A Systematic Review of Community-wide Media Physical Activity Campaigns: An Update From 2010

BACKGROUND

Mass media campaign is an integral tool to influence physical activity participant behaviors. The purpose of the systematic review was to identify the effectiveness of mass media campaigns in promoting physical activity.

METHODS

Literature update from January 2010 to September 2016 was conducted in 13 databases. Full text articles of 128 were screened, and 23 articles (18 campaigns) were selected from the initial 1692 articles.

RESULTS

All campaigns involved mass media advertisements to promote physical activity to general individuals (n = 2), adults (8), children (4), older adults (2), and parents of children (n = 2). The campaign evaluation designs included clustered RCT (2), cohort (3), quasi-experimental (9), and cross-sectional (9). Eight articles demonstrated significant campaign impact on proximal, 6 on intermediate, 5 on distal outcomes, and 6 on distal change based on either proximal or intermediate outcome.

CONCLUSION

The current review assessed the outcome evaluation of mass media physical activity campaigns that varied in their respective scope, target population and outcomes measured to identify individual changes at proximal, intermediate, and distal level. Results from formative and process evaluation as well as dose-response and cost-effective analysis are suggested to provide valuable evidence for campaign stakeholders and planners.

Moderators of Implicit-Explicit Exercise Cognition Concordance

Investigating implicit-explicit concordance can aid in understanding underlying mechanisms and possible intervention effects. This research examined the concordance between implicit associations of exercise with health or appearance and related explicit motives. Variables considered as possible moderators were behavioral regulations, explicit attitudes, and social desirability. Participants (N = 454) completed measures of implicit associations of exercise with health and appearance and questionnaire measures of health and appearance motives, attitudes, social desirability, and behavioral regulations. Attitudes significantly moderated the relationship between implicit associations of exercise with health and health motives. Identified regulations significantly moderated implicit-explicit concordance with respect to associations with appearance. These results suggest that implicit and explicit exercise-related cognitions are not necessarily independent and their relationship to each other may be moderated by attitudes or some forms of behavioral regulation. Future research that takes a dual-processing approach to exercise behavior should consider potential theoretical moderators of concordance.

Pink Ribbons and Red Dresses: A Mixed Methods Content Analysis of Media Coverage of Breast Cancer and Heart Disease

This research examined media coverage of breast cancer (n = 145) and heart disease and stroke (n = 39) news articles, videos, advertisements, and images in a local Canadian context through quantitative and thematic content analyses. Quantitative analysis revealed significant differences between coverage of the diseases in placement, survivors as a source of information, health agency, human interest stories, citation of a research study, the inclusion of risk statistics, discussion of preventative behaviors, and tone used. The thematic analysis revealed themes that characterized a "typical" breast cancer survivor and indicated that "good" citizens and businesses should help the cause of breast cancer. Themes for heart disease and stroke articulated individual responsibility and the ways fundraising reinforced femininity and privilege. Findings provide insight on how these diseases are framed in local Canadian media, which might impact an individual's understanding of the disease.

Taking a hard look at the Heart Truth campaign in Canada: A discourse analysis

The Canadian Heart and Stroke Foundation launched the Heart Truth campaign to increase women’s awareness of heart disease. However, little is known about how such campaigns intersect with broader understandings of gender and health. This discourse analysis examined the construction of gender, risk, and prevention within campaign material. Two primary discourses emerged: one of acceptable femininity, which outlines whose risk, survivorship, and prevention matters, and another of selfless prevention. Women of diverse ethnic, sexual, and socio-economic background were largely absent. Prevention was portrayed as a personal choice, eclipsing conversations about social determinants of health and the socio-political context of heart disease.

