Community Interventions to Promote Physical Activity

Abstract

Physical activity (PA) is an essential health-promoting behavior. Unfortunately, the majority of U.S. adults are not sufficiently active, and certain groups are even less likely to engage in regular PA. To increase population-levels of PA and resolve PA disparities, community interventions are needed to address multiple levels of a social ecological framework. The purpose of this dissertation research was to contribute to the knowledge about effective community interventions for PA, with a particular focus on the process of engaging community members to participate in the design and implementation of community interventions. The dissertation research was comprised of three studies. The first study was a systematic literature review of community-based participatory research interventions for PA. The major finding of the systematic review was that community participation was integrated rather inconsistently in the intervention process, but nearly all interventions were able to impact multiple levels of a social ecological framework. In the second study, a grounded theory approach was used to develop a theory of change for how a community coalition, Get Fit Kaua‘i, was able to create policy and environmental changes. This qualitative study was comprised of semi-structured interviews with a purposeful sample of 25 coalition stakeholders. The theory resulting from the interviews highlighted the importance of capacity building, the influence of community context, and the complementary programmatic activities that enabled built environment policy changes. In the third study, a secondary data analysis employed structural equation modeling to assess the cross-sectional association between perceived social and built environment factors with PA levels in a sample of 3,626 Hawai‘i adults. The resulting model confirmed that community interventions must address intrapersonal factors, along with modifiable factors in the built and social environments. Together, the dissertation studies contribute to the evidence supporting the utility of community interventions to promote PA. The studies reflect the challenges facing community interventions that seek to address the upper levels of policy and environmental change in the social ecological model. Based on the dissertation findings and study limitations, the final chapter provides practice implications and directions for future research.