COMMUNITY MOBILIZATION WORKBOOK

for the

PHYSICAL ACTIVITY INTERVENTION POLICY FRAMEWORK

Prepared for the Ontario Ministry of Citizenship, Culture, and Recreation

and the Ministry of Health

@ Queen's Printer for Ontario, 1995

INTRODUCTION

This workbook is for use by members of the Community Mobilization Workgroup. Each member will complete the workbook in preparation for the January 30 and 31, 1996 consultation. Workgroup members may solicit feedback from people outside the workgroup and consolidate the input with their own.

Completed workbooks will be used as the basis for discussion on January 30th. The workbook is divided into the following sections:

A. Facts and Stats

This section provides a synopsis of the research and analysis generally, and specifically to this setting. The stats and facts provide background information to help you do the analysis and priority setting of strategies. Two types of information are included: what we know from research and analysis and where we are now.

B. Analysis

This section is for you to complete, using the information provided in Facts and Stats and your own knowledge and experience. This section begins with an analysis of the Community Mobilization setting. After reviewing the examples provided, you are asked to identify other key restraining and supporting factors. What are the major factors or forces which are preventing Ontarians from being active in the Community Mobilization? What are key factors supporting physical activity in the Community Mobilization?

Once you have done this analysis, you are asked to review the Priority Strategies for feasibility, impact, pitfalls and supports needed for implementation.

C. Priority Strategies

Finally, using your analysis, please do a priority rating of the strategies and identify your top three choices.

The last page of the workbook contains the names and addresses of your colleagues in the Community Mobilization workgroup. Your workgroup will reach agreement on strategies to be included in the Ontario Physical Activity Intervention Policy Framework at the January meeting. This information will be used by government officials to prepare a Cabinet Document to support physical activity. Your input is needed and appreciated.

A. FACTS AND STATS

What We Know: The Literature

Population Benefits

ù Physical activity contributes to optimal growth and development in children.

ù Childhood is an important time to lay the foundation for future health. Regular physical activity helps to maintain appropriate body weight, reducing the risk of childhood obesity. It also reduces the risk of coronary heart disease, rooted in childhood activity patterns.

ù Physical activity plays a significant role in primary and secondary prevention as well as in rehabilitation and treatment.

ù Physical inactivity is one of four primary risk factors of coronary heart disease. Physical activity is prescribed for rehabilitation of heart disease.

ù Physical inactivity represents the same degree of risk for coronary heart disease as smoking. A greater reduction in overall risk among Ontarians is expected if the inactive became active than if both smokers quit smoking, and hypertensives became normotensive.

ù Physical inactivity is associated with increased risk of chronic disease and conditions: type II diabetes; site specific cancers, especially colon cancer, with emerging evidence for breast and lung cancers; back pain; osteoporosis; hypertension; obesity; anxiety; depression; and stress. It also protects against the increased risk of cardiovascular disease associated with type II diabetes.

ù Physical activity plays a primary and secondary role in preventing acute back problems, and is effective in treating lower back problems.

ù Physical activity contributes to the management of other key risk factors to poor health Ä particularly high blood pressure and obesity.

ù Physical inactivity increases the risk of premature death. Physical activity adds as much as two years to average life expectancy. Furthermore, physical activity compresses the period of impairment and morbidity associated with aging, leading to increased quality of life. Furthermore, physical activity can increase vigour and clear-mindedness.

ù Older adults can achieve benefits from becoming physically active. They can increase their cardio-respiratory function and build muscular flexibility, strength and endurance.

ù Physical activity plays an important role in reducing stress.

ù Physical activity can help reduce social problems, e.g., vandalism, crime, substance abuse.

Behaviour

ù For children and youth, physical activities should: use large muscle groups, cover a range of motion; be dynamic and weight-bearing; range from moderate to high intensity; and be performed regularly.

ù Activities which build self-efficacy have been shown to have carry-over effects into other activities. Appropriate physical activities can build self-efficacy and self-esteem.

ù Activity patterns of children and youth is a determinant of future health, e.g., bone mass, propensity for obesity, some evidence role in breast cancer.

ù Daily physical activity may contribute to improved cognitive functioning. Positive social behaviours can also be increased through participation in physical activities, designed to enhance life skills.

ù Parent's knowledge and motivation can affect the activity level of children and youth.

ù For adults, the total amount of energy expended in doing physical activity appears to be more important a factor in achieving health benefits than the frequency, intensity and duration of the activity.

ù Many different types of activities achieve health benefits. These include taking the stairs over elevators, exercise breaks, active commuting, special events, fitness programs, home exercise routines and so on.

ù Participation levels are influenced by a number of factors related to the individual's social environment (e.g., social support, exercise class size), physical environment (e.g., transportation, safety), biological status (e.g., genetics, age), health status and function (e.g., disease, injury history) and personal factors (e.g., attitudes, goal setting and monitoring skills).

