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The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study.

ABSTRACT: BACKGROUND:Physical inactivity is the fourth highest cause of death globally and is a major contributor to increases in healthcare expenditure. Improving public open spaces such as parks in areas of low socio-economic position (SEP) may increase recreational physical activity in disadvantaged populations. We assessed the cost-effectiveness of the installation of a play-space in a large metropolitan park in a low socioeconomic area based on changes in physical activity. METHODS:Observational data of visitor counts and activities undertaken in the park before the installation of the new play-scape (T1), at two months (T2) and 14?months post-installation (T3) were obtained for the intervention and a control park (with no refurbishment) located in a high SEP metropolitan area. Observed sitting, standing, and moderate and vigorous-intensity physical activity were converted to yearly MET-h according to age. Costs of the play-scape and ongoing maintenance were obtained from the organisation managing the refurbishment. The incremental cost-effectiveness ratio (ICER) (ratio of incremental cost to incremental effect) was calculated based on the incremental increase in MET-h from T1 to T3 assuming a 20-year lifetime of the play-scape. Observation counts combining moderate and vigorous activity were used in the sensitivity analysis. RESULTS:When compared with T1, at T3 the new play-scape resulted in an overall incremental net gain of 114,114 MET-h (95% UI: 80,476?-?146,096) compared with the control park and an incremental cost effectiveness ratio (or cost per MET-h gained per park visitor) of AUD $0.58 (95% UI: $0.44-$0.80). The sensitivity analysis combining moderate and vigorous activity into one category showed an increase in estimated incremental MET-h of 118,190 (95% CI: 83,528?-?149,583) and a lower incremental cost per MET-h gained of AUD $0.56 (95% UI: $0.43-$0.77). CONCLUSIONS:Using a benchmark of cost-effectiveness for physical activity interventions of AUD $0.60-$1.30, this study suggests that the installation of a play-scape located in a low SEP area is cost-effective based on its potential to facilitate increases in MET-h. It provides much needed preliminary evidence and requires replication elsewhere.

SUBMITTER: Lal A

PROVIDER: S-EPMC6408832 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study.

Lal Anita A Moodie Marj M Abbott Gavin G Carver Alison A Salmon Jo J Giles-Corti Billie B Timperio Anna A Veitch Jenny J

The international journal of behavioral nutrition and physical activity 20190308 1

<h4>Background</h4>Physical inactivity is the fourth highest cause of death globally and is a major contributor to increases in healthcare expenditure. Improving public open spaces such as parks in areas of low socio-economic position (SEP) may increase recreational physical activity in disadvantaged populations. We assessed the cost-effectiveness of the installation of a play-space in a large metropolitan park in a low socioeconomic area based on changes in physical activity.<h4>Methods</h4>Obs ...[more]

PMID: 30849991

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Project description:BackgroundPhysical inactivity is a key risk factor for chronic disease, but a growing number of people are not achieving the recommended levels of physical activity necessary for good health. Australians are no exception; despite Australia's image as a sporting nation, with success at the elite level, the majority of Australians do not get enough physical activity. There are many options for intervention, from individually tailored advice, such as counselling from a general practitioner, to population-wide approaches, such as mass media campaigns, but the most cost-effective mix of interventions is unknown. In this study we evaluate the cost-effectiveness of interventions to promote physical activity.Methods and findingsFrom evidence of intervention efficacy in the physical activity literature and evaluation of the health sector costs of intervention and disease treatment, we model the cost impacts and health outcomes of six physical activity interventions, over the lifetime of the Australian population. We then determine cost-effectiveness of each intervention against current practice for physical activity intervention in Australia and derive the optimal pathway for implementation. Based on current evidence of intervention effectiveness, the intervention programs that encourage use of pedometers (Dominant) and mass media-based community campaigns (Dominant) are the most cost-effective strategies to implement and are very likely to be cost-saving. The internet-based intervention program (AUS$3,000/DALY), the GP physical activity prescription program (AUS$12,000/DALY), and the program to encourage more active transport (AUS$20,000/DALY), although less likely to be cost-saving, have a high probability of being under a AUS$50,000 per DALY threshold. GP referral to an exercise physiologist (AUS$79,000/DALY) is the least cost-effective option if high time and travel costs for patients in screening and consulting an exercise physiologist are considered.ConclusionsIntervention to promote physical activity is recommended as a public health measure. Despite substantial variability in the quantity and quality of evidence on intervention effectiveness, and uncertainty about the long-term sustainability of behavioural changes, it is highly likely that as a package, all six interventions could lead to substantial improvement in population health at a cost saving to the health sector. Please see later in the article for Editors' Summary.

