Rural Libraries Promoting Walking and Walkability in Their Rural Communities

PROJECT SUMMARY Rural residents generally lack the needed level of physical activity to benefit health and reduce disparities in chronic illness associated with physical inactivity, such as cardiovascular disease and certain cancers. The Socioecological Model describes physical activity as involving a dynamic and reciprocal interaction between

individual, social, and community factors; therefore, interventions designed to promote physical activity are likely to be most effective if they target individual, social and community factors. However, there is a dearth of such multilevel interventions, particularly with rural communities. Community group-based walking programs

are widely used because of the strong evidence base for increasing physical activity through individual and social factors. Civic engagement interventions aimed at improving the built environment for physical activity have had beneficial impacts on community (built environment) and social factors. However, while both the

group-based walking and civic engagement interventions have been successful in rural communities, neither targets all three factors. Additionally, relative to urban communities, rural communities generally lack the necessary resources to implement public health programming. An innovative public health partner in rural

communities is public libraries; however, rural libraries often lack the capacity to implement evidence-based programming. There is, therefore, a critical need to identify effective multilevel physical activity interventions that promote regular physical activity and are applicable to and feasible in rural communities. The overall

objectives for this project are to increase rural libraries' capacity for program implementation and conduct a comparative effectiveness study of a group-based walking (standard approach) versus a combined group- based walking plus civic engagement program aimed at enhancing walkability to increase physical activity

among rural adults. We will also identify key mediators between the program effects and change in outcomes. We will evaluate program implementation using a positive deviance analysis to understand experiences of high and low changers at the individual level on key outcomes. We will match and randomize 16 towns to one of the

two approaches and enroll a total of 336 rural residents. Measurements will be taken at baseline and six, twelve and twenty-four months. Our expected outcomes are to have built rural libraries capacity to implement evidence-based programs and determined the amplified effects of a combined group-based walking plus civic

engagement program. We also expect to have determined that self-efficacy, social support, group cohesion, and perceived environment are significant mediators. Finally, we anticipate having demonstrated successful implementation of the combined program and a completed evaluation including a cost analysis. The positive

impact of these results is that strong definitive evidence of the effectiveness of a multilevel physical activity intervention targeting rural residents will justify its continued development and future broad dissemination to rural communities.