreational physical activity. This is also true for any indicators based on the Welsh Outdoor Recreation

survey, which can also give an idea of the range of different recreational activities taken up.

33

o LIB145: the percentage of residents surveyed using different

modes of transport, their reasons for and distance of travel.

4.4.3 Adults at risk

The Quality and Outcomes Framework (QOF) rewards GPs financially for achieving healthcare targets.28 In 2009, QOF included physical activity for

the first time under a „cardiovascular risk assessment and management‟

indicator.

PP2: The percentage of people diagnosed with hypertension diagnosed after 1 April 2009 who are given lifestyle advice in the last 15 months

for: increasing physical activity, smoking cessation, safe alcohol consumption and healthy diet. (5 points thresholds 40 – 70%).

The QOF Advisory Committee has made recommendations for indicator development47. This notes that indicator(s) are to be developed “that

addresses identification of inactive adults using a validated tool and the provision of physical activity in patients with hypertension.”

The Committee highlight recommendation 1 from the NICE Public Health

Intervention guidance no.2 (Four commonly used methods to increase physical activity, namely:

“Primary care practitioners should take the opportunity, whenever possible, to identify inactive adults and advise them to aim for 30

minutes of moderate activity on 5 days of the week (or more). They

should use their judgement to determine when this would be inappropriate (for example, because of medical conditions or personal

circumstances). They should use a validated tool, such as the Department of Health‟s forthcoming general practitioner physical

activity questionnaire (GPPAQ), to identify inactive individuals”.

Weiler and Stamakis29 describe (GPPAQ) as being relevant for “patients

aged 16-74 without longstanding illness or disability” and note that it can be completed in 60 seconds. These authors comment that it is currently

underutilised; according to a recent survey of the 2010 General Practice Research Database only 660/9556849 (0.007%) of records were found to

have ever been coded for any of the GPPAQ read codes across 524 practices in the UK. These authors also comment that the training needs

A pragmatic way forward for indicator development in this area is to adopt indicators already adopted by the Statistical Directorate of Welsh Assembly Government monitoring report for the Walking and Cycling Action Plan

(Appendix A 8:) as these appear to be reasonably robust and are already being collated and published.

34

of doctors to deliver preventative medicine, health promotion and lifestyle

modification skills at undergraduate, postgraduate and continuing professional development courses should be addressed.

The Quality and Outcomes Framework (QOF) may include an indicator that addresses identification of inactive adults using a validated tool and

the provision of physical activity in patients with hypertension.

Use of these data for indicators of levels of physical activity will not be

valid as they describe advice given rather than activity undertaken.

4.5 Sport for All theme

Creating an Active Wales aims to increase participation in sport by all

sectors of the population. This section considers data sources in relation

to adult sport participation, facilities and human resources.

4.5.1 Active Adults Survey

Sport Wales has commissioned large-scale population-based surveys of adult participation in sport in Wales since 1987. The data from the Active

Adults Survey (Appendix A 1:) feeds into key national and local authority performance indicators.

The Active Adults survey replaced the Adult‟s Sports and Physical Activity Participation Survey in 2008-9. There has been a concurrent change in

sampling methodology to enable the reporting of margin of error around estimates. Therefore, it is not possible to demonstrate statistically

significant differences in participation prior to 2008-9 though „suggested

direction of change‟ is still possible. The survey no longer reports data on general levels of physical activity and will not collect this data from 2011

onwards; its main focus is data relating to the contribution of sport to physical activity. Questions explore the themes of:

Although adults at risk are an important group in which to encourage

physical activity, the data sources available relate to advice rather than outcome measures of improved physical activity levels. This reduces their validity as outcome measures for the Creating an Active Wales action plan.

35

Participation levels in a range of sports and physical recreation

activities Sports club membership and participation Volunteering in sport Participation in competitive sport Usage of leisure and fitness centres Barriers and motivation for participation in sport

4.5.2 Visits to leisure centres

The Sport Wales Active Adults Survey (Appendix A 1:) provides data

on participation in sport at an all-Wales and Local Authority level. It examines leisure centre use, together with motivations for and

barriers to participation. One of the performance indicators held by the Welsh Local

Government Data Unit (Appendix A 12:) relates to the number of visits to Local Authority sport and leisure centres during the year,

where the visitor will be participating in physical activity. This indicator may be able to demonstrate whether participation at leisure

centres is increasing or decreasing but it is unable to demonstrate whether, for example, increases are related to active people

becoming more active or whether sedentary individuals are starting to become more physically active. The measure does not describe

the frequency of attendance of individuals; neither does this measure

relate to intensity, duration or type of physical activity. Changing participation at leisure centres may also be offset by opposite

changes at other times or locations (e.g. private gyms or pools) for given individuals.

