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MoveU? Assessing a Social Marketing Campaign to Promote Physical Activity a
a
a
Tanya M. F. Scarapicchia , Catherine M. F. Sabiston , Michelle Brownrigg , Althea Blackburna
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Evans , Jill Cressy , Janine Robb & Guy E. J. Faulkner
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Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada b
Health & Wellness, University of Toronto, Toronto, Ontario, Canada
c
Graduate Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada Accepted author version posted online: 16 Mar 2015.
Click for updates To cite this article: Tanya M. F. Scarapicchia, Catherine M. F. Sabiston, Michelle Brownrigg, Althea Blackburn-Evans, Jill Cressy, Janine Robb & Guy E. J. Faulkner (2015): MoveU? Assessing a Social Marketing Campaign to Promote Physical Activity, Journal of American College Health, DOI: 10.1080/07448481.2015.1025074 To link to this article: http://dx.doi.org/10.1080/07448481.2015.1025074
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ACCEPTED MANUSCRIPT Major Article MoveU? Assessing a Social Marketing Campaign to Promote Physical Activity
Tanya M. F. Scarapicchia1 ; Catherine M. F. Sabiston1; Michelle Brownrigg1; Althea Blackburn-Evans1 ; Jill Cressy1 ; Janine Robb2 ; Guy E. J. Faulkner3 Downloaded by [University of Auckland Library] at 15:56 22 April 2015
1
Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada 2
3
Health & Wellness, University of Toronto, Toronto, Ontario, Canada
Graduate Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada Received: 24 March 2014 Revised: 15 December 2014 Accepted 26 February 2015
Abstract. Objective: MoveU is a social marketing initiative aimed at increasing moderate-tovigorous physical activity (MVPA) among undergraduate students. Using the Hierarchy of Effects model (HOEM), this study identified awareness of MoveU and examined associations between awareness, outcome expectations, self-efficacy, intentions and MVPA. Participants: Students (N = 2,784) from a Canadian university in March 2013. Methods: A secondary analysis of the National College Health Assessment-II survey and measures specific to the MoveU campaign. The main associations were examined in a path analysis. Results: MoveU awareness (36.4%) was lower than other well-established university health campaigns. Younger students, females, and individuals living on campus were more likely to be aware of MoveU. The HOEM was supported, and improvements in model fit were evident with additional direct relationships between outcome expectancy and intention, and between self-efficacy and MVPA. Conclusions:
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ACCEPTED MANUSCRIPT The intended population was aware of the campaign. The HOEM was useful in the development and evaluation of the MoveU campaign. Longitudinal studies are needed to further test the efficacy of the HOEM in the social marketing of physical activity.
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Keywords: active living, awareness, females, social marketing, university students
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ACCEPTED MANUSCRIPT The benefits of physical activity in reducing the risk of chronic disease and premature all-cause mortality are well established.1 Despite the well-documented benefits, many university students do not engage in the recommended levels of physical activity required to achieve health benefits.2 According to national guidelines, adults should accumulate at least 150 minutes a week of moderate-to-vigorous physical activity (MVPA) in at least 10 minute bouts, to achieve health
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advantages.2,3 A systematic review by Irwin demonstrated that greater than half of university students in Canada and the United States are not meeting physical activity guidelines.4 Women have consistently been shown to be among the least active as well as students living oncampus.2,4 Furthermore, there is a significant decline in physical activity participation between high school and university.5 Given low levels of physical activity participation among university students, especially females, and declines during the transition to university and college, there is a need for tailored interventions for first year students. This was the impetus for the development of the MoveU campaign at the University of Toronto.