Heart disease and breast cancer perceptions: Ethnic differences and relationship to attentional bias

Differences in perceptions of susceptibility, seriousness, and fear of heart disease and breast cancer were examined and related to attentional bias for disease-related words among Canadian women of various ethnic ancestry. Women (n = 831) completed an online survey, and 503, among them, also completed an attentional bias task. Perceived seriousness of breast cancer predicted attentional bias for breast cancer in women of South Asian ancestry. Lifestyle behaviors were related to breast cancer attentional bias in women with British ancestry. Understanding relationships between modifiable risk factors, disease risk perceptions, and attentional biases among different ethnic groups can help create targeted promotional campaigns.

Evaluating the ParticipACTION “Think Again” Campaign

Introduction. ParticipACTION’s 2011 “Think Again” campaign aimed to draw parents’, and specifically mothers’, attention to the amount of physical activity (PA) their children do relative to the national guidelines (physical activity guidelines [PAG]). Purpose. To evaluate ParticipACTION’s “Think Again” campaign in the context of the hierarchy of effects model. Methods. Data were drawn from “Think Again” campaign evaluations conducted among two cohorts of parents with children ages 5 to 11 years (3 months postcampaign launch [T1], n = 702; 15 months postlaunch [T2], n = 670). Results. At T2, campaign awareness was weakly associated with parents agreeing that their children were not active enough ( p = .01, d = .18). Parents who were aware of the campaign showed greater knowledge of PAG ( ps < .01, ϕs > .14), had higher outcome expectations about their children engaging in PA ( p < .01, d = .16), had stronger intentions to help their child meet the guidelines ( p < .01, d = .18), and engaged in more parental support behaviors ( p < .001, d = .31) as compared with parents who were not aware. At T1, parents aware of the campaign had greater perceived behavioral control (PBC) to influence their child’s PA participation ( p < .01, d = .22), whereas parents not aware of the campaign had greater PBC to find practical ways to help their child be active ( p < .01, d = .26). Parental awareness of the campaign was not associated with children meeting the PAG at either time point ( ps > .05). Conclusions. The campaign appeared marginally effective for increasing parental knowledge of PAG and for creating realistic awareness of children’s PA levels. Additional intervention strategies are needed to produce larger effects and to change parental behavior.

An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active

The objective of the My ParticipACTION campaign was to inspire Canadian adults to increase their physical activity through messaging that was relevant, engaging, and designed to build self-efficacy to be more active. This research examined the communication effects of the campaign according to the a priori Hierarchy of Effects Model (saliency → cognitive engagement → self-efficacy to become more active → trial behavior) and investigated how these effects related to overall self-efficacy for physical activity, intention to be active, and current activity level. Participants (N = 1,110) were recruited from an existing panel of Canadian adults 18 years and older and completed a short online questionnaire about the potential communication effects. Logistic regression models were constructed to test the communication effects adjusting for age, gender, and education. The relations were consistent with those hypothesized in the model. In addition, some earlier outcomes in the sequence of effects were associated with other outcomes further down the progression. When intention to be active was included, the initial relation between ad-specific self-efficacy and current physical activity disappeared. This analysis suggested that the campaign was successful in increasing self-efficacy to be more active and that using the Hierarchy of Effects Model was useful in guiding the design of campaign messages and assessing communication effects. Given the limited amount of theoretical testing of the Hierarchy of Effects Model, future research employing longitudinal designs is required to further confirm the communication effects of such an intervention and further test the model.

Longitudinal changes in beliefs by stage of physical activity adoption in Iranian girls

BACKGROUND

The aims of this study were to examine the relationships among physical activity (PA)-related beliefs and to determine to what extent Iranian adolescents in different stages of PA adoption differ in perceived benefits and barriers during a 3-year transition from junior high school to high school.

METHODS

Data were collected from female adolescents in 2010 (N = 558), of whom 412 provided follow-up data in 2013. One-way analysis of variance and logistic regression were conducted for statistical analysis.

RESULTS

Participants in the action and maintenance stages reported the greatest agreement with benefits. Pre-contemplators were about 4 times more likely to cite "not enough time" than preparers (OR = 3.95). Pre-contemplators were over 4 times more likely to cite not liking exercise than those in action and maintenance stages at baseline (OR = 4.32 and 4.85), a finding which was maintained at follow-up (OR = 3.66 and 8.65).

