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Chapter 19: Community Level Intervention
Strategies
Community Level Interventions
 Community strategies typically include a
number of institutions, organizations, and
groups to deliver a variety of interventions
 Target ________________ rather than
individual behavior change
 Primary distinction between individual,
group, and community interventions is …
Community Level Interventions
Karen Glanz (1997) provided an outline of the
benefit and breadth of community level
interventions

Community-level models suggest strategies and
initiatives that are planned and led by
organizations and institutions whose missions are
to protect and improve health: schools, worksites,
health care settings, community groups, and
governmental agencies. Other institutions for
whom health enhancement is not a central
mission, such as the mass media, also play a
critical role.
Community Defined
An aggregate of people who share
___________________________________
Shared institutions include: local hospitals,
recreation centers, worksites, faith-based
institutions, and schools
Refers to the locality of an aggregate of
people, groups or institutions
Informal social norms, belief systems,
interdependent groups, and attachments
Why Focus on Communities?
There is practicality in developing and
implementing physical activity
interventions at the community level

A community-based intervention should
increase ________________________
invested into health promotion because of
the inter-group relationships, shared
values, and a common attachment within
the community
Community Interventions
Community programs for the
promotion of physical activity
4 primary sections:
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Site-based interventions
Community-wide and policy interventions
Mass media interventions
The Centers for Disease Control and
Prevention guidelines for communitybased physical activity interventions.
Site-Based Interventions: Schools
Elementary, middle, and high schools
have traditionally offered physical
education classes
Schools are offering fewer, and shorter
duration, physical education classes and
have even eliminated them completely is
some cases
Site-Based Interventions: Schools
Two Areas of Focus:
Increasing physical activity
______________________________
Increasing
______________________
Stone and associates (1998) examined
the effectiveness of 14 school
interventions
Site-Based Interventions: Schools
Stone and associates found:

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
Interventions were often successful at
improving knowledge and attitudes
towards physical activity
Interventions were typically successful at
increasing physical activity
____________________________
Interventions were often unsuccessful at
increasing _________________________
Site-Based Interventions: Schools
The Child and Adolescent Trial for
Cardiovascular Health (CATCH)
96 elementary schools in California,
Louisiana, Minnesota, and Texas
CATCH targeted increasing physical activity
during physical education classes and outside
of school time
Based on ________________________ and
organizational change strategies
Site-Based Interventions: Schools
3rd grade year
5-week curriculum
Policy interventions such as the
provision of space, equipment and
supervision during non-school hours
Policy and curricula in physical
education classes were also introduced
Site-Based Interventions: Schools
 4th and 5th grade years
 12-week curriculum
 Policy components were sustained
 The CATCH project resulted in positive
changes in physical activity through the 3
years of the study
 The __________________ increase in physical
activity was still present 3 years later
Site-Based Interventions: Worksites
Worksites have also been targeted
environments for physical activity
programs
Expert narrative reviews of literature
provided ____________________
effectiveness of these programs
Site-Based Interventions: Worksites
Dishman and associates (1998) conducted a
meta-analysis on 26 studies examining
worksite interventions
The __________________ was coded as
either behavior modification, cognitive
behavior modification, health education,
health risk appraisal, exercise prescription,
or a combination of strategies.
______________________ was coded as
face-to-face, mediated (indirectly through
print or telephone), or a combination of the
two, while location was coded as on or offsite.
Site-Based Interventions: Worksites
The results of the meta-analysis revealed a
small positive effect for worksite physical
activity interventions
The size of this effect was not significantly
different from zero
______________________ to the size of effect
based on any of the moderators
Based upon this meta-analysis it was
concluded that worksite physical activity
interventions ______________________
Site-Based Interventions: Health Care
Settings
Simons-Morton and colleagues (1998)
provided a review of health care setting
physical activity interventions.

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___________________: Physical activity
promotion for apparently healthy
individuals
___________________: Physical activity
promotion for individuals with
cardiovascular disease
Site-Based Interventions: Health Care
Settings
 12 primary prevention studies
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Based on patient counseling
No interventions included structured physical
activity programs
Half were based on an underlying theory
75 % implemented by doctors while nurses or
other health professionals administered the
remaining interventions.
 The results of these studies were
_____________________________________
 Effects __________________________
Site-Based Interventions: Health Care
Settings
Secondary Prevention studies
 Simons-Morton et al. (1998) identified
24 studies of physical activity
interventions for patients with
cardiovascular disease
________________________ reported
significant changes in physical activity or
fitness.
Site-Based Interventions: Health Care
Settings
Secondary Prevention Studies (cont.)
In studies that used an intervention that
targeted many risk behaviors (including
inactivity), about half were effective in
changing physical activity
Based upon the review interventions that
included supervised exercise with behavior
modification techniques or the provision of
home equipment were most often effective
(i.e., 75% of the studies)
Community-wide and Policy Interventions
 King and collaborators (1995) provided an
excellent description of legislative, policy, and
environmental approaches to increase
physical activity in communities.
 _________________refers
to formal legal
structures at the local, state, or federal levels of
government.
 ____________is the formal or informal rules
that provide structure to a governing
organization.
 ________________________ involve providing,
for example, bike paths and facilities with
exercise to community
Community-wide and Policy Interventions
The Navel Community Project in California
Three groups: an intervention community, a
control community, and a Navy-wide
sample
Cardiovascular fitness was assessed before
and after the 1-year intervention period
The environmental and policy strategies
used focused on physical activity and
healthy eating
Community-wide and Policy Interventions
Policy strategies:
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_____________________ the community
recreation center was open
Communications between superiors and
subordinates ___________________ that
all members of the base should be involved
in regular exercise
Include fruits and vegetables at all snack
shops on the Naval base was implemented
Community-wide and Policy Interventions
Environmental changes:
New
exercise equipment was purchased for
the gymnasia
A women-only fitness center was opened on
the base
1.5 mile running routes were marked out
around the base
The organization of athletic events and
jogging clubs
Community-wide and Policy Interventions
The intervention had a number of
positive benefits for participants who
experienced the environmental change
condition
They completed a 1.5-mile run 18
seconds faster following the
intervention
A reduced failure rate during the
physical testing (12.4% pre-test down to
5.1% post-intervention)
Community-wide and Policy Interventions
Did not gain body fat while participants
in both control conditions showed
significant increases in percent body fat
Although the number of sedentary
individuals (<2000 kcal of activity)
increased in all groups, the increase was
at a lower rate in the intervention group
(about 3%) when compared to the
control conditions (about 7%).
Community-wide And Policy Interventions
Perhaps the most important finding of
the study was the extent of the impact
for the intervention
______________________ of the
population were positively influenced by
the intervention strategy thereby
providing support for the King et al.
(1995) hypothesis that both
environmental and policy approaches
are effective for increasing physical
activity
Mass Media Interventions
Mass media is often associated with
television, radio, and newspapers, but may
also included the use of telephones, internet
technology, and postal services
Mass Media Interventions
Example
• Marcus et al. (1998) ___________________
motivationally tailored PA intervention.
• Based on ________________________
• Sedentary subjects in Two groups:
– Stage matched self-help booklet
– Standard self-help booklet (action oriented)
• Both treatments worked. The stage-matched was
more effective (increase from 5.5 min to 151 min
of PA per week)
Recommendations For Community
Programs To Promote Physical Activity
___________ report to summarize
recommendations for encouraging physical
activity in young people
The recommendations focused on school and
general community programs but most are
valuable for, and can be generalized to, any
type of community-based intervention
See table 17-1 in text book