Journal of Health Communication International Perspectives
ISSN: 1081-0730 (Print) 1087-0415 (Online) Journal homepage: http://www.tandfonline.com/loi/uhcm20
An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active Cora Lynn Craig, Adrian Bauman, Amy Latimer-Cheung, Ryan E. Rhodes, Guy Faulkner, Tanya R. Berry, Mark S. Tremblay & John C. Spence To cite this article: Cora Lynn Craig, Adrian Bauman, Amy Latimer-Cheung, Ryan E. Rhodes, Guy Faulkner, Tanya R. Berry, Mark S. Tremblay & John C. Spence (2015) An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active, Journal of Health Communication, 20:9, 995-1003, DOI: 10.1080/10810730.2015.1012240 To link to this article: http://dx.doi.org/10.1080/10810730.2015.1012240
Published online: 07 Jul 2015.
Submit your article to this journal
Article views: 72
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=uhcm20 Download by: [Ecole Hautes Etudes Commer-Montreal]
Date: 12 September 2015, At: 05:08
Journal of Health Communication, 20:995–1003, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 1081-0730 print/1087-0415 online DOI: 10.1080/10810730.2015.1012240
An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active CORA LYNN CRAIG1,2, ADRIAN BAUMAN1,2, AMY LATIMER-CHEUNG3, RYAN E. RHODES4, GUY FAULKNER5, TANYA R. BERRY6, MARK S. TREMBLAY7, and JOHN C. SPENCE6 1
Canadian Fitness and Lifestyle Research Institute, Ottawa, Ontario, Canada School of Public Health, University of Sydney, Sydney, New South Wales, Australia 3 School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada 4 School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada 5 Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada 6 Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada 7 Healthy Active Living and Obesity Research, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
2
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 ¼ 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.
Physical inactivity accounts for 9% of the avoidable premature deaths worldwide and up to 10% of the burden of breast and colon cancer (Lee et al., 2012). The prevalence of physical inactivity ranges from 17% in southeast Asia to a high of 43% in the Americas and eastern Mediterranean (Hallal et al., 2012). National mass media campaigns involving a television advertising component have proven an effective component of a mix of strategies to increase population levels of physical activity (PA; Bauman, Bowles, & Huhman 2008; Booth, Bauman, Oldenburg, Owen & Magnus, 1992; Bauman, Bellew, Owen, & Vita, 2001; Cavill & Bauman, 2004; Craig, Cragg, Tudor-Locke, & Bauman, 2006; Hillsdon, Cavill, Nanchahal, Diamond, & White, Address correspondence to Adrian Bauman, School of Public Health, University of Sydney, Level 6, The Hub, Charles Perkins Centre D17, Sydney, 2006 NSW, Australia. E-mail: [email protected] Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/uhcm.
2001; Wimbush, MacGregor & Fraser, 1998). Particip ACTION is a national nonprofit Canadian organization dedicated to increasing physical activity in the Canadian population (see Latimer-Cheung, Murumets, & Faulkner, 2014). ParticipACTION ran serial national PA communications campaigns between 1973 and 2001, and then annually since it was reintroduced in 2007. Despite Particip ACTION’s long history running mass communication campaigns, it did not evaluate its early campaigns beyond basic recognition of the ParticipACTION brand, with awareness of ParticipACTION remaining above 75% of the Canadian adults for more than two decades (Bauman, Madil, Craig, & Salmon, 2004; Spence et al., 2009). Theoretically based studies evaluating mass communications to encourage PA are relatively rare (Cavill & Bauman, 2004), with notable examples being the VERB (Huhman, Bauman, & Bowles, 2008) and 5-2-1-0 childhood obesity (Rogers et al., 2013) campaigns. Evidence on the use of theories and models in social marketing interventions is sparse (Luca & Suggs, 2013). The Hierarchy of Effects
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
996 Model (HOEM) was designed as a logic model to explain campaign effects in marketing (Lavidge & Steiner, 1961) and has been useful for planning and evaluating health communication campaigns (McGuire, 1984). It posits that campaign effects occur in a sequenced set of stages from initial awareness of the campaign, and then progressing through targeted intermediate outcomes, which may include knowledge, saliency, attitudes, health beliefs, self-efficacy, and intention, and to distal outcomes such as trialing and adoption of behaviors. This model has been infrequently tested in the context of PA. Employing a Canadian panel recruited in 1981 and followed up in 1988 and 2003, Craig, Bauman, and Reger-Nash (2010) tested the HOEM on the basis of awareness of early ParticipACTION campaigns (1981), potential intermediate effects (1988), and long-term PA maintenance (1988 and 2003). This analysis noted that among inactive Canadians 13 years of age and older, campaign recall predicted outcome expectancy and then each subsequent intermediate outcome sequentially predicted the next, with intention then predicting PA maintenance. Similarly, Spence and colleagues (2009) found that (a) outcome