The problem. Getting people to integrate physical activity into their daily routines is a challenge. The key for Active Living by Design partnerships in four locales—Honolulu, Santa Ana, Calif., Portland, Ore. and Isanti County, Minn.—was finding a unique hook to engage local residents. Their strategies ranged from tapping strong cultural connections to the land to naming walking routes after pies.
Building a nature park in Kalihi Valley. In Hawaii and other Polynesian islands, people have an intimate connection with the land. The Kalihi Valley Active Living Program, based in Honolulu, used that connection to get people moving.
Thousands of community members, ranging from schoolchildren to senior citizens, are transforming a 100-acre parcel of land into the Ho'oulu 'Aina Nature Preserve. In the process, they are getting lots of exercise.
Kalihi Valley is a densely populated community that includes Hawaii's two largest public housing developments. Nearly one-quarter of the residents have incomes below the federal poverty level, and 35 percent are immigrants, mostly from the Philippines, Samoa and Micronesia. Most live in cramped quarters with no access to green space or parks.
An unused, overgrown state park 10 minutes from downtown Honolulu provided the perfect setting for active living. The Kalihi Valley Active Living Program worked with the State of Hawai'i, Division of State Parks, one of its partners, to secure a 20-year lease on the land. The partnership raised funds for infrastructure, equipment and programming. Through the health center, schools and community organizations, the partnership organized volunteers to co-create the Ho'oulu 'Aina Nature Preserve.
For example, a diabetes group of 50- to 70-year-old Micronesian women at the health center helped create the community farm. The word exercise didn't exist in the Micronesian language and attempts to organize walking groups were not well-received. But when the women learned of an opportunity to work the land, which in turn would help them help their health, they were eager to get involved.
"The next week we had about 20 women with machetes clearing the land for our first garden. They were excited to get back to the land and grow food for their families," said David D. Derauf, M.D., M.P.H., executive director of Kokua Kalihi Valley Comprehensive Family Services, a federally qualified health center that was the lead agency for the program. "It's a spectacularly beautiful place, and there's a real hunger to be engaged in something like this."
The Kalihi Valley Active Living Program brought together groups ranging from the Kalihi Neighborhood Board to the Pig Hunters Association. Students from Honolulu Community College renovated the dilapidated caretaker's quarters into a facility to support programs on active living, healthy eating and the environment. Key partners also include Farrington High School and Kamehameha School (kindergarten through 12th grade), which participate in Ho'oulu 'Aina programs.
With 100 acres of land, there's plenty of physical activity to go around. Volunteers are clearing the overgrown land, removing non-native plants, replacing them with native plants, and creating 20 acres of community food production.
Using neighborhood associations and parks to get Santa Ana moving. Parks were also an important part of Active Living in Santa Ana (ALISA), in Orange County, Calif. The mostly Latino community is of one of the nation's most densely populated cities. The residents were eager to get outside. However, parks and fields were not well maintained, and residents considered them dangerous.
The Santa Ana Parks, Recreation and Community Services Agency, a key partner in ALISA, worked with neighborhood associations to improve local parks—in exchange for a commitment by the groups to engage residents in active living.
The program, called Safe and Active Living United Districts (SALUD), began after the Madison Park Neighborhood Association sent the mayor a list of concerns about the park. Gerardo Mouet, executive director of parks and recreation, and Jeannie Juredo, recreation supervisor, met with the association's board. Mouet committed to removing graffiti faster, making repairs promptly and ensuring that rangers patrol the park more often, if the association would champion active living.
"We removed graffiti or did repairs, whatever they brought to our attention, right away because we wanted them motivated to do their part," said Mouet.
In response, Madison Park Neighborhood Association started a walking club and an annual walkathon. The association also partnered with parks and recreation in an annual adopt-a-park event, where neighbors work with Mouet and his staff to remove graffiti, clean the landscape and plant trees. "The word got out. Other neighborhood associations wanted a SALUD too," said Mouet.
By the end of the Active Living by Design grant, SALUD was operating in five parks: Madison Park, Santa Anita Park, El Salvador Park, Jerome Park and Angeles Community Park. Each neighborhood had a walking club, with a map created by parks and recreation. Other activities, such as mountain biking for kids, programs for seniors and exercise classes for moms, varied with each neighborhood's needs and interests.
"People realize that the city, in this case the parks and recreation department, feels it's very important for us to put our heads together to combat obesity, eat the right stuff and get healthy," said Mouet.
Focusing on relationships in Portland, Ore. Engaging people in active living in Portland's Lents neighborhood wasn't as easy as in Kalihi Valley or Santa Ana. Residents of Lents were leery of outsiders—tired of being studied or ignored, and of seeing promises by "do-gooders" and the government go unfulfilled.
Active Living Lents had to build credibility. "We worked to become familiar with the community, to partner with efforts that community-led groups were doing," said Noelle Dobson, project coordinator and later director of Active Living Lents.
The Active Living by Design initiative began with the realization that Lents was different from most Portland neighborhoods. It is one of the city's few ethnically diverse communities, with many residents from Eastern Europe and Southeast Asia. The community has more crime than most neighborhoods and its residents have less income. Lents also had few sidewalks and bike lanes, and an eight-lane freeway splits the neighborhood.
To build relationships with local residents and groups, Active Living Lents participated in events such as the Lents Community Fair and Founders' Day. The partnership sponsored part of an event, or set up booths with bike maps, pedometers and information on active living.
