Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design

The 'Double Risk' of Aging: Examining Vulnerability and (Un)supportive Built Environments in Canadian Cities

The confluence of rapid population aging and the overwhelming desire of older adults to age in place begs the question: Do our cities support the health and well-being of aging populations? Using a neighbourhood-by-neighbourhood approach, this macro-scale investigation explores the "double risk" that many older adults live with - the potential of being disadvantaged by socio-demographic risk factors (being older, living alone, low income) and by living in an unsupportive built environment. It is an integration of what we know about supportive built form for older adults and applies this knowledge to Canadian cities, using a spectrum approach to classifying built environments. We found that most older adults with socio-demographic risk factors are living in unsupportive built environments in Canada; however, the distribution between built environments along the spectrum and between municipalities reveals a variegated landscape of double risk. Previous research suggests that unsupportive built environments can be supplemented with services, small-scale improvements in the built environment, and larger-scale retrofitting of neighbourhoods. Since the spatial distribution of vulnerability varies greatly within the 33 Canadian cities analysed, it highlights the need for this kind of inquiry to target age-friendly policy interventions.

Modeling the resilience of urban mobility when exposed to the COVID-19 pandemic: A qualitative system dynamics approach

In December 2019, coronavirus disease (COVID-19) was detected in Wuhan, China. Due to the rapid spread of the disease, containment measures were adopted, which caused unprecedent shifts in individual mobility. Although some studies explored the impacts of the COVID-19 pandemic on travel patterns and resilience of transport systems based on different analysis techniques, there is a lack of studies addressing the impacts of the pandemic on the sustainability and resilience of urban mobility systems using in-depth and holistic methods, such as system dynamics. This research aims to characterize the dynamics present in urban mobility systems when exposed to pandemics and analyze the changes needed for systems to increase their resilience to pandemics using qualitative system dynamics modeling. The framework comprises the characterization of cause-and-effect relationships and the creation of systems' causal loop diagrams (CLD) in their basic state of functionality, when affected by pandemics, and still operating owing to its resilience. Our findings indicated that the CLD of a resilient system is driven by strategic preparedness and response plans, as well as research and development, which balance the spread of the pandemic and increase support on technological strengths and the activities performed from home.

Cross-Cultural Information for Japanese Nurses at an International Hospital: A Controlled Before-After Intervention Study

This study sought to evaluate the efficacy of providing health information through an ordinary travel guidebook combined with a short digital video compared with an ordinary travel guidebook alone by measuring the anxiety levels of Japanese nurses dealing with foreign patients. We conducted a controlled before-after intervention study in 2016 at a major international hospital in Japan. We created two interventions: (1) a brief piece of health information from a travel guidebook for Japan, (2) the same travel guidebook, and a four-minute digital video in English on health information in Japan, titled Mari Info Japan for nurses. After each intervention, we assessed the nurses' levels of anxiety about caring for foreign patients. We evaluated the results through statistical testing and the State-Trait Anxiety Inventory Form Y. Of 111 nurses, 83 (74.8%) completed both interventions and the questionnaires. The second intervention (the guidebook and video) proved more effective than the first (the guidebook) for reducing anxiety related to caring for foreign patients. Japanese nurses can lower their anxiety about dealing with foreign patients by learning about the content of various forms of health care information currently accessible to overseas visitors. Using both guidebooks and digital videos can help to reduce nurses' anxiety.

Evaluating physical activity interventions for socioeconomically disadvantaged adults through the RE-AIM framework: A systematic review of experimental and non–/quasi-experimental trials

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The review evaluated internal and external validity using the rE-AIM Framework.

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Results indicate an overall low reporting of validity factors.

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Information on adoption and maintenance was particularly low.

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Future studies should improve the reporting across all rE-AIM dimensions.

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Future studies should consider adaptations during the implementation phase.

The promotion of physical activity in people from lower social strata is a public health priority. Previous reviews of physical activity interventions among socioeconomically disadvantaged adults have focused on intervention effectiveness without considering their translation into practice. This review utilised the RE-AIM framework (Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance) to (1) evaluate the extent to which experimental and non–/quasi-experimental trials of interventions to promote physical activity among socioeconomically disadvantaged adults report on issues of internal and external validity and (2) to provide recommendations for future intervention studies.