expectations, self-efficacy, and intention to be physically active varied significantly by awareness of ParticipACTION among Canadian adults; and (b) outcome expectations and self-efficacy accounted for much of the association between awareness and PA. The HOEM has also been tested among young American teenagers (Bauman, Bowles, & Huhman, 2008), where campaign effects did not follow the proposed sequence of effects. Here, knowledge directly predicted action. Another campaign targeted parents, to increase the saliency of children’s inactivity, and found that campaign awareness was associated with knowledge about PA, and that this, in turn, was associated with high saliency of the issue (Craig, Bauman, Gauvin, Robertson, & Murumets, 2009). High saliency was associated with parental reports of trial attempts to increase their children’s PA level. Therefore, the HOEM performed as hypothesized among adults and parental reports, but a direct pathway between knowledge and action was found among teenagers. ParticipACTION’s 2010 campaign was designed to increase selected intermediate outcomes among adults based on a HOEM. Influencing knowledge of the amount of PA was not part of the model or campaign as it was known that Canadian PA guidelines (Tremblay et al., 2011) would be changing after the campaign was executed. Given that Canadians are knowledgeable about the benefits of PA (Cameron, Craig, & Paolin, 2005), the campaign’s purpose was to foster saliency and increase self-efficacy to be more active, which is considered one of the most important determinants of PA (Latimer, Brawley, & Bassett, 2010; McAuley & Blissmer, 2000). To do this, ParticipACTION ran a promotional campaign in which well-known Canadians invited individuals to submit their stories about how PA had made a difference in their lives (ParticipACTION’s Canadian Icons, n.d.). Individuals were told that their story might be chosen to inspire others to be active. The My ParticipACTION campaign was then devised according to an a priori HOEM. This study responds to a recent call for more thorough reporting of the
C. L. Craig et al. use of behavioral theory within social marketing activities (Luca & Suggs, 2013). We posed two research questions. First, are the campaign effects consistent with the a priori HOEM framework (saliency ! cognitive engagement ! campaign-related self-efficacy to become more active ! initial trial behavior)? Second, is campaign-specific self-efficacy related to intermediate (overall situational self-efficacy for PA and future intentions to be active) and distal (activity level) effects in a as predicted by HOEM (campaign-related self-efficacy ! intermediate outcomes ! distal outcomes).
Method Campaign Design Television advertisements were used to invite Canadians to tell their story about becoming more active. After initial screening of about 1,800 submitted stories for media appeal by the advertising agency and ParticipACTION, the short listed stories were reviewed against a number of criteria by one of the authors (C.L.C.), a member of ParticipACTION staff and a representative of the advertising agency. The criteria were relevance to the overall adult population (saliency) while portraying diversity across stories (women, men, family, ethnicity, and ability), mass appeal of the PA portrayed (saliency), clear statements outlining what steps the individual took to build PA into his or her lifestyle (to foster cognitive processes and build self-efficacy), their humor or a media hook, and if possible the rationale for becoming more active (reinforce knowledge of benefits). A short list of stories was identified that met all criteria and ranked according to the clarity of the information provided on the steps taken to become more active. The highest ranking stories which also had the best media appeal as judged by the advertising agency (on the basis of humor, popularity of PA portrayed, range of population groups covered) were chosen. As a result, the campaign involved four English and two French advertisements that featured stories of individual Canadians (see Figure 1) with an underlying theme of ‘‘If they can do it, I can do it.’’ At the end of each story, the individuals involved in the ad were featured saying ‘‘My ParticipACTION is’’ and the physical activity that they did (e.g., take the stairs at work, walk the dog) to cue trialing of physical activity. Each individual granted permission to be featured along with his or her story in the advertisement. The campaign ran intermittently over a period of 33 weeks ending March 31, 2010. Because of budget limitations, gross ratings points (GRPs) were 1200 in the English media and 864 in the French media. Respondent Recruitment In April 2010, participants were recruited from an existing online Angus Reid Strategies panel (N > 60,000) of Canadian adults who had previously given consent to be contacted for future research surveys. The panel (Angus Reid Forum, n.d.) is a convenience sample recruited through randomized invitations. Individuals viewing the Angus Reid
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
My ParticipACTION Campaign
997
Fig. 1. My ParticipACTION campaign messages. Neither the media clip nor the content of campaign story were provided to respondents.