The partnership also organized guided walks to highlight the community's strengths and get people moving. Active Living Lents paid residents to identify walking routes focusing on local history or community gardens, write scripts about the routes and lead the walks. For 10 weeks in the summer of 2006, residents walked their neighborhoods every Tuesday night and Saturday morning using maps created by Active Living Lents.
The partnership—which grew to include schools, neighborhood development associations and the Oregon Coalition for Promoting Physical Activity, among others—also helped residents advocate for their share of infrastructure funds. For example, coalition members sat on committees that allocated park funding and supported residents at meetings with government agencies.
Results included the creation of local parks, such as Earl Boyle Park, a more walkable town center, and miles of new bike lanes and sidewalks. Earl Boyle Park has all the features the community wanted: a community garden, benches, a walking path and a sprayground (a water playground).
Walking the town in Isanti County. The rural setting and cold climate of Isanti County, Minn., make it hard to engage people in active living. The Isanti County Active Living by Design partnership worked to create and promote an environment that encouraged people in Cambridge, Isanti and Braham—the county's three primary cities—to be more active.
To find out what would motivate county residents to become more active and what prevented them from doing so, Isanti County Active Living partnered with the Minnesota Department of Health and the Isanti County Public Health Department to survey nearly 3,000 people and hold two focus groups.
Findings in 2005 led to a partnership with the Cambridge Lutheran Church to create Prime Time Walkers, a walking program for seniors. Project Director Bill Carlson and Project Coordinator Lisa Perlick created walking logs and incentives for participating (gold stars and pins), wrote a newsletter to highlight the activities and participated themselves.
To encourage more people to walk, Isanti County Active Living also created Walk the Town maps for Cambridge, Isanti and Braham, which provide walking routes, the distance, steps and time for each route, and tips for walking.
"These things are helping to get more people out walking," said Carlson.
Isanti County Active Living even managed to add a walk to Braham's annual pie day. Initially, the Braham Pie Day Committee—the "pie ladies"—didn't want to change their traditional event. After Perlick suggested ways to integrate a walk with pies—such as using signs shaped like a piece of pie saying "walk pie calories off" and naming walking routes after pies—the pie ladies changed their minds. Now, Braham Pie Day includes a 5k walk. And the city has walking routes with names like Blueberry Pie Loop and All American Apple Pie Route.
Isanti County Active Living also brought back the annual Rum River Bicycle Classic and sponsored the Isanti Jubilee Run/Walk, and worked with the local chamber of commerce to put bike routes on its county map. "We were trying to show people how easy it is to use their own community to get physical activity every day, that the shoulders are safe to ride your bike on, and there are great trails and sidewalks to run and walk on," said Perlick.
These changes have made a difference between 2005 and 2008:
- Moderate exercise three or more times per week has increased.
- More Isanti County residents perceive their neighborhood as conducive to physical activity.
- Cost, which is often an element outside the control of project directors, has moved to third in the top barriers to physical activity. The top barriers are now ones people can address with a little motivation: lack of time due to work or school obligations, lack of time due to family obligations, cost, and lack of self-discipline/willpower.
RWJF perspective. RWJF looked at the growing evidence that individual behavior change efforts are most successful when they take place in a larger community and social context. As a result, the Active Living by Design program examined ways to combine individually oriented behavior change approaches with community-based strategies to create environments that are more conducive to physical activity.
Active Living by Design has harnessed community design and livable community initiatives as a vehicle and force for making communities more activity-friendly. It has created community-led change by working with local and national partners to build a culture of active living and healthy eating.
"The Active Living by Design communities faced the challenges of changing the built environment, re-thinking the design and land use policies that shape the environment, and, in some instances, re-inventing the practices of an entire community. They demonstrate how creativity, determination, vision and a willingness to see into the future can help make change happen," said Jamie Bussel, RWJF program officer.
RWJF Scholar examines neighborhood-based death rates from opiate-based painkiller overdoses, compared with heroin overdose deaths.
Unengaged patients can incur costs of up to 21% higher than patients who are highly engaged in care. This suite of materials from RWJF's AF4...
This month the Johns Hopkins Bloomberg School of Public Health published a special issue of its magazine devoted to food.
RWJF Nurse Faculty Scholar Jennifer Bellot writes about losing her grandmother to complications from a medical error.
This revolutionary concept gives patients the tools they need improve their own health and health care by transforming the doctor-patient re...
Learn how The Robert Wood Johnson Foundation is dedicated to building a culture of health in Risa Lavizzo-Mourey's 2014 annual message.
The reconvened Commission to Build a Healthier America will provide new guidance in three key areas: early childhood, healthy communities, a...
Adverse working conditions contribute substantially to the risk of depression for working-age adults, according to new research from a team ...
CDC: Reducing High-risk Antibiotic Prescriptions Could Also Reduce Deadly Infections - Poorer Women Most Likely to Be Caught in ‘Vicious’ Ca...
Team members, grantees, and guests discuss breakthrough ideas that will allow us to move toward solving challenges in health care.
The RWJF DataHub tracks state-level data, and allows visitors to customize and visualize facts and figures.
Ronald A. Yee, MD, became chief medical officer of the NACHC last year. NewPublicHealth recently spoke with Yee about the mission of health ...