Empirical Testing

Model: Ecological Model of Four Domains of Active Living (Sallis, 2006)

Objective: Pilot study tested the feasibility and acceptability of a novel multilevel walking intervention for older adults in a continuing care retirement community (CCRC). The intervention included site-specific walking route maps, pedometers, and individualized goal setting. Pedometers were worn for self-monitoring and for the primary outcome (steps per day).

Methods: Adults over the age of 65 years were recruited for a multilevel walking intervention, from a CCRC for military veterans located near San Diego, CA. A pre-test post-test design was used. All eligible volunteers were accepted.

Intervention Development: Development of the individual, social, and environmental interventions was based on literature reviews, focus groups with seniors, and pre-testing of written materials. The main novel component was improving perceptions of the environment for supporting walking by giving participants site-tailored walking route maps. The multilevel intervention included several components: changing perceptions of the environment via tailored walking route maps, social support, pedometers and self-monitoring, and brief individually tailored counseling for goal setting and problem solving.

Intervention Overview

  • Baseline: Wear pedometers at usual level of activity. Complete survey.
  • Beginning of Week 1: Record baseline step count. Receive intervention materials as a group. Meet with individual health counselor. Monitor steps for the week.
  • Beginning of Week 2: Record step count from Week 1. Meet with individual health counselor. Monitor steps for the week.
  • End of Week 2: Record final step count from Week 2. Complete final survey.


  • Participants had very low activity levels at baseline with a mean daily step count of 3020 (SD=1858). Participants were also older and overweight on average.
  • Average daily pedometer steps increased between baseline (M=3020; SD=1858) and Week 1 (M=4314; SD=2627; t(11)=âˆ'2.99, p=.012) and Week 2 (M=4246; SD=2331; t(11)=3.42, p=.006).
    • Daily step counts between Weeks 1 and 2 were not significantly different (p=.79).
  • All participants met their daily step goals (generally a 10% increase from baseline) in Week 1 while 50% met their step goals in Week 2.
  • The results of this pilot study indicated that a brief multilevel place-based walking intervention is a promising method for promoting walking among seniors who live in CCRCs.
    • Combining site-tailored maps and materials with brief weekly individualized goal setting led to a 41% increase in average dail y steps after 2 weeks.

Model: Social Ecological Model (Sorensen, 2003)

Study: Healthy Directions-Health Centers Study (a component of the Harvard Cancer Prevention Program Project)

Objective: Reduce cancer risk factors among working class, multiethnic populations seen in community health centers

Methods: Ten community health centers were randomized to intervention or control. Patients who resided in low-income, multiethnic neighborhoods were eligible. The intervention targeted fruit and vegetable consumption, red meat consumption, multivitamin intake, and physical activity. Outcomes were measured at 8 months among 2219 participants (1088 intervention, 1131 control).

Intervention Components: The intervention used a social contextual approach targeting multiple levels of influence on behaviors, with special attention to low literacy skills and the shared and unique features of culture across racial/ethnic groups. Project messages explicitly acknowledged that health behavior is influenced by context. The social context of health behavior change was addressed through:

  1. interventions that targeted social networks and participants' families and support systems
  2. the use of interventions designed with sensitivity toward limitations in material resources and toward cultural differences
  3. development of linkages to relevant activities in the participants' community
  4. the integration of the intervention into the health care delivery system, including efforts to draw upon positive aspects of the patients' relationship with their health care provider


  • The intervention produced the largest effect on multivitamin use, with 70% of intervention participants reporting daily use at follow up.
  • Fruit and vegetable consumption increased by ~1/3 serving among intervention participants, whereas control participants reported a decrease in consumption.
  • Intervention yielded a significant reduction in red meat consumption compared with a slight increase in consumption among the control group.
  • Physical activity did not change as a result of the intervention.

Findings suggest that interventions that incorporate aspects of the social context can lead to significant improvements in behavioral risk factors for cancer among low-income populations. Changes in social networks were not reported.