website may volunteer to participate and are then accepted into the panel after completing a short screening questionnaire. Individuals working in market or survey research are ineligible. Potential participants were (a) sent an e-mail inviting them to respond online to a survey, (b) informed that all responses would be kept strictly confidential according to the company’s privacy policy (Angus Reid Privacy Policy, n.d.), and (c) provided a unique link in the emails to the Internet-based survey instrument. Participants were not informed ahead of time about the specific content of the survey. Participation in the survey and each of its items was completely voluntary, but a small incentive (US$3) was offered. A copy of the denominalized dataset was provided to ParticipACTION for its own purposes and for the secondary analysis supporting this investigation. Ethics approval for this study was obtained from the Human Research Ethics Committee of the University of Sydney. Measures Overall Measures Self-efficacy, future intention to be active, and activity level were asked of all participants. The measure of self-efficacy assessed participants’ confidence to be physically active on
the basis of three constructs (Velicer, DiClemente, Rossi, & Prochaska, 1990): (a) ‘‘no matter how busy your day is?’’ (scheduling=negative affect); (b) ‘‘on a day when you don’t really feel like doing it?’’ (coping=habit=addictive); and (c) ‘‘and still spend the time you want with your family’’ (positive social). Each statement was ranked on 7-point scale ranging from 1 (not at all confident) to 7 (very confident). The items were summed (Cronbach a ¼ .85). Intention was determined from the question, ‘‘Thinking ahead over the next six months, to what extent do you intend to be physically active?’’ with the response categories reported on a 7-point scale ranging from 1 (no intention at all) to 7 (fully intend) (Cameron, Craig, Bull, & Bauman, 2007). In addition, PA was assessed using the 1998 Canadian PA guidelines (Health Canada & Canadian Society for Exercise Physiology, 1998), which required being active 60 min daily, by a question that was similar to a validated single item questionnaire (Milton, Clemes, & Bull, 2013): ‘‘Over the past seven days, on how many days were you physically active for a total of at least 60 minutes per day?’’ (response categories: no days; 1; 2 to 3 days; 4 days). After we asked these questions, we measured awareness by unprompted and prompted recall of ParticipACTION’s campaign. Respondents were asked whether they had seen any media messages within the past 3 months related to
998
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
physical inactivity and, if they had, to specify the content of the messages. Multiple responses were permitted; responses were coded by the survey company as being consistent or not consistent with the specific ParticipACTION campaign messages (such as mother playing soccer, taking the elevator). Subsequently, prompted recall was defined as having seen at least one of the specific storyboard images (Figure 1, column 1) related to the campaign. No detail of the content of the ad was provided. Campaign-Specific Measures Campaign-specific measures were asked about the particular content of the ads among those who indicated that they had recalled one of the images: . Campaign-specific saliency was measured with the following
randomly presented items that were rated on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree): ‘‘The story spoke to you,’’ ‘‘What the ad said and showed was interesting to you,’’ and ‘‘You could relate to the person in the ad.’’ Because of the rarity of the strongly disagree responses, we combined this category with disagree and reverse-coded and summed the resulting scores. Cronbach’s a exceeded .81 for all stories except one seen by only 12 participants where Cronbach’s a ¼ .41. Responses for all stories were retained in the analysis. Overall saliency was computed by summing the individual scores. . Cognitive engagement was assessed by the single item, ‘‘The ad gave you ideas about how you could increase your physical activity’’ rated on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree). . Campaign-specific self-efficacy to be more active was determined as strongly agreeing with the statement, ‘‘The ad made you think that if they could be more active, you could too,’’ for at least one story. This item was also rated on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree). . Trialing behaviors was assessed by summing yes=no responses to the items following the question: ‘‘And, as a result of seeing this particular ad, have you done any of the following?’’: ‘‘encouraged a friend to be active with me’’; ‘‘took the stairs at work’’; ‘‘looked for opportunities to be active as a family’’; ‘‘tried a variety of activities’’; ‘‘actively commuted for short distance’’; ‘‘if you have a dog, walked your dog more often or longer’’; and ‘‘reduced your amount of screen time.’’ All measures were coded into dichotomous variables. Specifically, future intention and all scales were coded into highest quintile versus other. Demographic characteristics were gathered for classification purposes. These included age (in years), gender, and education (classified as secondary education or less, college or technical school, and university). Analysis The prevalence of the overall and campaign-related measures were calculated stratified by gender to determine whether separate communication models might be required.