Initiatives

ù A variety of physical activities should be encouraged, including those easily incorporated into daily living.

ù In addition to changing individual behaviour, strategies are needed to make social and physical environments more supportive of physical activity. Community mobilization strategies can affect the social systems influencing people's lives.

ù Balanced intervention strategies promote healthful behaviour at the individual level and create supportive social and physical environments. The following strategies are often used: self-help programs, mass media, and screening.

ù Messages should be tailored specifically to different population segments, be complementary and build on one another.

ù A variety of models explaining the change process should be incorporated into the design of initiatives in order to develop comprehensive, well-integrated messages for various segments of the community.

.ù Information should be provided through multiple channels to increase synergy and opportunity for success. Mass media is important in the early stages, becoming an effective adjunct for multi-faceted initiatives in the latter stages.

ù Integrated strategies should be developed for communication (to change attitudes and levels of motivation), environmental changes (to create supportive social and physical environments), and provision of supports (to create community mobilization);

ù A community mobilization strategy should be developed to involve key sectors, expedite system and organizational change access large segments of the population, and leverage resources.

ù A community change process should provide the foundation of the mobilization strategy, incorporating communications, issue development, group formation, and recognition of efforts of organizations.

ù Approaches should be integrated across levels and sectors since coordination enhances efficiency. Schools, workplaces, health units, recreation system and neighbourhoods should be linked through initiatives and these should be coordinated within broader initiatives.

ù Non-traditional settings (e.g., subsidized housing, seniors groups/housing, friendship centres, reserves) need to be used in order to reach some inactives, e.g., low income, seniors, aboriginals.

ù Healthy public policy should be aimed at developing supportive social and physical environments, such as making stairways more convenient.

ù Strategies need the endorsement of Ministers and key leaders to add support and legitimacy.

ù Mobilizing community opinion leaders and organizing coalitions provides social and structural support.

ù The Stanford Five-City Project suggests that the role of the coalition should be carefully defined and its membership tailored to achievement of goals.

ù Other strategies addressing risk factors should be linked to a physical activity strategy since changes in one behaviour can influence changes in another.

Where We Are: Current Status

Population

ù By definition, people live, work and play in communities. Communities reach Ontarians of all ages and both genders, all income and education levels and cultural backgrounds.

ù Inactive people face both real and perceived barriers. To increase participation, strategies are needed 1) to remove barriers and create supportive physical and social environments, and 2) to respond to an individual's motivation and response, biological factors, health status and function.

ù Each setting in a community has a role to play in decreasing the barriers and demonstrating that benefits exceed the costs of activity.

ù Inactivity is pervasive in Ontario, affecting individuals from all age groups, both genders, and all income and education levels. Approximately two-thirds of adults in Ontario are not active enough to benefit their cardiovascular health.

ù More children and youth are active than adults. More men are active than women. Higher income earners and those with a university degree tend to be more active.

ù The majority of children and youth are not active enough to lay the foundations for life-long health. That is, they are not active at levels recommended for optimal growth and development.

™5ù More women aged 55 and older are inactive. Levels of inactivity are higher among older adults with lower education and income levels.

ù Older adults who are inactive are less likely to rate their health as good; and three-quarters report chronic conditions. Fewer receive encouragement from their doctor to be active. Those who are inactive are more likely to smoke cigarettes, less likely to follow Canada's Food Guide or limit fat in their diet.

ù Inactive older adults have smaller support networks, i.e., fewer friends and family to whom they can turn for help.

ù Inactive women are more likely to be retired, work in sales, hold clerical or blue collar jobs, or be homemakers.

ù Inactive women are less likely to rate regular physical activity as important to their health compared to their active counterparts.

ù Among inactive married women, fewer receive encouragement to be active from their spouses. Also, their spouses tend to be inactive.

ù Inactive women tend to report less control over their choice to be active. Perceived barriers include time pressures due to family, lack of energy, ability and self-discipline (motivation), feeling ill at ease and illness and injury.

ù Profiles of inactives among lower income levels parallel those of women. They tend to rate their health as lower, to smoke, to adhere less to Canada's Food Guide, and to be less likely to view regular physical activity as important to their health.

ù Lower income earners who are inactive have smaller social support networks, are less likely to be encouraged to be active, and tend to have inactive spouses.

ù Cost is not ranked as one of the top barriers to being more active.

ù Very little statistical data exists about physical activity patterns among aboriginals. About half the Aboriginals living on reserves report participating in sports, dance or recreational physical activity. The proportion is slightly higher among those off reserves.

ù Half the Aboriginals on reserves rate their health as very good. Over 60% have seen a physician in the last year. Among those living off reserves, 65% rate their health as very good and 79% have seen a physician in the last year.

