The Mile Starts Here: A Walking Program

State: MO Type: Promising Practice Year: 2015

Who Are We? The City of Independence Health Department (IHD) ensures the public’s health through activities that protect the public from environmental hazards, prevents injury and disease, and promotes healthy behaviors and lifestyles. Independence is the fourth largest city in the state of Missouri with 117,246 residents. It encompasses approximately 78 square miles and is located in Jackson County with a small portion in Clay County. Independence is part of the Kansas City Metropolitan Area. Independence largely reflects a population age distribution consistent with that of Missouri: the majority (52%) of both populations are between the ages of 24-64. According to U.S. Census data, 86% of City residents identify as white, while 94% spoke only English in the home.   What’s the Issue? Overweight and obesity are health factors that affect both adults and children of Independence. The 2013 Community Health Assessment (CHA), a biannual survey of residents’ current perceptions of public health in Independence, designated overweight/obesity as a top priority. IHD set a goal to reduce rates of overweight and obesity based on the CHA’s results and utilizing activities within the Building a Healthier Independence (BHI), an initiative that promotes healthy eating, active living, and a tobacco-free lifestyle. Activities included: ·         Improving access to healthy foods, ·         Increasing opportunities for physical activity, ·         Increasing knowledge and skills for weight reduction, and ·         Developing coordinated messages on obesity prevention.   What Did We Set Out to Achieve? Reducing the effects of chronic disease on health that results from a lack of physical activity continues to be a goal for IHD and “The Mile Starts Here” (TMSH) walking program.  The objectives of TMSH are: ·         Increase utilization of parks and trails ·         Increase physical activity in Independence ·         Increase the social connectedness of the community   What Was Our Plan? TMSH began in 2012 in response to community members requesting a walking group, the need for safe spaces for physical activity in Independence, and high overweight/obesity rates. Just finishing a successful third year, the strategy to reach the objectives consisted of planning walks every Wednesday from May to October at Independence parks and trails. A promotional plan using newspapers, flyers, and a mobile app designed for smartphones and tablets helped increase participation from residents. Participants received a free pedometer by attending, which aided them in tracking the amount of steps they walked. If a participant completed every walk, they received a yearlong membership to a local gym.   Hitting the Target: Objectives & Indicators of Success To achieve an environment of social connectedness to the community, TMSH gave residents the opportunity to connect. By providing a venue for these social connections to occur, friendships and new groups formed organically. These groups exemplify the success and sustainability of the program and keep the program strong via the participants’ attendance and willingness to walk more than the planned one-mile walk. They are sustainable outside of TMSH and often meet other times during the week. TMSH has created a safe environment where those who do not feel comfortable walking alone now have a group where physical activity is part of the culture.  The innovative style of health promotion and communication to the public increased the reach of the program, which led to its success. The group is able to connect via email and social media.  Just the act of attending the walk met the objective of utilizing parks and trails, but also increased awareness of the great facilities in Independence. By planning the walks in different areas of town, TMSH identified routes that could accommodate residents from all areas of Independence. Many first-time participants commented that they were unaware of the variety of facilities that were walkable and within an accessible distance. Increasing the physical activity of participants was achieved and measurable down to the distance walked, attendance frequency, and proximity of participants’ residence from the route. A weekly sign-in sheet was used to track attendance and gather contact information. The participants also increased their knowledge of other physical activity programs and how easy it can be to reach recommended physical activity levels via promotional materials handed out at the walks.   Lasting Impressions for Public Health Practitioners Each year the program has gained followers and increased interest from the community, as well as increased participation frequency. This program requires little to no cost to conduct and leads to its sustainability year-to-year. It has brought public health and the IHD to the face of the public. The best representation of the program comes from this video: TMSH.   Where to Find Us  
The Problem Starts Here According to the 2013 CHA, overweight/obesity is a top priority to citizens. This led IHD to adopt the issue as a main priority. The CHA also demonstrated that 68 percent of Independence residents were overweight or obese and 57 percent of respondents indicated they do not use the city parks or trails. In addition, 25 percent of respondents indicated they spent an hour or less per day performing some sort of physical activity.   Who do we serve? The IHD is located in Independence, MO, a suburb of Kansas City, MO. Overall, “The Mile Starts Here” (TMSH) walking program is intended for Independence residents. However, it serves anyone who is available Wednesday mornings to participate in the weekly walks.  Independence has a population of 117,246 and is the fourth most populated city in the state. The target population is overweight/obese residents. According to the CHA, 32 percent of respondents were overweight (BMI of 25-29.9%) and nearly 36 percent of respondents were obese (BMI of 30% or greater). One quarter of respondents indicated they spent an hour or less per day performing some sort of physical activity. Respondents who indicated they use a bicycle for some form of physical activity totaled 22 percent. Forty-three percent of respondents indicated they use the city parks or trails. TMSH has 2,225 total participants from 2012-2014 and the percentage of the target population reached would be based on the findings from the CHA.   