CONCLUSIONS

These findings could help with the creation of interventions tailored to encourage pre-contemplators to progress toward adoption of PA. Providing transportation supports, enhancing time management, and mitigating boredom may be helpful strategies either to prevent relapse in adoption stages or to move females in early stages of change toward action and maintenance.

Assessing intentions to eat low-glycemic index foods by adults with diabetes using a new questionnaire based on the theory of planned behaviour

OBJECTIVE

The Canadian Diabetes Association recommends that people with diabetes choose foods with low-glycemic index (GI). This study developed a questionnaire measuring Theory of Planned Behaviour (TPB) constructs relative to consuming a low-GI diet by people with diabetes so as to achieve a better understanding of which TPB constructs, demographic characteristics and diabetes-related variables best predict intention to consume a low-GI diet.

METHOD

A questionnaire to measure intentions to consume a low-GI diet was developed based on TPB constructs and was administered to 369 adults (30 to 75 years) with type 1 or type 2 diabetes. Responses were analyzed using multiple linear regression.

RESULTS

More than 90% of participants (mean age, 56.5±10.8 years; mean body mass index, 30.5±7.2 kg/m(2)) cited reduction and maintenance of healthy blood glucose levels as an advantage of eating low-GI foods. Older age, higher income, female gender, having type 2 diabetes, diabetes treatment (diet only) and understanding of the GI were positively associated with intention to eat a low-GI diet. TPB constructs that significantly predicted intentions to eat a low-GI diet were instrumental attitude (beta = 0.24, p<0.001); subjective norms (beta = 0.13, p=0.007); and perceived behavioural control (beta = 0.55, p<0.001).

CONCLUSIONS

This new questionnaire is a valid tool to assess TPB constructs contributing to intentions to eat a low-GI diet by people with diabetes. Future studies that use this questionnaire can shed light on how TPB concepts in clinical practice can help people with diabetes to change their dietary intake.

Mothers' intentions to support children's physical activity related to attention and implicit agreement with advertisements

BACKGROUND

ParticipACTION's Think Again campaign targeted mothers who think their children are sufficiently active, yet whose children do not achieve recommended amounts of physical activity.

PURPOSE

This research examined the relationship of mothers' intentions to support children's physical activity with explicit believability and implicit agreement with the Think Again campaign message, attention paid to the advertisement, involvement with the issue, concern regarding children's inactivity, and attitudes.

METHOD

Participants were mothers from Edmonton, Canada (N = 102) who viewed one Think Again advertisement then completed a measure of implicit agreement with the campaign message and questionnaires.

RESULTS

The mothers who paid attention to the message and were concerned for their own children were more likely to intend to act on campaign messages. The majority of participants implicitly agreed that children's physical inactivity was a problem, but there was less agreement that physical inactivity was a problem for their own children.

CONCLUSION

Participants automatically tended to agree with campaign messages when the focus was on children in general, but there was greater disagreement when asked about participant's own children. Why most mothers were not in agreement with the reality of how much physical activity their children needs remains to be determined.

An Internet-based intervention for promoting and maintaining physical activity: a randomized controlled trial

OBJECTIVES

To evaluate the efficacy of a Social Cognitive Theory-based Internet intervention designed to promote and maintain leisure-time physical activity in university-aged female students in Thailand.

METHODS

The 3-month intervention was delivered through a website and e-mails with a follow-up evaluation 3 months after the end of the intervention. Female students (N = 220) were allocated to 4 parallel groups.

RESULTS

Significant increases in steps/ day, weekly leisure-time activity score, self-efficacy, outcome expectations, and self-regulation, and reduced resting heart rate were observed at the end of the intervention. With the exception of resting heart rate, the intervention effects on these variables also remained at the follow-up.

CONCLUSIONS

The Internet intervention program was effective in promoting and maintaining leisure-time physical activity in university-aged female students.

