INTRODUCTION: An Overview of WHEELING WALKS

Background of the Campaign

The WHEELING WALKS Campaign Message

Engaging the Community

Goals and Objectives

Assessing Success--Evaluation Methodology

Project Timetable

Specifics of the 8-week Campaign

Booster Campaigns

Outcomes

Significance

Cost Effectiveness

Principal Personnel

References

 a program
of

West Virginia University
Department of Community Medicine 

and

The Wheeling-Ohio County Health Department
with financial assistance
from

The Robert Wood Johnson Foundation
The West Virginia Bureau for Public Health
The Claude Worthington Benedum Foundation
WesBanco
Wheeling Hospital
Ohio Valley Health Services and Education Corporation

TRAINING MANUAL
 made possible with a grant from the
Osteoporosis Prevention Education Program
WV Bureau for Public Health

INTRODUCTION

WHEELING WALKS

WHEELING WALKS was designed to promote and sustain moderate intensity walking among sedentary and irregularly exercising 50 to 65-year-old adults.  Different from other community interventions, the campaign had a targeted message: Walk at a moderate pace for at least 30 minutes daily.  WHEELING WALKS used extensive paid television, radio, and print ads, public relations,* local public health activities, policy and environmental changes.

The program name, WHEELING WALKS, reflects the fact that the campaign was piloted in Wheeling, West Virginia, a community of 32,000 residents.  Similar names could work as well for other communities, e.g., PHOENIX WALKS, ALBANY WALKS, or KAUAI WALKS.

Background -- The WHEELING WALKS Campaign

The lack of physical activity contributes significantly to death and disability in the United States.^1-4  Physical inactivity alone annually accounts for approximately 200,000 deaths.⁵  Current public health guidelines that recommend moderate intensity and duration of physical activity on almost every day ^l-4 are effective in improving cardiovascular mortality and risk factor profiles for all ages.^6,7  Programs focused on individual behavioral change have been shown to be effective.  However, community-based health promotion and disease prevention programs designed to lower the prevalence of cardiovascular disease risk factors in target communities ^8-16 have had only limited effects.^{17, 18}  Further, the cost and complexity of these programs make them difficult to reproduce.^19-21  Therefore, while public health professionals may well know what needs to be done to remove the risk of ill health, public health intervention strategies designed to cost effectively promote physical activity by changing the behavior of entire communities remain underdeveloped ²² and may require a new approach.

Current literature indicates that interventions in the past 15 years have not made a major difference in increasing physical activity.  All these previous studies have used excellent scientific designs, but the net contribution to population wide physical activity change has been very modest.  Moreover, much of the intervention work has been conducted with highly motivated, self-selected, volunteer samples, and is not generalizable to less motivated, everyday people as is found in communities throughout the world.

This project combines the elements essential to making it a successful “new approach.”   This approach empowers the local community to address their community problem (sedentary lifestyle), uses a targeted physical activity message (walk 30 minutes daily) in an intensive eight- week media-based intervention, and incorporates strategies to promote policy and environmental changes.  While innovative in nature, the intervention is fully consistent with other population based health promotion frameworks used to promote physical activity.  We integrated Transtheoretical/stages-of-change theory and Theory of Reasoned Action/Planned Behavior with social marketing and a strong community wide intervention approach to produce powerful outcomes.

*Since public relations are designed to have the campaign message delivered on local news programs, some people refer to this as “earned” or free media.

The WHEELING WALKS Campaign Message

Drawing from the best available international research on the promotion of physical activity across an entire community, we knew that it was important to: (1) use mass media, (2) target the physical activity message, (3) focus on a specific high-risk group (sedentary and irregularly exercising adults, 50 to 65 years of age), and (4) take a population approach.

Field staff used the Theory of Reasoned Action and Planned Behavior to determine the exact words and actions to use in the television, radio, and newspaper ads.  Toward this end, extensive qualitative and quantitative research was conducted .  This process is further explained in the insert below and in Preventive Medicine, September, 2002;353:285-292.  

