Policy interventions to make travel more inclusive for people with mental health conditions

A significant proportion of the adults living in the United States and Britain have been diagnosed with a mental health condition (for example, anxiety and depression). The purpose of this presentation is to discuss the difficulties faced by these people when they travel, and ways in which policy interventions could be used to encourage them to travel more. The main evidence in the presentation comes from an on-line survey people with mental health conditions carried out by distributing the link to the questionnaire through a number of organizations involved with mental health or travel in Britain. Because the survey was carried out on-line it was not possible to control the demographic structure of the responses. In order to address this issue, the results were weighted to match the age and gender profile of the Adult Psychiatric Morbidity Survey. This meant that 363 responses were considered in the results being presented here. Linear regression analysis has been used with the various issues affect travel as the dependent variable and gender, age and type of area as the independent variables. The type of area varied from large cities to rural areas. After considering the various mental illness that the respondents have and the effects that these have, including the differences between men and women, the presentation examines the anxiety issues that the respondents have when travelling. These are considered under five headings: interacting with fellow travellers, interacting with staff and purchasing tickets, wayfinding, needing support, and needing to take urgent action. Policy interventions to improve access to infrastructure and services to help address the anxieties are discussed under these headings. The number of respondents who say that they would travel more if some of the interventions were introduced is then considered, with the variations by gender, age and type of area, examined. It is found, for example, that policies and actions that would increase confidence when travelling, such as having clearer information on buses and trains and having more staff around, would increase travel by women more than men, whereas men would prefer improvements to the physical environment such as less clutter on the street and more public toilets. People living in urban areas would like more signposts on the street whereas those living in rural areas would like to see better trained bus and rail staff. The presentation concludes that there are ways in which some of the anxieties that people have when travelling can be addressed and that introducing these types of intervention would increase travel by people with mental health conditions

Negotiating multisectoral evidence: a qualitative study of knowledge exchange in transport and public health

Background Evidence-based public health requires research to support policy. There is a large amount of literature on strategies for knowledge translation or more discursive knowledge exchange. However, little evidence exists for their effectiveness and underlying mechanisms, especially with regard to multisectoral, multidisciplinary evidence in knowledge mobilisation. Taking the opportunity of a knowledge exchange forum at the end of a natural experimental study, we investigated how stakeholders assess, negotiate, and use multisectoral evidence. Methods Participants represented both existing and newly interested stakeholders of the natural experimental study, from national and local government, the third sector, and academia. We conducted participant observation during an interactive event with 41 stakeholders and semi-structured interviews with 17 of them. Formal and informal interactions between stakeholders were recorded in field notes. Interviews considered the event format and content as well as knowledge exchange in general. Thematic content analysis of field notes and transcripts was undertaken. Findings Stakeholders working across sectors expressed uncertainties about finding a common language between research and practice and between sectors, and about who had the capacity to translate across these boundaries. They also expressed differing expectations of evidence. Whereas public health specialists tended to have a hierarchical view of evidence that favoured trials, transport specialists tended to prefer case studies as precedents for workable solutions. However, stakeholders encountered uncertainties about their preferred evidence. Population health studies generated more complex results than did those of apparently clear-cut randomised controlled trials; case studies highlighted the context-dependency of evidence and difficulties in transferring insights across settings. Finally, stakeholders had to reconcile uncertainties about “health in all remits”. Despite its premise, public health was not always acknowledged to contribute to the goals of other policy sectors, and stakeholders had to negotiate competing priorities, such as those between health improvement and economic growth, or between integrated and designated budgets. Interpretation This case study of stakeholders' experiences indicates that multisectoral research, practice, and policymaking require the ability and capacity to locate, understand, and communicate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases

Negotiating multisectoral evidence: a qualitative study of knowledge exchange at the intersection of transport and public health.

BACKGROUND: For the prevention and control of chronic diseases, two strategies are frequently highlighted: that public health should be evidence based, and that it should develop a multisectoral approach. At the end of a natural experimental study of the health impacts of new transport infrastructure, we took the opportunity of a knowledge exchange forum to explore how stakeholders assessed, negotiated and intended to apply multisectoral evidence in policy and practice at the intersection of transport and health. We aimed to better understand the challenges they faced in knowledge exchange, as well as their everyday experiences with working in multisectoral remits. METHODS: In 2015, we conducted participant observation during an interactive event with 41 stakeholders from national and local government, the third sector and academia in Cambridge, UK. Formal and informal interactions between stakeholders were recorded in observational field notes. We also conducted 18 semistructured interviews reflecting on the event and on knowledge exchange in general. RESULTS: We found that stakeholders negotiated a variety of challenges. First, stakeholders had to negotiate relatively new formal and informal multisectoral remits; and how to reconcile the differing expectations of transport specialists, who tended to emphasise the importance of precedence in guiding action, and health specialists' concern for the rigour and synthesis of research evidence. Second, research in this field involved complex study designs, and often produced evidence with uncertain transferability to other settings. Third, health outcomes of transport schemes had political traction and were used strategically but not easily translated into cost-benefit ratios. Finally, knowledge exchange meant multiple directions of influence. Stakeholders were concerned that researchers did not always have skills to translate their findings into understandable evidence, and some stakeholders would welcome opportunities to influence research agendas. CONCLUSIONS: This case study of stakeholders' experiences indicates that multisectoral research, practice and policymaking requires the ability and capacity to locate, understand and communicate complex evidence from a variety of disciplines, and integrate different types of evidence into clear business cases beyond sectoral boundaries

Impact of New Transport Infrastructure on Walking, Cycling, and Physical Activity.

