Can a motivational intervention overcome an unsupportive environment for walking--findings from the Step-by-Step Study.
BACKGROUND
Interventions to promote walking have rarely examined how their effects varied by the attributes of the physical environment.


OBJECTIVE
The purpose of this study is to examine whether perceptions of environmental walkability predicted change in walking behavior following an individual-based intervention to promote walking and whether the intervention buffered the effects of unsupportive environment for walking.


METHODS
Inactive adults (aged 30-65 years, 85% women) who completed a 3-month randomized control trial comparing the effect of a single mail-out of a theoretically based self-help walking program (WP, n = 102); the same program plus a pedometer (WPP, n = 105); and a "no-treatment" control group (C, n = 107). Measures included change in self-reported walking time for all purposes and in the proportion of people reporting regular walking (i.e., > or =150 min/week and > or =5 sessions/wk). Perceptions of environmental esthetics, safety from crime, proximity to destinations, access to walking facilities, traffic, streetlights, connectivity, and hilliness were assessed at baseline and dichotomized into "low" or "high" by the median score. Covariates were social support, self-efficacy, intention to change behavior, and sociodemographic characteristics.


RESULTS
Adjusting for baseline walking, significant covariates, and study groups, walking time at follow-up was lower if streetlights or esthetics were perceived to be "low" (-24% and -22%, respectively) compared with "high" (p < 0.05). In "low" esthetic conditions, those in the WPP were significantly more likely than controls to increase total walking time (Exp (b) = 2.53, p < 0.01) and to undertake regular walking (OR = 5.85, 95% CI 2.60-12.2), whereas in esthetically pleasing environments, the between-group differences were nonsignificant.


CONCLUSIONS
Walkability attributes can influence individual-based walking programs. Some environmental barriers for walking can be overcome by motivational aids.
Merom
Dafna
D
School of Public Health, University of Sydney, Sydney, Australia. dafnam@health.usyd.edu.au
Bauman
Adrian
A
Phongsavan
Philayrath
P
Cerin
Ester
E
Kassis
Mazen
M
Brown
Wendy
W
Smith
Ben J
BJ
Rissel
Chris
C
D000328:Adult; D000368:Aged; D004777:Environment; D015444:Exercise / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009043:Motor Activity; D015999:Multivariate Analysis; D016017:Odds Ratio; D010465:Perception; D020377:Self Efficacy; D012737:Sex Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D016138:Walking / Q000523:psychology*