Mixed methods analysis of a multi-strategy, community-wide physical activity intervention : Active Launceston

Extensive evidence is published on the numerous physical and psychological benefits of physical activity across the human lifespan (Tucker and Carr, 2016). Australia, like other developed countries, has very low levels of physical activity (Australian Bureau of Statistics, 2012). Tasmania has the lowest levels in the country with 69.4% reporting inadequate levels of physical activity participation in comparison to the rest of Australia, which is 67.5% (Population Health, 2013). Australian Physical Activity Guidelines recommend at least 30 minutes of moderate physical activity for adults on at least five days of the week, equating to 150 minutes a week (Australian Department of Health, 2014). Thus, developing effective interventions to increase population physical activity levels is undoubtedly important to the health of Tasmanians. Best practice research recommends that a multi-strategy approach is most effective to increase population level physical activity levels; however, there is little evidence of successful initiatives in peer reviewed literature due to the complexities of effectively measuring multi-strategy community-wide projects (Deakin University, 2012). Therefore, the purpose of this study was to use an interrupted time-series process and impact mixed-methods research design in an attempt to effectively measure the efficacy of a multi-strategy community-wide physical activity intervention in the Launceston community. Active Launceston was a community-based programme implemented between February 2008 and December 2015 aimed at improving health and wellbeing through physical activity. Active Launceston used a multi-strategy approach to engaging the community and program delivery: supportive environments, mass media, community initiatives and professional support. An evaluation of Active Launceston between 2008 and 2015 consisted of participation statistics, focus groups, stakeholder interviews, a serial online survey (n=734) and a randomised cross-sectional serial population telephone survey of Launceston residents. Active Launceston's free activities included diverse programs: dancing, hydrotherapy, archery, orienteering, yoga, tai chi, rock climbing, sailing and laser tag. These initiatives engaged community members ranging in age from 1 to 87 years. Over one-third of participants (35.1%) were aged under 15, while 14.5% were aged over 55. Two-thirds of participants were female (65.8%), and over one-third (37.7%) were health care card holders. Almost half (43.2%) of Active Launceston participants resided in suburbs representing the five lowest deciles of socio-economic indexes for areas (SEIFA), with 19.3% in the lowest decile. Active Launceston attracted 11,887 attendees, who participated in 30,342 sessions, amounting to 38,088 hours of physical activity between 2008 and 2015. Focus groups, stakeholder interviews and the online survey highlighted a range of benefits relating to individual involvement and social engagement. Process evaluation revealed that there were four ways in which participants perceived Active Launceston had benefited them directly: increased engagement in exercise and activities, health benefits, personal development, and social connectedness. The features of Active Launceston that participants perceived facilitated their participation were: the accessibility and no-cost nature of programs, the friendly and non-threatening environments, the capacity of programs to cater for people with different abilities and specific needs, the focus on complementing other community programs, and the enthusiasm of facilitators. Furthermore, participants described the enjoyment they gained from involvement as a feature that facilitated ongoing engagement. The overarching impression of Active Launceston from interviews and focus groups was that it was viewed as a unique model that complements existing services (sports clubs, fitness centres, not-for-profit organisations) and successfully carried the additional responsibility of providing advocacy for sections of the community less able to access these types of activities. Impact evaluation demonstrated that, between 2008 and 2015, there was no change in the proportion of telephone survey respondents who reported that they were physically active in the past 12 months. In contrast, a higher proportion (overall p<0.001) of respondents reported participating in vigorous physical activity in 2012 (IRR 1.67, 95%CI: 1.36 to 2.03, p<0.001) and 2015 (IRR 1.26, 95%CI: 1.01 to 1.56, p=0.03) compared to 2008, with the highest proportion in 2012 (2015 vs 2012: IRR 1.32, 95%CI 1.09 to 1.60, p=0.007). For respondents participating in physical activity in the last 12 months, there was a gradual increase in the proportion who were sufficiently active for health over the three years. There was a significantly higher proportion achieving sufficient activity in 2015 compared to 2008 (overall p=0.03; 2008 vs 2012: IRR 1.08, 95% CI 0.97 to 1.21, p= 0.14; 2008 vs 2015: IRR 1.16, 95%CI 1.03 to 1.29, p=0.01). The proportion of respondents who were aware of Active Launceston increased over time (p<0.001). Only 31.8% (95%CI 28.23 to 35.81) of respondents were aware of Active Launceston in 2008 compared to 61.33% (95%CI 56.32 to 66.67) and 65.11% (95%CI 59.95 to 70.60) in 2012 and 2015, respectively. Respondents who were aware of Active Launceston were significantly more likely to be sufficiently active for health than those who were unaware of Active Launceston in 2012 and 2015 (p < 0.01). The findings suggest Active Launceston did support a wide range of individuals to engage in regular physical activity, and increase their level of social engagement. I conclude that establishing multi-faceted partnerships to improve participation in physical activity is an effective option for governments, universities and the community sector. My findings provide a rationale for implementing community-wide interventions that encourage and support people to increase their physical activity levels.