C. L. Craig et al. The association between awareness and overall self-efficacy was tested by a chi-square test of independence. The percentage that was aware of the campaign was plotted by self-efficacy score and the best fit of the relation depicted using SPSS 18 Curvefit. Logistic regression models were constructed to test the potential communication effects of the campaign according to the posited hierarchy underlying the ParticipACTION messaging, with age, gender, and education as covariates. More specifically, a series of sequential models was tested for potential effects specific to the campaign (saliency ! cognitive engagement ! self-efficacy to become more active ! initial trial behavior) and for the relation between these campaign-specific and overall effects within the HOEM that were independent of the campaign (i.e., overall self-efficacy, future intention, and PA) according to the method of Baron and Kenny (1986). In particular, mediation was investigated by testing whether the proposed mediator (e.g., cognitive engagement) was a significant predictor of the subsequent variable in the hierarchy (i.e., campaign-related self-efficacy), the preceding variable (i.e., saliency) predicted both the proposed mediator and the subsequent variable in the hierarchy and, if these conditions were true, testing whether the preceding variable (i.e., saliency) was no longer a predictor of the subsequent variable (i.e., campaign-related self-efficacy) when the potential mediator and the preceding variable were considered simultaneously. In addition, if both predictors (i.e., cognitive engagement and campaign-related self efficacy) remained significant then partial mediation was tested using the Aroian version of the Sobel test (MacKinnon & Dwyer, 1993). In one case (self-efficacy ! future intention ! activity level), it was possible to test mediation on the full sample as well as on those receiving the campaign specific measures. As there was no significant difference in findings, the results for the full sample are presented. Last, the independence of predictors was assessed by examining the interaction effect between a variable in the hierarchy and the preceding predictor. Tests were performed using SPSS 18 Complex Samples procedures for Tabulate and Logistic Regression to account for sample weights.
Results Participants In total, 569 men and 541 women 18 years of age and older participated in the overall study (N ¼ 1,110). A higher percentage of participants were 35–54 years old, were married, had a college or technical education, had household incomes in the US$50,000–$99,999 range, and completed the survey in English (see Table 1). Overall, 56.1% of participants did not recall the campaign. Of the 43.9% recalling the campaign, 6.1% (95% CI [4.8%, 7.7%]) of participants recalled messages consistent with the ParticipACTION campaign without prompting and 37.8% (95% CI [34.9%, 40.8%]) did so after being shown only the story board image. Prompted recall by ad ranged from 6.8% (95% CI [8%, 11.8%]) for the hockey vignette to 37.3% (95% CI [30.3%, 45.0%]) for the karate advertisement. There were no significant differences
999
My ParticipACTION Campaign Table 1. Participant characteristics
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
All participants (N ¼ 1,110)
Gender Male Female Age (years) 18–34 35–54 55þ Education High school or less College=tech school University or more Income
ISSN: 1081-0730 (Print) 1087-0415 (Online) Journal homepage: http://www.tandfonline.com/loi/uhcm20
An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active Cora Lynn Craig, Adrian Bauman, Amy Latimer-Cheung, Ryan E. Rhodes, Guy Faulkner, Tanya R. Berry, Mark S. Tremblay & John C. Spence To cite this article: Cora Lynn Craig, Adrian Bauman, Amy Latimer-Cheung, Ryan E. Rhodes, Guy Faulkner, Tanya R. Berry, Mark S. Tremblay & John C. Spence (2015) An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active, Journal of Health Communication, 20:9, 995-1003, DOI: 10.1080/10810730.2015.1012240 To link to this article: http://dx.doi.org/10.1080/10810730.2015.1012240
Published online: 07 Jul 2015.