ù On reserves, unemployment is ranked first among community concerns, followed by alcohol abuse, drug abuse, family violence, suicide, sexual abuse and not feeling safe alone at night. A similar pattern occurs among those living off reserves, except that not feeling safe at night is a greater concern than suicide and sexual abuse.

Behaviour

ù There is a significant decrease in the general level of activity between younger and older teenagers.

ù Only a small percentage of youth are active enough to achieve the benefits associated with optimal growth and development.

ù About one in five children may be considered to be inactive. Significantly fewer girls are active compared to boys.

ù About two out of three adults in Ontario are not sufficiently active to benefit their cardiovascular health.

ù There is a clustering of healthy behaviours. That is, increased levels of activity are associated with other healthy behaviours such as not smoking.

ù Internal factors such as lacking energy, ability, and self-discipline or motivation, are associated with inactivity.

Initiatives

ù All Ontarians could benefit from receiving information and self-help materials provided through initiatives at the community level.

ù More emphasis is being placed on the community level and the role of community coalitions in assisting Ontarians to be more active. At the same time, there is a lack of recognition and support for networking.

ù Provincial programs, logos and slogans provide a foundation for mobilization (e.g., Summeractive, Heart and Stroke Healthy Schools Program).

ù Transportation systems, housing, and outdoor resources all influence how supportive a community is in encouraging long-lasting behaviour change. Suburban design tends to support use of the car over walking or bicycling.

ù People tend to view urban environments as unsafe. Some communities have adopted 'request stops' for buses after dark. Choices of activities can be limited by unsafe environments, for example, walking or jogging in parks after dark.

ù Ontario has few (if any) projects at the community level which have been evaluated for their impact on increasing the prevalence of physical activity.

ù Fear of fall is a serious concern for older adults in icy winter conditions.

ù Housing concepts have not generally encouraged active lifestyles in their design. High rise apartments offer few spaces for physical activity. Stairwells are frequently uninviting.

ù Policies and practices of community resources, which encourage activity, often favour certain segments of the population.

ù Provincial parks and conservation areas are outside urban areas, making access available primarily on weekends and by car. Municipal parks are developed primarily through the five percent parkland requirement of the Planning Act and are usually developed as sports fields or sit-in parks.

ù Healthy public policy and environmental change strategies have been used less frequently than individual change strategies.

ù There is an increasing need for partnerships to coordinate and collaborate on common needs and issues, programs, resources, facilities and equipment, e.g., between education and physical educators, between schools and the recreation system.

ù Support is needed to build community capacity. This includes training, consultation and information exchange, such as sharing successful models.

ù Additional educational opportunities are needed around lobbying, coalition building, advocacy, and professional upgrading.

ù Generic tools which can be adapted by the community are needed to avoid incurring development costs. Tools include needs assessments and user-friendly resources.

ù Identification and recognition of community leaders to act as peer leaders could assist in the mobilization process.

ù Strategies should embrace current health, recreation, education, and social service policies and agendas (e.g., children, environment, day care, land use planning, long-term care, health, crime, justice).

B. ANALYSIS

i. Force Field Analysis

In analyzing the entire area of Community Mobilization, identify those factors or forces in Community Mobilization which restrain or prevent physical activity, and those which support or sustain physical activity.

Restraining Factors

Sustaining Factors

e.g., There is a lack of recognition and support for community-based coalitions.

e.g., There is a trend toward sharing resources, reducing duplication and working collaboratively.

ii. Analysis of Priority Strategies

The following priority strategies have been suggested by the research and analysis phase, and by the November consultation. Please feel free to make additions and modifications.

1. That an awards program recognizing exemplary community efforts, coalition network development, and model communities for providing physical and social environments that support physical activity, be implemented.

2. That support of key community politicians and leaders be solicited to add legitimacy and support to the strategy at the local level.

3. That training opportunities (for community physical activity leaders) be offered on advocacy for physical activity and on the community mobilization process.

4. That the provincial government provide support for communities as they develop new initiatives that may serve as demonstration projects for other communities.

5. That knowledge and information exchange between community leaders be facilitated through mechanisms such as the Leisure Information Network, conferences, ACALP, ALAO, etc..

6. That the strategy support the development of task groups and coalitions involving appropriate sectors and consumers to work on policy and program development.

7. That an array of community initiatives such as contests, challenges, etc. be developed and coordinated for Ontario communities, in order to increase the profile of physical activity.

8. That a coordinated provincial strategy, which is community-driven, provide the overall direction and links the community coalitions to provincial programs and policies.

9.

10.

Strategies should ensure a comprehensive approach to affecting change. When adding and analyzing strategies, keep the following information in mind:

CONSIDERATIONS FOR A COMPREHENSIVE APPROACH

Initiatives aimed at changing individual behaviour are insufficient for creating long-term behaviour change.