Project description:BACKGROUND:Designing parks that optimise visitation and support visitors to be active is important for public health. Yet there is very little evidence about whether playground refurbishment achieves these objectives. This study examined the impact of the installation of a play-scape in a large metropolitan park in Melbourne, Australia. METHODS:Natural experiment study (intervention vs control). At both parks, park visitation and physical activity were assessed before (T1, 2013) and after the intervention at 12 (T2, 2014) and 24 months (T3, 2015). At each time point, measures included: observations of park visitors using the System for Observing Play and Recreation in Communities on four weekdays and four weekend days, objective monitors to record usage of the walking paths and the number of cars entering the park; and intercept surveys with adult park visitors. Cross-sectional surveys were conducted with local residents at T1 and T3. RESULTS:The observational data showed a 176% increase in park visitor counts from T1 to T2 (Incidence Rate Ratio (IRR)?=?2.76, 95% CI?=?1.04-7.33), at the intervention park relative to the control park. The intervention park had a 119% increase in counts of visitors observed engaging in MVPA from T1 to T2 (IRR?=?2.19, 95% CI?=?1.14-4.20), and a 128% increase from T1 to T3 (IRR?=?2.28, 95% CI?=?1.19-4.38), relative to the control park. The relative increases in visitation at the intervention park play-scape compared with the control park playground were highly statistically significant from both T1 to T2 (IRR?=?18.12, 95% CI?=?5.51-59.59) and T1 to T3 (IRR?=?15.05, 95% CI?=?4.61-49.16). Similarly, there was a significant interaction between time and park with regard to the number of visitors observed engaging in MVPA in the play-scape/playground areas. The intercept survey data showed an increased odds of children's regular visitation to the intervention park at T2 (OR?=?2.67, 95% CI?=?1.08, 6.64), compared with T1, relative to the control park. The remaining results from the intercept survey, objective monitors and resident surveys showed no significant differences in visitation between the two parks. CONCLUSIONS:These findings confirm that a well-designed play-scape installation has the potential to increase park visitation and encourage visitors to be physically active. TRIAL REGISTRATION:Current controlled trial ISRCTN50745547 .

Project description:BackgroundDigital technologies such as wearables, websites and mobile applications are increasingly used in interventions targeting physical activity (PA). Increasing access to such technologies makes an attractive prospect for helping individuals of low socioeconomic status (SES) in becoming more active and healthier. However, little is known about their effectiveness in such populations. The aim of this systematic review was to explore whether digital interventions were effective in promoting PA in low SES populations, whether interventions are of equal benefit to higher SES individuals and whether the number or type of behaviour change techniques (BCTs) used in digital PA interventions was associated with intervention effects.MethodsA systematic search strategy was used to identify eligible studies from MEDLINE, Embase, PsycINFO, Web of Science, Scopus and The Cochrane Library, published between January 1990 and March 2020. Randomised controlled trials, using digital technology as the primary intervention tool, and a control group that did not receive any digital technology-based intervention were included, provided they had a measure of PA as an outcome. Lastly, studies that did not have any measure of SES were excluded from the review. Risk of Bias was assessed using the Cochrane Risk of Bias tool version 2.ResultsOf the 14,589 records initially identified, 19 studies were included in the final meta-analysis. Using random-effects models, in low SES there was a standardised mean difference (SMD (95%CI)) in PA between intervention and control groups of 0.06 (- 0.08,0.20). In high SES the SMD was 0.34 (0.22,0.45). Heterogeneity was modest in both low (I2 = 0.18) and high (I2 = 0) SES groups. The studies used a range of digital technologies and BCTs in their interventions, but the main findings were consistent across all of the sub-group analyses (digital interventions with a PA only focus, country, chronic disease, and duration of intervention) and there was no association with the number or type of BCTs.DiscussionDigital interventions targeting PA do not show equivalent efficacy for people of low and high SES. For people of low SES, there is no evidence that digital PA interventions are effective, irrespective of the behaviour change techniques used. In contrast, the same interventions in high SES participants do indicate effectiveness. To reduce inequalities and improve effectiveness, future development of digital interventions aimed at improving PA must make more effort to meet the needs of low SES people within the target population.