Submit your article to this journal
Article views: 72
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=uhcm20 Download by: [Ecole Hautes Etudes Commer-Montreal]
Date: 12 September 2015, At: 05:08
Journal of Health Communication, 20:995–1003, 2015 Copyright # Taylor & Francis Group, LLC ISSN: 1081-0730 print/1087-0415 online DOI: 10.1080/10810730.2015.1012240
An Evaluation of the My ParticipACTION Campaign to Increase Self-Efficacy for Being More Physically Active CORA LYNN CRAIG1,2, ADRIAN BAUMAN1,2, AMY LATIMER-CHEUNG3, RYAN E. RHODES4, GUY FAULKNER5, TANYA R. BERRY6, MARK S. TREMBLAY7, and JOHN C. SPENCE6 1
Canadian Fitness and Lifestyle Research Institute, Ottawa, Ontario, Canada School of Public Health, University of Sydney, Sydney, New South Wales, Australia 3 School of Kinesiology and Health Studies, Queen’s University, Kingston, Ontario, Canada 4 School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada 5 Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada 6 Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada 7 Healthy Active Living and Obesity Research, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
2
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 ¼ 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.
Physical inactivity accounts for 9% of the avoidable premature deaths worldwide and up to 10% of the burden of breast and colon cancer (Lee et al., 2012). The prevalence of physical inactivity ranges from 17% in southeast Asia to a high of 43% in the Americas and eastern Mediterranean (Hallal et al., 2012). National mass media campaigns involving a television advertising component have proven an effective component of a mix of strategies to increase population levels of physical activity (PA; Bauman, Bowles, & Huhman 2008; Booth, Bauman, Oldenburg, Owen & Magnus, 1992; Bauman, Bellew, Owen, & Vita, 2001; Cavill & Bauman, 2004; Craig, Cragg, Tudor-Locke, & Bauman, 2006; Hillsdon, Cavill, Nanchahal, Diamond, & White, Address correspondence to Adrian Bauman, School of Public Health, University of Sydney, Level 6, The Hub, Charles Perkins Centre D17, Sydney, 2006 NSW, Australia. E-mail: [email protected] Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/uhcm.
2001; Wimbush, MacGregor & Fraser, 1998). Particip ACTION is a national nonprofit Canadian organization dedicated to increasing physical activity in the Canadian population (see Latimer-Cheung, Murumets, & Faulkner, 2014). ParticipACTION ran serial national PA communications campaigns between 1973 and 2001, and then annually since it was reintroduced in 2007. Despite Particip ACTION’s long history running mass communication campaigns, it did not evaluate its early campaigns beyond basic recognition of the ParticipACTION brand, with awareness of ParticipACTION remaining above 75% of the Canadian adults for more than two decades (Bauman, Madil, Craig, & Salmon, 2004; Spence et al., 2009). Theoretically based studies evaluating mass communications to encourage PA are relatively rare (Cavill & Bauman, 2004), with notable examples being the VERB (Huhman, Bauman, & Bowles, 2008) and 5-2-1-0 childhood obesity (Rogers et al., 2013) campaigns. Evidence on the use of theories and models in social marketing interventions is sparse (Luca & Suggs, 2013). The Hierarchy of Effects
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
996 Model (HOEM) was designed as a logic model to explain campaign effects in marketing (Lavidge & Steiner, 1961) and has been useful for planning and evaluating health communication campaigns (McGuire, 1984). It posits that campaign effects occur in a sequenced set of stages from initial awareness of the campaign, and then progressing through targeted intermediate outcomes, which may include knowledge, saliency, attitudes, health beliefs, self-efficacy, and intention, and to distal outcomes such as trialing and adoption of behaviors. This model has been infrequently tested in the context of PA. Employing a Canadian panel recruited in 1981 and followed up in 1988 and 2003, Craig, Bauman, and Reger-Nash (2010) tested the HOEM on the basis of awareness of early ParticipACTION campaigns (1981), potential intermediate effects (1988), and long-term PA maintenance (1988 and 2003). This analysis noted that among inactive Canadians 13 years of age and older, campaign recall predicted outcome expectancy and then each subsequent intermediate outcome sequentially predicted the next, with intention then predicting PA maintenance. Similarly, Spence and colleagues (2009) found that (a) outcome expectations, self-efficacy, and intention to be physically active varied significantly by awareness of ParticipACTION among Canadian adults; and (b) outcome expectations and self-efficacy accounted for much of the association between awareness and PA. The HOEM has also been tested among young American teenagers (Bauman, Bowles, & Huhman, 2008), where campaign