Engaging Older Adults to Be More Active Where They Live: Audit Tool Development

1. Engaging Older Adults to Be More Active Where They Live: Audit Tool Development Melissa Kealey University of California, Berkeley And the Healthy Aging Research Network 2005 Conference on Chronic Disease Prevention and Control, Atlanta, Georgia

2. Overview • Background on Healthy Aging Network (HAN) • Audit tool development and pilot • Qualitative interviews • Findings, implications, and future directions

3. HAN Mission • The mission of the Healthy Aging Research Network is to better understand the determinants of healthy aging in older adult populations; to identify interventions that promote healthy aging; and to assist in the translation of such research into sustainable community-based programs throughout the nation. • (HAN) was envisioned to: • Develop healthy aging research agenda for CDC-PRC Network • Serve as a model theme network for the CDC-PRC program

4. Network Partners and Affiliates Academic-Community Partnerships: Texas A & M University University of California at Berkeley University of Chicago at Illinois University of Colorado at Denver & Health Sciences Center University of North Carolina at Chapel Hill University of Pittsburgh University of South Carolina University of Washington, LCC West Virginia University Affiliates: CDC, Healthcare & Aging Studies and Physical Activity & Health Branches The National Council on the Aging, Director, Nancy Whitelaw, PhD Chronic Disease Directors, Director of Program Services, Fran C. Wheeler, PhD

5. Prevention Research Centers’Healthy Aging Research Network University of Washington University of Illinois at Chicago University of Pittsburgh University of California at Berkeley University of Colorado at Denver West Virginia University University of North Carolina at Chapel Hill University of South Carolina Texas A&M University

6. HAN Environmental Measures Approach In older adult populations: • What are the environmental factors that promote or are barriers to physical activity? • How do we measure these environmental factors?

7. Audit Pilot Purpose • Segment and Intersection Audit Tools developed based on St. Louis University analytic audit tool (http://prc.slu.edu/iafc.htm) • Pilot audit across 7 HAN sites to identify auditing issues and determine inter-rater reliability • Interviews to determine content validity, suggest items for addition, deletion, or modification • Ultimate goal refined and improved audit instrument

8. Pilot Audit Methods • Sites selected based on proximity to senior center or senior housing • One audit per street segment or intersection • Trained researchers • Audit tool piloted across 7 HAN sites • 152 segments audited by at least 1 auditor • 97 segments audited by at least 2 auditors

9. Locations of Audits • Small town: • Hendersonville, North Carolina • Alamosa, Colorado • Urban: • Columbia, South Carolina • McKeesport, Pennsylvania • Chicago, Illinois • Seattle, Washington • Berkeley, California

10. GIS map for labeling segments

11. Audit Domains • Land Use Environment • Transportation/Street Design • Sidewalks • Bike lanes • Trails • Public Transportation • Traffic • Design • Facilities/Amenities • Aesthetics and Physical Disorder • Social Environment

12. Audit lessons: • 1. Map issues • Inaccurate map • Defining oddly-shaped segments • Auditors labeled sides of street differently • 2. Segment Items vs. Area Items • Speed limit posted in area on another segment? • Transportation route but no transportation stop?

13. Audit lessons: • 3. Subjective items/ Unclear definitions • Minor vs. moderate • Empty vs. abandoned buildings • % tree cover; % landscape/buildings well maintained. • Categorization of businesses, specifically fast food restaurant vs. non- fast food; bar vs. restaurant/café • “Eyes on the street” • “Adjacent to street” • No space between buildings

14. Audit lessons: • 4. Changing environment, esp. time of day • People • Traffic, frequency of driveway use • Litter and debris • Lighting • 5. Auditor error • Details overlooked • Need to distinguish between missing data and item not present.

15. Interrater reliability • Kappa for dichotomous variables and nonordered categorical variables • Interclass correlation coefficient (ICC) for ordered categories • Wide range of kappas and ICCs, from negative numbers (less agreement than by chance) to 1 (perfect agreement).

17. Qualitative methods • To date, 50 qualitative semi-structured interviews at 6 of the sites. • Open-ended questions • Audit items as prompts • Environmental factors that influenced: • Decision to walk • Route choice • Quality of walk

18. Themes identified from qualitative interviews • Destination-driven (transportation) vs. leisure-driven walking (pleasure) • Variable perceptions of environments • Safety

19. Barriers to walking:Will I be safe? • Traffic/Pedestrian Safety • Threat from heavy, high speed, or aggressive traffic • Avoid crossing busy streets or even walking on some streets during rush hour • Difficulty crossing intersections • Need for better traffic signals • Sidewalk issues where no sidewalk means walking too close to traffic

20. Barriers to walking:Will I be safe? • Personal Safety • Fear of crime and/or intrusive people, esp. at night • Difficulty navigating sidewalk and intersections surfaces • Cracks and heaves • Gravel on the surfaces • Poor quality or missing curb cuts • Most important for people with health or mobility problems or users of assistive devices • Concerns about access to respite and to help • Absence of benches or other places to rest • Fear of falling or adverse health event • Most important for people with health or mobility problems or users of assistive devices

21. Facilitators for walking Walking for Transportation – Can I get where I want to go? • Desirability of available destinations • Perceived safety and pleasantness of possible routes Walking for Pleasure– Will I enjoy myself? • Presence of interesting things going on • Variety (taking different routes) • Pleasant views, e.g., flowers/seasonal foliage • Opportunities to talk with others • Quiet time for self

22. Common destinations walked • Grocery stores • Banks • Pharmacies/ drug stores • Restaurants • Beauty salons • Churches • Libraries • Parks • Homes of family, friends, and neighbors

23. Next steps: • Comparison of audit data with secondary data sources in GIS • Creation of summary scores with factor analysis • Refined and improved audit instruments • Pilot test in two rural areas • Determine which environmental audit items are correlated with actual walking behavior in an older population.

24. Future HAN projects • 2005 RWJ Active Living Research Project, “Environmental Correlates of Physical Activity among Older Adults.”

25. Contributing authors: • Judy Kruger, Centers for Disease Control • Susan L. Ivey, William A. Satariano, Melissa Kealey, University of California, Berkeley • Rebecca Hunter, Christen Sible, University of North Carolina, Chapel Hill • Constance Bayles, Courtney Johnson, Kathleen McTigue, Kathy Williams, Kendra Winters, University of Pittsburgh • Laura K. Brennan Ramirez, St. Louis University • Lucinda L. Bryant, University of Colorado at Denver & Health Sciences Center • Chanam Lee, David Levinger,Gwen Moni, Anne Vernez Moudon, University of Washington • Delores M. Pluto, Sabrina Tindal, Sara Wilcox, University of South Carolina • Laura Hawkes, Thomas Prohaska, University of Illinois, Chicago

26. Contact Healthy Aging Research Network www.prc-han.org contact: logerfo@u.washington.edu Melissa Kealey mkealey@berkeley.edu