Before The Mile IHD has offered a number of programs and educational resources to residents of Independence to increase opportunities for active living and healthy eating. Several community events have been organized focusing on physical activity. A “Complete Streets Policy” was passed by the City Council in 2011 to encourage incorporation of all modes of transportation, including walking and cycling, among planning and construction projects. Several food demos at various farmers’ markets helped to demonstrate ways to incorporate fruit and vegetables into meals and snacks. These are a few activities that IHD has employed to decrease overweight and obesity in Independence.   Perfect Practice Makes Perfect Play TMSH is superior to prior physical activity initiatives because it incorporates technology into health promotion and has filled a gap where there was a need in Independence. A unique aspect of this walking program is that the walks take place at a different park or trail each week as part of a rotating schedule. It also has the flexibility to be indoors or outdoors if necessary in case of inclement weather or in extreme heat or cold. The program is open to people of all ages and is a great way to encourage physical activity in a noncompetitive way. It has done a great job of improving awareness of existing parks and recreational facilities in Independence that can be used outside of the scheduled weekly walk. In fact, the groups of friends that have been created through TMSH hold walks even without IHD presence. The use of technology (i.e. Garmin watch, BHI app) has been part of the process from the accurate first route mapping to placing routes on the BHI app to social media.   The Mile is Innovative TMSH utilizes an existing tool in a creative and innovative way. Creating a free, mobile app for the community incorporates the use of technology, health resources and education to encourage residents to become more physically active and consume healthier food options. Incorporating mobile health among public health practice will allow for greater exposure of healthy resources to members of the population IHD serves. By using the app to inform the community of walking routes and trails, IHD continues to gain participants. The app also displays the rotating schedule, which gives equal opportunities to residents who live in all areas of Independence by strategically planning the walks in various ZIP codes. Tracking TMSH group via the Garmin Connect website is innovative in creating a social connectedness that is sometimes absent in health promotion activities. TMSH has also expanded on the typical walking program by utilizing a rotating schedule, which gives equal opportunities to residents who live in all areas of Independence. Walking in different locations keeps the program exciting and interesting for the residents so they keep coming back.   Evidence-based Walkability Information Scientific research has shown that regular physical activity not only promotes health and well-being, it also reduces the risk of developing many chronic diseases and becoming overweight or obese.(1) Walking routes offer a safe and fun way to get physical activity. Walking requires little or no equipment and can be enjoyed by most individuals, regardless of their abilities. Adults should be moderately active (a brisk walk would fit this definition) for 30 or more minutes on most days of the week. Scientific evidence has demonstrated that providing access to places for physical activity increases the level of physical activity in a community. Studies have shown that access to places for physical activity results in a 25 percent increase in physical activity levels among people who use the improved facilities.(1) Participating in regular physical activity is one of the most important things that can be done to promote health.  It can help control your weight, reduce your risk of numerous chronic diseases, improve your ability to do daily activities and prevent falls if you are an older adult.(2) (1) (2)
Nutrition, Physical Activity, and Obesity
Our Mile Mission Reducing the effects of chronic diseases that result from a lack of physical activity was and continues to be a goal for IHD and TMSH walking program. The objectives of the program are: ·         Increase utilization of City parks and trails ·         Increase physical activity in the City of Independence ·         Increase the social connectedness of the community   The Long & Winding Mile The steps taken to achieve the goals and objectives took place over an eight-month period. Stakeholders involved in the planning and implementation process allowed a platform for TMSH to grow and become successful. The City of Independence Parks & Recreation Department aided in the scheduling, maintenance, and creation of facilities for the walking group. The City of Independence Technology Services Department was crucial to the design, maintenance, and creation of the “Building a Healthier Independence” app to support walking group schedules, activities, and locations. Technology Services also helped with the creation of walking videos. Community stakeholders met with IHD staff to discuss lessons learned from previous years and continue to provide input on a weekly basis. Also to foster collaboration with community stakeholders, leadership at IHD maintains regular updates with community stakeholders via email, Facebook updates, and Twitter postings, as well as face-to-face discussion before and after walks. Leadership uses the following as a guide to organize and implement TMSH: ·         Setting meetings with IHD staff, technology services, community stakeholders and parks and recreation staff to determine walking group leadership, strategy and                 possible locations/routes. ·         Identifying routes based on four council