MoveU is a social marketing initiative aimed at
increasing MVPA among undergraduate students. Social marketing is defined as “the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designated to influence the voluntary behavior of intended audiences in order to improve their personal welfare and that of their society”.6(p.7) It has been shown to be an effective means to not only motivate individuals to change, but also assist them in making appropriate health decisions, such as becoming more physically active.7–9 Theoretically-based studies evaluating mass communications to encourage physical activity are relatively rare.10 However, development and evaluation of the MoveU campaign was
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ACCEPTED MANUSCRIPT guided by the Hierarchy of Effects model (HOEM) which has been used to design and evaluate previous mass media physical activity campaigns.11–14 Based on the model, campaign effects transpire in a sequence of stages, beginning with proximal variables such as initial awareness of a campaign, then progress through directed intermediate variables such as outcome expectations, self-efficacy and intentions, and to distal variables such as adoption of behaviors.15 The first
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stage of the HOEM, awareness, refers to whether individuals have seen the elements of the campaign or if they are able to recognize the brand or its tagline.16 A subsequent stage in the model is outcome expectation, which refers to contingencies between executing a behavior and the desired outcome (e.g., regular physical activity helps to manage stress).10,17 The third stage in the model, self-efficacy, refers to an individual’s judgment or their confidence in their ability to execute a task (e.g., I am confident that I can regularly do 30 minutes or more of moderate physical activity per day most days of the week).18,19 A subsequent stage in the model is intention, which refers to an individual’s plan to be active.16 The most distal variable in the model is the adoption of the behaviors, such as engaging in MVPA.16 Based on the HOEM, campaign success becomes increasingly difficult as the process moves from proximal to distal outcomes. To date, no university-wide physical activity campaign has utilized a social marketing approach in promoting physical activity participation among students. The main objectives of this study were to (1) identify awareness of MoveU, (2) explore correlates of MoveU awareness and (3) using the HOEM, test the associations between MoveU campaign awareness, outcome expectations, self-efficacy, intentions, and MVPA. It was hypothesized that (1) MoveU awareness will be less than other well-established university wide campaigns (2) being younger,
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ACCEPTED MANUSCRIPT female and living on campus would be correlated with greater MoveU awareness; and (3) the associations within the HOEM will be supported with the data. METHODS Design and Sample In the spring of 2013, data were collected using the National College Health Assessment-
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II which is a national research survey organized by the American College Health Association (ACHA – NCHA II; for further information, see American College Health Association).20 The NCHA survey consists of approximately 300 items assessing student health status and health behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of health areas such as alcohol, tobacco, sexual health and other drug use.20 Additional questions were specifically added to assess the MoveU campaign and these items have been used in similar evaluations of physical activity social marketing campaigns14. The original items from the ACHA – NCHA have been evaluated at length for reliability and validity among university students. 21,22 A total of 13500 students at all three campuses of the University of Toronto, Ontario, Canada were randomly selected to receive an e-mail invitation to participate in the survey. Over a duration of one month, each potential participant received three similar invitations, which directed him or her to a secure Web site, hosted by ACHA, in order to complete the ACHA – NCHA II web version of the survey. As an incentive to participate, participants were entered into a draw to receive prizes. Approval for the research protocol was granted by the relevant campus research ethics board. MoveU Campaign
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ACCEPTED MANUSCRIPT Messaging in the MoveU campaign was specifically intended towards first year female students although the broader goal of MoveU is to increase physical activity among all university students. Focus groups with 36 first year university students were initially conducted to identify the most salient benefits of physical activity for their university experience. A web-based survey of 950 students was then conducted to assess which of these benefits would ‘most motivate you
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to get active?’ The message ‘Physical activity could be the most productive 30 minutes of your day’ was ranked the most motivating message by 42.7% of the participants. Accordingly, the key messaging of MoveU identified physical activity as ‘being the most productive part of your day’ – helping to manage stress, being fun, and helping to be productive academically, and make new friends (see Figures 1 and 2 as an example of marketing material). Campaign messaging was disseminated through posters and postcards across campus, a campaign portal page, social media platforms, and a range of other strategies such as in-class MoveU breaks within large class settings (approximately 1000 students), and peer-to-peer interactions (via student ambassadors). Other activities were organized through the MoveU campaign, such as free Zumba, yoga and dance classes, dodgeball games and active campus tours. The campaign was launched in September 2012. Measures Demographics Participants provided the following demographic information: age, gender (females coded as 1, males as 2), current residence (living on campus coded as 1, off campus as 2), ethnicity, relationship status (not in a relationship coded as 1, in a relationship as 2) year in
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ACCEPTED MANUSCRIPT school (first year undergraduate coded as 1 and graduate degree coded as 6) and body mass index (BMI; determined from self-reported weight [kg] and height [m]). Awareness of Health Campaigns To assess awareness of MoveU and other existing programs on campus, participants were asked to respond to the following question: “at the University of Toronto, have you heard, read,
