Healthy Town, healthier people? An investigation into changes in knowledge, attitudes

and behaviour in healthy living in a ‘Healthy Town’

intervention in England.

‘[Tewkesbury’s] like abroad’.

Diane Crone,

Professor, Exercise Science, University of Gloucestershire.

Co-authors: James, D.V.B., O’Connell-Gallagher, N., Mahoney, M. and Gidlow, C.

The problem…

Introduction

• Increasing concern regarding the public

health of the nation in the UK

• Range of programmes and interventions but

little impact on population based health and

behaviour change

• National initiative – Health Towns

• £30 million, 9 ‘healthy towns’ - complex

community interventions

Public health campaign

• Change4Life – family focus

• Hints and programmers

• TV advertisements

– Weight management

– Healthy eating

– Alcohol awareness

Healthy towns Programme

• 9 Healthy Towns

• Tewkesbury Town (18000 people)

• £2.2 million project over 2 ¼ years (Nov ‘08 – March ‘11).

Tewkesbury

Healthy Town Intervention

P A promotion

Healthy

FoodResearch

Transport

Research/evaluation questions

1. Changes (pre-during-post) in knowledge, attitudes and behaviour, and factors associated with any change (through longitudinal household survey of adults)

2. Engagement with individual interventions, and description of those engaging (through intervention attendance lists)

3. Experiences of CMI! (through interviews and focus groups focusing on families, young people and children).

Research Question 1 and Method

• RQ1: Changes (pre-during-post) in knowledge, attitudes and behaviour, and factors associated with any change (through longitudinal household survey of adults)

• Method

• Community Survey (June 2009/June 2010/April 2011)• Demographic data , e.g. age, gender, post code, employment

status, etc.

• Outcome measure data included: • Attitude, knowledge and behaviour in relation to the three areas

(PA, food, transport).

• Self reported data on wellbeing,

• 8000 homes, postal survey

Food Choices

Results – Food Choices

• Changes in knowledge of recommendations

of portions of fruit and vegetables per day

(31.7% of the aligned sample had improved

their knowledge)

• Changes in the consumption of portions of

fruit and vegetables per day (30.5% of the

aligned sample had improved their

consumption).

Physical Activity

Results – Physical Activity

• Changes in behaviour in two areas;

– physical activity, per day (in minutes)

(41.6% of the aligned sample had

improved the amount of physical activity

per day)

– spending (minutes) outside per day (44.6%

of the aligned sample had improved the

amount of minutes spent outside).

Transport

Cycle signs that include

length of time

and distance walking

and cycling

Findings - Transport

• Change in attitudes to cycling (perceptions

that Tewkesbury is suitable for cycling

improved in 41.9% of the sample).

• Changes in perceptions that Tewkesbury has

accessible Public Transport

• Change in the perceptions of the importance

of choice of transport for health and

wellbeing (33.53%).

Findings – Life satisfaction

• Perception of personal satisfaction

with life as a whole improved in

40.1% of the aligned sample

• Associations found for gender

where females were significantly

more likely to improve their

perception of personal satisfaction

with life as a whole.

RQ 2 and Method

• RQ2: Engagement with individual interventions,

and description of those engaging (through

intervention attendance lists)

• Method

• Individual Intervention Evaluation:

• Demographic data (age, post code [place of

residence/ward], gender, etc)

• Outcome measures, e.g. attendance and adherence.

Findings from RQ 2

• Total n=6139 attendances, with 3413 (62.9%) used in the

final analysis

• Largest proportion of attendances children (5-17 years)

and adults (30–49 years)

• More female than males (57.2% vs 37.4%)

• All five wards represented but attendances from two most

deprived wards were the highest (21.6% and 20.6%).

• Total attendances by theme

– environment and transport 51.8%,

– physical activity 26.0%,

– food theme 6.8%

RQ 3 and Method

• RQ3: Experiences of CMI! (through interviews and focus groups focusing on families, young people and children).

• Method:

• Focus groups and interviews (n=16) with ‘discreet communities’ including:• Family's – one from each ward (n=5)

• Young people - local youth club (n=1)

• Children (primary (y6) and secondary (y7) (n=2)

• Undertaken during Jan 2010 (pre intervention) and Jan 2011 (post(ish) intervention).

Findings - summary

• an increased awareness of the brand and of the

project:

‘I see it as encouragement to change to healthy, instead of

unhealthy.’

‘[town’s] people coming together and doing exercise’.

• changes in behaviour and attitude:

‘I can certainly see it [the town] becoming healthier,

because I do think attitudes change over time; people are

becoming more aware,…more people will be turning to

walking and cycling’.

Findings - summary

• increase in opportunities and health benefits:

• physical activity:

‘one thing we’ve found is having walked backwards and

forwards to school, we have actually found ourselves

being happier.’

• food choices:

‘It means like eating and being in a healthy lifestyle.’

• active transport:

‘there is a giant bike shed at my school where you could

fit at least 100 bikes in .... probably a couple of

hundred. It is pretty good.’

Conclusions

• Evidence of change in physical activity, time spent

outside, consumption of fruit and vegetables, and

behaviour regarding the use of the car.

• Knowledge of recommendations for fruit and

vegetables improved

• Participants had positive experiences of living in

Tewkesbury during the intervention period

• Residents in the five wards attended the

interventions in all three theme areas.

Complexities - a researchers observations

• Multifaceted intervention

• Postal survey…

• Measure/assess change in 18,000 people

• Capturing ‘broad range’ of lived

experiences

• Partnership working

• Budget…. £2.2m – but £50K for

evaluation

• Policital climate during and at end….

CMI! has demonstrated that:

• Large complex interventions: – Potential to engage communities, including those from

deprived areas,

– Facilitate improvements in health related behaviour,

knowledge and perceptions of life satisfaction.

• Further information (Evaluation Report and Exec

Summary) can be found at:

http://insight.glos.ac.uk/academicschools/dse/research/Pa

ges/Tewkesbury-LivingfortheFuture.aspx