INTRODUCTION: Walking and cycling bring health and environmental benefits, but there is little robust evidence that changing the built environment promotes these activities in populations. This study evaluated the effects of new transport infrastructure on active commuting and physical activity. STUDY DESIGN: Quasi-experimental analysis nested within a cohort study. SETTING/PARTICIPANTS: Four hundred and sixty-nine adult commuters, recruited through a predominantly workplace-based strategy, who lived within 30 kilometers of Cambridge, United Kingdom and worked in areas of the city to be served by the new transport infrastructure. INTERVENTION: The Cambridgeshire Guided Busway opened in 2011 and comprised a new bus network and a traffic-free walking and cycling route. Exposure to the intervention was defined using the shortest distance from each participant's home to the busway. MAIN OUTCOME MEASURES: Change in weekly time spent in active commuting between 2009 and 2012, measured by validated 7-day recall instrument. Secondary outcomes were changes in total weekly time spent walking and cycling and in recreational and overall physical activity, measured using the validated Recent Physical Activity Questionnaire. Data were analyzed in 2014. RESULTS: In multivariable multinomial regression models--adjusted for potential sociodemographic, geographic, health, and workplace confounders; baseline active commuting; and home or work relocation-exposure to the busway was associated with a significantly greater likelihood of an increase in weekly cycle commuting time (relative risk ratio=1.34, 95% CI=1.03, 1.76) and with an increase in overall time spent in active commuting among the least active commuters at baseline (relative risk ratio=1.76, 95% CI=1.16, 2.67). The study found no evidence of changes in recreational or overall physical activity. CONCLUSIONS: Providing new sustainable transport infrastructure was effective in promoting an increase in active commuting. These findings provide new evidence to support reconfiguring transport systems as part of public health improvement strategies.JP is supported by a National Institute for Health Research (NIHR) post-doctoral fellowship (PDF- 2012-05-157). EH is supported by an NIHR Public Health Research project grant (see below) and DO is supported by the Medical Research Council [Unit Programme number MC_UP_12015/6]. RM is funded by the Higher Education Funding Council for England. The Commuting and Health in Cambridge Study was initially funded under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The study is now funded by the National Institute for Health Research Public Health Research programme (project number 09/3001/06). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the NIHR PHR programme or the Department of HealthThis is the final version of the article. It was first available from Elsevier via http://dx.doi.org/10.1016/j.amepre.2015.09.02

Correlates of time spent walking and cycling to and from work: baseline results from the commuting and health in Cambridge study.

PURPOSE: Environmental perceptions and psychological measures appear to be associated with walking and cycling behaviour; however, their influence is still unclear. We assessed these associations using baseline data from a quasi-experimental cohort study of the effects of major transport infrastructural developments in Cambridge, UK. METHODS: Postal surveys were sent to adults who travel to work in Cambridge (n = 1582). Questions asked about travel modes and time spent travelling to and from work in the last week, perceptions of the route, psychological measures regarding car use and socio-demographic characteristics. Participants were classified into one of two categories according to time spent walking for commuting ('no walking' or 'some walking') and one of three categories for cycling ('no cycling', '1-149 min/wk' and ' ≥ 150 min/wk'). RESULTS: Of the 1164 respondents (68% female, mean (SD) age: 42.3 (11.4) years) 30% reported any walking and 53% reported any cycling to or from work. In multiple regression models, short distance to work and not having access to a car showed strong positive associations with both walking and cycling. Furthermore, those who reported that it was pleasant to walk were more likely to walk to or from work (OR = 4.18, 95% CI 3.02 to 5.78) and those who reported that it was convenient to cycle on the route between home and work were more likely to do so (1-149 min/wk: OR = 4.60, 95% CI 2.88 to 7.34; ≥ 150 min/wk: OR = 3.14, 95% CI 2.11 to 4.66). Positive attitudes in favour of car use were positively associated with time spent walking to or from work but negatively associated with cycling to or from work. Strong perceived behavioural control for car use was negatively associated with walking. CONCLUSIONS: In this relatively affluent sample of commuters, a range of individual and household characteristics, perceptions of the route environment and psychological measures relating to car use were associated with walking or cycling to and from work. Taken together, these findings suggest that social and physical contexts of travel decision-making should be considered and that a range of influences may require to be addressed to bring about behaviour change.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

An extended conceptualization of the relationship between the built environment and travel behavior

Despite a large body of research suggesting that the built environment influences individual travel behavior, uncertainty remains about the true nature, size, and strength of any causal relationships between the built environment and travel behavior. Residential self-selection, the phenomenon whereby individuals or households select a residential area based on their transport attitudes, is a frequently proposed alternative explanation for the reported associations. To resolve the issue of residential self-selection, longitudinal studies are often recommended. In this paper, we argue that intervention study designs are insufficient to fully resolve the problem and that intervention studies on the built environment and travel behavior may still be biased by residential selfselection. The aim of this paper is to extend existing conceptualizations of the relationships between the built environment, travel behavior, and attitudes and to provide suggestions for how a causal relationship between the built environment and travel behavior may be ascertained with more accurate estimates of effect sizes. We discuss the complexities of determining causal effects in intervention studies with participants who relocate, and the biases that may occur. We illustrate the complexities by presenting extended conceptualizations. Based on these conceptualizations, we provide considerations for future research. We suggest repeating analyses with and without individuals who relocated during the study, and with and without statistical controls for residential relocation. Additional quantitative and qualitative analyses will be necessary to obtain more accurate effect size estimates and a better understanding of the causal relationships. JP and DO were supported by the Medical Research Council [Unit Program number MC_UP_12015/6]. The Commuting and Health in Cambridge study was developed by David Ogilvie, Simon Griffin, Andy Jones and Roger Mackett and initially funded under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, National Institute for Health Research and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. The study was subsequently funded by the National Institute for Health Research Public Health Research program. Document type: Articl