Testing the effectiveness of community-engaged citizen science to promote physical activity, foster healthier neighborhood environments, and advance health equity in vulnerable communities: The Steps for Change randomized controlled trial design and methods

Exploring the Relationship between Built Environment Attributes and Physical Activity in Lower-Income Aging Adults: Preliminary Insights from a Multi-Level Trial

The built environment has been linked to physical activity (PA) behaviors, yet there is limited knowledge of this association among lower-income midlife and older adults who are insufficiently active. The present cross-sectional study utilized baseline data collected between October 2017 and November 2019 from a clustered randomized controlled trial to determine how built environment attributes were associated with PA behaviors among midlife and older adults (n = 255) residing in or near affordable housing sites (n = 10). At each site, perceptions of the built environment were collected and scored at the participant level via the abbreviated Neighborhood Environment Walkability Survey (NEWS-A), while objective built environment attributes were measured and scored by trained research staff using the Physical Activity Resource Assessment (PARA). Multiple PA behaviors-walking, total PA, and moderate-to-vigorous PA (MVPA) (min/wk)-were measured using the validated Community Healthy Activities Model Program for Seniors (CHAMPS) questionnaire. Adjusted linear regression models examined associations between NEWS-A measures and PA behaviors, and site-level correlations between PARA measures and PA behaviors were examined using Spearman's rank correlations. At the participant level, adjusted models revealed that a one point increase in the NEWS-A aesthetics score was associated with a 57.37 min/wk increase in walking (β = 57.37 [95% CI: 20.84, 93.91], p = 0.002), with a similar association observed for street connectivity and MVPA (β = 24.31 min/wk [95% CI: 3.22, 45.41], p = 0.02). At the site level, MVPA was positively correlated with the quality of the features of local, PA-supportive environmental resources (ρ = 0.82, p = 0.004). Findings indicate that participant- and site-level measures of the built environment may play a role in promoting PA behavior among this demographic and similar populations. Results also suggest that improvements in aesthetic attributes and street connectivity, along with enhancing the quality of local, PA-supportive environmental resources, may be effective strategies for promoting physical activity among lower-income midlife and older adults.

Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping

Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.

Recruitment and Retention Strategies for Underrepresented Populations and Adults With Arthritis in Behavioral Interventions: A Scoping Review

OBJECTIVE

To identify strategies used to recruit and retain underrepresented populations and populations with arthritis or fibromyalgia (FM) into behavioral programs targeting exercise, physical activity, or chronic disease self management.

METHODS

Five bibliographic databases were searched for articles published between January 2000 and May 2022. The search focused on strategies and best practices for recruiting and retaining underrepresented populations or populations with arthritis or FM into disease self-management or physical activity/exercise programs. Abstracts and full-text articles were screened for inclusion by 2 independent reviewers, and 2 reviewers extracted data from included articles.

RESULTS

Of the 2,800 articles, a total of 43 publications (31 interventions, 8 reviews, 4 qualitative/descriptive studies) met criteria and were included. The majority of studies focused on physical activity/exercise (n = 36) and targeted African American (n = 17), Hispanic (n = 9), or arthritis populations (n = 7). Recruitment strategies that were frequently used included having race- or community-matched team members, flyers and information sessions in areas frequented by the population, targeted emails/mailings, and word of mouth referrals. Retention strategies used included having race- or community-matched team members, incentives, being flexible, and facilitating attendance. Most studies used multiple recruitment and retention strategies.

CONCLUSION

This scoping review highlights the importance of a multifaceted recruitment and retention plan for underrepresented populations and populations with arthritis or FM in behavioral intervention programs targeting exercise, physical activity, or chronic disease self management. Additional research is needed to better understand the individual effects of different strategies and the costs associated with the various recruitment/retention methods in underrepresented populations and populations with arthritis.

