A controlled natural experimental study of new walking infrastructure and changes to green space ... more A controlled natural experimental study of new walking infrastructure and changes to green space along an urban canal on physical activity and other wellbeing behaviours
Background: Creating or improving urban green space has the potential to be an effective, sustain... more Background: Creating or improving urban green space has the potential to be an effective, sustainable and farreaching way to increase physical activity and improve other aspects of wellbeing in the population. However, there is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on physical activity and wellbeing. This is especially true in older adults and in the United Kingdom. This paper describes a natural experimental study to evaluate the effect of four small-scale urban street greening interventions on older adults' physical activity and wellbeing over a 1-year period, relative to eight matched comparison sites. All sites are located in deprived urban neighbourhoods in Greater Manchester, United Kingdom. Methods: Components of the interventions include tree and flower planting, and artificial tree decorations. Eight unimproved comparison sites were selected based on a systematic process of matching using several known objective and subjective environmental correlates of physical activity in older adults. The outcome measures are physical activity and two other behavioural indicators of wellbeing (Connect: connecting with other people; and Take Notice: taking notice of the environment), collected using a newly developed observation tool. The primary outcome is Take Notice behaviour due to largest effects on this behaviour being anticipated from improvements in the aesthetic quality of green space at the intervention sites. Baseline data collection occurred in September 2017 before the interventions were installed in November 2017. Follow-up data collection will be repeated in February/ March 2018 (6 months) and September 2018 (12 months). Discussion: The present study permits a rare opportunity to evaluate the causal effects of small-scale changes in urban green space in an understudied population and setting. Although the interventions are expected to have small effects on the outcomes, the present study contributes to developing natural experiment methodology in this field by addressing key methodological weaknesses causing high risk of bias in previous natural experimental studies. Key improvements to reduce risk of bias in the present study are rigorous matching of multiple comparison sites and appropriate statistical control of key confounders. Trial registration: Retrospectively registered with study ID NCT03575923. Date of registration: 3 July 2018.
UNSTRUCTURED Improving the environment is an important upstream intervention to promote populatio... more UNSTRUCTURED Improving the environment is an important upstream intervention to promote population health by influencing behaviours such as physical activity, smoking and social distancing. Examples of promising environmental interventions include creating new green spaces, building active transport infrastructure and urban planning regulation. However, there is little robust evidence to inform policy and decision makers about what kinds of environmental interventions are effective and for which populations. In this viewpoint, we make the case that this evidence gap is partly because health behaviour research is dominated by obtrusive methods that focus on studying how individuals behave, and which ignore environmental influences. By contrast, unobtrusive observation can assess how behaviour varies by environmental features. It thereby provides valuable data relating to environmental influences on behaviour, which is often more useful knowledge. These observation methods are currently under-used because considerable time, labour and cost is needed for in-person observers. We discuss how developing the use of video technology can provide a scalable, easily deployable solution for assessing health behaviours, and allow a more thorough investigation of how environments influence behaviour.
International Journal of Behavioral Nutrition and Physical Activity, Oct 7, 2016
Background: Evidence regarding the association of the built environment with physical activity is... more Background: Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity. Methods: Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar systematic reviews; these were published in the past five years and were selected to provide a range of different built environment interventions. The risk of bias in these studies was analysed using the Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI). Results: Twelve eligible natural experiments were identified. Risk of bias assessments were conducted for each physical activity outcome from all studies, resulting in a total of fifteen outcomes being analysed. Intervention sites included parks, urban greenways/trails, bicycle lanes, paths, vacant lots, and a senior citizen's centre. All outcomes had an overall critical (n = 12) or serious (n = 3) risk of bias. Domains with the highest risk of bias were confounding (due to inadequate control sites and poor control of confounding variables), measurement of outcomes, and selection of the reported result. Conclusions: The present review focused on the strongest natural experiments conducted to date. Given this, the failure of existing studies to adequately control for potential sources of bias highlights the need for more rigorous research to underpin policy recommendations for changing the built environment to increase physical activity. Suggestions are proposed for how future natural experiments in this area can be improved.
