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ORIGINAL RESEARCH article

Front. Public Health

Sec. Public Health Education and Promotion

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1577056

Cluster Randomized Multilevel Intervention for Promoting Physical Activity in Rural Communities

Provisionally accepted
Alan M. BeckAlan M. Beck1*Natalicio SerranoNatalicio Serrano2Dixie DuncanDixie Duncan1Amy A EylerAmy A Eyler1Amanda GilbertAmanda Gilbert1Fatemeh NaghilooFatemeh Naghiloo3Rodrigo ReisRodrigo Reis1Rachel G TabakRachel G Tabak1Ross BrownsonRoss Brownson1,4
  • 1Prevention Research Center, Washington University in St. Louis, St. Louis, United States
  • 2Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • 3Children’s National Hospital, Washington D.C., District of Columbia, United States
  • 4Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, United States

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Introduction. Rural areas of the United States lack the samehave lower levels of physical activity (PA) as compared to their urban and suburban counterparts, leading to higher levels of chronic diseases. The objective of the study was to increase (PA) in rural communities via a multilevel intervention. Methods. We implemented a cluster randomized controlled trial of a community-based multilevel PA intervention between 2019 and 2022 in 14 rural communities. The intervention consisted of 1) text messaging (i.e., individual level), 2) encouragement of walking groups (i.e., interpersonal level), and 3) community-based marketing (i.e., community level). Results. Participants meeting the 2018 PA guidelines for aerobiccardiovascular PA increased among the intervention group, with no differences in recreational (Effect Size [ES]=.39), occupational (ES=.05), transportation (ES=.17), or total (ES=.13) PA. Discussion. In this multilevel study the intervention is associated with meeting PA guidelines. The complexities of the impact of COVID-19 make it hard to disentangle the effects of the intervention on PA and other outcomes. Though the main tenets of the multilevel intervention had to be altered due to the pandemic, there was value in text messaging in rural areas to promote PA. Future studies should consider incorporating text messages into the use of text messaging in rural areas as a component of a PA promotion campaign.

Keywords: Rural Health, prevention, physical activity, Multilevel intervention, Text Messaging

Received: 14 Feb 2025; Accepted: 08 Aug 2025.

Copyright: © 2025 Beck, Serrano, Duncan, Eyler, Gilbert, Naghiloo, Reis, Tabak and Brownson. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Alan M. Beck, Prevention Research Center, Washington University in St. Louis, St. Louis, United States

Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Supplementary Material