Community Walks: a cluster randomized controlled trial of a multilevel physical activity intervention for low income public housing residents

BACKGROUND

Physical activity behavioral interventions to change individual-level drivers of activity, like motivation, attitudes, and self-efficacy, are often not sustained beyond the intervention period. Interventions at both environmental and individual levels might facilitate durable change. This community-based study seeks to test a multilevel, multicomponent intervention to increase moderate intensity physical activity among people with low incomes living in U.S. public housing developments, over a 2 year period.

METHODS

The study design is a prospective, cluster randomized controlled trial, with housing developments (n=12) as the units of randomization. In a four-group, factorial trial, we will compare an environmental intervention (E) alone (3 developments), an individual intervention (I) alone (3 developments), an environmental plus individual (E+I) intervention (3 developments), against an assessment only control group (3 developments). The environmental only intervention consists of community health workers leading walking groups and indoor activities, a walking advocacy program for residents, and provision of walking maps/signage. The individual only intervention consists of a 12-week automated telephone program to increase physical activity motivation and self-efficacy. All residents are invited to participate in the intervention activities being delivered at their development. The primary outcome is change in moderate intensity physical activity measured via an accelerometer-based device among an evaluation cohort (n=50 individuals at each of the 12 developments) from baseline to 24-month follow up. Mediation (e.g., neighborhood walkability, motivation) and moderation (e.g., neighborhood stress) of our interventions will be assessed. Lastly, we will interview key informants to assess factors from the Consolidated Framework for Implementation Research domains to inform future implementation.

DISCUSSION

We hypothesize participants living in developments in any of the three intervention groups (E only, I only, and E+I combined) will increase minutes of moderate intensity physical activity more than participants in control group developments. We expect delivery of an intervention package targeting environmental and social factors to become active, combined with the individual level intervention, will improve overall physical activity levels to recommended guidelines at the development level. If effective, this trial has the potential for implementation through other federal and state housing authorities.

TRIAL REGISTRATION

Clinical Trails.gov PRS Protocol Registration and Results System, NCT05147298 . Registered 28 November 2021.

Bringing Micro to the Macro: How Citizen Science Data Enrich Geospatial Visualizations to Advance Health Equity

Social and spatial contexts affect health, and understanding nuances of context is key to informing successful interventions for health equity. Layering mixed methods and mixed scale data sources to visualize patterns of health outcomes facilitates analysis of both broad trends and person-level experiences across time and space. We used micro-scale citizen scientist-collected data from four Bay Area communities along with aggregate epidemiologic and population-level data sets to illustrate barriers to, and facilitators of, physical activity in low-income aging adults. These data integrations highlight the synergistic value added by combining data sources, and what might be missed by relying on either a micro- or macro-level data source alone. Mixed methods and granularity data integration can generate a deeper understanding of environmental context, which in turn can inform more relevant and attainable community, advocacy, and policy improvements.

Better health through better housing - Current impact and future prospects of randomized trials

Safe and stable housing in integrated neighborhoods with access to basic amenities and social elements is indispensable for good health. Recent randomized controlled trials have demonstrated that improvements in the built environment have positive impacts on malaria, fall injuries, and gun violence outcomes. There are several challenges associated with performing studies that assess house improvement as an intervention for advancing human health and well-being, including ethical issues, lack of blinding, spillover effects, and differential behavior. Future research is warranted to evaluate the clinical benefits and cost-effectiveness of prototype houses or energyefficient prefabricated modular homes by employing more holistic strategies, such as integration of data analytics, peer support, and whole health coaching, addition of social contextual perspectives on mobile technology-supported community-based interventions, and combination of digital technology-informed community-engaged citizen science and participatory action programs with multi-sector partnerships. Gleaning stronger evidence from clinical trials and model-based economic analyses that ascertain the effects of multiple intersecting factors on individuals and communities would illuminate effective policymaking options in healthy housing and guide successful implementation of sustainable public health policies. Straightforward and cost-effective pathways should therefore be created based on highest-quality scientific data to lead the scaling up of novel housing interventions and capacity building for health-in-all-policies to support population health equity, thereby ensuring that everyone has access to housing and the chance to live a healthy and productive life.