Background The assessment and communication of disease risk that is personalised to the individua... more Background The assessment and communication of disease risk that is personalised to the individual is widespread in healthcare contexts. Despite several systematic reviews of RCTs, it is unclear under what circumstances that personalised risk estimates promotes change in four key health-related behaviours: smoking, physical activity, diet and alcohol consumption. Purpose The present research aims to systematically identify, evaluate and synthesise the findings of existing systematic reviews. Methods This systematic review of systematic reviews followed published guidance. A search of four databases and two-stage screening procedure with good reliability identified nine eligible systematic reviews. Results The nine reviews each included between three and 15 primary studies, containing 36 unique studies. Methods of personalising risk feedback included imaging/visual feedback, genetic testing, and numerical estimation from risk algorithms. The reviews were generally high quality. For a broad range of methods of estimating and communicating risk, the reviews found no evidence that risk information had strong or consistent effects on health-related behaviours. The most promising effects came from interventions using visual or imaging techniques and with smoking cessation and dietary behaviour as outcomes, but with inconsistent results. Few interventions explicitly used theory, few targeted self-efficacy or response efficacy, and a limited range of Behaviour Change Techniques were used. Conclusions Presenting risk information on its own, even when highly personalised, does not produce strong effects on health-related behaviours or changes which are sustained. Future research in this area should build on the existing knowledge base about increasing the effects of risk communication on behaviour.
Cities must address many challenges including air quality, climate change and the health and well... more Cities must address many challenges including air quality, climate change and the health and wellbeing of communities. Public authorities and developers increasingly look to improve these through the implementation of interventions and innovations, such as low traffic neighbourhoods, deep housing retrofits and green infrastructure. Monitoring the impacts of interventions is essential to determine the success of such projects and to build evidence for broader urban transformation. In this paper we present a mixedmethod cross-disciplinary approach that brings together cutting edge atmospheric and data science, measurements of activity in public spaces and novel methods to assess wellbeing-promoting behaviours. The Manchester Urban Observatory focuses on living areas that have a high density of interrelated systems, which require observation, understanding and intervention at multiple levels. This must be completed in line with urban planning goals as well as a clear and succinct data solution that allows robust scientific conclusions to be made and viewed in real time. Delivery of such a monitoring strategy is not trivial and is time, resource and expertise heavy. This paper discusses the methods employed by the Manchester Urban Observatory to monitor the effectiveness off interventions implemented within cities and effective communication strategies with local communities.
Background: "Healthy Living for People with type 2 Diabetes (HeLP-Diabetes)" was a theory-based d... more Background: "Healthy Living for People with type 2 Diabetes (HeLP-Diabetes)" was a theory-based digital self-management intervention for people with type 2 diabetes mellitus that encouraged behavior change using behavior change techniques (BCTs) and promoted self-management. HeLP-Diabetes was effective in reducing HbA1c levels in a randomized controlled trial (RCT). National Health Service (NHS) England commissioned a national rollout of HeLP-Diabetes in routine care (now called "Healthy Living"). Healthy Living presents a unique opportunity to examine the fidelity of the national rollout of an intervention originally tested in an RCT. Objective: This research aimed to describe the Healthy Living BCT and self-management content and features of intervention delivery, compare the fidelity of Healthy Living with the original HeLP-Diabetes intervention, and explain the reasons for any fidelity drift during national rollout through qualitative interviews. Methods: Content analysis of Healthy Living was conducted using 3 coding frameworks (objective 1): the BCT Taxonomy v1, a new coding framework for assessing self-management tasks, and the Template for Intervention Description and Replication. The extent to which BCTs and self-management tasks were included in Healthy Living was compared with published descriptions of HeLP-Diabetes (objective 2). Semistructured interviews were conducted with 9 stakeholders involved in the development of HeLP-Diabetes or Healthy Living to understand the reasons for any changes during national rollout (objective 3). Qualitative data were thematically analyzed using a modified framework approach. Results: The content analysis identified 43 BCTs in Healthy Living. Healthy Living included all but one of the self-regulatory BCTs ("commitment") in the original HeLP-Diabetes intervention. Healthy Living was found to address all areas of self-management (medical, emotional, and role) in line with the original HeLP-Diabetes intervention. However, 2 important changes were identified. First, facilitated access by a health care professional was not implemented; interviews revealed this was because general practices had fewer resources in comparison with the RCT. Second, Healthy Living included an additional structured web-based learning curriculum that was developed by the HeLP-Diabetes team but was not included in the original RCT; interviews revealed that this was because of changes in NHS policy that encouraged referral to structured education. Interviewees described how the service provider had to reformat the content of the original HeLP-Diabetes website to make it more usable and accessible to meet the multiple digital standards required for implementation in the NHS. Conclusions: The national rollout of Healthy Living had good fidelity to the BCT and self-management content of HeLP-Diabetes. Important changes were attributable to the challenges of scaling up a digital intervention from an RCT to a nationally implemented
