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Concentrated effort needed when planning community-wide campaigns

By Sarah Wilcox, Dennis Shepard, Sarah Levin Martin, Leigh Ramsey Buchanan, and Robin E. Soler

This is an excerpt from Promoting Physical Activity: A Guide for Community Action, Second Edition, by the Centers for Disease Control and Prevention, David R. Brown, Gregory W. Heath, and Sarah Levin Martin, Editors.


Community-Wide Campaigns

A community-wide campaign is a concentrated effort to promote physical activity using a variety of methods delivered in multiple settings. As you may suspect, community-wide campaigns are not single events, short-term interventions, or small-scale endeavors. According to the Task Force on Community Preventive Services (Kahn, et al., 2002; Zaza, et al., 2005), community-wide campaigns involve many community sectors and partnerships, are large in scale and require high-intensity efforts with sustained high visibility, and use communication techniques to develop the physical activity campaign messages. Characteristics of community-wide campaigns are listed in the sidebar.

Unlike mass-media campaigns, community-wide campaigns have multiple components. Your community-wide campaign may include components such as self-help groups, physical activity counseling support, risk factor screening and education, community events, and policy or environmental changes such as the creation of walking trails (Kahn et al., 2002; Zaza et al., 2005).

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Community Guide Task Force on Community Preventive Services Recommendation for Community-Wide Campaigns

The Guide to Community Preventive Services (Zaza et al., 2005), which is usually referred to as the Community Guide, included 10 articles that examined the effectiveness of community-wide campaigns (Goodman et al., 1995; Jason et al., 1991; Luepker et al., 1994; Malmgren and Andersson, 1986; Meyer et al., 1980; Osler and Jespersen, 1993; Owen et al., 1987; Tudor-Smith et al., 1998; Wimbush et al., 1998; Young et al., 1996). Of these, all but three studies (Jason et al., 1991; Owen et al., 1987; Wimbush et al., 1998) were interventions designed to decrease cardiovascular disease morbidity and mortality in a community over several years. The fact that these interventions possess the potential to promote physical activity broadly among community members means that they may be used in diverse communities small and large. The Community Guide emphasizes that community-wide campaigns will need to be adapted to resonate with community residents who may include both genders, a wide range of age groups and abilities, different racial and ethnic groups, and different levels of socioeconomic status. For example, bilingual or multilingual materials may need to be developed to reach people who have limited abilities to speak and read English, or materials may need to be available to accommodate low reading literacy. Because community-wide campaigns may take place over the course of many months or years, you may also need to consider a wide variety of activities or events to accommodate the seasonal changes in weather. Relative to more targeted interventions, community-wide campaigns may require greater and more creative efforts on your part to reach the large and diverse population subgroups that characterize most communities.

The Community Guide reports that in studies that examined the increase in the percentage of physically active people, the median net increase was 4.2 percent. In studies that examined increased energy expenditure, the median net increase was 16.3 percent. Most of the community-wide campaigns also yielded improvements in other cardiovascular disease risk factors and contributed to building and strengthening social capital and social networks in the communities where they were implemented (Kahn et al., 2002; Zaza et al., 2005). Given the favorable effects on physical activity participation and energy expenditure, the Task Force on Community Preventive Services concluded that there is strong evidence to recommend community-wide campaigns to increase physical activity in communities (Zaza et al., 2005).

Update on Community-Wide Campaigns Research

Since publication of the Community Guide, a number of other relatively large-scale community-wide campaigns to increase physical activity have been published. These include the Stockholm Diabetes Prevention Program (Bjaras et al., 2001), Wheeling Walks (Reger et al., 2002; Reger-Nash et al., 2005), Agita Sao Paulo Program (Matsuda et al., 2002, 2004), 10,000 Steps Ghent (De Cocker et al., 2007, 2008), 10,000 Steps Rockhampton (Brown et al., 2006), Romsås in Motion (Jenum et al., 2006; Lorentzen et al., 2007), Burngreave in Action (Cochrane and Davey, 2008), and the largely mass media and social marketing VERB campaign (Huhman, Heitzler, et al., 2005; Huhman, Potter, et al. 2005; Wong et al., 2005). These campaigns have generally shown positive results, consistent with findings of the Community Guide.

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Application and Special Considerations

Community-wide campaigns use a range of methods to disseminate information and engage community partners in promotional or educational efforts focused on increasing physical activity. These methods may include several coordinated activities such as establishing walking groups at schools or work sites, building a new trail for walking and biking, or providing health risk appraisals and physical activity counseling at the local mall. Table 3.1 presents examples of activities that may be part of community-wide campaigns. If multiple activities are used as part of a community-wide campaign, they should be part of a comprehensive long-term plan. This type of plan ensures that a variety of methods will be connected by a common theme, such as reducing cardiovascular disease or increasing physical activity among middle-aged and older adults, and will be delivered in multiple settings over a sustained period of time. Community-wide campaigns also typically use a wide range of media as an ongoing part of the campaign. Typically, the campaign messages about physical activity are directed widely to large and relatively undifferentiated audiences through diverse media, including television, radio, newspaper columns and inserts, direct mailings, billboards, advertisements in transit stations, and trailers in movie theaters (Kahn et al., 2002; Zaza et al., 2005). Consider using different media outlets to ensure that your methods reach a broad cross-section of the community.

Across the various methods you and your partners use, consider adopting a logo, theme, or tag line to increase “brand recognition” and the visibility of your campaign. It is best to budget for a creative advertising firm to pilot test what is developed. An additional critical ingredient for you to consider during the development of your community-wide campaign is a plan for successfully sustaining as many aspects of the campaign as resources allow.

You will need to evaluate the effect of the campaign on the community. This is especially important because many of the community-wide campaigns that have been evaluated have addressed other cardiovascular disease risk factors in addition to physical inactivity (Pearson et al., 2001). This makes it difficult to tease out the outcomes associated with the different behavioral changes that may occur as a result of a multicomponent community intervention. Asking specific questions about physical activity and other targeted behaviors can provide valuable insight into whether people participate in your physical activity component and what benefits are obtained. For example, does the campaign increase community members’ readiness and willingness to become more active? Does it improve their knowledge, attitudes, and beliefs about physical activity? To what extent do community members participate? Does the campaign help community members become more physically active? As part of the evaluation, keep a record of the events you conduct, mass media efforts, and the reach of all these activities. For additional discussion on evaluating your physical activity intervention, see chapter 7.



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