Association between neighborhood physical characteristics and mental health among older adults in Spain

The aim was to assess the impact of neighborhood physical environment on mental health among non-institutionalized older adults. A cross-sectional analysis was conducted over a representative sample of 5,071 people ≥65 years from the Spanish National Health Survey. The survey included nine items addressing the self-perceived degree of discomfort due to neighborhood physical problems. Participants were categorized into groups with "no problems", "some problems" (somewhat discomfort on 1-4 items) and "many problems" (somewhat discomfort on ≥5 items or very much discomfort on ≥1 item). Mental health status was assessed using the General Health Questionnaire, consisting of 12 items assessing the severity of a psychological distress over the past few weeks. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated using logistic regressions. A dose-response association (p-trend<0.001) was found between living in neighborhoods with some (OR: 1.41; 95% CI: 1.14-1.75) or many problems (OR: 1.93; 95% CI: 1.55-2.42) affecting the physical environment with poor mental health of community dwelling older adults. Integrating and articulating health considerations into public policymaking regarding housing and the residential environment can have broad implications for healthy aging.

The "Our Voice" Method: Participatory Action Citizen Science Research to Advance Behavioral Health and Health Equity Outcomes

Citizen science research that more fully engages the community can systematically involve people from under-resourced groups to create practical health-enhancing improvements across physical, social and food environments. Exemplary health equity-focused outcomes include key health behaviors (e.g., healthy eating or physical activity) and community-level changes (e.g., public transit to food shops) that are central to health promotion while being demonstrably impacted by local environmental contexts. Yet, few examples of this approach are readily available for application within complex, community-based settings. In this paper, we present the Our Voice (OV) four-step method to demonstrate an integrated participatory citizen science approach and its usability for action-focused researchers and community health practitioners. In addition, we present a summary of the major research, processes, and community outcomes, with examples drawn from nutrition and healthy food access areas, among others. Finally, we explore the hallmark features of the OV method that effectively engage citizen scientists, empowering action and fostering solution-building across social and environmental structures impacting community health. Expanding research that marries participatory research philosophies with innovative citizen science methods, supported by systematic data collection, visualization, and delivery technologies, in turn provides a powerful toolkit for tackling local to global health equity challenges.

Our Voice NOLA: Leveraging a Community Engaged Citizen Science Method to Contextualize the New Orleans Food Environment

OBJECTIVE

We employed the Our Voice citizen scientist method using a mobile application (app) to identify and contextualize neighborhood-level features influencing food access and wellbeing in New Orleans, Louisiana.

DESIGN

A three-phase, multi-method study comprised of: (1) a researcher-assisted tag-a-long neighborhood walk (referred to as a 'journey') with the Discovery Tool (DT) app to document neighborhood-level features via geo-coded photos and audio-recorded narratives; (2) a post-journey interview to enable citizen scientists to share their lived experiences; and (3) a community meeting with citizen scientists and local stakeholders.

SETTING

Various neighborhoods in New Orleans, Louisiana, USA.

PARTICIPANTS

Citizen Scientists (i.e., residents) aged 18 years and older.

MAIN OUTCOME MEASURE(S)

Features that influence food access and health behaviors.

ANALYSIS

Descriptive statistics and a thematic content analysis were conducted to assess survey and app data.

RESULTS

Citizen scientists (N = 14) captured 178 photos and 184 audio narratives. Eight major themes were identified: safety; walkability; aesthetics; amenities; food; health services; neighborhood changes; and infrastructure/city planning. The post-journey interview provided insights around the abovementioned themes. The community meeting demonstrated the willingness of citizen scientists and stakeholders to convene and discuss issues and relevant solutions.