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or seen anything with the following slogan or campaign name or phase or image…” ‘Leave the Pack Behind’, ‘MoveU’, ‘Green Dot’ and ‘Safetalk’. Participants were asked awareness of two ‘ghost’ physical activity and nutrition campaigns including ‘Move your body at least 30 minutes each day’ and ‘5 a day’ that do not exist but are evocative of a potential campaign message. Response categories were no (coded as 1) or yes (coded as 2). In the current study, only the MoveU item was used in the main analysis. Outcome Expectations Reflecting the MoveU campaign messaging, outcome expectations for participation in regular physical were assessed using the following four questions: “Regular physical activity”… ‘helps me manage stress’, ‘is fun’, ‘helps me be more productive academically’ and ‘helps me make new friends’. Response selections ranged from 5, strongly agree to 1, strongly disagree; the four items for outcome expectations were reverse-scored such that higher scores represented higher outcomes expectations (α = .81).17 Self-efficacy Participants were asked to respond to the following two questions: “I am confident that I can regularly do 30 minutes or more of moderate physical activity per day most days of the week” and “I have easy access to places on campus where I can be physically active”. Response
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ACCEPTED MANUSCRIPT options ranged from 5 (strongly agree) to 1 (strongly disagree), and the two items were reversescored such that higher scores represented higher self-efficacy (α = .67) .14 Intention Intention to participate in physical activity was assessed by the following question, which consisted of one item: “thinking ahead over the next six months, I intend to be physically active
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at a moderate intensity for at least 30 minutes most days of the week”. Response selections ranged from 5 (strongly agree) to 1, (strongly disagree), the items was reverse-scored such that higher scores represented higher intentions.14 Physical Activity Reflecting current Canadian physical activity guidelines of 150 minutes of MVPA per week,3 participants were asked to respond to the following question, which consisted of one items: “over the past 7 days how many total minutes of moderate-to-vigorous physical activity did you do in at least 10 minute bouts”. Response categories were less than 30 minutes (coded as 1), 30-60 minutes, 61-90 minutes, 91-150 minutes, greater than 150 minutes (coded as 5). Statistical Analyses All participants who did not respond to the question of whether or not they were aware of the MoveU campaign were excluded from all analyses (N = 84). There were very few additional missing data points, including 3.26 % for BMI and less than 1% for all other study variables. All missing continuous data were addressed by group mean replacement.23 Frequencies were calculated to identify level of awareness of MoveU and other health campaigns. Path analysis using maximum likelihood estimation was used to test the adequacy of the HOEM with LISREL 8.80. Specifically, the following paths were specified in the model:
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ACCEPTED MANUSCRIPT MoveU awareness → outcome expectancy → self-efficacy → intention → MVPA. Age, gender, current residence and BMI were included in the model as covariates. The following indicators were used to assess the model goodness of fit:24 (a) Comparative Fit Index [(CFI); values approximating 0.95], (b) Non-Normed Fit Index [(NNFI); values approximating 0.95] and (c) Root Mean Square Error of Approximation [(RMSEA); values approximating 0.05 with small
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95% confidence interval (CI)] and (d) non-significant chi-square ( χ² ) values. Modification indices were examined to investigate other possible relationships in the model given Meehl’s assertion that every variable is associated with every other variable at some level.25 RESULTS Demographics The final analytical sample consisted of 2784 students, which represents a response rate of 20.6%. This response rate is in line with the 20.4% to 27.4% response rate reported in other university studies that have used the NCHA-II data.20,26 Median age of the sample was 22 years old and the age range was to 18 - 61 years old. Participants were predominantly female (71.1%), reported living off campus (87%), identified as Caucasian (61.5%), were not in a relationship (58.7%), reported being in their 1st year of their undergraduate degree (22.6%) and had a mean BMI of 22.8 kg/m2, which is classified as a healthy body weight. Descriptive statistics and bivariate correlations are presented in Table 1. Awareness levels Of the final analytical sample, 36.4% of the participants indicated that they were aware of the MoveU campaign six months after campaign launch and 38.7% of the females and 31.9 % of the males surveyed indicated they were aware of MoveU. This level of awareness was lower than
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ACCEPTED MANUSCRIPT well-established health campaigns such as Leave the Pack Behind (43.7%), Green Dot (45.6%) but higher than that of safeTALK (35.4%). Awareness of MoveU was higher than the two ‘ghost’ campaigns – 19.8% for ‘Move your body at least 30 extra minutes each day’ and 13.8% for ‘5 a day’. Hierarchy of Effects Model
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The fit statistics for the original model indicated a poor fit [χ² (6) = 337.69, p = 0.00, RMSEA = 0.14, 90% CI = 0.13 to 0.16, NNFI = 0.48, CFI = 0.89, SRMR = 0.08, R2 = 0.13]. Given associations among study variables (see Table 1), the modification indices, and theoretical propositions19, paths between self-efficacy and MVPA and between outcome expectations and intentions were added. With these modifications, the data were a good fit to the model [χ² (4) = 52.53, p = 0.00, RMSEA = 0.07, 90% CI = 0.05 to 0.08, NNFI = 0.90, CFI = 0.99, SRMR = 0.02]. The HOEM, with the additional paths, accounted for 16% of the variance in MVPA (see Figure 3). Specifically, higher awareness of MoveU was associated with higher outcome expectancies, which were significantly associated with higher self-efficacy perceptions and higher intentions. Self-efficacy was significantly related to greater intentions to be active and greater MVPA participation, and intentions were also directly associated with greater MVPA participation. In the model, being older was indicative of lower MoveU awareness, greater outcome expectations, self-efficacy and MVPA participation. Furthermore, females were more aware of MoveU, reported lower outcome expectations, self-efficacy and MVPA participation than males. Lastly, living on-campus was indicative of greater MoveU awareness and greater self-efficacy. There were no significant associations with BMI.
