Impact of community led intervention on reducing health inequalities relating to physical activity & healthy eating

Siu-Ann Pang and Judy Kurth,NHS Stoke on TrentGemma Hurst, Graham Smith, Rachel Davey and Sarah Grogan, Staffordshire UniversityWednesday 21 October 2009

Context - Drivers

WHO Healthy City Phase 5 status

Health Inequalities Strategy

Local Agreement Targets: adult physical activity and obesity

Common themes

Need to address wider social determinants more systematically

Impact of where we live/ the environment influencing and impacting on our ability to choose and adopt healthier lifestyles

Community engagement – communities as agents for change

- Ecological Approach - - Community Participatory Research -

My Health Matters

CDW for Health – pilot in 3 areas in Stoke (Bentilee, Burslem South and Meir North)

3 Year Targets:

- 9000 individuals engaged,

- 3000 increase in physical activity to 3x30min over a 4-week period,

- 1800 increase of at least 1 portion of fruit and vegetables per day.

Programme Objectives

Use community participatory research to build effective community partnership & strengthen community “engagement” in their own health,

Based on partnership consensus, identify, prioritise and design intervention(s) related to specific health disparities (and their relevant determinants, mediators),

Recruit local residents to help with the delivery and sustainability of the target intervention(s),

Establish systems for ongoing monitoring and evaluation and overall impact on social capital and health inequalities.

Programme Phases

Phase I: Baseline mapping (GIS) - built environment integrated with community postal survey.

Phase II: Develop effective partnerships.

Phase III: Community intervention mapping: identify, prioritise and design pragmatic intervention(s) to address wider environmental determinants.

Phase IV: Evaluate intervention(s) and determine impact

(follow up GIS, survey & focus groups).

Outcome Measures

Indicators will include;

Change in levels of physical activity, healthy nutrition and better health.

Number of environmental barriers identified and addressed, change in neighbourhood perceptions and social capital.

Number of community and voluntary sector organisations that have increased awareness and understanding of the relationship between healthy lifestyles and the urban environment.

Number of staff trained in participatory methodologies across the Local Strategic Partnership.

Phase 1; Baseline Findings

Neighbourhood Mapping; Study Areas Data Collection Summary of Findings

Community Survey; The Questionnaire Positive Neighbourhood Characteristics Negative Neighbourhood Characteristics Physical Activity and Healthy Eating Summary of Findings

Neighbourhood Mapping;E.g. Burslem South

Neighbourhood Mapping across 4 out of 8 Lower Super Output Areas within the ward.

1,132 residential addresses mapped.

Neighbourhood environment measured around each address.

Lower Super Output areas have a population of approximately 1,500.

Data Collection – GIS Indices

Residential Population – address location and density Physical Activity Facilities / Green Space Commercial Outlets – Food Outlets (by type) Roads and Pathways (street connectivity) Land Use mix

Road Traffic levels Road Accidents (especially pedestrians) Crime and Anti-Social Behaviour

Area defined within 1km of the residential addresses mapped within the study area.

All environment data collected and mapped within this area.

Data Collection Area;E.g. Burslem South

Neighbourhood Mapping; Findings

Selected GIS Indices;

Access to Green Space

Commercial Outlets – Food Outlets (by type)

Access to Physical Activity Facilities

Access to Green Space

Green Space mapped by:

- Size- Access- Purpose- Quality

Green Space Access Points mapped.

Walking distance measured from every residential address to every green space access point.

Access to Green SpaceSummary of Results

Overall there is a high level of access to green space across Burslem South, Bentilee and Townsend, and Meir North study areas.

96.1% (Burlsem South), 67% (Bentilee and Townsend) and 76.5% (Meir North) of households are within 300m of green space with unrestricted access.

43.6% (Burlsem South), 4% (Bentilee and Townsend) and 0% (Meir North) of households are within 300m of ‘excellent quality’ green space.

Access to Shops and Services

Shops and services mapped by type.

Food outlets mapped by:- Food eaten on premises- Food eaten off premises (fast food)- Food Retail (including fresh food)

Walking distance measured from every residential address to every shop/service.

Access to Fast Food / Fresh Food (500m)Summary of Results

Burslem South 98.6% of households within 500m of a fast food outlet. Only 21.3% are within 500m of a fresh food retail outlet.

Bentilee and Townsend

79.9% of households within 500m of a fast food outlet. Only 32.6% are within 500m of a fresh food retail outlet.