Four databases were searched through June 2021. We included studies published in English or German since 2000 that tested physical activity interventions for socioeconomically disadvantaged adults. Two researchers coded all studies using a validated RE-AIM data extraction tool with 61 indicators referring to internal and external validity. Binary coding (yes = 1/no = 0) was applied to calculate the number and percentage of studies reporting each of the indicators.

We included 39 studies of which 22 were non–/quasi-experimental trials. Indicators of reach were most frequently reported (59.2%), followed by implementation (38.9%) and efficacy/effectiveness (28.9%). Dimensions related to external validity were least frequently reported (adoption: 21.9%, maintenance: 17.8%). Few differences were found between experimental and non–/quasi-experimental trials.

Analysis showed overall poor reporting of components related to internal and external validity. We recommend that future research should increase attention on reporting indicators of internal and external validity to facilitate their translation and implementation into real world settings.

Trial registration: The review was registered with PROSPERO (CRD42021283688).

A scoping review of systems approaches for increasing physical activity in populations

Introduction

The past decade has increasingly seen systems approaches as a featured theme in public health studies and policy documents. This trend is evident in the area of physical activity, which is a significant global health risk factor that is addressed in WHO’s Global Action Plan on Physical Activity. We undertook a comprehensive scoping review to characterize the application of systems approaches to physical activity, to develop a typology of the objectives, themes and methods of research papers that purported to apply systems thinking to this issue.

Methods

We searched electronic databases (PubMed, Web of Science, Scopus and PsycINFO) for studies published during the period 2010–2021 that explicitly applied systems approaches or methods to investigate and/or address population physical activity. A framework using systems-based methodological approaches was adapted to classify physical activity studies according to their predominant approach, covering basic descriptive, complex analytical and advanced forms of practice. We selected case studies from retained studies to depict the current “state of the art”.

Results

We included 155 articles in our narrative account. Literature reporting the application of systems approaches to physical activity is skewed towards basic methods and frameworks, with most attention devoted to conceptual framing and predictive modelling. There are few well-described examples of physical activity interventions which have been planned, implemented and evaluated using a systems perspective. There is some evidence of “retrofitted” complex system framing to describe programmes and interventions which were not designed as such.

Discussion

We propose a classification of systems-based approaches to physical activity promotion together with an explanation of the strategies encompassed. The classification is designed to stimulate debate amongst policy-makers, practitioners and researchers to inform the further implementation and evaluation of systems approaches to physical activity.

Conclusion

The use of systems approaches within the field of physical activity is at an early stage of development, with a preponderance of descriptive approaches and a dearth of more complex analyses. We need to see movement towards a more sophisticated research agenda spanning the development, implementation and evaluation of systems-level interventions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12961-022-00906-2.

Methods for Evaluating Environmental Health Impacts at Different Stages of the Policy Process in Cities

PURPOSE OF REVIEW

Evaluating the environmental health impacts of urban policies is critical for developing and implementing policies that lead to more healthy and equitable cities. This article aims to (1) identify research questions commonly used when evaluating the health impacts of urban policies at different stages of the policy process, (2) describe commonly used methods, and (3) discuss challenges, opportunities, and future directions.

RECENT FINDINGS

In the diagnosis and design stages of the policy process, research questions aim to characterize environmental problems affecting human health and to estimate the potential impacts of new policies. Simulation methods using existing exposure-response information to estimate health impacts predominate at these stages of the policy process. In subsequent stages, e.g., during implementation, research questions aim to understand the actual policy impacts. Simulation methods or observational methods, which rely on experimental data gathered in the study area to assess the effectiveness of the policy, can be applied at these stages. Increasingly, novel techniques fuse both simulation and observational methods to enhance the robustness of impact evaluations assessing implemented policies. The policy process consists of interdependent stages, from inception to end, but most reviewed studies focus on single stages, neglecting the continuity of the policy life cycle. Studies assessing the health impacts of policies using a multi-stage approach are lacking. Most studies investigate intended impacts of policies; focusing also on unintended impacts may provide a more comprehensive evaluation of policies.