4.5.3 Swimming

The WLGDU holds data by local authority swimming pool on the numbers

of paid swims for those 17 years and over (Appendix A 12:)

The Data Unit has collated data in relation to the Free Swimming Initiative

(FSI); this demonstrates trends in numbers of free swims in different target groups (for example, the over 60s). It does not identify changes in

frequency, intensity, duration or type of activity at the level of the

individual. Therefore it is difficult to ascertain the contribution of swimming to physical activity.

The evaluation of the FSI by Sports Wales in 200826 does hold some information over and above that held by the WLGDU. This has been

collated from surveys of target groups, Local Authority managers and officers, pool managers and disability support officers, and from case

study research and focus groups of non-participants of the 60+ scheme.

36

In terms of impact on physical activity in the 60+ group the evaluation

notes:

“82% of managers reported (2006 survey) that the scheme was

attracting newcomers and 92% thought it has led to an increase in frequency of swimming amongst existing users. The user survey

undertaken during June 2005 emphasised that the majority of participants were existing swimmers who were increasing their physical

activity levels. It showed that 79% were existing swimmers and 21% had not swum regularly prior to the FSI.”

However, the evaluation also notes that latent demand for swimming among people aged 60+ is low, at 8%.

4.5.4 Membership of sports clubs and bodies

Sport Wales aims to collect National Governing Body data for a number of sports annually. Data for the sports of athletics, gymnastics, hockey,

swimming, netball, and golf was last collected in 2010. Data for the sports of rugby, football, tennis and cricket were last collected in 2009.

Typical data held are number of clubs, number of active coaches and officials, membership, information on the coach and official education

workforce and performance at significant events. Usability of these data in robust indicators is unknown.

4.5.5 Sports Facilities and workforce

Sport Wales have a built facilities database that has continuous data

collection and can be analysed to give data on sports facility provision by

Local Authority.25 The database holds information on sports halls, swimming pools, squash courts, indoor tennis courts, indoor bowls halls,

indoor athletics facilities, health and fitness facilities, studios, dry ski slopes, ice rinks, golf courses, outdoor tennis courts, outdoor bowling

greens, athletics tracks and synthetic turf pitches. It does not, however, give a picture of sports pitches and playing fields across Wales.

The Living in Wales surveys (Appendix A 4:) asked questions about usage, access and satisfaction with local sports and leisure facilities and

membership of community groups. Questions for the successor National Survey for Wales are not yet finalised (Appendix A 5:).

Sport Wales‟ National Governing Body data includes information on numbers of coaches and officials and on the coach and officials education

workforce.

A discussion has been opened with Cyclists‟ Touring Club (CTC) to

ascertain whether there are any data on the number of cycle instructors.

37

Such data is held in a database hosted by the Department of Transport

and it has not been possible to access or collate this data within the timeframe of this report. A representative of CTC is currently also trying

to collate data on the quantity of training delivered under Bikeability in Wales. Not all Local Authorities participate in the scheme currently.

4.6 Equality group data from identified sources

4.6.1 Local authority data

WLGDU performance indicators do not include information on equality

groups.

Swimming data from the Data Unit can be stratified by gender and by age bands for under 16 year olds and for those who are 60+. There is

information relating to number of disability sessions attended within free structured activity programs at leisure centres. The Data Unit

have indicated that ethnicity may be collected in the future. However,

reporting mechanisms in Local Authorities would need to be able to capture such data. This not currently the case.

The evaluation of the Free Swim Initiative by the Sports Council26 has

some insight, albeit not quantitative data, on inclusion of „hard to reach‟ groups. The evaluation notes that in the 2006 Centre Manger‟s

survey:

o Fewer than half respondents reported that proactive steps had been taken to attract children with disabilities

o Just over half (54%, n=77) believed that FSI was effective in attracting children from Communities First areas

There are a number of data sources to describe adult involvement in sport,

However, many are limited in their ability to provide a systematic picture of involvement in sport across the entire population as they are based on use

of facilities or membership of clubs rather than population based measures. The Active Adults survey is a good potential source on which to base an indicator although continuity of data to develop trend analysis is

problematic. The survey asks respondents to pick from a wide range of sports activities in which they participate, helping to build up a picture of

uptake of different sports across Wales.

38

o 11 Local Authorities had targeted specifically free swimming

provision for children and young people from disadvantaged backgrounds

o Only two Local Authorities, Cardiff and Swansea have emphasised provision for children from ethnic minority backgrounds.