Meir North 68.8% of households within 500m of a fast food outlet. ‘None’ are within 500m of a fresh food retail outlet.

Access to Physical Activity Facilities

Physical Activity facilities mapped.

Includes locations where activity currently takes place & locations which have the potential to facilitate physical activity

Walking distance measured from every residential address to every facility.

Access to PA Facilities within 1kmSummary of Results

Burslem South 89.5% of households are within 1km of between 2 and 4

known physical activity facilities. (100% for at least 1).

Bentilee and Townsend

Only 22% of households are within 1km of between 2 and 4 known physical activity facilities. (92% for at least 1).

Meir North A very low 3.2% of households are within 1km of between 2

and 4 known physical activity facilities. (53% for at least 1).

Key Findings – GIS mapping

Lack of access to fresh food outlets,

Relatively large areas of green space – but lack of quality, functionality and properly “maintained/managed” green space,

PA facilities are within walking distance for some, but most are not within walking distance. PA facilities need to be better utilised.

Baseline Community Survey

General Health (SF12v2) – including Physical & Mental Health,

Neighbourhood Environment Walkability (ANEWS) – including land use mix, street connectivity, infrastructure and safety for walking, aesthetics, traffic hazards, crime, lack of parking, lack of cul-de-sacs, hilliness & physical barriers,

Social Capital – investment in the local community, including, enjoyment, trust and reciprocity & participation,

Physical Activity (IPAQ) – including the contribution of different domains to total weekly physical activity (work, active transport, garden & domestic, & leisure),

Healthy Eating – Fruit & vegetable consumption.

Positives; Land-Use-Mix

< 5 minutes walk Burslem South > 30 minutes walk

Bus stopConvenience storeFast-food restaurant Local park

54.8%49.6%33%

29.6%

Workplace / place of studyGym / leisure centre Post office Large supermarket

26.1%25.2%20.9%18.3%

< 5 minutes walk Bentilee and Townsend > 30 minutes walk

Bus stop Convenience store Fast-food restaurant

49%46.7%33.3%

Non fast-food restaurantGym / leisure centre Local park

57.3%47.3%16.7%

< 5 minutes walk Meir North > 30 minutes walk

Bus stop Convenience store School

55.1%42.3%39.7%

Local parkGym / leisure centre Large supermarket

61.5%56.4%34.6%

Negatives; Aesthetics

Physical Activity; Domains

Physical Activity; Recommendations

International Physical Activity Questionnaire (IPAQ) (Categorical Scoring);

Moderate Physical Activity;> 5 days of moderate-intensity activity or walking of > 30 min / day.

33% (Burslem South), 30% (Bentilee and Townsend) and 24.4% (Meir North) of respondents were participating in moderate physical activity. ~70% of the population are not meeting recommended level of PA.

Key Findings – Survey (1) General Health (SF12); - Lower than average physical and mental health scores.

Neighbourhood Environment Walkability (ANEWS); - Positive characteristics; Land-use-mix (access & diversity),

infrastructure and safety for walking, - Negative characteristics; Aesthetics, traffic hazards & crime.

Social Capital;- Three-quarters enjoyed living in their area with individuals on

average living in the area for over 20 years,- Low perception of trust and reciprocity,- One-third participated in groups or organisations,- Perceived access to leisure facilities is poor,- Perceived problems with teenagers and vandalism in the area.

Physical Activity (IPAQ); - Sixty-percent of total weekly PA, for each ward, comes in the

form of work-related PA.- One-quarter of total weekly PA from garden and domestic

activities,- Active transport and leisure time PA accounted for the lowest

contribution to weekly PA,- 24-33% of respondents were taking part in moderate weekly

PA.

Healthy Eating ; - Approximately 70% of respondents were not meeting the

recommendations for daily consumption of fruit and vegetables.

Key Findings – Survey (2)

Next Steps

Use Community Intervention Mapping to address key areas of the environment that can be modified, for example;

1. Increase access to fresh produce (community allotments, fruit and vegetable door-to-door delivery, social enterprise)

2. Improve quality and functionality of green space and facilitate PA for segmented groups i.e. families and youths

3. Optimise use of local community venues for PA/exercise and provide more local provision for PA

4. Look at traffic calming measures in key areas

Overall aim is to create built and natural environments that support healthy behaviour.

Acknowledgements

Stoke Primary Care Trust

Area Implementation Teams – Stoke City Council

Stoke-on-Trent Healthy City Partnership

Transport Planning Stoke City Council

VAST and Changes – voluntary sector

Local Strategic Partnership