Envisioning Happy Places for All: A Systematic Review of the Impact of Transformations in the Urban Environment on the Wellbeing of Vulnerable Groups

Urban planning and design can impact mental health, but it is unclear how ever-growing and changing cities can sustain the psychological wellbeing of vulnerable groups, who are among the most mentally sensitive to spatial inequalities. This systematic review synthesised quantitative and qualitative studies on urban design interventions and their impact on wellbeing in vulnerable groups. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched five online databases from inception to May 2020. A total of 10 papers were included. We found mixed evidence of benefits for wellbeing linked to urban regeneration projects or focused interventions (green spaces, transport, security). Interventions that were centred around participation, sustainable living, and quality of design (e.g., perceived sense of safety) were associated with increased residential satisfaction and wellbeing, particularly among low-income communities and women. Risk of bias was low to medium, but there was high methodological heterogeneity; studies were mainly from Western countries, and none of the included studies investigated the experiences of people with disabilities, migrants, or racial minorities. This review highlights the importance of inclusive and sustainable design interventions to create happy places for all strata of society, although further investigation is warranted.

Local-Indigenous Autonomy and Community Streetscape Enhancement: Learnings from Māori and Te Ara Mua-Future Streets Project

In settler countries, attention is now extending to the wellbeing benefits of recognising and promoting the Indigenous cultural identity of neighbourhoods as a contributing factor to more equitable and healthier communities. Re-indigenisation efforts to (re)implement cultural factors into urban design can be challenging and ineffective without the leadership and collaboration of local-Indigenous peoples. Undertaken in Aotearoa New Zealand, Te Ara Mua - Future Street project, demonstrated that co-design has critical potential in the reclamation of Indigenous autonomy, increased local-Indigenous presence and revitalisation of cultural identity. Employing a Kaupapa Māori (Māori-centred) research approach, we focused on the workings and perspectives of mana whenua (local-Indigenous peoples) and community stakeholder engagement in Te Ara Mua. An Indigenous theoretical framework, Te Pae Mahutonga, was utilised in the data analysis to explore perspectives of Indigenous collective agency, empowerment, and wellbeing. Our research demonstrates that developing capacity amongst Indigenous communities is integral for effective engagement and that the realisation of autonomy in urban design projects has broader implications for Indigenous sovereignty, spatial justice and health equity. Significantly, we argue that future community enhancement strategies must include not only re-designing and re-imagining initiatives, but also re-indigenising.

An ORBIT Phase 1: Design study of a citywide employer-based walking challenges in a predominantly Mexican American metropolitan area

Most Mexican-Americans do not meet current physical activity recommendations. This paper uses the ORBIT model of obesity intervention development as a framework to outline the process of establishing three employer-based walking challenges in El Paso, Texas, a predominantly Mexican American community. The walking challenges were planned and implemented through the Border Coalition for Fitness and participating partnering organizations. Over 2000 participants and several employers took part in the walking challenges. Results from this ORBIT Phase 1 design intervention suggest that walking challenges are a feasible approach to increase physical activity in Mexican-Americans.

Suburb-level changes for active transport to meet the SDGs: Causal theory and a New Zealand case study

The 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs) represent a historic global linking of health, equity and environmental sustainability. Accumulated evidence suggests that improving urban neighbourhoods to make them safer and more attractive for walking and cycling can accelerate progress towards the SDGs. The pathways to change are complex, non-linear and involve multiple pathways and multiple SDG outcomes, yet the SDG goals are often considered in isolation. Further, there have been few studies of environmental interventions for healthier transport that foreground equity. The aim of this paper is to describe and demonstrate practically how integrated interventions for placemaking and active transport can contribute to a wide range of SDG targets. First, we take an evidence-based approach to describing how such interventions are connected to targets within the SDGs. Second, we propose a complex causal theory of the pathways to change and the inter-relationships between SDGs. Third, we show, with concrete examples, how a case study project in Auckland, New Zealand illustrates these pathways, contributing to achieving the SDG targets, including barriers and challenges. We find that by addressing Goal 11 in particular ways that focus on equity (Goal 10), eight of the other goals can also be advanced. Our causal theory describes one balancing and 12 reinforcing patterns of behaviour that link interventions improvements to neighbourhoods with ten of the SDGs in a complex system. Our case study demonstrates that it is possible to successfully put this causal theory into practice through interventions, but these require strong partnerships between researchers, public health practitioners, policy-makers and communities, long-term evaluation and addressing both physical and social environments.

Built environment changes and active transport to school among adolescents: BEATS Natural Experiment Study protocol

INTRODUCTION

Natural experiments are considered a priority for examining causal associations between the built environment (BE) and physical activity (PA) because the randomised controlled trial design is rarely feasible. Few natural experiments have examined the effects of walking and cycling infrastructure on PA and active transport in adults, and none have examined the effects of such changes on PA and active transport to school among adolescents. We conducted the Built Environment and Active Transport to School (BEATS) Study in Dunedin city, New Zealand, in 2014-2017. Since 2014, on-road and off-road cycling infrastructure construction has occurred in some Dunedin neighbourhoods, including the neighbourhoods of 6 out of 12 secondary schools. Pedestrian-related infrastructure changes began in 2018. As an extension of the BEATS Study, the BEATS Natural Experiment (BEATS-NE) (2019-2022) will examine the effects of BE changes on adolescents' active transport to school in Dunedin, New Zealand.

