Synthesis of Evidence Relating to Barriers and Facilitators To
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Synthesis of evidence relating to barriers and facilitators to implementing interventions that promote cycling and walking, and to carrying out cycling and walking for recreational and travel purposes. Authors: Maxine Johnson Lindsay Blank Roy Jones Helen Buckley Woods Nick Payne School of Health and Related Research (ScHARR) University of Sheffield Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK CONTENTS 1. List of ABBREVIATIONS ......................................................................... 3 2. EXECUTIVE SUMMARY ........................................................................... 4 Introduction................................................................................................... 4 Methods ....................................................................................................... 6 Summary of study identification .................................................................... 7 Summary of identified research .................................................................... 7 Summary of findings ..................................................................................... 8 Applicability in the UK context .................................................................... 10 Implications of the review findings .............................................................. 11 Evidence Statements ................................................................................. 12 3. INTRODUCTION ...................................................................................... 31 3.1. Aims and objectives ............................................................................ 31 3.2 Research questions .............................................................................. 31 4 . BACKGROUND ........................................................................................ 32 5. METHODS ................................................................................................. 34 5.1 Search methods ................................................................................... 34 5.2 Inclusion and exclusion criteria ............................................................. 36 Populations................................................................................................. 36 5.3 Data extraction strategy........................................................................ 37 5.4 Summary of study identification ............................................................ 37 5.5 Quality assessment criteria for effectiveness studies ........................... 38 5.6 Data analysis ........................................................................................ 38 6. SUMMARY RESULTS ............................................................................... 40 6.1. Quantity of the evidence available ....................................................... 40 6.2 Study designs ....................................................................................... 41 6.3 Quality of the evidence available .......................................................... 42 6.4 Populations and settings ...................................................................... 42 7. NARRATIVE SYNTHESIS ......................................................................... 47 7.1 Question 1: What factors help or hinder the planning and delivery of walking and cycling-related interventions for recreation or travel purposes? ................................................................................................................... 47 7.1.1 Providers’ views about delivering interventions to increase walking .. 47 7.1.2 Participants’ views about interventions to increase walking .............. 51 7.1.3 Intervention participant views about cycling interventions ................. 64 7.2 Question 2: What factors help or prevent people from walking and cycling for recreation or travel? .................................................................. 67 7.2.1 Views about walking for travel or leisure (non-intervention) .............. 67 7.2.2 Views about active travel (walking and / or cycling) .......................... 75 7.2.3 Views about walking and cycling trails for leisure (utilising walking / cycling trails) ............................................................................................... 82 7.2.4 Adult views about cycling for transport .............................................. 87 8. DISCUSSION ............................................................................................. 92 8.1. Summary of identified research ........................................................... 92 8.2 Applicability in the UK context .............................................................. 94 8.4 Implications of the review findings ........................................................ 95 9. REFERENCES .......................................................................................... 96 10. APPENDICES .......................................................................................... 98 2 10.1 Appendix 1: Evidence table for included studies ................................ 98 a) Qualitative studies .................................................................................. 98 b) Survey studies ...................................................................................... 165 10.2 Appendix 2: Quality assessment criteria and table ........................... 178 10.3 Appendix 3: Included studies ............................................................ 181 10.4 Appendix 4: Excluded studies .......................................................... 187 10.5 Appendix 5: Search Strategies and Details of Evidence Sources .... 188 TABLES AND FIGURES Table 1. Criteria used for study grading ........................................................ 38 Figure 1. Quorum diagram ............................................................................. 41 Table 2. Characteristics and main themes of included studies ...................... 43 1. List of ABBREVIATIONS BMI Body Mass Index CVD Cardiovascular Disease DH Department of Health EU European Union GP General Practitioner Hr Hour NA Not Applicable NHS National Health Service NICE National Institute for Health and Clinical Excellence NR Not Reported PA Physical activity RCT Randomised Controlled Trial SES Socio-economic status WSB Walking school Bus WWW Walking for Wellbeing 3 2. EXECUTIVE SUMMARY Introduction Physical activity can help reduce the risk of coronary heart disease, stroke and type 2 diabetes by up to 50% (DH 2004) and promote mental wellbeing. However, based on self-reporting, 61% of men (71% of women) in England aged 16 and over did not meet national recommended levels (Craig et al. 2009). Guidance for adults has recently been revised to recommend 150mins (two and half hours) each week of moderate to vigorous intensity physical activity (and adults should aim to do some physical activity every day). The proportion of men who are physically active enough to meet national recommended levels decreases markedly as they get older, from 53% at age 16–24 to 16% at 65 plus. The level of activity among women is considerably lower once they reach age 65, with around 12% of women over 65 meeting the recommended levels compared to 28–36% of younger women. In children, sixty three per cent of girls (72% of boys) aged between 2–15 report being physically active for 60 minutes or more on 7 days a week. Girls’ activity declines after the age of 10 (The Information Centre 2007). However, objective data suggest this is an overestimate. Black African and Asian adults and black Caribbean women are less likely to meet the recommended activity levels of physical activity than the general population (The Information Centre 2006). Walking is reported to be the most common, and cycling the fourth most common recreational and sporting activity undertaken by adults in Britain (Fox & Rickards 2004). Among women of all ages, walking (for any purpose) is the most important way of achieving the recommended physical activity levels. It is also one of the most important physical activities for men of all ages –accounting for between 26% and 42% of total MVPA (Belanger et al. 2011). Of all trips made in Great Britain in 2009, 20% covered less than 1 mile. More than half (56%) of car journeys were less than 5 miles (Department for Transport 2010b). It is estimated that, on an average day in London, around 4.3 million trips are 'potentially cyclable' (Transport for London 2010). However, in Britain, the average time spent travelling on foot or by bicycle has decreased, from 12.9 4 minutes per day in 1995/97 to 11 minutes per day in 2007 (Department for Transport 2010c). Cycle use in Britain is lower than in other European Union (EU) countries. It is estimated that bicycles are used for 2% of journeys in Britain compared to about 26% of journeys in the Netherlands, 10% in Denmark and 5% in France (Ministry of Transport, Public Works and Water Management 2009). Changes in the number of people walking and cycling could have an impact on health, the environment and the economy. These may be positive or negative, and can be experienced by individuals or populations. Health outcomes include increased physical activity and changes to conditions such as obesity, cardiovascular disease (CVD), type 2 diabetes, some cancers, and mental wellbeing. Cycling and walking are also important ways for people to get to local places and services (such as education,