Developing an Effective Campaign Message This was both a technical and a creative endeavor. It involved formative research in the form of three discrete tasks that guided message development and tested the final message to be used in the campaign. The TV, radio, and print ads were produced by Zimmerman & Markman, Inc., a ad development agency located in Los Angeles. To guide the message content for Zimmerman & Markman's ad development, the constructs of the Theory of Reasoned Action and Planned Behavior were utilized23-26 and an elicitation survey (Task I), quantitative survey (Task 2), and qualitative pre-testing of story boards (Task 3) were conducted; Task 1 - The Elicitation Survey was designed to identify salient psychosocial factors about moderate-intensity walking by two groups of people in the contemplation and preparers stages of change: (1) those who are sedentary or irregularly active ("non-doer"), and (2) those who are currently regularly walking ("doer"). The survey was conducted during October and November of 2000 with 20 volunteer "doers" and 20 volunteer "non-doers" aged 50-65, recruited from the target population. Specifically, participants provided written responses about behavioral, normative, and control beliefs related to walking 30 minutes on almost every day. The responses for each belief were then coded by trained technicians. From these results the Task 2 survey were created. These included all unique behavior belief statements, all unique norm belief statements, and all unique control belief statements. Task 2 - Quantitative Survey identified which psychosocial factors differentiate "doers" from "non-doers" to aid in message development. A total of 150 volunteer "doers" and 150 volunteer "non-doers " in the target population, approximating the demographic of the intervention community population, were recruited for participation in this task. As an incentive to participate, each person completing the survey received $10. The volunteers first completed a standardized survey measuring behavioral belief, subjective norm, perceived control, intention, and stage of change for regular physical activity. They then provided responses on a Likert Scale to all belief statements generated during the Elicitation Survey (Task 1). Mean scores were computed for each belief statement. Belief statements at one standard deviation above or below the mean (i.e., the most intensely favorable and unfavorable items) were selected. The selected items were reviewed by our regional public relations consultant and then provided to Zimmerman & Markman with a recommendation that they use the most intense beliefs to construct the television ad messages.

Engaging the Community and Ensuring Adequate Help to Conduct the Campaign

A key to the success of the WHEELING WALKS campaign was community involvement.  From its inception, interested community members were involved in designing, implementing, and evaluating the campaign.  The intervention had a distinct community ownership. 

A five-member steering committee helped the principal investigator to identify potential supporters and advisory committee members.  More than 50 interested individuals and agency representatives were contacted, with 37 participating in a special 12-week Community Participatory Planning Program (see Chapter 3). 

Goals and Objectives

Our media-based community physical activity campaign intended to:

1. effectively communicate the walking message to 85% of the target population;
2. increase regular moderate-intensity walking behavior in the target population by 10%;
3. effect community ownership for the campaign;
4. effect environmental and policy changes supportive of regular moderate intensity walking;
5. effect population wide positive changes in attitudes, beliefs, and intentions about walking, and sustain the community and population changes at six and twelve months post-intervention.

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Assessing Success--Evaluation Methodology

Two measures were used to determine the impact of the campaign on the community:(1) telephone surveys, and (2) behavioral observations, in both Wheeling and in a comparison community (where there was no campaign).   There were four evaluation periods: before we started the campaign (baseline), immediately after the intensive eight-week intervention (immediately post-intervention), and at six month and twelve months post-intervention.  The evaluation framework is briefly explained in the insert below.

WHEELING WALKS Evaluation Methodology Two methods used to evaluate the campaign: (1) a telephone survey questionnaire was constructed in order to measure physical activity and walking habits in a random sample of 1,500 adults, 50-65 years--750 in the intervention and 750 in the comparison communities. The survey was administered to the same individual on four different occasions: baseline, immediately post , six months post , and twelve months post-intervention. Standard CDC Behavioral Risk Factor Survey physical activity questions were incorporated in order to determine total physical activity. Stage-of-change questions were used to determine interviewee stage in relation to physical activity and walking behavior. Also, additional questions were added to assess both knowledge and impact of the campaign message. (2) trained observer counts of the number of adult walkers for two hours per day for one week at baseline, immediately post-, six months post , and 12 months post-intervention in both communities. The observations extended for a total of 14 hours per week at five predetermined popular walking sites, for a total of 70 hours at each time point for each of the two communities. Observers recorded: (1) total number of walkers, (2) gender of walkers, (3) number walking alone, (4) number walking in a group. Observers did not differentiate walkers based on pace. For data analysis, walking observation data were analyzed using a repeated measures ANOVA with four time periods (baseline, immediately post intervention, six months post , 12 months year post-intervention) as the within group factor, and city as the between-group factor. A specific contrast test within the repeated measures analysis was conducted. The telephone survey questionnaire data was analyzed by conducting z tests on the difference between proportions. Tests of statistical significance were determined by use of chi square analyses. For all analyses, two tailed tests were used with 0.05 as the alpha level. All analyses were performed by the statistical package SYSTAT.

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WHEELING WALKS Project Timetable

Our intervention was a four-year (1999-2002), three-phase project.  The activities of each phase are:

PHASE ONE (July 1,1999 to June 30, 2000) – Conduct a Community Participatory Planning Program, establish a community advisory committee, pursue grant sources, select media producers, developing protocols, and identify staff and consultants.

PHASE TWO (July 1, 2000 to March 30, 2001) -- Conduct formative research; produce the campaign ads (two 30-second television ads, two 60-second radio ads, and two print ads); develop informational materials; plan for public relations and community-based educational activities; and finalize the evaluative framework for the campaign.

PHASE THREE (April 1, 2001 to December 31, 2002) -- Implement and evaluate the WHEELING WALKS media-based community walking campaign; data entry and analysis; interpretation of results; and preparation of the final report, articles, and replication package.

