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BARRIERS TO PHYSICAL ACTIVITY
Barriers to Physical Activity in the Community of Cold Spring, MN
Marcia Scherer, MS, RN, CNE, PHN, LSN
PSY 627: Multivariate Statistics in the Behavioral Sciences
Presented to Dr. David Stockburger
Missouri State University
Final Statistics Project
August 4, 2011
Abstract
The desire to decrease health care costs due to ramifications of chronic illness secondary to obesity and a sedentary lifestyle continues to haunt the United States citizens. In a study completed by the Center for Disease Control (CDC) covering 36 states, physical activity decreased from 30.5% in 1989 to 25% in 2008 (2010). Under funding through a grant from the Minnesota legislature, Stearns County Public Health Department continues to assess and formulate suggestions for towns/cities within the county. The goal of this paper is to determine barriers to physical activity for a single community, the town of Cold Spring for the public health department.
A descriptive survey design was completed to determine if there were barriers to physical activity for the community of Cold Spring, MN. A convenience sample of 56 Cold Spring residents completed a 10 statement Likert survey tool describing aspects of the community.
The findings suggest that there are no barriers to physical activity in Cold Spring according to residents surveyed. There was however an inverse correlation found; the older the resident the tendency to disagree with the 10 statements. The fact remains, physical activity is necessary for a healthy and productive life.
Keywords: barriers to physical activity, physical inactivity, obesity, Statewide Health Improvement Program, Minnesota Department of Health, Centers for Disease Control, sedentary lifestyle
Barriers to Physical Activity in the Community of Cold Spring, MN
Obesity is an increasing phenomenon in the United States (US) while motivation towards physical activity appears to be dwindling. In a study of 36 states completed by the Center for Disease Control (CDC), physical activity decreased from 30.5% in 1989 to 25% in 2008 (2010). In response, the U.S. Department of Health and Human Services released a “National Prevention Strategy” addressing four areas fundamental to improving health within the nation (2011). Two of these areas provide direction for states to implement in improving health; “Building Healthy and Safe Community Environments” and “Empowering People to Make Healthy Choices” (2011, p. 1). Stearns County Public Health Department has taken this directive seriously and with funding provided by the Minnesota legislature continues to assess cities/towns within their jurisdiction. Upon completion of the assessment process, creative ideas for environmental improvements are suggested to the city/town with potential implementation through state funding. Taking one such city, Cold Spring, within the county was a directive given by the director of the public health department. Therefore, the goal of this research project was to determine if there are community barriers to physical activity for residents of Cold Spring, Minnesota (MN).
According to the Minnesota Department of Health (MDH) 97 million adults in the U.S. are overweight or obese (2009). In Minnesota nearly 63% adults are overweight or obese (2009). Typically obesity is associated with a sedentary lifestyle along with poor eating habits. Are there environmental changes where people reside that preclude people from being physically active on a regular basis? Physical inactivity contributes to obesity which in turn leads to chronic illnesses such as Diabetes Mellitus Type II, hypertension, stroke, cancer, and heart disease. One way to respond to the increasing incidence of chronic illnesses due to obesity and a sedentary lifestyle is to encourage physical activity. Healthy People 2020 addresses physical activity by encouraging communities to increase availability of sidewalks, bike lanes, trails, and parks” for their residents (U.S. Department of Health and Human Services, 2011, p. 1).
Healthy People 2020 states that to “understand the barriers to and facilitators of physical activity are important to ensure the effectiveness of interventions and other actions to improve levels of physical activity” (U. S. Department of Health and Human Services, 2011, p. 2). In 2009 the MDH introduced the Statewide Health Improvement Program (SHIP) where community health boards and tribal governments could apply for a grant to “prevent obesity in Minnesota” (Minnesota Department of Health [MDH], 2010, p. 2). Since 2009 the Stearns County Public Health Department has been utilizing a SHIP grant to identify environmental needs of cities within the county to increase physical activity towards overall improvement of resident health (Sherry O’Brien, personal communication, May 20, 2011). O’Brien, Public Health Nursing Supervisor for Stearns County Public Health Department, requested completion of a physical assessment for the city of Cold Spring to identify barriers to physical activity and address community needs for future city planning.