ABSTRACT Background : Short individual Subjective Wellbeing (SWB) survey instruments are increasi... more ABSTRACT Background : Short individual Subjective Wellbeing (SWB) survey instruments are increasingly used to measure the impact of policy and community health initiatives. Neighbourhood-level interventions should affect social SWB, where intervention impact relates to a geographically bounded area. Existing social SWB measures lack spatial focus and have not been tested with low literacy users. The objective of the study was to develop and validate a short and inclusive neighbourhood flourishing tool. Methods : Five key stages, started with conceptualisation built on recent reviews and a community survey. Second, a set of survey items were operationalised. Third, cognitive interviews with six low education readers refined and reduced the pool. Fourth, these items plus new and established measures of SWB and predictors of both, were tested with 292 participants and subject to psychometric analyses. Fifth, the nine strongest items were validated in two deprived UK neighbourhoods with a further 221 participants and subjected to readability formulas. Results : Initial work revealed 12 relevant concepts and 101 survey items assessing these were developed. Approximately half the new short items were acceptable in ‘think aloud’ interviews (n=6). Two rounds of completion of items revealed a 2-factor solution consisting of neighbourhood feelings and functionings. The final solution consisted of three high loading items assessing feelings (safety, trust and respect) and three items assessing functionings (celebration, autonomy and participation), that did not cross-load, and demonstrated predictive and discriminant validity. Based on eight reading score formulas, the final measure was found to suit a reading age of 12-14 years old. Conclusion : The new valid six-item measure was tested with 519 participants, is acceptable and usable with people from deprived neighbourhoods, and with evidence of validity. This is a robust practical and inclusive tool for the measurement of Neighbourhood Flourishing, relevant to urban regeneration, inequalities and climate change policy and research.
Abstract This study assessed the impact of low-cost physical changes to four urban amenity green ... more Abstract This study assessed the impact of low-cost physical changes to four urban amenity green spaces on older adults’ wellbeing behaviours (people taking notice of the environment, physical activity levels, social interactions), relative to eight matched comparison sites in Greater Manchester, United Kingdom. Systematic observations were conducted at baseline, six- and twelve months, with a nested qualitative study. There was no evidence that the intervention increased observable wellbeing behaviours or use of these spaces. This study demonstrates the feasibility of robust natural experimental methods and highlights the need for more nuanced policy and practice recommendations for improving urban green spaces.
International Journal of Environmental Research and Public Health, 2019
Green spaces are known to improve health and wellbeing via several mechanisms, such as by reducin... more Green spaces are known to improve health and wellbeing via several mechanisms, such as by reducing stress and facilitating physical activity. However, little is known about the impact of the smaller green spaces typically found in urban environments on wellbeing, especially for older adults. This study investigated experiences in adults (5 males and 10 females) aged 60 years and over of small urban green spaces in a large UK city. Fifteen older adults were interviewed using semi-structured walk-along interviews and photo elicitation methods in Old Moat, Greater Manchester. Twelve of the participants lived in Old Moat at the time of the study, and the remaining three participants previously lived in Old Moat and were frequent visitors. Transcribed interviews were analyzed using Thematic Analysis. Smaller urban green spaces were perceived differently to large green spaces, and participants were more likely to use larger green spaces such as parks. The smaller green spaces were perceiv...
Creating or improving urban green space has the potential to be an effective, sustainable and far... more Creating or improving urban green space has the potential to be an effective, sustainable and far-reaching way to increase physical activity and improve other aspects of wellbeing in the population. However, there is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on physical activity and wellbeing. This is especially true in older adults and in the United Kingdom. This paper describes a natural experimental study to evaluate the effect of four small-scale urban street greening interventions on older adults' physical activity and wellbeing over a 1-year period, relative to eight matched comparison sites. All sites are located in deprived urban neighbourhoods in Greater Manchester, United Kingdom. Components of the interventions include tree and flower planting, and artificial tree decorations. Eight unimproved comparison sites were selected based on a systematic process of matching using several known objective an...
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 13, 2017
The assessment and communication of disease risk that is personalised to the individual is widesp... more The assessment and communication of disease risk that is personalised to the individual is widespread in healthcare contexts. Despite several systematic reviews of RCTs, it is unclear under what circumstances that personalised risk estimates promotes change in four key health-related behaviours: smoking, physical activity, diet and alcohol consumption. The present research aims to systematically identify, evaluate and synthesise the findings of existing systematic reviews. This systematic review of systematic reviews followed published guidance. A search of four databases and two-stage screening procedure with good reliability identified nine eligible systematic reviews. The nine reviews each included between three and 15 primary studies, containing 36 unique studies. Methods of personalising risk feedback included imaging/visual feedback, genetic testing, and numerical estimation from risk algorithms. The reviews were generally high quality. For a broad range of methods of estimati...
