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BMJ Open. 2015 Sep 3;5(9):e007593. doi: 10.1136/bmjopen-2015-007593.

Theorising and testing environmental pathways to behaviour change: natural experimental study of the perception and use of new infrastructure to promote walking and cycling in local communities.

Author information

1
Medical Research Council Epidemiology Unit and UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.

Abstract

OBJECTIVE:

Some studies have assessed the effectiveness of environmental interventions to promote physical activity, but few have examined how such interventions work. We investigated the environmental mechanisms linking an infrastructural intervention with behaviour change.

DESIGN:

Natural experimental study.

SETTING:

Three UK municipalities (Southampton, Cardiff and Kenilworth).

PARTICIPANTS:

Adults living within 5 km of new walking and cycling infrastructure.

INTERVENTION:

Construction or improvement of walking and cycling routes. Exposure to the intervention was defined in terms of residential proximity.

OUTCOME MEASURES:

Questionnaires at baseline and 2-year follow-up assessed perceptions of the supportiveness of the environment, use of the new infrastructure, and walking and cycling behaviours. Analysis proceeded via factor analysis of perceptions of the physical environment (step 1) and regression analysis to identify plausible pathways involving physical and social environmental mediators and refine the intervention theory (step 2) to a final path analysis to test the model (step 3).

RESULTS:

Participants who lived near and used the new routes reported improvements in their perceptions of provision and safety. However, path analysis (step 3, n=967) showed that the effects of the intervention on changes in time spent walking and cycling were largely (90%) explained by a simple causal pathway involving use of the new routes, and other pathways involving changes in environmental cognitions explained only a small proportion of the effect.

CONCLUSIONS:

Physical improvement of the environment itself was the key to the effectiveness of the intervention, and seeking to change people's perceptions may be of limited value. Studies of how interventions lead to population behaviour change should complement those concerned with estimating their effects in supporting valid causal inference.

KEYWORDS:

EPIDEMIOLOGY; PREVENTIVE MEDICINE; PUBLIC HEALTH

PMID:
26338837
PMCID:
PMC4563264
DOI:
10.1136/bmjopen-2015-007593
[Indexed for MEDLINE]
Free PMC Article

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