Rural libraries implementing walking groups or walking groups plus civic engagement for walkability in rural communities: a comparative effectiveness trial study protocol.

BACKGROUND: Rural residents generally lack adequate physical activity to benefit health and reduce disparities in chronic diseases, such as cardiovascular disease and certain cancers. The Socioecological Model describes physical activity as involving a dynamic and reciprocal interaction between individual, social, and community factors. Community group-based walking programs and civic engagement interventions aimed at enhancing physical activity have been successful in rural communities but have not targeted all three socioecological levels. Public libraries can act as innovative public health partners in rural communities. However, challenges remain because rural libraries often lack the capacity to implement evidence-based health promotion programming. The goals of this study are (1) build the capacity for rural libraries to implement evidence-based health promotion programs, (2) compare changes in physical activity between a group-based walking program and a combined group-based walking and civic engagement program with rural residents, and (3) conduct an implementation evaluation. METHODS: We will conduct a comparative effectiveness study of a group-based walking (standard approach) versus a group-based walking plus civic engagement program (combined approach) aimed at enhancing walkability to increase physical activity among rural adults. Key mediators between the program effects and change in outcomes will also be identified. Finally, we will evaluate program implementation, conduct a cost effectiveness evaluation, and use a positive deviance analysis to understand experiences of high and low changers on key outcomes. Twenty towns will be matched and randomized to one of the two conditions and our aim is to enroll a total of 350-400 rural residents (15-20 per town). Study outcomes will be assessed at baseline, and 6, 12, and 24 months. DISCUSSION: This study will build the capacity of rural libraries to implement evidence-based walking programs as well as other health promotion programs in their communities. The study results will answer questions regarding the relative effectiveness and cost effectiveness of two multilevel physical activity interventions targeting rural communities. We will learn what works and how these multilevel interventions can be implemented in rural populations. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05677906.

Understanding Libraries as Part of the Rural Active Living Environment: Evidence From a Content Analysis of Library Facebook Posts Made in Summer 2022.

As both public health and public libraries continue to evolve, there are opportunities for collaboration focused on building policies, systems, and environments that support communities making healthy choices easy choices. Given the health disparities related to physical inactivity, such as diabetes and heart disease in rural America, public libraries within rural communities are emerging as important settings for health promotion and disease prevention. This study sought to better understand how rural libraries promote physical activity opportunities on Facebook. Based on a content analysis of Facebook posts of a random sample of 118 libraries made during the Summer of 2022, 47 of the 118 had at least one post related to physical activity and 42 had multiple posts. The most frequent offering was events or classes; libraries also supported physical activity by lending equipment and making changes to the built environment. This study provides evidence that some rural libraries are offering physical activity opportunities through community health partnerships, particularly for youth and families. Considering this evidence, public health professionals are encouraged to collaborate with local libraries to promote physical activity and advance rural health equity. Researchers are invited to continue to develop the evidence base around promoting physical activity with rural libraries.

Rural Libraries as Resources and Partners for Outside Active Play Streets.

BACKGROUND: Urban and rural areas have different types of built environments and community infrastructure, which lead to different types of successful community-based physical activity initiatives. Temporary Play Streets are a supported way to increase physical activity and perceptions of the built environment as a space for active lifestyles. PURPOSE: Within the field of public health, public libraries constitute an underutilized community partner. To begin to understand the capacity of rural librarians to support rural Play Streets, a cross-sectional questionnaire was developed for distribution to rural librarians. METHODS: The sampling frame targeted members of the membership-based U.S. Association for Rural & Small Libraries (ARSL). Among respondents, 65% reported offering outdoor physical activity programs in the past, and 61% reported continuing to offer versions of this programming during the COVID-19 pandemic. Librarians work with a broad range of community partners on this programming, and already own much of the equipment necessary for a successful Play Streets initiative. CONCLUSIONS: The results of this study corroborate claims from previous research, which shows that in small and rural communities, public libraries have the capacity to play a role in promoting physical activity through involvement in community partnerships. Additional work is needed to understand, evaluate, and support this opportunity to weave rural librarians into community-based physical activity promotion efforts more fully.

Substance Use and Overdose in Public Libraries: Results from a Five-State Survey in the US.

In the U.S., overdoses have become a health crisis in both public and private places. We describe the impact of the overdose crisis in public libraries across five U.S. states, and the front-line response of public library workers. We conducted a cross-sectional survey, inviting one worker to respond at each public library in five randomly selected states (CO, CT, FL, MI, and VA), querying participants regarding substance use and overdose in their communities and institutions, and their preparedness to respond. We describe substance use and overdose patterns, as well as correlates of naloxone uptake, in public libraries. Participating library staff (N = 356) reported witnessing alcohol use (45%) and injection drug use (14%) in their libraries in the previous month. Across states surveyed, 12% of respondents reported at least one on-site overdose in the prior year, ranging from a low of 10% in MI to a high of 17% in FL. There was wide variation across states in naloxone uptake at libraries, ranging from 0% of represented libraries in FL to 33% in CO. Prior on-site overdose was associated with higher odds of naloxone uptake by the library (OR 2.5, 95% CI 1.1-5.7). Although 24% of respondents had attended a training regarding substance use in the prior year, over 90% of respondents wanted to receive additional training on the topic. Public health professionals should partner with public libraries to expand and strengthen substance use outreach and overdose prevention efforts.

Health Equity and Small and Rural Public Libraries During COVID-19.

Rural communities in the United States struggle with many health inequities that predate the COVID-19 Pandemic. This poster analyzes how public libraries responded to COVID-19 from March 2020 through March 2021 by utilizing the social media platform Facebook to continue sharing content that supports community health and wellness. It situates these responses in the context of health inequities in rural America. Although libraries in different parts of the country responded to COVID-19 in unique ways, common practices include sharing timely information about the pandemic and social services; adapting services to continue serving communities safely; and providing enriching educational content that also addresses social determinants of health. The poster concludes with a call to better understand the work small and rural public librarians do to address health inequities.

Public Libraries and Walkable Neighborhoods.

Public libraries constitute a ubiquitous social infrastructure found in nearly every community in the United States and Canada. The hypothesis of this study is that public libraries can be understood as important supports of walking in neighborhoods, not only as walkable destinations, but also as providers of programs that increase walking in communities. Recent work by public health scholars has analyzed how libraries contribute to community health. This particular topic has not previously been researched. As such, a qualitative, exploratory approach guides this study. Grounded theory techniques are used in a content analysis of a corpus of 94 online articles documenting this phenomenon. Results show that across North America public librarians endeavor to support walking through programs oriented around stories, books, and local history, as well as through walking groups and community partnerships. While this exploratory study has many limitations, it does set the stage for future, more rigorous research on the contributions public libraries and public librarians make to walking in neighborhoods. The principal conclusion of this study is that additional research is needed to comprehensively understand the intersection between public librarianship and public health.