The international journal of behavioral nutrition and physical activity, Oct 7, 2016
Evidence regarding the association of the built environment with physical activity is influencing... more Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity. Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar sy...
Journal for the measurement of physical behaviour, Jun 1, 2023
Systematic observation is a promising unobtrusive method of assessing human behavior in urban env... more Systematic observation is a promising unobtrusive method of assessing human behavior in urban environments without many issues typically associated with self-report measures (e.g., recall bias, low response rates). Improvements in video camera technologies make it more feasible for researchers to conduct systematic observation, which could reduce the time, labor, and cost to facilitate high-quality observational research in urban environments at scale. However, there are important ethical and information governance challenges driven by data protection laws, which discourage many researchers from using camera-based observation methods. The European Union General Data Protection Regulation is a leading global standard for data protection. Drawing on our experiences of conducting three studies using video cameras in public spaces, we discuss how to conduct this kind of research in line with General Data Protection Regulation requirements. The paper outlines issues concerning data protection, privacy, informed consent, and confidentiality, and how we addressed them. In doing this, the paper provides support for responsible use of camera-based observation methods, which will be of value to researchers, ethics committees, and funders. Outlining how to use video cameras responsibly will enable more research to be conducted that, in turn, will build the case for its benefits to researchers and society.
International Journal of Behavioral Nutrition and Physical Activity
Background Using infrared counters is a promising unobtrusive method of assessing footfall in urb... more Background Using infrared counters is a promising unobtrusive method of assessing footfall in urban parks. However, infrared counters are susceptible to reliability and validity issues, and there is limited guidance for their use. The aims of this study were to (1) determine how many weeks of automated active infrared count data would provide behaviourally stable estimates of urban park footfall for each meteorological season, and (2) determine the validity of automated active infrared count estimates of footfall in comparison to direct manual observation counts. Methods Three automated active infrared counters collected daily footfall counts for 365 days on three footpaths in an urban park within Northampton, England, between May 2021 – May 2022. Intraclass correlation coefficients were used to compare the behavioural stability of abbreviated data collection schedules with total median footfall within each meteorological season (Spring, Summer, Autumn, Winter). Public holidays, eve...
Direct observation of behaviour offers an unobtrusive method of assessing physical activity in ur... more Direct observation of behaviour offers an unobtrusive method of assessing physical activity in urban spaces, which reduces biases associated with self-report. However, there are no existing observation tools that: (1) assess other behaviours that are important for people's wellbeing beyond physical activity; (2) are suitable for urban spaces that typically have lower numbers of users (e.g. amenity green spaces) or that people pass through (e.g. green corridors); and (3) have been validated in Europe. MOHAWk (Method for Observing pHysical Activity and Wellbeing) is a new observation tool for assessing three levels of physical activity (Sedentary, Walking, Vigorous) and two other evidence-based wellbeing behaviours (Connect: social interactions; Take Notice: taking notice of the environment) in urban spaces. Across three studies, we provide evidence that MOHAWk is reliable and valid from 156 hours of observation by six observers in five urban spaces in the UK. MOHAWk can be used in policy or practice (e.g. by local authorities or developers), or in more formal institutional based research projects. This new tool is an inexpensive and easy-to-use method of generating wellbeing impact evidence in relation to the urban physical or social environment. A manual providing detailed instruction on how to use MOHAWk is provided.
International Journal of Behavioral Nutrition and Physical Activity
Background There are few robust natural experimental studies of improving urban green spaces on p... more Background There are few robust natural experimental studies of improving urban green spaces on physical activity and wellbeing. The aim of this controlled natural experimental study was to examine the impact of green space improvements along an urban canal on canal usage, physical activity and two other wellbeing behaviours (social interactions and taking notice of the environment) among adults in Greater Manchester, UK. The intervention included resurfaced footpaths, removal of encroaching vegetation, improved entrances, new benches and signage. Methods Two comparison sites were matched to the intervention site using a systematic five-step process, based on eight correlates of physical activity at the neighbourhood (e.g. population density) and site (e.g. lighting) levels. Outcomes were assessed using systematic observations at baseline, and 7, 12 and 24 months post-baseline. The primary outcome was the change in the number of people using the canal path from baseline to 12 months...