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ACCEPTED MANUSCRIPT COMMENT The first objective of this study was to determine the level of awareness of the University of Toronto’s MoveU campaign and to compare those levels to other health campaigns. This assessment was conducted approximately six months after the launch of MoveU. The levels of MoveU awareness were lower than other well-established health initiatives such as ‘Leave the
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Pack Behind’ or ‘ParticipACTION – let’s get moving’. Awareness for MoveU was higher than for ‘safeTALK’, a suicide prevention program which was established in 2005.27,28 In addition, levels of MoveU awareness were also higher than the ‘ghost’ campaigns. This suggests a real campaign effect, which needs confirmation in future, NCHA evaluations. Findings were also encouraging based on the correlates of awareness, which was the second study objective. Younger, female students were more likely to report awareness of the campaign and this was the intended population. Students living on campus were also more aware of MoveU and this makes intuitive sense given that much of the social marketing materials have been distributed at campus buildings and residential colleges. A future iteration of the campaign messaging will address how to tailor MoveU to the significant number of commuter students at the University of Toronto. The third objective was to apply the HOEM in designing and evaluating MoveU. The HOEM postulates a cascade of cognitive and behavioural effects arising from social marketing campaigns.16 Consistent with the model, awareness was related to outcome expectancies, which was independently associated with self-efficacy, which in turn was independently associated with intentions, and finally intentions were independently associated with MVPA. However, the model fit was significantly strengthened with the addition of two direct paths between outcome expectations and intentions, and between self-efficacy and MVPA.
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ACCEPTED MANUSCRIPT Both outcome expectations and self-efficacy were highly correlated in addition to outcome expectations and intentions. Stemming from Social Cognitive Theory,29 self-efficacy is described as an individual’s belief in his or her own capability to succeed in a specific situation, such as engaging in physical activity.18 Several studies have demonstrated that self-efficacy predicts physical activity participation.30–32 Moreover, self-efficacy has been shown to be
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predictive of both the adoption and maintenance of physical activity behaviors.33 In addition, based on the Theory of Planned Behaviour, an individuals’ behavior is dictated by their intentions to execute the behaviour.34 According to this theory, intentions are predicted by attitudes and subjective norms. It may be that outcome expectancies, as operationalized in the MoveU campaign, reflect attitudes toward physical activity at least in terms of some potential instrument benefits. There is theoretical justification then for these additional paths in the model. Limitations In spite of the novelty of the current findings, there are some limitations that need to be acknowledged. First, the cross-sectional design prevents assessment of the direction of relationships and formal tests of mediation35. Second, the study is based on self-report measures, some of which are single item, and may be subject to bias36. Third, although in line with response rates typically reported in the literature using the NCHA,37 the response rate was low and there is the risk of response bias. Fourth, data was collected six months after the launch of the MoveU campaign, there were therefore no baseline attitudinal (i.e. outcome expectations) and behavioral (MVPA) data, consequently we were unable to compare if there were any changes in these variables from baseline. This will be the focus of future evaluations. Lastly, the instructional stems for the questions assessing components of the HOEM referred to physical
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ACCEPTED MANUSCRIPT activity differently with respect to intensity and time. As such, responses to these questions may have been based on different perceptions of physical activity. While the scales were not modified to main psychometric rigor, further research is needed to confirm the study findings. Conclusions Overall, the HOEM was useful in guiding the design and evaluation of the MoveU
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campaign. Findings supported the model although the data suggests other direct paths beyond the sequential series of steps outlined by HOEM. This initial cross-sectional analysis also suggests that the MoveU campaign was successful in reaching the intended population. Longitudinal designs will be needed in further testing its effectiveness for the social marketing of physical activity initiatives and examining changes in the variables of interest over time. These findings are particularly relevant to campus student wellness services, as the social marketing techniques utilized in the MoveU campaign, could be applied in the development of future wellness initiatives at other institutions. Note For comments and further information, address correspondence to Guy E. J. Faulkner, University of Toronto, Graduate Department of Exercise Sciences, 55 Harbord Street, Toronto, Ontario, M5S 2W6 Canada (e-mail: [email protected]).
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ACCEPTED MANUSCRIPT TABLE 1. Descriptive statistics and correlations of HOEM variables and covariates Mean (SD) Age
Age
Current Awarene living ss
Outcome expectatio n
SelfIntention efficacy s
22.11(5.24 ) -
.05*
1
Current living
-
.14**
-.03
1
Awarenes s
-
-.14**
-.09**
1
Outcome expectatio n
4.25(.78)
.12**
.07* * .06* *
.00
.08**
1
Selfefficacy
4.19(.89)
.01**
.11* *
.07**
.07**
.39**
1
Intentions
4.07(1.02)
.01
.04*
.01
.06**
.43**
.56**
1
MVPA
4.32(1.39)
.11**
.11* *
-.03
.04*
.29**
.33**
.34**
Sex
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Sex
MVP A
1
*p < .05, ** p < .01
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Figure 1. Effective study groups start here
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Figure 2. Balance your body and your workload
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Age (.10)
(-.11)
.11
(.13)
-.11
(.11)
.13
.11 (.10)
(.41)
(.46)
.10
.41
.57
Awareness
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.22
Outcome expectation s
Self-efficacy
Intentions
(.34) .22
MVPA
.26 .05 -.06
(.05)
.09 (.09)
(-.06)
.06 (.08)
Sex
-.06
(-.06)
Current living situation
-.09 (-.09) .09)
FIGURE 3. Path model illustrating the associations between MoveU awareness, outcome expectations, self-efficacy, intentions, MVPA and the study covariates. Note that original model path coefficients are in parentheses
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Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
MoveU? Assessing a Social Marketing Campaign to Promote Physical Activity a
a
a
Tanya M. F. Scarapicchia , Catherine M. F. Sabiston , Michelle Brownrigg , Althea Blackburna
a
b
Evans , Jill Cressy , Janine Robb & Guy E. J. Faulkner
c
a
Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada b
Health & Wellness, University of Toronto, Toronto, Ontario, Canada
c
Graduate Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada Accepted author version posted online: 16 Mar 2015.