Project description:BackgroundModifying the built environment by improving parks is potentially a sustainable way to increase population level physical activity. Despite considerable investment in parks and park renovations, few natural experiments on the impact of improving amenities on park use and park-based physical activity have been conducted. REVAMP is a natural experiment that aims to examine whether park improvement increases overall park usage, park-based physical activity and active travel to and from the park in the intervention compared with the control park over a two-year period; and to identify which specific aspects of the park refurbishment attracts park visitors and encourages park users to be more active. This paper describes the methods of the REVAMP study.MethodsThe intervention park is a large regional park (329 hectares) located in a low socio-economic status (SES) area in the north-eastern suburbs of Melbourne, Australia. The control park is a regional park (120 hectares) located in a high SES area in the eastern suburbs of Melbourne. Multiple methodologies to evaluate the impact of the park renovation are being employed including: cross-sectional surveys of local residents living near the two parks, direct observations of park users, intercept surveys with park users, and electronic monitoring of path usage and car traffic within the parks. Baseline measures were conducted in April-May 2013 (T1), and an innovative play space suitable for children of all ages and abilities was installed at the intervention park between September 2013 and February 2014. Follow-up measures will be repeated in April-May 2014 (T2) and April-May 2015 (T3). All methodologies will be completed at both the intervention and control parks at all three time-points, with the exception of the cross-sectional survey of local residents which will only be conducted at T1 and T3.ConclusionThis research will inform future park developments, and will contribute to creating an evidence base of the impact of park refurbishment, and the development of natural experiment methodology.Trial registrationCurrent controlled trial ISRCTN50745547, registration date 11.1.2014.

Project description:BackgroundGovernment interest in investing in commercial physical activity apps has increased with little evidence of their cost-effectiveness. This is the first study to our knowledge to examine the cost-effectiveness of a commercial physical activity app (Carrot Rewards) despite there being over 100,000 in the major app stores.MethodsA cost-effectiveness analysis was performed to calculate the incremental cost-effectiveness ratio (ICER) of the app compared to a no-intervention reference scenario using a five-year time horizon. Primary data was collected between 2016 and 2017. Data synthesis, model creation, and statistical analyses were conducted between 2019 and 2020. An age-, sex-, and geography-dependent Markov model was developed assuming a public healthcare payer perspective. A closed cohort (n = 38,452) representing the population reached by Carrot Rewards in two Canadian provinces (British Columbia, Newfoundland & Labrador) at the time of a 12-month prospective study was used. Costs and effects were both discounted at 1.5% and expressed in 2015 Canadian dollars. Subgroup analyses were conducted to compare ICERs between provinces, sexes, age groups, and engagement levels.ResultsCarrot Rewards had an ICER of $11,113 CAD per quality adjusted life year (QALY), well below a $50,000 CAD per QALY willingness-to-pay (WTP) threshold. Subgroup analyses revealed that the app had lower ICERs for British Columbians, females, highly engaged users, and adults aged 35-64 yrs., and was dominant for older adults (65 + yrs). Deterministic sensitivity analyses revealed that the ICER was most influenced by the relative risk of diabetes. Probabilistic sensitivity analyses revealed varying parameter estimates predominantly resulted in ICERs below the WTP threshold.ConclusionsThe Carrot Rewards app was cost-effective, and dominant for older adults. These results provide, for the first time, rigorous health economic evidence for a commercial physical activity app as part of public health programming.

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The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study.

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The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study.

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