A controlled natural experimental study of new walking infrastructure and changes to green space ... more A controlled natural experimental study of new walking infrastructure and changes to green space along an urban canal on physical activity and other wellbeing behaviours
Background: Creating or improving urban green space has the potential to be an effective, sustain... more Background: Creating or improving urban green space has the potential to be an effective, sustainable and farreaching way to increase physical activity and improve other aspects of wellbeing in the population. However, there is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on physical activity and wellbeing. This is especially true in older adults and in the United Kingdom. This paper describes a natural experimental study to evaluate the effect of four small-scale urban street greening interventions on older adults' physical activity and wellbeing over a 1-year period, relative to eight matched comparison sites. All sites are located in deprived urban neighbourhoods in Greater Manchester, United Kingdom. Methods: Components of the interventions include tree and flower planting, and artificial tree decorations. Eight unimproved comparison sites were selected based on a systematic process of matching using several known objective and subjective environmental correlates of physical activity in older adults. The outcome measures are physical activity and two other behavioural indicators of wellbeing (Connect: connecting with other people; and Take Notice: taking notice of the environment), collected using a newly developed observation tool. The primary outcome is Take Notice behaviour due to largest effects on this behaviour being anticipated from improvements in the aesthetic quality of green space at the intervention sites. Baseline data collection occurred in September 2017 before the interventions were installed in November 2017. Follow-up data collection will be repeated in February/ March 2018 (6 months) and September 2018 (12 months). Discussion: The present study permits a rare opportunity to evaluate the causal effects of small-scale changes in urban green space in an understudied population and setting. Although the interventions are expected to have small effects on the outcomes, the present study contributes to developing natural experiment methodology in this field by addressing key methodological weaknesses causing high risk of bias in previous natural experimental studies. Key improvements to reduce risk of bias in the present study are rigorous matching of multiple comparison sites and appropriate statistical control of key confounders. Trial registration: Retrospectively registered with study ID NCT03575923. Date of registration: 3 July 2018.
UNSTRUCTURED Improving the environment is an important upstream intervention to promote populatio... more UNSTRUCTURED Improving the environment is an important upstream intervention to promote population health by influencing behaviours such as physical activity, smoking and social distancing. Examples of promising environmental interventions include creating new green spaces, building active transport infrastructure and urban planning regulation. However, there is little robust evidence to inform policy and decision makers about what kinds of environmental interventions are effective and for which populations. In this viewpoint, we make the case that this evidence gap is partly because health behaviour research is dominated by obtrusive methods that focus on studying how individuals behave, and which ignore environmental influences. By contrast, unobtrusive observation can assess how behaviour varies by environmental features. It thereby provides valuable data relating to environmental influences on behaviour, which is often more useful knowledge. These observation methods are currently under-used because considerable time, labour and cost is needed for in-person observers. We discuss how developing the use of video technology can provide a scalable, easily deployable solution for assessing health behaviours, and allow a more thorough investigation of how environments influence behaviour.
International Journal of Behavioral Nutrition and Physical Activity, Oct 7, 2016
Background: Evidence regarding the association of the built environment with physical activity is... more Background: Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity. Methods: Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar systematic reviews; these were published in the past five years and were selected to provide a range of different built environment interventions. The risk of bias in these studies was analysed using the Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions (ACROBAT-NRSI). Results: Twelve eligible natural experiments were identified. Risk of bias assessments were conducted for each physical activity outcome from all studies, resulting in a total of fifteen outcomes being analysed. Intervention sites included parks, urban greenways/trails, bicycle lanes, paths, vacant lots, and a senior citizen's centre. All outcomes had an overall critical (n = 12) or serious (n = 3) risk of bias. Domains with the highest risk of bias were confounding (due to inadequate control sites and poor control of confounding variables), measurement of outcomes, and selection of the reported result. Conclusions: The present review focused on the strongest natural experiments conducted to date. Given this, the failure of existing studies to adequately control for potential sources of bias highlights the need for more rigorous research to underpin policy recommendations for changing the built environment to increase physical activity. Suggestions are proposed for how future natural experiments in this area can be improved.
Background The assessment and communication of disease risk that is personalised to the individua... more Background The assessment and communication of disease risk that is personalised to the individual is widespread in healthcare contexts. Despite several systematic reviews of RCTs, it is unclear under what circumstances that personalised risk estimates promotes change in four key health-related behaviours: smoking, physical activity, diet and alcohol consumption. Purpose The present research aims to systematically identify, evaluate and synthesise the findings of existing systematic reviews. Methods This systematic review of systematic reviews followed published guidance. A search of four databases and two-stage screening procedure with good reliability identified nine eligible systematic reviews. Results The nine reviews each included between three and 15 primary studies, containing 36 unique studies. Methods of personalising risk feedback included imaging/visual feedback, genetic testing, and numerical estimation from risk algorithms. The reviews were generally high quality. For a broad range of methods of estimating and communicating risk, the reviews found no evidence that risk information had strong or consistent effects on health-related behaviours. The most promising effects came from interventions using visual or imaging techniques and with smoking cessation and dietary behaviour as outcomes, but with inconsistent results. Few interventions explicitly used theory, few targeted self-efficacy or response efficacy, and a limited range of Behaviour Change Techniques were used. Conclusions Presenting risk information on its own, even when highly personalised, does not produce strong effects on health-related behaviours or changes which are sustained. Future research in this area should build on the existing knowledge base about increasing the effects of risk communication on behaviour.
