@article{ref1,
title="Can a Motivational Intervention Overcome an Unsupportive Environment for Walking-Findings from the Step-by-Step Study",
journal="Annals of behavioral medicine",
year="2009",
author="Merom, Dafna and Bauman, Adrian E. and Phongsavan, Philayrath and Cerin, Ester and Kassis, Mazen and Brown, Wendy and Smith, B. Jill and Rissel, Chris E.",
volume="38",
number="2",
pages="137-146",
abstract="BACKGROUND: Interventions to promote walking have rarely examined how their effects varied by the attributes of the physical environment. PURPOSE: 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 &quot;no-treatment&quot; 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., >/=150 min/week and >/=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 &quot;low&quot; or &quot;high&quot; 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 &quot;low&quot; (-24% and -22%, respectively) compared with &quot;high&quot; (p < 0.05). In &quot;low&quot; 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.<p /> <p>Language: en</p>",
language="en",
issn="0883-6612",
doi="10.1007/s12160-009-9138-z",
url="http://dx.doi.org/10.1007/s12160-009-9138-z"
}