Click for updates To cite this article: Tanya M. F. Scarapicchia, Catherine M. F. Sabiston, Michelle Brownrigg, Althea Blackburn-Evans, Jill Cressy, Janine Robb & Guy E. J. Faulkner (2015): MoveU? Assessing a Social Marketing Campaign to Promote Physical Activity, Journal of American College Health, DOI: 10.1080/07448481.2015.1025074 To link to this article: http://dx.doi.org/10.1080/07448481.2015.1025074
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ACCEPTED MANUSCRIPT Major Article MoveU? Assessing a Social Marketing Campaign to Promote Physical Activity
Tanya M. F. Scarapicchia1 ; Catherine M. F. Sabiston1; Michelle Brownrigg1; Althea Blackburn-Evans1 ; Jill Cressy1 ; Janine Robb2 ; Guy E. J. Faulkner3 Downloaded by [University of Auckland Library] at 15:56 22 April 2015
1
Faculty of Kinesiology & Physical Education, University of Toronto, Toronto, Ontario, Canada 2
3
Health & Wellness, University of Toronto, Toronto, Ontario, Canada
Graduate Department of Exercise Sciences, University of Toronto, Toronto, Ontario, Canada Received: 24 March 2014 Revised: 15 December 2014 Accepted 26 February 2015
Abstract. Objective: MoveU is a social marketing initiative aimed at increasing moderate-tovigorous physical activity (MVPA) among undergraduate students. Using the Hierarchy of Effects model (HOEM), this study identified awareness of MoveU and examined associations between awareness, outcome expectations, self-efficacy, intentions and MVPA. Participants: Students (N = 2,784) from a Canadian university in March 2013. Methods: A secondary analysis of the National College Health Assessment-II survey and measures specific to the MoveU campaign. The main associations were examined in a path analysis. Results: MoveU awareness (36.4%) was lower than other well-established university health campaigns. Younger students, females, and individuals living on campus were more likely to be aware of MoveU. The HOEM was supported, and improvements in model fit were evident with additional direct relationships between outcome expectancy and intention, and between self-efficacy and MVPA. Conclusions:
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ACCEPTED MANUSCRIPT The intended population was aware of the campaign. The HOEM was useful in the development and evaluation of the MoveU campaign. Longitudinal studies are needed to further test the efficacy of the HOEM in the social marketing of physical activity.
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Keywords: active living, awareness, females, social marketing, university students
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ACCEPTED MANUSCRIPT The benefits of physical activity in reducing the risk of chronic disease and premature all-cause mortality are well established.1 Despite the well-documented benefits, many university students do not engage in the recommended levels of physical activity required to achieve health benefits.2 According to national guidelines, adults should accumulate at least 150 minutes a week of moderate-to-vigorous physical activity (MVPA) in at least 10 minute bouts, to achieve health
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advantages.2,3 A systematic review by Irwin demonstrated that greater than half of university students in Canada and the United States are not meeting physical activity guidelines.4 Women have consistently been shown to be among the least active as well as students living oncampus.2,4 Furthermore, there is a significant decline in physical activity participation between high school and university.5 Given low levels of physical activity participation among university students, especially females, and declines during the transition to university and college, there is a need for tailored interventions for first year students. This was the impetus for the development of the MoveU campaign at the University of Toronto.
