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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Physical Activity.

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Strategy. Activity-Friendly Routes to Everyday Destinations

Approach. Use built surroundings approaches to create or enhance community characteristics to make physical activity easier, more appealing, and more usable

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Overview. Studies show that communities with activity-friendly features, implemented through various initiatives and policies, report higher physical activity among residents, including children, than those without these features.[1, 2] Examples of studies with positive outcomes include those where routes such as sidewalks and bicycle lanes were connected to destinations such as parks, green spaces, stores, homes, schools, worksites, and libraries [3].

Evidence. Scientifically Rigorous Evidence. Strategies based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Project plan records
  • Community resident perception surveys
  • Community engagement and public feedback logs

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Community Organizing (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of new for improved sidewalks, bike lanes, and walking paths created by Title V. (Assesses increase in active transportation infrastructure)
  • Number of community workshops held to gather input on activity-friendly route design. (Measures impact of strategy)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of activity-friendly routes designed in partnership with Title V with universal usability features. (Measures design standards)
  • Percent of route plans that incorporate green space and aesthetic improvements. (Evaluates comprehensive design approach)
  • Percent increase in active transportation usage on new for improved routes. (Measures community uptake)
  • Percent of residents reporting improved perception of neighborhood walkability and bikeability. (Assesses changes in community attitudes)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of local transportation policies supported by Title V updated to prioritize active transportation. (Shows policy-level changes)
  • Number of community programs initiated to promote use of activity-friendly routes that results in an increase in physical activity. (Assesses supportive programming)
  • Number of car trips replaced by walking for biking on new activity-friendly routes. (Quantifies behavior change)
  • Number of health improvements reported by regular users of activity-friendly routes. (Assesses health impacts)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of local transportation policies supported by Title V updated to prioritize active transportation. (Shows policy-level changes)
  • Percent of community programs initiated to promote use of activity-friendly routes that results in an increase in physical activity. (Assesses supportive programming)
  • Percent of car trips replaced by walking for biking on new activity-friendly routes. (Quantifies behavior change)
  • Percent of health improvements reported by regular users of activity-friendly routes. (Assesses health impacts)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Calise TV, Heeren T, DeJong W, Dumith SC, Kohl HW 3rd. Do neighborhoods make people active, or do people make active neighborhoods? Evidence from a planned community in Austin, Texas. Prev Chronic Dis. 2013;10:E102.

2 Lee C, Zhu X, Xu M, Lee H, Ory M. Moving to an activity-friendly community can increase physical activity. Paper presented at: Active Living Conference; February 5, 2020; Orlando, FL.

3 Guide to Community Preventive Services. Physical activity: built environment approaches combining transportation system interventions with land use and environmental design. Systematic Review. 2016.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.