effects did not follow the proposed sequence of effects. Here, knowledge directly predicted action. Another campaign targeted parents, to increase the saliency of children’s inactivity, and found that campaign awareness was associated with knowledge about PA, and that this, in turn, was associated with high saliency of the issue (Craig, Bauman, Gauvin, Robertson, & Murumets, 2009). High saliency was associated with parental reports of trial attempts to increase their children’s PA level. Therefore, the HOEM performed as hypothesized among adults and parental reports, but a direct pathway between knowledge and action was found among teenagers. ParticipACTION’s 2010 campaign was designed to increase selected intermediate outcomes among adults based on a HOEM. Influencing knowledge of the amount of PA was not part of the model or campaign as it was known that Canadian PA guidelines (Tremblay et al., 2011) would be changing after the campaign was executed. Given that Canadians are knowledgeable about the benefits of PA (Cameron, Craig, & Paolin, 2005), the campaign’s purpose was to foster saliency and increase self-efficacy to be more active, which is considered one of the most important determinants of PA (Latimer, Brawley, & Bassett, 2010; McAuley & Blissmer, 2000). To do this, ParticipACTION ran a promotional campaign in which well-known Canadians invited individuals to submit their stories about how PA had made a difference in their lives (ParticipACTION’s Canadian Icons, n.d.). Individuals were told that their story might be chosen to inspire others to be active. The My ParticipACTION campaign was then devised according to an a priori HOEM. This study responds to a recent call for more thorough reporting of the
C. L. Craig et al. use of behavioral theory within social marketing activities (Luca & Suggs, 2013). We posed two research questions. First, are the campaign effects consistent with the a priori HOEM framework (saliency ! cognitive engagement ! campaign-related self-efficacy to become more active ! initial trial behavior)? Second, is campaign-specific self-efficacy related to intermediate (overall situational self-efficacy for PA and future intentions to be active) and distal (activity level) effects in a as predicted by HOEM (campaign-related self-efficacy ! intermediate outcomes ! distal outcomes).
Method Campaign Design Television advertisements were used to invite Canadians to tell their story about becoming more active. After initial screening of about 1,800 submitted stories for media appeal by the advertising agency and ParticipACTION, the short listed stories were reviewed against a number of criteria by one of the authors (C.L.C.), a member of ParticipACTION staff and a representative of the advertising agency. The criteria were relevance to the overall adult population (saliency) while portraying diversity across stories (women, men, family, ethnicity, and ability), mass appeal of the PA portrayed (saliency), clear statements outlining what steps the individual took to build PA into his or her lifestyle (to foster cognitive processes and build self-efficacy), their humor or a media hook, and if possible the rationale for becoming more active (reinforce knowledge of benefits). A short list of stories was identified that met all criteria and ranked according to the clarity of the information provided on the steps taken to become more active. The highest ranking stories which also had the best media appeal as judged by the advertising agency (on the basis of humor, popularity of PA portrayed, range of population groups covered) were chosen. As a result, the campaign involved four English and two French advertisements that featured stories of individual Canadians (see Figure 1) with an underlying theme of ‘‘If they can do it, I can do it.’’ At the end of each story, the individuals involved in the ad were featured saying ‘‘My ParticipACTION is’’ and the physical activity that they did (e.g., take the stairs at work, walk the dog) to cue trialing of physical activity. Each individual granted permission to be featured along with his or her story in the advertisement. The campaign ran intermittently over a period of 33 weeks ending March 31, 2010. Because of budget limitations, gross ratings points (GRPs) were 1200 in the English media and 864 in the French media. Respondent Recruitment In April 2010, participants were recruited from an existing online Angus Reid Strategies panel (N > 60,000) of Canadian adults who had previously given consent to be contacted for future research surveys. The panel (Angus Reid Forum, n.d.) is a convenience sample recruited through randomized invitations. Individuals viewing the Angus Reid
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
My ParticipACTION Campaign
997
Fig. 1. My ParticipACTION campaign messages. Neither the media clip nor the content of campaign story were provided to respondents.