MoveU is a social marketing initiative aimed at
increasing MVPA among undergraduate students. Social marketing is defined as “the application of commercial marketing technologies to the analysis, planning, execution and evaluation of programs designated to influence the voluntary behavior of intended audiences in order to improve their personal welfare and that of their society”.6(p.7) It has been shown to be an effective means to not only motivate individuals to change, but also assist them in making appropriate health decisions, such as becoming more physically active.7–9 Theoretically-based studies evaluating mass communications to encourage physical activity are relatively rare.10 However, development and evaluation of the MoveU campaign was
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ACCEPTED MANUSCRIPT guided by the Hierarchy of Effects model (HOEM) which has been used to design and evaluate previous mass media physical activity campaigns.11–14 Based on the model, campaign effects transpire in a sequence of stages, beginning with proximal variables such as initial awareness of a campaign, then progress through directed intermediate variables such as outcome expectations, self-efficacy and intentions, and to distal variables such as adoption of behaviors.15 The first
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stage of the HOEM, awareness, refers to whether individuals have seen the elements of the campaign or if they are able to recognize the brand or its tagline.16 A subsequent stage in the model is outcome expectation, which refers to contingencies between executing a behavior and the desired outcome (e.g., regular physical activity helps to manage stress).10,17 The third stage in the model, self-efficacy, refers to an individual’s judgment or their confidence in their ability to execute a task (e.g., I am confident that I can regularly do 30 minutes or more of moderate physical activity per day most days of the week).18,19 A subsequent stage in the model is intention, which refers to an individual’s plan to be active.16 The most distal variable in the model is the adoption of the behaviors, such as engaging in MVPA.16 Based on the HOEM, campaign success becomes increasingly difficult as the process moves from proximal to distal outcomes. To date, no university-wide physical activity campaign has utilized a social marketing approach in promoting physical activity participation among students. The main objectives of this study were to (1) identify awareness of MoveU, (2) explore correlates of MoveU awareness and (3) using the HOEM, test the associations between MoveU campaign awareness, outcome expectations, self-efficacy, intentions, and MVPA. It was hypothesized that (1) MoveU awareness will be less than other well-established university wide campaigns (2) being younger,
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ACCEPTED MANUSCRIPT female and living on campus would be correlated with greater MoveU awareness; and (3) the associations within the HOEM will be supported with the data. METHODS Design and Sample In the spring of 2013, data were collected using the National College Health Assessment-
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II which is a national research survey organized by the American College Health Association (ACHA – NCHA II; for further information, see American College Health Association).20 The NCHA survey consists of approximately 300 items assessing student health status and health behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of health areas such as alcohol, tobacco, sexual health and other drug use.20 Additional questions were specifically added to assess the MoveU campaign and these items have been used in similar evaluations of physical activity social marketing campaigns14. The original items from the ACHA – NCHA have been evaluated at length for reliability and validity among university students. 21,22 A total of 13500 students at all three campuses of the University of Toronto, Ontario, Canada were randomly selected to receive an e-mail invitation to participate in the survey. Over a duration of one month, each potential participant received three similar invitations, which directed him or her to a secure Web site, hosted by ACHA, in order to complete the ACHA – NCHA II web version of the survey. As an incentive to participate, participants were entered into a draw to receive prizes. Approval for the research protocol was granted by the relevant campus research ethics board. MoveU Campaign
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ACCEPTED MANUSCRIPT Messaging in the MoveU campaign was specifically intended towards first year female students although the broader goal of MoveU is to increase physical activity among all university students. Focus groups with 36 first year university students were initially conducted to identify the most salient benefits of physical activity for their university experience. A web-based survey of 950 students was then conducted to assess which of these benefits would ‘most motivate you
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to get active?’ The message ‘Physical activity could be the most productive 30 minutes of your day’ was ranked the most motivating message by 42.7% of the participants. Accordingly, the key messaging of MoveU identified physical activity as ‘being the most productive part of your day’ – helping to manage stress, being fun, and helping to be productive academically, and make new friends (see Figures 1 and 2 as an example of marketing material). Campaign messaging was disseminated through posters and postcards across campus, a campaign portal page, social media platforms, and a range of other strategies such as in-class MoveU breaks within large class settings (approximately 1000 students), and peer-to-peer interactions (via student ambassadors). Other activities were organized through the MoveU campaign, such as free Zumba, yoga and dance classes, dodgeball games and active campus tours. The campaign was launched in September 2012. Measures Demographics Participants provided the following demographic information: age, gender (females coded as 1, males as 2), current residence (living on campus coded as 1, off campus as 2), ethnicity, relationship status (not in a relationship coded as 1, in a relationship as 2) year in
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ACCEPTED MANUSCRIPT school (first year undergraduate coded as 1 and graduate degree coded as 6) and body mass index (BMI; determined from self-reported weight [kg] and height [m]). Awareness of Health Campaigns To assess awareness of MoveU and other existing programs on campus, participants were asked to respond to the following question: “at the University of Toronto, have you heard, read,