Assessment of a city layout yields important information that can improve the health of its residents. Fenton (2005) points out that the obesity epidemic can be controlled through a redefinition of obesity to that “of physical inactivity and poor nutrition” (p. S115). By restructuring communities with accessible and safe sidewalks, bikeways, and parks residents are more apt to become more physically active. In a report, “F as in Fat: How Obesity Threatens America’s Future,” funded by the Robert Wood Johnson Foundation, specifically identifies convenience and security are major factors influencing physical activity of residents in a community (2011). When residents are more physically active they will have a tendency to be healthier; which could be the topic of another research project for the community of Cold Spring!
The purpose of this research project then is to identify barriers within the community of Cold Spring, MN that prohibit activity among its residents. The question is, “Are there barriers to physical activity for residents of Cold Spring?” The Stearns Public Health Department is interested in identifying the barriers to physical activity for this community so improvements can be made to the city’s structural environment to increase physical activity of its residents. From this question the null hypothesis is formulated which states, “There are no barriers to physical activity for residents of Cold Spring.” While the alternative hypothesis is, “There are barriers to physical activity for residents of Cold Spring.”
Methods
Participants
A convenience sampling of Cold Spring residents was attained. Residents were asked to complete a paper survey as they entered the grocery store, golf course, bank, hardware store, or bar. Nursing students introduced themselves and asked each resident for verbal permission before filling out the short survey. Prior to completing the survey, residents were also asked their approximate residence location after being shown a map with clear section delineations of the city; north, south, east, or west (see Appendix A). Residents were given the tool after a brief introduction to and rationale for the survey, along with residence location within the city limits. All of the surveys were anonymous. Resident names and addresses were not asked for nor required for completion of this survey. 56 residents finished the written survey (N=56). This survey was designed and conducted in part as a request by the Stearns County Public Health Department and as a follow-up to observations of the city after finishing a “walkability” study.
Instrument
In preparation for development of a Likert scale tool, a walkability survey was completed for the city. On May 24, 2011 the city was divided into three specific areas and nursing students in a public health nursing course observed each area that they walked. Sidewalks, lighting, curbs, aesthetic appeal, crosswalks, parks, benches, bike and walking trails were assessed and comments made using a walkability survey developed by Health by Design (n.d.). After reviewing the data collected by the students, the students and I developed a Likert scale.
The Likert scale tool was aimed at identifying and understanding the physical activity needs of the city's occupants along with identifying environmental barriers for the residents of Cold Spring. This tool consisted of a ten item four point Likert scale with an additional five demographic questions (see Appendix B). Demographics asked included gender, age, area within city, hours of exercise per week, and hours of exercise wished to do per week. There were 10 Likert type statements. The following is an example for scoring of the Likert type responses
Statements / Missing / Score 1 / Score 2 / Score 3 / Score 41. I live in a physically active community. / No Response / Strongly Disagree / Disagree / Agree / Strongly Agree
After completing the walkability study there were several areas of concern and was hopeful by completing this survey that residents would give their perspective for safety and other environmental issues. The walkability study demonstrated easy access to downtown businesses, the fragrance of flowers, and benches to rest upon. Concerns noted were faded crosswalks, sidewalks with cracks, heaves, and unevenness, a bridge with only a knee high ledge (safety concern for curious children), school crossing signs missing, and sidewalks leading to schools for children who walk to school are non-existent. So, do residents of Cold Spring feel that their community is safe to walk? Are there barriers to resident physical activity within the city limits?
Results
The results of this study show that there are no barriers to physical activity in the city of Cold Spring. The null hypothesis is retained, “There are no barriers to physical activity for residents of Cold Spring.” Further examination of the data leads to this result.