Cities must address many challenges including air quality, climate change and the health and well... more Cities must address many challenges including air quality, climate change and the health and wellbeing of communities. Public authorities and developers increasingly look to improve these through the implementation of interventions and innovations, such as low traffic neighbourhoods, deep housing retrofits and green infrastructure. Monitoring the impacts of interventions is essential to determine the success of such projects and to build evidence for broader urban transformation. In this paper we present a mixedmethod cross-disciplinary approach that brings together cutting edge atmospheric and data science, measurements of activity in public spaces and novel methods to assess wellbeing-promoting behaviours. The Manchester Urban Observatory focuses on living areas that have a high density of interrelated systems, which require observation, understanding and intervention at multiple levels. This must be completed in line with urban planning goals as well as a clear and succinct data solution that allows robust scientific conclusions to be made and viewed in real time. Delivery of such a monitoring strategy is not trivial and is time, resource and expertise heavy. This paper discusses the methods employed by the Manchester Urban Observatory to monitor the effectiveness off interventions implemented within cities and effective communication strategies with local communities.
Background: "Healthy Living for People with type 2 Diabetes (HeLP-Diabetes)" was a theory-based d... more Background: "Healthy Living for People with type 2 Diabetes (HeLP-Diabetes)" was a theory-based digital self-management intervention for people with type 2 diabetes mellitus that encouraged behavior change using behavior change techniques (BCTs) and promoted self-management. HeLP-Diabetes was effective in reducing HbA1c levels in a randomized controlled trial (RCT). National Health Service (NHS) England commissioned a national rollout of HeLP-Diabetes in routine care (now called "Healthy Living"). Healthy Living presents a unique opportunity to examine the fidelity of the national rollout of an intervention originally tested in an RCT. Objective: This research aimed to describe the Healthy Living BCT and self-management content and features of intervention delivery, compare the fidelity of Healthy Living with the original HeLP-Diabetes intervention, and explain the reasons for any fidelity drift during national rollout through qualitative interviews. Methods: Content analysis of Healthy Living was conducted using 3 coding frameworks (objective 1): the BCT Taxonomy v1, a new coding framework for assessing self-management tasks, and the Template for Intervention Description and Replication. The extent to which BCTs and self-management tasks were included in Healthy Living was compared with published descriptions of HeLP-Diabetes (objective 2). Semistructured interviews were conducted with 9 stakeholders involved in the development of HeLP-Diabetes or Healthy Living to understand the reasons for any changes during national rollout (objective 3). Qualitative data were thematically analyzed using a modified framework approach. Results: The content analysis identified 43 BCTs in Healthy Living. Healthy Living included all but one of the self-regulatory BCTs ("commitment") in the original HeLP-Diabetes intervention. Healthy Living was found to address all areas of self-management (medical, emotional, and role) in line with the original HeLP-Diabetes intervention. However, 2 important changes were identified. First, facilitated access by a health care professional was not implemented; interviews revealed this was because general practices had fewer resources in comparison with the RCT. Second, Healthy Living included an additional structured web-based learning curriculum that was developed by the HeLP-Diabetes team but was not included in the original RCT; interviews revealed that this was because of changes in NHS policy that encouraged referral to structured education. Interviewees described how the service provider had to reformat the content of the original HeLP-Diabetes website to make it more usable and accessible to meet the multiple digital standards required for implementation in the NHS. Conclusions: The national rollout of Healthy Living had good fidelity to the BCT and self-management content of HeLP-Diabetes. Important changes were attributable to the challenges of scaling up a digital intervention from an RCT to a nationally implemented
ABSTRACT Background : Short individual Subjective Wellbeing (SWB) survey instruments are increasi... more ABSTRACT Background : Short individual Subjective Wellbeing (SWB) survey instruments are increasingly used to measure the impact of policy and community health initiatives. Neighbourhood-level interventions should affect social SWB, where intervention impact relates to a geographically bounded area. Existing social SWB measures lack spatial focus and have not been tested with low literacy users. The objective of the study was to develop and validate a short and inclusive neighbourhood flourishing tool. Methods : Five key stages, started with conceptualisation built on recent reviews and a community survey. Second, a set of survey items were operationalised. Third, cognitive interviews with six low education readers refined and reduced the pool. Fourth, these items plus new and established measures of SWB and predictors of both, were tested with 292 participants and subject to psychometric analyses. Fifth, the nine strongest items were validated in two deprived UK neighbourhoods with a further 221 participants and subjected to readability formulas. Results : Initial work revealed 12 relevant concepts and 101 survey items assessing these were developed. Approximately half the new short items were acceptable in ‘think aloud’ interviews (n=6). Two rounds of completion of items revealed a 2-factor solution consisting of neighbourhood feelings and functionings. The final solution consisted of three high loading items assessing feelings (safety, trust and respect) and three items assessing functionings (celebration, autonomy and participation), that did not cross-load, and demonstrated predictive and discriminant validity. Based on eight reading score formulas, the final measure was found to suit a reading age of 12-14 years old. Conclusion : The new valid six-item measure was tested with 519 participants, is acceptable and usable with people from deprived neighbourhoods, and with evidence of validity. This is a robust practical and inclusive tool for the measurement of Neighbourhood Flourishing, relevant to urban regeneration, inequalities and climate change policy and research.