districts within the City of Independence to allow residents equal opportunity to gain access to physical activity. ·         Mapping walking routes in parks, trails, and facilities using the Garmin watch and coinciding website to ensure accurate distance walked for evaluation purposes. ·         Setting the day of the week, place and time for weekly walks. ·         Using the BHI app, weekly routes become accessible via mobile devices as well as the Garmin group page where the maps were designed. Additional distribution of             fliers takes place in the two months leading up to the first walk. ·         Creating a sign-in sheet which includes ZIP codes and emails of residents to record miles walked and distance traveled for evaluation, communication, and                           sustainability purposes at the end of the walking season. ·         Tracking data is used as a guide for next year’s planning purposes.   The Mile Costs This Much The total start-up and maintenance of TMSH is $650-$850 for the first year. ·         Bottled Water (donations helpful): $200-$400 ·         Printing Costs: <$100 ·         Garmin Watch: $150 ·         Pedometers for participants: $200
Outcomes, Objectives & Results Reducing the effects of chronic disease on health that results from a lack of physical activity was and continues to be a goal for IHD and TMSH walking program. The objectives of the program are: ·         Increase utilization of City parks and trails ·         Increase physical activity in the City of Independence ·         Increase the social connectedness of the community TMSH collected both quantitative and qualitative data to gain a better understanding of the practice’s outcomes. TMSH walking program directly met the objectives that were set out to be achieved. IHD collected primary data via the sign-in sheet the participants filled out upon arriving at the walk. IHD evaluated the practice by having participants fill out the sign-in sheet that recorded their ZIP code, and name for participation. From that list, sign-in information was compiled into an Excel spreadsheet to track the miles walked, number of unique participants, average number of participants per year, first time participants, and where most participants were coming from. Quantitatively, IHD was able to exceed the objective of getting residents to utilize parks and trails by recording the increase in participants and the increase in number of miles walked. Over the course of the three years, there have been 75 mile-led walks. By holding the weekly walks at the different parks and trails, there was an increased utilization of parks and trails by residents. The average number of participants per walk has increased more than 150 percent during the course of 3 years. An average of 17 participants per walk in 2012 grew to an average of 45 participants per walk in 2014. Tracking Results                                     Total Participants             Total Miles Walked                 Weekly Average 2012                                     397                                     408                                   17 2013                                     670                                     772                                   31 2014                                    1158                                   1315                                  45   Overall Total                        2225                                   2495                                  31   Through strategic community engagement and effective partnership building, IHD has determined there is a strong community desire to be physically active based on the expressed satisfaction of using parks, trails, and recreational facilities. Thus, IHD has successfully engaged community participation and awareness. Qualitatively, IHD exceeded the objectives of social connectedness and residents increasing their physical activity by conducting interviews with participants. After conducting interviews with the participants, many participants expressed wanting to extend the program past the normal program period- whether that included walking indoors or outdoors. Participants also reported walking before and after the walks and creating friendship and “walking buddies.”   The Mile Changes From results and wanting to achieve continuous quality improvement, IHD and stakeholders have modified the program each year. By spreading out the walks, we were able to include equal access in each council district to residents- a change from 2012 to 2014. In 2014, ZIP code tracking was added to gain insight into our target population. The tracking identified where participants were traveling from to walk and will provide future route mapping in new and exciting locations.  
The Mile Taught Us ·         Anticipating a participation increase every year if the practice is promoted correctly and through many different avenues should be expected. Increasing the reach of               promotion is only enhanced by both old-school (word-of-mouth) and new-school (BHI app) means of communication. ·         Preparing to work with the community and their comments and concerns should be expected. ·         Modifying courses based on participant responses – for example, the modification of the most popular site at Waterfall Park by changing the initial route from a 1-mile               route on roads to a 2-mile course and/or option of 1-mile course. ·         Sustaining the practice can be enhanced by the friendships/collaboration created during the walks.   The Miles Roll On Because members of the group continue walking during the months that IHD does not participate, there is a strong probability that this practice aids sustainability. Community leadership is taking hold as participants make suggestions and plans for where and when to walk. Community leadership have access to the group email list, Garmin Connect Group webpage admin login to map routes and will have the support of IHD. This stakeholder commitment to the program will be valuable to its success. There was not a cost and benefit analysis was conducted.    
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