website may volunteer to participate and are then accepted into the panel after completing a short screening questionnaire. Individuals working in market or survey research are ineligible. Potential participants were (a) sent an e-mail inviting them to respond online to a survey, (b) informed that all responses would be kept strictly confidential according to the company’s privacy policy (Angus Reid Privacy Policy, n.d.), and (c) provided a unique link in the emails to the Internet-based survey instrument. Participants were not informed ahead of time about the specific content of the survey. Participation in the survey and each of its items was completely voluntary, but a small incentive (US$3) was offered. A copy of the denominalized dataset was provided to ParticipACTION for its own purposes and for the secondary analysis supporting this investigation. Ethics approval for this study was obtained from the Human Research Ethics Committee of the University of Sydney. Measures Overall Measures Self-efficacy, future intention to be active, and activity level were asked of all participants. The measure of self-efficacy assessed participants’ confidence to be physically active on
the basis of three constructs (Velicer, DiClemente, Rossi, & Prochaska, 1990): (a) ‘‘no matter how busy your day is?’’ (scheduling=negative affect); (b) ‘‘on a day when you don’t really feel like doing it?’’ (coping=habit=addictive); and (c) ‘‘and still spend the time you want with your family’’ (positive social). Each statement was ranked on 7-point scale ranging from 1 (not at all confident) to 7 (very confident). The items were summed (Cronbach a ¼ .85). Intention was determined from the question, ‘‘Thinking ahead over the next six months, to what extent do you intend to be physically active?’’ with the response categories reported on a 7-point scale ranging from 1 (no intention at all) to 7 (fully intend) (Cameron, Craig, Bull, & Bauman, 2007). In addition, PA was assessed using the 1998 Canadian PA guidelines (Health Canada & Canadian Society for Exercise Physiology, 1998), which required being active 60 min daily, by a question that was similar to a validated single item questionnaire (Milton, Clemes, & Bull, 2013): ‘‘Over the past seven days, on how many days were you physically active for a total of at least 60 minutes per day?’’ (response categories: no days; 1; 2 to 3 days; 4 days). After we asked these questions, we measured awareness by unprompted and prompted recall of ParticipACTION’s campaign. Respondents were asked whether they had seen any media messages within the past 3 months related to
998
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
physical inactivity and, if they had, to specify the content of the messages. Multiple responses were permitted; responses were coded by the survey company as being consistent or not consistent with the specific ParticipACTION campaign messages (such as mother playing soccer, taking the elevator). Subsequently, prompted recall was defined as having seen at least one of the specific storyboard images (Figure 1, column 1) related to the campaign. No detail of the content of the ad was provided. Campaign-Specific Measures Campaign-specific measures were asked about the particular content of the ads among those who indicated that they had recalled one of the images: . Campaign-specific saliency was measured with the following
randomly presented items that were rated on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree): ‘‘The story spoke to you,’’ ‘‘What the ad said and showed was interesting to you,’’ and ‘‘You could relate to the person in the ad.’’ Because of the rarity of the strongly disagree responses, we combined this category with disagree and reverse-coded and summed the resulting scores. Cronbach’s a exceeded .81 for all stories except one seen by only 12 participants where Cronbach’s a ¼ .41. Responses for all stories were retained in the analysis. Overall saliency was computed by summing the individual scores. . Cognitive engagement was assessed by the single item, ‘‘The ad gave you ideas about how you could increase your physical activity’’ rated on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree). . Campaign-specific self-efficacy to be more active was determined as strongly agreeing with the statement, ‘‘The ad made you think that if they could be more active, you could too,’’ for at least one story. This item was also rated on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree). . Trialing behaviors was assessed by summing yes=no responses to the items following the question: ‘‘And, as a result of seeing this particular ad, have you done any of the following?’’: ‘‘encouraged a friend to be active with me’’; ‘‘took the stairs at work’’; ‘‘looked for opportunities to be active as a family’’; ‘‘tried a variety of activities’’; ‘‘actively commuted for short distance’’; ‘‘if you have a dog, walked your dog more often or longer’’; and ‘‘reduced your amount of screen time.’’ All measures were coded into dichotomous variables. Specifically, future intention and all scales were coded into highest quintile versus other. Demographic characteristics were gathered for classification purposes. These included age (in years), gender, and education (classified as secondary education or less, college or technical school, and university). Analysis The prevalence of the overall and campaign-related measures were calculated stratified by gender to determine whether separate communication models might be required.
