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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. Prompts to Encourage Physical Activity

Approach. Use signage or other prompts located at points where people make decisions about being active to increase physical activity

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Overview. Analysis indicates that posters, signs, or media placed at elevators or escalators are associated with more people choosing an active option, such as taking the stairs. These low-cost strategies can be part of a larger campaign that includes additional programmatic, policy, and surrounding interventions.[1, 2]

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.

This strategy is also supported as “Points-of-Decision Prompts for Physical Activity” in the What Works for Health Database

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

  • Observational data
  • Survey and interview data
  • Community partner implementation reports

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 evidence-based prompt designs developed for various settings. (Assesses quality of intervention materials)
  • Number of Title V designated locations where physical activity prompts are installed. (Measures scale of implementation)

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

  • Percent of evidence-based prompt designs developed for various settings. (Assesses quality of intervention materials)
  • Percent of Title V designated locations where physical activity prompts are installed. (Measures scale of implementation)

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

  • Number of organizations integrating physical activity prompts into broader wellness initiatives who report improvements in physical activity. (Shows comprehensive approach)
  • Number of individuals reporting increased awareness of physical activity opportunities due to prompts. (Assesses changes in knowledge)
  • Number of individuals reporting sustained behavior change due to regular exposure to prompts. (Quantifies long-term impact)
  • Number of new policies adopted to support the use of physical activity prompts in public spaces. (Assesses policy-level impact)

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

  • Percent of prompt installations in areas with low physical activity rates. (Measures strategic resource allocation)
  • Percent of prompts that are usable to individuals with visual for cognitive impairments. (Assesses design impact)
  • Percent increase in physical activity levels in prompted areas, disaggregated by demographic factors. (Directly evaluates behavior change across subgroups)
  • Percent reduction in gaps in active choices between different socioeconomic groups. (Measures improvements in health outcomes)

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 Soler RE, Leeks KD, Ramsey Buchanan L, et al. Point-of-decision prompts to increase stair use: a systematic review update. Am J Prev Med 2010;38(2S):292-300.

2 Task Force on Community Preventive Services. Recommendation for use of point-of-decision prompts to increase stair use in communities. Am J Prev Med 2010;38(2S):290-291.

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.