An ecological approach to promoting health-enhancing physical activity in a deprived inner-city population

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Increasing population physical activity (PA) is a priority for improved public health. The research proposed will integrate best practice from research evidence across public, voluntary and private service providers to increase PA in deprived parts of Stoke on Trent (SoT). The study has three parts: (i) detailed mapping of the environment at lower super output area (SOA) level and study of the relationship between environment, PA and health, (ii) targeted intervention designed to increase the proportion of the target community that is sufficiently active to benefit health and (iii) evaluation of effectiveness and cost-effectiveness of the intervention. The environmental mapping will aggregate data from available databases, augmented by local data gathering and validation, to produce a comprehensive geo-coded map of 10 SOAs (covering a population ~15000). Further analysis, using graphical information systems (GIS) and software, will be used to derive indices through which to evaluate the relationship between environmental characteristics and levels of physical activity and health using hierarchical linear modelling. The intervention will be in two parts, one community-based and one schools-based, both of which will use the social ecological approach, supported by the stages of change model as a potentially useful guide to designing the interventions and measuring the processes and outcomes of PA behaviour change. A multi-factorial, multi-agency approach to deliver multiple PA interventions, each based on best available evidence and making use of information derived from the environment and health mapping, will be carried out in targeted intervention neighbourhoods and schools (5 SOAs selected randomly from 79 eligible in SoT) over two years. Matched non-adjacent neighbourhood areas and schools (5 SOAs, 5 schools) will act as controls. The schools-based intervention will be designed around the school-day. Effectiveness of the community-based intervention will be assessed by independent panel survey conducted at baseline and at two years, with expected 10% increase in the proportion of the population more physically active at the end of the intervention. Effectiveness of the schools-based intervention will be assessed using cluster RCT design to detect an increase ~15 minutes/day in school children?s moderate to vigorous PA. Resource use, cost, willingness-to-pay and incidental consequences data will be collected alongside the community-based intervention to enable economic evaluation from health and social care, societal, other public service and participant perspectives. Findings from the project will inform public policy for increasing population PA and urban design. A Toolkit for Local Action will be produced for wider dissemination.