Specifics of the WHEELING WALKS Eight-Week Media-Based Campaign

The intensive eight-week campaign involved: (1) purchase of television, radio, and newspaper ads, (2) public relations activities to attract media coverage, thus reinforcing the campaign message, (3) other public health activities to offer social support and help effect a change in the social norm, and (4) establishing mechanisms for enduring policy and environmental changes.

1.  Television, radio, and print ads.  The number needed to be sufficient to enable at least 85% of the
     targeted adults in Wheeling to see the ads repeatedly in the eight-week period.  We bought and ran:

• 683 thirty-second paid TV advertisements on local network-affiliated stations rating points) and   1,164 thirty-second paid TV advertisements on local cable stations,
   
• 1,988 sixty-second paid radio ads on local stations (3,450 gross rating points),
   
• 14 quarter-page newspaper ads in local newspapers.

2.   Public relations activities to attract free television, radio, and newspaper coverage (news stories,
      interviews, talk shows, promotions, etc.) as a means of reinforcing the campaign message.  These
      included:

• In WEEK 1--a campaign kickoff press conference.
• In WEEK 3--a press conference of prominent physicians urging the community to walk.
• In WEEK 4--a mid-campaign press event giving an update on campaign’s progress.
• In WEEK 6--the Mayor’s Walking Cup, a two-mile noon-time walk to demonstrate that walking can fit into a busy schedule.
• In WEEK 7--promotion of participation in the “walking” division of the Ogden 20K Distance Classic, the premier athletic event in Wheeling for the past 26 years. 
• In WEEK 8--a campaign finale press conference.                                                                  
  
  All events were open to the public.  Special invitations were sent to the mayor; financial sponsors; local and state health department representatives; community leaders; representatives of minority communities; and local, state, and national government officials.  Special efforts were made to ensure that TV, radio, and newspaper reporters were present and covering each event.

3.  Public health activities provided for social support, helped effect a change in social norm, and provide
     additional opportunities for media exposure.  These included:

Worksite Wellness Walking Challenge--A four-week Worksite Wellness Walking Challenge   held throughout the community with 40 worksites participating.  Registered participants submitted weekly logs of minutes walked to the local worksite campaign coordinator. 

Physician “Prescriptions for Walking”--The Ohio County (Wheeling) Medical Society agreed to participate in this intervention.  Physicians were given “walking prescription” pads and asked to write prescriptions for their patients to walk 30 minutes or more on almost every day, as appropriate to the health status of the patient. 

United Way-type thermometer—Residents enrolled in the campaign and submit weekly walking logs (via the website, etc.).  The minutes were converted to miles (20 minutes was considered one mile), totaled, and displayed on a United Way-type campaign thermometer located in the Wheeling Waterfront Park.  Our goal was to log 25,000 miles for the 8-week campaign.  A local sponsor paid to have the thermometer displayed weekly on the evening news.

Mayor’s Walking Cup --During week six, a two-mile Mayor’s Walking Cup was held on the Wheeling Riverfront Trail.  One goal for this activity was the development of social support for walking and to demonstrate that moderate intensity walking can fit into a busy lifestyle.  A local industry sponsored the event.

Campaign website--The local coordinator worked with a community volunteer who designed and maintained the campaign website.  The website enabled community members to find out about the overall campaign, learn about local walking events, read about celebrity endorsements of the campaign, submit their minutes walked, and much more.  The website operate during the entire campaign and continues today (www.wheelingwalks.org).

Weekly media specials--The principal investigator wrote a weekly column on walking for the Sunday edition of the local newspaper, which has a regional subscription of 43,000.  The article was placed on the front page of the regional section and was accompanied by a picture. The Wheeling television station broadcasted weekly educational features on walking.

Other programs—Seven local health professionals were trained to give presentations about walking that emphasized fitness and health benefits.  Speakers addressed local residents in worksites, civic groups, and churches.  Approximately 1,000 community residents were reached by the volunteers.  In addition, church ministers were recruited to place information about the health benefits of walking in church bulletins.

4.  Policy and environmental changes began to be initiated.  These occur over years, not weeks or
     months.

WHEELING WALKS Booster Campaigns

As a means for reminding community members about the campaign and the benefits of walking, two one-month booster campaigns were implemented during the fifth and the eleven months of the campaign.

Fifth Month Booster Campaign

We developed a public relations campaign/earned media only campaign for month five of the intervention.  However, the unfortunate world events of September 11, 2001, eliminated this booster campaign. 

Eleven Month Booster Campaign

This booster included the purchase of 200 television ads, 370 radio ads, and one newspaper ad as well as four press events.  The 2^nd Annual Mayor’s Fitness Cup was held at the end of the booster campaign.

WHEELING WALKS Outcomes  (Immediately-Post)