C. L. Craig et al. The association between awareness and overall self-efficacy was tested by a chi-square test of independence. The percentage that was aware of the campaign was plotted by self-efficacy score and the best fit of the relation depicted using SPSS 18 Curvefit. Logistic regression models were constructed to test the potential communication effects of the campaign according to the posited hierarchy underlying the ParticipACTION messaging, with age, gender, and education as covariates. More specifically, a series of sequential models was tested for potential effects specific to the campaign (saliency ! cognitive engagement ! self-efficacy to become more active ! initial trial behavior) and for the relation between these campaign-specific and overall effects within the HOEM that were independent of the campaign (i.e., overall self-efficacy, future intention, and PA) according to the method of Baron and Kenny (1986). In particular, mediation was investigated by testing whether the proposed mediator (e.g., cognitive engagement) was a significant predictor of the subsequent variable in the hierarchy (i.e., campaign-related self-efficacy), the preceding variable (i.e., saliency) predicted both the proposed mediator and the subsequent variable in the hierarchy and, if these conditions were true, testing whether the preceding variable (i.e., saliency) was no longer a predictor of the subsequent variable (i.e., campaign-related self-efficacy) when the potential mediator and the preceding variable were considered simultaneously. In addition, if both predictors (i.e., cognitive engagement and campaign-related self efficacy) remained significant then partial mediation was tested using the Aroian version of the Sobel test (MacKinnon & Dwyer, 1993). In one case (self-efficacy ! future intention ! activity level), it was possible to test mediation on the full sample as well as on those receiving the campaign specific measures. As there was no significant difference in findings, the results for the full sample are presented. Last, the independence of predictors was assessed by examining the interaction effect between a variable in the hierarchy and the preceding predictor. Tests were performed using SPSS 18 Complex Samples procedures for Tabulate and Logistic Regression to account for sample weights.
Results Participants In total, 569 men and 541 women 18 years of age and older participated in the overall study (N ¼ 1,110). A higher percentage of participants were 35–54 years old, were married, had a college or technical education, had household incomes in the US$50,000–$99,999 range, and completed the survey in English (see Table 1). Overall, 56.1% of participants did not recall the campaign. Of the 43.9% recalling the campaign, 6.1% (95% CI [4.8%, 7.7%]) of participants recalled messages consistent with the ParticipACTION campaign without prompting and 37.8% (95% CI [34.9%, 40.8%]) did so after being shown only the story board image. Prompted recall by ad ranged from 6.8% (95% CI [8%, 11.8%]) for the hockey vignette to 37.3% (95% CI [30.3%, 45.0%]) for the karate advertisement. There were no significant differences
999
My ParticipACTION Campaign Table 1. Participant characteristics
Downloaded by [Ecole Hautes Etudes Commer-Montreal] at 05:08 12 September 2015
All participants (N ¼ 1,110)
Gender Male Female Age (years) 18–34 35–54 55þ Education High school or less College=tech school University or more Income