Abstract This study assessed the impact of low-cost physical changes to four urban amenity green ... more Abstract This study assessed the impact of low-cost physical changes to four urban amenity green spaces on older adults’ wellbeing behaviours (people taking notice of the environment, physical activity levels, social interactions), relative to eight matched comparison sites in Greater Manchester, United Kingdom. Systematic observations were conducted at baseline, six- and twelve months, with a nested qualitative study. There was no evidence that the intervention increased observable wellbeing behaviours or use of these spaces. This study demonstrates the feasibility of robust natural experimental methods and highlights the need for more nuanced policy and practice recommendations for improving urban green spaces.
International Journal of Environmental Research and Public Health, 2019
Green spaces are known to improve health and wellbeing via several mechanisms, such as by reducin... more Green spaces are known to improve health and wellbeing via several mechanisms, such as by reducing stress and facilitating physical activity. However, little is known about the impact of the smaller green spaces typically found in urban environments on wellbeing, especially for older adults. This study investigated experiences in adults (5 males and 10 females) aged 60 years and over of small urban green spaces in a large UK city. Fifteen older adults were interviewed using semi-structured walk-along interviews and photo elicitation methods in Old Moat, Greater Manchester. Twelve of the participants lived in Old Moat at the time of the study, and the remaining three participants previously lived in Old Moat and were frequent visitors. Transcribed interviews were analyzed using Thematic Analysis. Smaller urban green spaces were perceived differently to large green spaces, and participants were more likely to use larger green spaces such as parks. The smaller green spaces were perceiv...
Creating or improving urban green space has the potential to be an effective, sustainable and far... more Creating or improving urban green space has the potential to be an effective, sustainable and far-reaching way to increase physical activity and improve other aspects of wellbeing in the population. However, there is a dearth of well-conducted natural experimental studies examining the causal effect of changing urban green space on physical activity and wellbeing. This is especially true in older adults and in the United Kingdom. This paper describes a natural experimental study to evaluate the effect of four small-scale urban street greening interventions on older adults' physical activity and wellbeing over a 1-year period, relative to eight matched comparison sites. All sites are located in deprived urban neighbourhoods in Greater Manchester, United Kingdom. Components of the interventions include tree and flower planting, and artificial tree decorations. Eight unimproved comparison sites were selected based on a systematic process of matching using several known objective an...
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, Jan 13, 2017
The assessment and communication of disease risk that is personalised to the individual is widesp... more The assessment and communication of disease risk that is personalised to the individual is widespread in healthcare contexts. Despite several systematic reviews of RCTs, it is unclear under what circumstances that personalised risk estimates promotes change in four key health-related behaviours: smoking, physical activity, diet and alcohol consumption. The present research aims to systematically identify, evaluate and synthesise the findings of existing systematic reviews. This systematic review of systematic reviews followed published guidance. A search of four databases and two-stage screening procedure with good reliability identified nine eligible systematic reviews. The nine reviews each included between three and 15 primary studies, containing 36 unique studies. Methods of personalising risk feedback included imaging/visual feedback, genetic testing, and numerical estimation from risk algorithms. The reviews were generally high quality. For a broad range of methods of estimati...