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or seen anything with the following slogan or campaign name or phase or image…” ‘Leave the Pack Behind’, ‘MoveU’, ‘Green Dot’ and ‘Safetalk’. Participants were asked awareness of two ‘ghost’ physical activity and nutrition campaigns including ‘Move your body at least 30 minutes each day’ and ‘5 a day’ that do not exist but are evocative of a potential campaign message. Response categories were no (coded as 1) or yes (coded as 2). In the current study, only the MoveU item was used in the main analysis. Outcome Expectations Reflecting the MoveU campaign messaging, outcome expectations for participation in regular physical were assessed using the following four questions: “Regular physical activity”… ‘helps me manage stress’, ‘is fun’, ‘helps me be more productive academically’ and ‘helps me make new friends’. Response selections ranged from 5, strongly agree to 1, strongly disagree; the four items for outcome expectations were reverse-scored such that higher scores represented higher outcomes expectations (α = .81).17 Self-efficacy Participants were asked to respond to the following two questions: “I am confident that I can regularly do 30 minutes or more of moderate physical activity per day most days of the week” and “I have easy access to places on campus where I can be physically active”. Response
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ACCEPTED MANUSCRIPT options ranged from 5 (strongly agree) to 1 (strongly disagree), and the two items were reversescored such that higher scores represented higher self-efficacy (α = .67) .14 Intention Intention to participate in physical activity was assessed by the following question, which consisted of one item: “thinking ahead over the next six months, I intend to be physically active
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at a moderate intensity for at least 30 minutes most days of the week”. Response selections ranged from 5 (strongly agree) to 1, (strongly disagree), the items was reverse-scored such that higher scores represented higher intentions.14 Physical Activity Reflecting current Canadian physical activity guidelines of 150 minutes of MVPA per week,3 participants were asked to respond to the following question, which consisted of one items: “over the past 7 days how many total minutes of moderate-to-vigorous physical activity did you do in at least 10 minute bouts”. Response categories were less than 30 minutes (coded as 1), 30-60 minutes, 61-90 minutes, 91-150 minutes, greater than 150 minutes (coded as 5). Statistical Analyses All participants who did not respond to the question of whether or not they were aware of the MoveU campaign were excluded from all analyses (N = 84). There were very few additional missing data points, including 3.26 % for BMI and less than 1% for all other study variables. All missing continuous data were addressed by group mean replacement.23 Frequencies were calculated to identify level of awareness of MoveU and other health campaigns. Path analysis using maximum likelihood estimation was used to test the adequacy of the HOEM with LISREL 8.80. Specifically, the following paths were specified in the model:
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ACCEPTED MANUSCRIPT MoveU awareness → outcome expectancy → self-efficacy → intention → MVPA. Age, gender, current residence and BMI were included in the model as covariates. The following indicators were used to assess the model goodness of fit:24 (a) Comparative Fit Index [(CFI); values approximating 0.95], (b) Non-Normed Fit Index [(NNFI); values approximating 0.95] and (c) Root Mean Square Error of Approximation [(RMSEA); values approximating 0.05 with small
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95% confidence interval (CI)] and (d) non-significant chi-square ( χ² ) values. Modification indices were examined to investigate other possible relationships in the model given Meehl’s assertion that every variable is associated with every other variable at some level.25 RESULTS Demographics The final analytical sample consisted of 2784 students, which represents a response rate of 20.6%. This response rate is in line with the 20.4% to 27.4% response rate reported in other university studies that have used the NCHA-II data.20,26 Median age of the sample was 22 years old and the age range was to 18 - 61 years old. Participants were predominantly female (71.1%), reported living off campus (87%), identified as Caucasian (61.5%), were not in a relationship (58.7%), reported being in their 1st year of their undergraduate degree (22.6%) and had a mean BMI of 22.8 kg/m2, which is classified as a healthy body weight. Descriptive statistics and bivariate correlations are presented in Table 1. Awareness levels Of the final analytical sample, 36.4% of the participants indicated that they were aware of the MoveU campaign six months after campaign launch and 38.7% of the females and 31.9 % of the males surveyed indicated they were aware of MoveU. This level of awareness was lower than
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ACCEPTED MANUSCRIPT well-established health campaigns such as Leave the Pack Behind (43.7%), Green Dot (45.6%) but higher than that of safeTALK (35.4%). Awareness of MoveU was higher than the two ‘ghost’ campaigns – 19.8% for ‘Move your body at least 30 extra minutes each day’ and 13.8% for ‘5 a day’. Hierarchy of Effects Model
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The fit statistics for the original model indicated a poor fit [χ² (6) = 337.69, p = 0.00, RMSEA = 0.14, 90% CI = 0.13 to 0.16, NNFI = 0.48, CFI = 0.89, SRMR = 0.08, R2 = 0.13]. Given associations among study variables (see Table 1), the modification indices, and theoretical propositions19, paths between self-efficacy and MVPA and between outcome expectations and intentions were added. With these modifications, the data were a good fit to the model [χ² (4) = 52.53, p = 0.00, RMSEA = 0.07, 90% CI = 0.05 to 0.08, NNFI = 0.90, CFI = 0.99, SRMR = 0.02]. The HOEM, with the additional paths, accounted for 16% of the variance in MVPA (see Figure 3). Specifically, higher awareness of MoveU was associated with higher outcome expectancies, which were significantly associated with higher self-efficacy perceptions and higher intentions. Self-efficacy was significantly related to greater intentions to be active and greater MVPA participation, and intentions were also directly associated with greater MVPA participation. In the model, being older was indicative of lower MoveU awareness, greater outcome expectations, self-efficacy and MVPA participation. Furthermore, females were more aware of MoveU, reported lower outcome expectations, self-efficacy and MVPA participation than males. Lastly, living on-campus was indicative of greater MoveU awareness and greater self-efficacy. There were no significant associations with BMI.