METHODS AND ANALYSIS

The BEATS-NE Study will employ contemporary ecological models for active transport that account for individual, social, environmental and policy factors. The published BEATS Study methodology (surveys, accelerometers, mapping, Geographic Information Science analysis and focus groups) and novel methods (environmental scan of school neighbourhoods and participatory mapping) will be used. A core component continues to be the community-based participatory approach with the sustained involvement of key stakeholders to generate locally relevant data, and facilitate knowledge translation into evidence-based policy and planning.

ETHICS AND DISSEMINATION

The BEATS-NE Study has been approved by the University of Otago Ethics Committee (reference: 17/188). The results will be disseminated through scientific publications and symposia, and reports and presentations to stakeholders.

TRIAL REGISTRATION NUMBER

ACTRN12619001335189.

Systems thinking in the context of road safety: Can systems tools help us realize a true "Safe Systems" approach?

Purpose of review

Road traffic injuries are one of the leading causes of death in the U.S. and globally. We introduce the Safe Systems approach as a promising paradigm for road safety practice and describe how systems thinking tools can help bridge the gap between the current status quo and a Safe Systems approach.

Recent findings

Systems thinking tools can help us align with a Safe Systems approach by identifying latent risks in the transportation system, examining factors that coalesce to produce high travel speeds and kinetic energy transfer, and supporting safety prioritization through goal alignment.

Summary

The Safe Systems approach represents a significant change in the way we have historically designed transportation systems; it puts safety at the forefront and calls for designing a system that accounts for human fallibility. Operationalizing holistic Safe Systems concepts may be difficult, but systems thinking tools can help. Systems thinking tools provide a common language for individuals from diverse disciplines and sectors to express their unique understanding of the interconnected factors shaping road safety problems and support discussions about potential solutions that align with a Safe Systems approach.

System dynamics applications to injury and violence prevention: a systematic review

Purpose of review

System dynamics (SD) is an approach to solving problems in the context of dynamic complexity. The purpose of this review was to summarize SD applications in injury prevention and highlight opportunities for SD to contribute to injury prevention research and practice.

Recent findings

While SD has been increasingly used to study public health problems over the last few decades, uptake in the injury field has been slow. We identified 18 studies, mostly conducted in the last 10 years. Applications covered a range of topics (e.g., road traffic injury; overdose; violence), employed different types of SD tools (i.e., qualitative and quantitative), and served a variety of research and practice purposes (e.g., deepen understanding of a problem, policy analysis).

Summary

Given the many ways that SD can add value and complement traditional research and practice approaches (e.g., through novel stakeholder engagement and policy analysis tools), increased investment in SD-related capacity building and opportunities that support SD use are warranted.

Mortality from Homicides in Slums in the City of Belo Horizonte, Brazil: An Evaluation of the Impact of a Re-Urbanization Project

Background: Homicide rates in Brazil are among the highest worldwide. Although not exclusive to large Brazilian cities, homicides find their most important determinants in cities' slums. In the last decade, an urban renewal process has been initiated in the city of Belo Horizonte, in Brazil. Named Vila Viva project, it includes structuring urban interventions such as urban renewal, social development actions and land regularization in the slums of the city. This study evaluates the project's effect on homicide rates according to time and interventions. Methods: Homicide rates were analyzed comparing five slums with interventions (S1⁻S5) to five grouped non-intervened slums (S0), with similar socioeconomic characteristics from 2002 to 2012. Poisson regression model estimates the effect of time of observation and the effect of time of exposure (in years) to a completed intervention, besides the overall risk ratio (RR). Results: Using the time of observation in years, homicide rates decreased in the studied period and even more if considered cumulative time of exposure to a completed intervention for S1, S2, S3 and S4, but not for S5. Conclusions: Although the results of the effect of the interventions are not repeated in all slums, a downward trend in homicide rates has been found, which is connected to the interventions. New approaches could be necessary in order to verify the nexus between slum renewal projects and the reduction of homicide rates.