The international journal of behavioral nutrition and physical activity, Oct 7, 2016
Evidence regarding the association of the built environment with physical activity is influencing... more Evidence regarding the association of the built environment with physical activity is influencing policy recommendations that advocate changing the built environment to increase population-level physical activity. However, to date there has been no rigorous appraisal of the quality of the evidence on the effects of changing the built environment. The aim of this review was to conduct a thorough quantitative appraisal of the risk of bias present in those natural experiments with the strongest experimental designs for assessing the causal effects of the built environment on physical activity. Eligible studies had to evaluate the effects of changing the built environment on physical activity, include at least one measurement before and one measurement of physical activity after changes in the environment, and have at least one intervention site and non-intervention comparison site. Given the large number of systematic reviews in this area, studies were identified from three exemplar sy...
Journal for the measurement of physical behaviour, Jun 1, 2023
Systematic observation is a promising unobtrusive method of assessing human behavior in urban env... more Systematic observation is a promising unobtrusive method of assessing human behavior in urban environments without many issues typically associated with self-report measures (e.g., recall bias, low response rates). Improvements in video camera technologies make it more feasible for researchers to conduct systematic observation, which could reduce the time, labor, and cost to facilitate high-quality observational research in urban environments at scale. However, there are important ethical and information governance challenges driven by data protection laws, which discourage many researchers from using camera-based observation methods. The European Union General Data Protection Regulation is a leading global standard for data protection. Drawing on our experiences of conducting three studies using video cameras in public spaces, we discuss how to conduct this kind of research in line with General Data Protection Regulation requirements. The paper outlines issues concerning data protection, privacy, informed consent, and confidentiality, and how we addressed them. In doing this, the paper provides support for responsible use of camera-based observation methods, which will be of value to researchers, ethics committees, and funders. Outlining how to use video cameras responsibly will enable more research to be conducted that, in turn, will build the case for its benefits to researchers and society.
International Journal of Behavioral Nutrition and Physical Activity
Background Using infrared counters is a promising unobtrusive method of assessing footfall in urb... more Background Using infrared counters is a promising unobtrusive method of assessing footfall in urban parks. However, infrared counters are susceptible to reliability and validity issues, and there is limited guidance for their use. The aims of this study were to (1) determine how many weeks of automated active infrared count data would provide behaviourally stable estimates of urban park footfall for each meteorological season, and (2) determine the validity of automated active infrared count estimates of footfall in comparison to direct manual observation counts. Methods Three automated active infrared counters collected daily footfall counts for 365 days on three footpaths in an urban park within Northampton, England, between May 2021 – May 2022. Intraclass correlation coefficients were used to compare the behavioural stability of abbreviated data collection schedules with total median footfall within each meteorological season (Spring, Summer, Autumn, Winter). Public holidays, eve...
Direct observation of behaviour offers an unobtrusive method of assessing physical activity in ur... more Direct observation of behaviour offers an unobtrusive method of assessing physical activity in urban spaces, which reduces biases associated with self-report. However, there are no existing observation tools that: (1) assess other behaviours that are important for people's wellbeing beyond physical activity; (2) are suitable for urban spaces that typically have lower numbers of users (e.g. amenity green spaces) or that people pass through (e.g. green corridors); and (3) have been validated in Europe. MOHAWk (Method for Observing pHysical Activity and Wellbeing) is a new observation tool for assessing three levels of physical activity (Sedentary, Walking, Vigorous) and two other evidence-based wellbeing behaviours (Connect: social interactions; Take Notice: taking notice of the environment) in urban spaces. Across three studies, we provide evidence that MOHAWk is reliable and valid from 156 hours of observation by six observers in five urban spaces in the UK. MOHAWk can be used in policy or practice (e.g. by local authorities or developers), or in more formal institutional based research projects. This new tool is an inexpensive and easy-to-use method of generating wellbeing impact evidence in relation to the urban physical or social environment. A manual providing detailed instruction on how to use MOHAWk is provided.
International Journal of Behavioral Nutrition and Physical Activity
Background There are few robust natural experimental studies of improving urban green spaces on p... more Background There are few robust natural experimental studies of improving urban green spaces on physical activity and wellbeing. The aim of this controlled natural experimental study was to examine the impact of green space improvements along an urban canal on canal usage, physical activity and two other wellbeing behaviours (social interactions and taking notice of the environment) among adults in Greater Manchester, UK. The intervention included resurfaced footpaths, removal of encroaching vegetation, improved entrances, new benches and signage. Methods Two comparison sites were matched to the intervention site using a systematic five-step process, based on eight correlates of physical activity at the neighbourhood (e.g. population density) and site (e.g. lighting) levels. Outcomes were assessed using systematic observations at baseline, and 7, 12 and 24 months post-baseline. The primary outcome was the change in the number of people using the canal path from baseline to 12 months...
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Papers by Jack Benton