Overcoming Challenges to Build Strong Physical Activity Promotion Messages

Physical inactivity is a serious public health issue. Physical activity promotion messages are part of a comprehensive approach to creating a society in which physical activity is the norm. Although public health messages can be influential, they face tough competition from other sources of physical activity information that offer conflicting advice about being active and thus may undermine public health efforts. It is therefore necessary to consider the multiple sources of messages (eg, commercial, public health) that can cause confusion for consumers. This article reviews research on sources of physical activity information, where such information is sought and by whom, and how messages are processed at both automatic (ie, with little thought) and reasoned (ie, deliberate) levels. Having outlined the challenges, suggestions are made regarding how public health messages can be heard in an environment dominated by commercial advertising. These suggestions include tailoring theory-based messages, ensuring the benefits of being active are highlighted, branding, and forging collaborative partnerships within the physical activity sector. By enacting these strategies, public health messages may be more effective at attracting attention and being subsequently read and recalled by consumers, and thus contribute to an active society.

Effects of reading health and appearance exercise magazine articles on perceptions of attractiveness and reasons for exercise

Objective

To examine the effects of reading exercise-related magazine articles (health, appearance, or control) and the moderating effects of exercise self-identity on reasons for exercise and perceptions of attractiveness, among women in first year university. An additional purpose was to use a thought listing technique, the results of which were examined for evidence of internalization of the exercise-related messages.

Participants

Female students in their first year of studies between September 2010 and April 2011 (N = 173; mean age = 19.31 years, mean body mass index = 22.01).

Methods

Participants read a health, appearance, or control article, listed thoughts, and completed questionnaires measuring reasons for exercising, physical self-perception, and exercise self-identity.

Results

Participants in the health condition rated exercise for health significantly higher than control condition participants. Participants with high exercise self-identity rated attractiveness as a reason for exercising significantly higher than low exercise self-identity participants in both the health and appearance conditions. Participants with higher internalization scores (i.e., accepted societal norms of appearance) reported exercising for attractiveness reasons more so than participants with lower internalization scores.

Conclusions

The good news is that health messages may be influential and result in wanting to exercise for health purposes. However, exercising for attractiveness was rated highly by participants with high exercise identity who read either the health or appearance articles. Health and appearance are not necessarily distinct concepts for female undergraduate students and the media may influence cited reasons for exercise.

Source attribution and credibility of health and appearance exercise advertisements: Relationship with implicit and explicit attitudes and intentions

The relationship of attributed source (commercial or nonprofit) and credibility of exercise advertisements to explicit and implicit exercise-related attitudes and intentions was examined. Male and female participants ( N = 227) were randomly assigned to watch health or appearance-related advertisements and then completed an implicit attitudes task and questionnaires. Health advertisements and those attributed to a nonprofit source were rated more credible. Appearance condition participants who attributed the advertisement to a nonprofit source also rated the advertisement as more credible. Participants who rated a commercial advertisement as credible reported higher implicit instrumental attitudes. Implications for exercise promotion are discussed.

Effects of Biggest Loser exercise depictions on exercise-related attitudes

OBJECTIVES

To examine whether participants who watched an exercise-related segment of The Biggest Loser television program would have different explicit and implicit affective exercise-related attitudes than those of control participants.

METHODS

University students (N=138) watched a clip of The Biggest Loser or American Idol, then completed a Go/No-go Association Task, a thought-listing task, and questionnaires measuring explicit attitudes, activity level, and mood.

RESULTS

Participants who watched The Biggest Loser had significantly lower explicit, but not implicit, attitudes towards exercise than did control participants.

CONCLUSIONS

There is a need to examine the influence of popular media depictions of exercise.