Of the 56 residents, the frequency table (through the histogram below) reveals that 42.9 percent respondents (N=24) were male and 51.7 percent respondents (N=32) were female. This histogram provides age frequency with a normal distribution curve. The x axis is set for 1 = 18-24 years, 2 = 25-34 years, 3 = 35-44 years, 4 = 45-54 years, 5 = 55-64 years, and 6 = 65+ years.
Graph 1. Histogram of ages with normal curve distribution.
The mean (4.21) and median (4) age then corresponds to ages 45-54 years. The mode is represented by group 6, age 65+ years. The range is groups 1-6 with ages ranging from 18 years to 65+ years.
What parts of the city do these residents call home? A good portion of the respondents live in the North section (N=20) while the second largest group hails from the East (N=18).
Graph 2. Respondent area of residence
Treating the ten statements as ordinal data, percentages for responses are calculated.
Statement / No Response / Strongly Disagree / Disagree / Agree / Strongly Agree / PercentageAgree/Strongly Agree
1. I live in a physically active community. / 0 / 1 / 2 / 43 / 10 / 95%
2. I have somewhere I can exercise in Cold Spring. / 0 / 0 / 3 / 36 / 17 / 95%
3. I would exercise more if I had someone to exercise with. / 1 / 4 / 15 / 28 / 8 / 64%
4. I know of outdoor trails in Cold Spring. / 0 / 3 / 19 / 27 / 7 / 61%
5. My community is bicycle friendly. / 1 / 1 / 15 / 30 / 9 / 70%
6. There are enough sidewalks in Cold Spring. / 0 / 2 / 12 / 32 / 10 / 75%
7. Sidewalks are well-kept throughout the year. / 1 / 2 / 9 / 36 / 8 / 79%
8. If I lived close to the school I would allow my children to walk. / 1 / 2 / 5 / 38 / 10 / 86%
9. My neighborhood is well-lit at night. / 0 / 2 / 12 / 33 / 9 / 75%
10. I feel safe in my neighborhood / 0 / 1 / 0 / 35 / 20 / 98%
Table 1. Percentage respondents strongly agree/agree
This table demonstrates that respondents agree with the statements. Further delineation is necessary to determine if there are effects or barriers that influence physical activity by residents.
Statements in the tool were then scored using the following scale; missing = no response, 1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree. A new variable was transformed and called, totalstatements, by adding up the scores for each of the respondents for all 10 statements. The larger the score for the respondent, the more apt the respondent was to agree with the statements while the smaller the score the less likely. The maximum number a respondent could achieve is 40 (4 being strongly agree x 10 statements). Further basic statistical analysis resulted in the following table:
/ N / Minimum / Maximum / Mean / Std. Deviation /Gender / 56 / 1 / 2 / 1.57 / .499 /
Age / 56 / 1 / 6 / 4.21 / 1.569 /
Area / 56 / 1 / 4 / 2.25 / 1.100 /
Hrs of Ex / 56 / 1 / 4 / 2.98 / 1.000 /
Wish Hrs / 56 / 1 / 4 / 3.34 / .920 /
State 1 / 56 / 1 / 4 / 3.11 / .528 /
State 2 / 56 / 2 / 4 / 3.27 / .556 /
State 3 / 56 / 0 / 4 / 2.68 / .876 /
State 4 / 56 / 1 / 4 / 2.66 / .793 /
State 5 / 56 / 0 / 4 / 2.80 / .796 /
State 6 / 56 / 1 / 4 / 2.89 / .731 /
State 7 / 56 / 0 / 4 / 2.86 / .773 /
State 8 / 56 / 0 / 4 / 2.95 / .773 /
State 9 / 56 / 1 / 4 / 2.86 / .724 /
State 10 / 56 / 3 / 4 / 3.36 / .483 /
Totalstatements / 56 / 15.00 / 36.00 / 29.4286 / 3.75552 /
Valid N (listwise) / 56
Table 2. Descriptive Statistics for each variable