Integrated strategies should be developed for communication (to change attitudes and levels of motivation), environmental changes (to create supportive social and physical environments), and provision of supports (to create community mobilization). This can be accomplished through education, promotion, policy and legislation and capacity building strategies.

In addition, review the initiatives section of Where We Are Now and your restraining and sustaining factors, before answering the following questions on each strategy.

a. Is this feasible and realistic to implement? Yes ___ No ___ Why?

b Will implementation of this strategy make a significant difference in making Ontarians more active? Yes ___ No ___ Why?

c. What are potential pitfalls in implementation of this strategy?

d. What supports will be needed for effective implementation of this strategy?

e. Add any thoughts you have about roles and responsibilities for implementing this strategy.

Strategy 1: That an awards program recognizing exemplary community efforts, coalition network development, and model communities for providing physical and social environments that support physical activity, be implemented.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 2: That support of key community politicians and leaders be solicited to add legitimacy and support to the strategy at the local level.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 3: That training opportunities (for community physical activity leaders) be offered on advocacy for physical activity and on the community mobilization process.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 4: That the provincial government provide support for communities as they develop new initiatives that may serve as demonstration projects for other communities.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 5: That knowledge and information exchange between community leaders be facilitated through mechanisms such as the Leisure Information Network, conferences, ACALP, ALAO, etc..

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 6: That the strategy support the development of task groups and coalitions involving appropriate sectors and consumers to work on policy and program development.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 7: That an array of community initiatives such as contests, challenges, etc. be developed and coordinated for Ontario communities in order to increase the profile of physical activity.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 8. That a coordinated provincial strategy, which is community driven, provide the overall and links the community coalitions to provincial programs and policies.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 9.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 10.

a. feasible? Yes ___ No ___ Why?

b. significant difference? Yes ___ No ___ Why?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

C. PRIORITY STRATEGIES

Using your analysis on feasibility, impact, pitfalls and supports, rate each strategy according to priority. At the end of this section, identify your top three priority strategies.

Strategic Option

1 Highest priority

2 High priority

3 Middle priority

4 Low priority

5 Lowest priority

6 Not a priority

1. That an awards program recognizing exemplary community efforts, coalition network development, and model communities for providing physical and social environments that support physical activity, be implemented.

1 2 3 4 5 6

2. That support of key community politicians and leaders be solicited to add legitimacy and support to the strategy at the local level.

1 2 3 4 5 6

3. That training opportunities (for community physical activity leaders) be offered on advocacy for physical activity and on the community mobilization process.

1 2 3 4 5 6

4. That the provincial government provide support for communities as they develop new initiatives that may serve as demonstration projects for other communities.

1 2 3 4 5 6

5. That knowledge and information exchange between community leaders be facilitated through mechanisms such as the Leisure Information Network, conferences, ACALP, ALAO, etc..

1 2 3 4 5 6

6. That the strategy support the development of task groups and coalitions involving appropriate sectors and consumers to work on policy and program development.

1 2 3 4 5 6

7. That an array of community initiatives such as contests, challenges, etc. be developed and coordinated for Ontario communities in order to increase the profile of physical activity.

1 2 3 4 5 6

8. That a co-ordinated provincial strategy, which is community driven, provide the overall direction and links community coalitions to provincial programs and policies.

1 2 3 4 5 6

9.

1 2 3 4 5 6

10.

1 2 3 4 5 6

Your Top Three Priority Strategies

1. ______________________________________________

2. ______________________________________________

3. ______________________________________________

C. Community Mobilization Workgroup

Lisa Gallant

Ontario Prevention Clearinghouse

415 Yonge St. #1200

Toronto M5B 2E7

1-800-263-2846 ext 228

e-mail: [email protected]

Rosemary Walker (3W/B)+ Messaging WB

Health Behaviour Research Group

University of Waterloo, Waterloo

N2L 3G1

(519) 888-4567 ext.2924

e-mail: [email protected]

Alan Baird (2W/B)

Fitness Program @ Health Canada

Finance Blgd. 1st Floor

Tunney's Pasture, Ottawa K1A 1B4

O(613) 941-3507 Fax 941- 6666

Nancy Dubois (4W/B)

Heart Health, Brant Haldimand-Norfolk

402-233 Colborne St., Brantford

N3T 2H4

O(519) 754-4359 Fax 754-4368

Elizabeth Lindsay **

The Community Health Research Unit

University of Ottawa

451 Smyth Rd., Ottawa K1H 8M5

Rhea Shulman **

North York Seniors Centre

(same as Anita)

Mamoun Gamal

Canadian Mental Health Assoc- Ont

180 Dundas St W. Ste. 2301,Toronto

O (416) 975-5580 ext. 21

** To Be Confirmed

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