BACKGROUND: There are notable disparities in rates of physical activity in rural communities, with rural
residents at higher risk than urban/suburban residents for cancer and other chronic diseases. Given that rural
residents make up 15% of the US population, there is an imperative to develop and implement interventions to
promote physical activity. Changing the built environment (e.g., building walking trails) is likely a necessary but
not sufficient approach for increasing rates of physical activity—that is, communication/promotional efforts are
GOAL AND AIMS: This project’s primary goal is to identify novel approaches for increasing the rate of physical
activity in rural communities. To accomplish this goal, Aim 1 will inform intervention development based on the
existing science and engagement with local residents and leaders. Aim 2 will test the independent and
moderating (interactive) effects of a multilevel intervention and the community environment on physical activity.
DESIGN AND METHODS: Guided by an ecological framework, a group-randomized design will be used to
evaluate the effects of a three-level intervention for increasing physical activity among adults residing in 6 rural
communities (along with 6 control communities). The intervention includes components at the individual (short
message service [SMS] text messages), interpersonal (social support in walking groups), and community
levels (events at existing trails). The project will be conducted in close collaboration with local partners.
Innovative methods to encourage participation (e.g., use of “citizen scientists”) will be employed as well as a
focus on life priorities (e.g., family, recreation, hobbies) other than health. Activities for Aim 1 include updating
a “review of reviews” and conducting key informant interviews to determine the local contexts for intervention
adaptations. To accomplish Aim 2, a set of interventions will be refined and implemented to include individual,
interpersonal, and community-level approaches; evaluate the effects of intervention activities with objective (7-
day accelerometry to assess minutes of moderate-to-vigorous physical activity) and self-report (telephone
survey) methods. These data are supplemented by location based on Global Positioning System (GPS) and
community audits that provide information on recreational amenities, programs/policies, and street segments.
Study findings will be disseminated using traditional (publications, presentations) and less-traditional
dissemination methods (social media, issue briefs).
INNOVATIONS AND IMPACT: This project is innovative because it: 1) is among the first of its kind in rural
settings to test a multilevel intervention, 2) addresses life priorities that complement health outcomes, and 3)
examines moderation between behavioral interventions and the natural environments where people are
physically active. Our results will impact the field by enhancing the ability to scale-up innovative, physical
activity interventions with the potential to reach high-risk, rural populations.
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