Successful evidence-based programming for older rural participants: Geographic variations

Older Americans residing in rural communities have fewer opportunities to access evidence-based health promotion programs for behavior change than their urban counterparts. The purpose of this study is to: 1) identify the geographic distribution of A Matter of Balance (AMOB) classes in urban and rural settings, and 2) assess impact on mean days of physical activity per week. Data were collected from seniors enrolled in 66 AMOB classes conducted statewide in Texas between September 2007 and January 2009. Overall, 7.3% of AMOB attendees resided in rural areas and 5.6% of classes were conducted in rural settings. Pre- and post-test data of 692 participants showed that respondents who resided in rural areas engaged in fewer days of physical activity at baseline (t(49) = -2.49, p = .026). Significant increases in the number of days physically active per week were reported from baseline to follow-up among both participants residing in urban (t(646) = -2.84, p = .005, Cohen's d = .11) and rural (t(44) = -3.10, p = .003, Cohen's d = .48) areas. The larger effect sizes associated with outcomes for rural-dwelling participants suggests that strategies provided by session leaders to increase physical activity successfully address some of the traditional obstacles posed by environmental constraints in rural communities. Positive outcomes may also be attributed to smaller class sizes in rural areas (M = 13.42 compared to M = 15.66), which afford more individualized attention. Lessons learned from this study have implications to reduce risk in otherwise vulnerable and underserved populations.