A multilevel ecological approach to promoting walking in rural communities

Background. Walking is a key focus of public health interventions yet is particularly uncommon in rural residents. This studyʹs purpose was to determine whether a multilevel community intervention affected rates of moderate physical activity, in particular walking. Methods. A quasi-experimental design examined changes in walking in six rural intervention communities in Missouri and six comparison communities in Arkansas and Tennessee in 2003–2004. Interventions were developed with community input and included individually tailored newsletters; interpersonal activities that stressed social support and health provider counseling; and community-wide events such as fun walks. A dose variable estimated exposure to intervention activities. Primary outcomes were rates of walking and moderate physical activity in the past week. Results. At follow-up (n = 1531), the percentage of respondents who met the recommendation for walking was the same across the intervention and comparison areas. Among the dependent variables, walking showed some evidence of a positive linear trend across dose categories (P = 0.090). After adjusting for covariates and baseline rates, intervention participants in the moderate and high dose categories were about three times more likely to meet recommended guidelines for walking. Conclusions. Some evidence of effectiveness was shown for a multilevel intervention approach to promote walking.