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ACCEPTED MANUSCRIPT COMMENT The first objective of this study was to determine the level of awareness of the University of Toronto’s MoveU campaign and to compare those levels to other health campaigns. This assessment was conducted approximately six months after the launch of MoveU. The levels of MoveU awareness were lower than other well-established health initiatives such as ‘Leave the
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Pack Behind’ or ‘ParticipACTION – let’s get moving’. Awareness for MoveU was higher than for ‘safeTALK’, a suicide prevention program which was established in 2005.27,28 In addition, levels of MoveU awareness were also higher than the ‘ghost’ campaigns. This suggests a real campaign effect, which needs confirmation in future, NCHA evaluations. Findings were also encouraging based on the correlates of awareness, which was the second study objective. Younger, female students were more likely to report awareness of the campaign and this was the intended population. Students living on campus were also more aware of MoveU and this makes intuitive sense given that much of the social marketing materials have been distributed at campus buildings and residential colleges. A future iteration of the campaign messaging will address how to tailor MoveU to the significant number of commuter students at the University of Toronto. The third objective was to apply the HOEM in designing and evaluating MoveU. The HOEM postulates a cascade of cognitive and behavioural effects arising from social marketing campaigns.16 Consistent with the model, awareness was related to outcome expectancies, which was independently associated with self-efficacy, which in turn was independently associated with intentions, and finally intentions were independently associated with MVPA. However, the model fit was significantly strengthened with the addition of two direct paths between outcome expectations and intentions, and between self-efficacy and MVPA.
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ACCEPTED MANUSCRIPT Both outcome expectations and self-efficacy were highly correlated in addition to outcome expectations and intentions. Stemming from Social Cognitive Theory,29 self-efficacy is described as an individual’s belief in his or her own capability to succeed in a specific situation, such as engaging in physical activity.18 Several studies have demonstrated that self-efficacy predicts physical activity participation.30–32 Moreover, self-efficacy has been shown to be
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predictive of both the adoption and maintenance of physical activity behaviors.33 In addition, based on the Theory of Planned Behaviour, an individuals’ behavior is dictated by their intentions to execute the behaviour.34 According to this theory, intentions are predicted by attitudes and subjective norms. It may be that outcome expectancies, as operationalized in the MoveU campaign, reflect attitudes toward physical activity at least in terms of some potential instrument benefits. There is theoretical justification then for these additional paths in the model. Limitations In spite of the novelty of the current findings, there are some limitations that need to be acknowledged. First, the cross-sectional design prevents assessment of the direction of relationships and formal tests of mediation35. Second, the study is based on self-report measures, some of which are single item, and may be subject to bias36. Third, although in line with response rates typically reported in the literature using the NCHA,37 the response rate was low and there is the risk of response bias. Fourth, data was collected six months after the launch of the MoveU campaign, there were therefore no baseline attitudinal (i.e. outcome expectations) and behavioral (MVPA) data, consequently we were unable to compare if there were any changes in these variables from baseline. This will be the focus of future evaluations. Lastly, the instructional stems for the questions assessing components of the HOEM referred to physical
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ACCEPTED MANUSCRIPT activity differently with respect to intensity and time. As such, responses to these questions may have been based on different perceptions of physical activity. While the scales were not modified to main psychometric rigor, further research is needed to confirm the study findings. Conclusions Overall, the HOEM was useful in guiding the design and evaluation of the MoveU
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campaign. Findings supported the model although the data suggests other direct paths beyond the sequential series of steps outlined by HOEM. This initial cross-sectional analysis also suggests that the MoveU campaign was successful in reaching the intended population. Longitudinal designs will be needed in further testing its effectiveness for the social marketing of physical activity initiatives and examining changes in the variables of interest over time. These findings are particularly relevant to campus student wellness services, as the social marketing techniques utilized in the MoveU campaign, could be applied in the development of future wellness initiatives at other institutions. Note For comments and further information, address correspondence to Guy E. J. Faulkner, University of Toronto, Graduate Department of Exercise Sciences, 55 Harbord Street, Toronto, Ontario, M5S 2W6 Canada (e-mail: [email protected]).
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ACCEPTED MANUSCRIPT TABLE 1. Descriptive statistics and correlations of HOEM variables and covariates Mean (SD) Age
Age
Current Awarene living ss
Outcome expectatio n
SelfIntention efficacy s
22.11(5.24 ) -
.05*
1
Current living
-
.14**
-.03
1
Awarenes s
-
-.14**
-.09**
1
Outcome expectatio n
4.25(.78)
.12**
.07* * .06* *
.00
.08**
1
Selfefficacy
4.19(.89)
.01**
.11* *
.07**
.07**
.39**
1
Intentions
4.07(1.02)
.01
.04*
.01
.06**
.43**
.56**
1
MVPA
4.32(1.39)
.11**
.11* *
-.03
.04*
.29**
.33**
.34**
Sex
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Sex
MVP A
1
*p < .05, ** p < .01
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Figure 1. Effective study groups start here
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Figure 2. Balance your body and your workload
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Age (.10)
(-.11)
.11
(.13)
-.11
(.11)
.13
.11 (.10)
(.41)
(.46)
.10
.41
.57
Awareness
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.22
Outcome expectation s
Self-efficacy
Intentions
(.34) .22
MVPA
.26 .05 -.06
(.05)
.09 (.09)
(-.06)
.06 (.08)
Sex
-.06
(-.06)
Current living situation
-.09 (-.09) .09)
FIGURE 3. Path model illustrating the associations between MoveU awareness, outcome expectations, self-efficacy, intentions, MVPA and the study covariates. Note that original model path coefficients are in parentheses
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