Collective knowledge: using a consensus conference approach to develop recommendations for physical activity and nutrition programs for persons with type 2 diabetes

The purpose of this consensus conference was to have a lay panel of persons with type 2 diabetes (T2D) work in collaboration with an expert panel of diabetes professionals to develop strategies designed to improve dietary and physical activity adherence in persons with T2D. Lay panel participants were 15 people living with T2D. The seven experts had expertise in exercise management, cardiovascular risk factors, community-based lifestyle interventions, healthy weight strategies, the glycemic index, exercise motivation, and social, environmental and cultural interactions. All meetings were facilitated by a professional, neutral facilitator. During the conference each expert gave a 15-min presentation answering questions developed by the lay panel and all panel members worked to generate suggestions for programs and ways in which the needs of persons with T2D may be better met. A subgroup of the lay panel used the suggestions created from the conference to generate a final list of recommendations. Recommendations were categorized into (1) diagnosis/awareness (e.g., increasing awareness about T2D in the general public, need for lifelong self-monitoring post-diagnosis); (2) education for the person with diabetes (e.g., periodic "refresher" courses), professionals (e.g., regular interactions between researchers and persons with T2D so researchers better understand the needs of the affected population), and the community (e.g., support for families and employers); and (3) ongoing support (e.g., peer support groups). The recommendations from the conference can be used by researchers to design and evaluate physical activity and nutrition programs. The results can also be of use to policy makers and health promoters interested in increasing adherence to physical activity and nutrition guidelines among persons with T2D.

The Effect of Different Response Formats on Ratings of Exerciser Stereotypes

In this study we examined the relationships of different response formats, respondent gender, and activity level, to ratings of exercise stereotypes. Participants (N = 203) completed 8 question sets about 8 exerciser stereotypes. In each questionnaire, 1 question was inadvertently measured twice with different response options of definitely would not like to do this/definitely would like to do this (NL anchor) or definitely false/definitely true (FT anchor). Results showed that ratings on the FT statements were significantly higher than those on NL statements for 2 stereotypes: judgmental young women and overweight. There were also significant effects of gender by activity level on ratings of runners. Both gender and activity levels were related to ratings of liking to exercise for some, but not all, of the stereotypes.

Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres

In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination.

Implicit and explicit exercise and sedentary identity

We examined the relationship between implicit and explicit "exerciser" and "sedentary" self-identity when activated by stereotypes. Undergraduate participants (N = 141) wrote essays about university students who either liked to exercise or engage in sedentary activities. This was followed by an implicit identity task and an explicit measure of exercise self-identity. Results showed that implicit and explicit exerciser identities were not highly correlated. There were also no significant prime effects, but women showed greater implicit sedentary identity, whereas men showed greater implicit exercise identity. This research suggests that implicit exercise-related identity is a distinct construct from explicit exercise identity. The results also reflect responses to societal pressures for women to be thin and for men to be strong, when free of self-presentational bias.

From paper to practice: barriers to adopting nutrition guidelines in schools

OBJECTIVE

To explore the barriers associated with the adoption of the Alberta Nutrition Guidelines for Children and Youth in schools according to characteristics of the innovation (guidelines) and the organization (schools).

DESIGN

Cross-sectional telephone survey.

SETTING AND PARTICIPANTS

Schools in Alberta, Canada. Principals from 357 schools.

MAIN OUTCOME MEASURE

Barriers to adopting the nutrition guidelines.

ANALYSIS

A 19-question telephone survey, including open- and closed-ended questions, was used to obtain information regarding schools' characteristics and barriers to adopting the guidelines. Qualitative data were coded according to common themes a priori, based on constructs from the Diffusion of Innovations framework.

RESULTS

Schools reported many barriers related to the relative advantage, compatibility, and complexity of adopting the guidelines. Parents' resistance to change and cost were the key reported barriers. Lack of knowledge, student preferences, the physical location of the school, and barriers related to the provision of healthful food were also reported.

CONCLUSIONS AND IMPLICATIONS

Disseminating guidelines without providing adequate support for their implementation may not promote change within the school setting. School nutrition initiatives need to involve the parents and have access to sufficient financial and human resource support.