CONCLUSIONS AND IMPLICATIONS

Findings demonstrate the ability of technology and citizen science to help better understand the complexities of New Orleans' past, present and distinct culture-and implications for food access and wellbeing in the context of trauma in an urban ecosystem.

Citizen Science Approach to Home Radon Testing, Environmental Health Literacy and Efficacy

Exposure to radon is a leading cause of lung cancer worldwide. However, few test their homes for radon. There is a need to increase access to radon testing and decrease radon exposure. This longitudinal, mixed-methods study using a citizen science approach recruited and trained a convenience sample of 60 non-scientist homeowners from four rural Kentucky counties to test their homes for radon using a low-cost continuous radon detector, report back findings, and participate in a focus group to assess their testing experience. The aim was to evaluate changes in environmental health literacy (EHL) and efficacy over time. Participants completed online surveys at baseline, post-testing, and 4-5 months later to evaluate EHL, response efficacy, health information efficacy, and self-efficacy related to radon testing and mitigation. Mixed modeling for repeated measures evaluated changes over time. Citizen scientists reported a significant increase in EHL, health information efficacy, and radon testing self-efficacy over time. While there was a significant increase in citizen scientists' confidence in their perceived ability to contact a radon mitigation professional, there was no change over time in citizen scientists' beliefs that radon mitigation would reduce the threat of radon exposure, nor was there a change in their capacity to hire a radon mitigation professional. Further research is needed to understand the role of citizen science in home radon mitigation.

The Role of Urban Environments in Promoting Active and Healthy Aging: A Systematic Scoping Review of Citizen Science Approaches

Promoting active and healthy aging in urban spaces requires environments with diverse, age-friendly characteristics. This scoping review investigated the associations between urban characteristics and active and healthy aging as identified by citizen science (CS) and other participatory approaches. Using a systematic scoping review procedure, 23 articles employing a CS or participatory approach (participant age range: 54-98 years) were reviewed. An inductive and deductive thematic analysis was completed to (a) identify local urban barriers and facilitators and (b) map them against the World Health Organization (WHO) Checklist of Essential Features of Age-Friendly Cities. A new Citizen Science Appraisal Tool (CSAT) was developed to evaluate the quality of CS and other participatory approaches included in the reviewed articles. A range of interconnected urban barriers and facilitators was generated by residents across the personal (e.g. perceived safety), environmental (e.g. unmaintained infrastructure), socio-cultural (e.g. cross-cultural activities), economic (e.g. affordable housing) and political (e.g. governmental support to migrant communities) domains. Mapping the barriers and facilitators to the WHO age-friendly checklist underscored the checklist's relevance and elucidated the need to explore barriers for migrant and cross-cultural communities and neighborhood development and alterations. The CSAT demonstrated strengths related to active engagement of residents and study outcomes leading to real-world implications. To advance the potential of CS to enrich our understanding of age-friendly environments, employing co-production to enhance relevance and sustainability of outcomes is an important strategy. Overall, employing CS highlighted the value of systematically capturing the experiences of older adults within studies aimed at promoting active and healthy aging.

The Role of Citizen Science in Promoting Health Equity

While there are many definitions of citizen science, the term usually refers to the participation of the general public in the scientific process in collaboration with professional scientists. Citizen scientists have been engaged to promote health equity, especially in the areas of environmental contaminant exposures, physical activity, and healthy eating. Citizen scientists commonly come from communities experiencing health inequities and have collected data using a range of strategies and technologies, such as air sensors, water quality kits, and mobile applications. On the basis of our review, and to advance the field of citizen science to address health equity, we recommend (a) expanding the focus on topics important for health equity, (b) increasing the diversity of people serving as citizen scientists, (c) increasing the integration of citizen scientists in additional research phases, (d) continuing to leverage emerging technologies that enable citizen scientists to collect data relevant for health equity, and (e) strengthening the rigor of methods to evaluate impacts on health equity. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.