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PurposeThe purpose of this study was to develop and evaluate the reliability and validity of self-efficacy and intentions measures for time spent in nature (TSN). TSN is related to improvement in psychological well-being and health, yet most American adults spend very little time in such settings. Theory-based interventions have been effective in increasing physical activity, a related behavior, and may be one mechanism to increase TSN. Self-efficacy and intentions have been shown to be strong predictors of health behaviors and are used across several theories. However, scales to measure these factors have not yet been developed and are needed to facilitate effective interventions.MethodsTSN self-efficacy and intentions scales were developed using a sequential nine-step procedure: identification of the domain and item generation; content validity; pre-testing of questions; sampling and survey administration; item reduction; extraction of factors; tests of dimensionality; tests of reliability; and tests of validity. The 14-member multidisciplinary, researcher and practitioner investigative team generated 50 unique items for self-efficacy and 24 unique items for intentions. After subjecting items to content validity and pre-testing, item sets were reduced to 21 assessing self-efficacy and nine assessing intentions. A nationwide sample of 2109 adult participants (49.7% female, Mean Age = 58.1; 59.8% White, 18.4% Hispanic, 13.3% Black) answered these items via an on-line survey.ResultsUsing split-half measures, principal components analysis indicated a one-factor solution for both scales. The factor structure was upheld in confirmatory factor analyses and had high internal consistency (α = .93 self-efficacy; .91 intentions). The scales were moderately correlated with each other (r = .56,p 2 > .20).ConclusionsThe study resulted in reliable and valid self-efficacy (14 items) and intentions (8 items) scales that can be used to develop future theory-based interventions to increase TSN and thereby improve population health.

Physical activity (PA), associated with all-cause mortality, morbidity, and healthcare costs, improves vitamin D absorption, immune response, and stress when completed outdoors. Rural communities, which experience PA inequities, rely on trails to meet PA guidelines. However, current trail audit methods could be more efficient and accurate, which geospatial video may support. Therefore, the study purpose was (1) to identify and adopt validated instruments for trail audit evaluations using geospatial video and a composite score and (2) to determine if geospatial video and a composite score motivate (influence the decision to use) specific trail selection among current trail users. Phase 1 used a mixed-method exploratory sequential core design using qualitative data, then quantitative data for the development of the Spatial-temporal Trail Audit Tool (STAT). Geospatial videos of two Northeast Ohio trails were collected using a bicycle-mounted spatial video camera and video analysis software. The creation of STAT was integrated from Neighborhood Environment Walkability Scale (NEWS), Walk Score, and Path Environment Audit Tool (PEAT) audit tools based on four constructs: trail accessibility, conditions, amenities, and safety. Scoring was determined by three independent reviewers. Phase 2 included a mixed-method convergent core design to test the applicability of STAT for trail participant motivation. STAT has 20 items in 4 content areas computing a composite score and was found to increase trail quality and motivation for use. STAT can evaluate trails for PA using geospatial video and a composite score which may spur PA through increased motivation to select and use trails.

Introduction. The purpose of this paper is to describe development and preliminary assessment of an instrument designed to assess facilitators and barriers of provider-provided, place-based exercise prescriptions, including provider attributes, perceptions, knowledge, and resource needs. Although the American Medical Association-Supported “Exercise is Medicine” initiative encourages the practice of exercise prescription among member providers, only a small proportion engages in this practice. Additionally, little is known about the role of place-based exercise prescriptions, although access to physical activity resources differs based on residence, access to transportation, income, and other factors. To utilize potential for prescriptions to encourage physical activity, better understanding of the role of place is essential. Methods. Previously validated and newly developed items were combined to create an 88-item survey that was administered to 166 healthcare providers. Results. Results of principal components analysis suggested a five-factor structure; three factors—provider belief in exercise benefits, provider training needs, and place-based concerns—demonstrated high internal consistency. Factors demonstrating low internal consistency included provider attitudes about their role in exercise prescription and providers’ perceptions of patient barriers. Conclusions. Following this stage in survey validation, the 88-item developed survey could be shortened by eliminating items with low loadings. Providers may be more receptive to a shorter instrument, which could facilitate reliability and validity testing of a revised instrument. Further steps to validate the instrument include assessing consistent responses over time and considering predictive ability of the survey as an additional measure of validity. Results from the initial survey administration indicate that providers’ lack of training regarding how to prescribe exercise and lack of knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise present barriers to wider use of exercise prescriptions. Community-clinical linkages which network providers with area physical activity and exercise resources may present a partial solution. Knowledge of safe, affordable, or proximate locations for patients to engage in prescribed exercise presents a barrier to place-based exercise prescriptions.