4.6.2 Disability Sports Wales – Community Programme

Disability sport data is collated in each Local Authority on a 6 monthly

basis (Appendix B). Quality of data have not been assessed but may be variable across Wales.

4.6.3 Sport Wales

Information on age, gender, ethnicity and disability are generally

collected in Sport Wales surveys and there is a dedicated database collating data on disability sport, although no published reports could be

found on the Sport Wales website. Sample sizes are unlikely to be sufficient to allow detailed breakdown of information by equality groups,

particularly where numbers of respondents from these groups are small.

4.6.4 Welsh Government

There are limited data on equality groups for the six indicators for the

Walking and Cycling Action Plan. There would be none available relating to the National Travel Survey indicator. The Labour Force Survey may be

stratified by gender. For walking to work it is possible to examine the data by gender, however for cycling to work, the low numbers of women

cycling make analysis unreliable. Neither of these surveys is thought to be able to provide information in relation to ethnicity or disability.

Rights of Way Improvement Programme funding is contingent on Local Authorities demonstrating evidence of a project involving low user groups.

There may be ways of exploiting data from these projects but currently

these are not collated.

4.6.5 Sustrans

There are no data relevant to equality and diversity.

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4.6.6 Countryside Council for Wales (CCW)

Data are collected on age, gender, ethnicity, disability, income, education, employment status and car ownership. Analysis of these data are

probably only available at national level. The sample size is too small to be able to access useful data in relation to ethnicity. Data on disability is

normally linked to age of respondent.

4.6.7 Play Wales

There are no data relevant to equality and diversity.

4.7 Benchmarking performance against other countries

International comparisons are complicated by differences between

national definitions and data collection methods. There are few internationally co-ordinated studies using standardised methodologies and

measurement instruments.

4.7.1 Systems including Welsh data

Welsh Government Statistics for Wales recently released a report on international comparisons for Wales.30 The report includes international

comparisons for pedestrian road casualty fatalities and child (0-14) pedestrian road casualty fatalities using data from 2008. Latest figures

relating to Great Britain are available from the Department for Transport.

This report also compares figures on adults who participate regularly in sport, excluding walking (2009).

4.7.2 World Health Organisation (WHO)

The World Health Organisation (WHO) has developed a framework to

monitor and evaluate its global strategy on diet physical activity and health.24 The framework includes suggestions for process, output and

outcome indicators.

A variety of data are collected in relation to physical activity and equality

groups, however little survey data is published with this stratification. This is likely to be because of the small sample sizes for equality groups within

survey responses. Further work is needed to assess the reliability of survey data in relation to these groups.

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The WHO document also gives some advice on tailoring indicators to

different national settings.

4.7.3 European Physical Activity Surveillance System (EUPASS)

European Physical Activity Surveillance System (EUPASS)31 2001 noted in 2001 that data on physical activity available at national levels were not

directly comparable at the European level. The UK data related to the Health Survey for England as opposed to the Welsh Health Survey.

EUPASS pointed to the use of the International Physical Activity Questionnaire (IPAQ) as one way of overcoming this. The report

highlighted difficulties in implementing IPAQ across Europe, including the potential loss of trend data for individual countries. Validity and reliability

studies would need to be carried out in each country before a new surveillance instrument could be utilised. The authors highlighted that

measuring health-enhancing physical activity should encompass the four key dimensions of frequency, intensity, duration and type of activity.

They also suggested the following dimensions to be considered as additional indicators include:

Physical activity related self-efficacy Physical activity related social support

Physical activity related opportunities (through policy and environment).

4.7.4 European Health Indicators

Making way for a healthier lifestyle in Europe: a list of indicators (2003),32

the summary report of the project Monitoring Public Health Nutrition in Europe, gave the following information on physical activity indicators:

Indicator: PHYSICAL ACTIVITY LEVEL AND PATTERN

Operational measures:

Total amount of activity expressed either as activity energy

expenditure (kcal, Joules, MET mins, etc) or physical activity level

(PAL) Time (mins/day or week) spent at health enhancing physical activity

level (i.e. activity at moderate and vigorous intensity levels) Time (mins/day or week) spent sitting.

Justification: Physical activity is a complex behaviour. Any activity can be

described in terms such as intensity, frequency and duration, and these dimensions must be considered. An assessment methodology should also

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consider inactivity, such as time spent sitting. Physical activity can be

related to work, transportation, home and leisure time. The activities at either of these domains may have specific health consequences, and

advanced monitoring should also consider these.

Indicator: ENVIRONMENTAL DETERMINANTS FOR PHYSICAL

ACTIVITY

Justification: There is increasing interest in the contextual

(environmental) barriers that prevent or