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1. Persuasive communication strategies and technologies for physical activity promotion:The MoveM8 case study Research Saturday, 9th April, 2011 School of Nursing, Midwifery & PhysiotherapyUniversity of Nottingham Marco Bardus Institute for Public Communication and Education (ICIeF) marco.bardus@usi.ch

2. Overview BACKGROUND & RATIONALE THE MOVEM8 PROJECT RESEARCH QUESTIONS METHODS PRELIMINARY ANALYSIS & RESULTS LIMITATIONS DISCUSSION Nottingham, 9/04/2011 © Marco Bardus, ICIeF 2

3. MY BACKGROUND AND RESEARCH INTERESTS

4. THE PURPOSE OFMY DISSERTATION

5. The purpose of my dissertation Testingthe use of persuasive communication strategies in promoting physical activity through new technologies (i.e. e-mail and SMS). Evaluating the impact and effectiveness of a technology-based intervention(i.e. MoveM8). Describing the reasons for participation. Nottingham, 9/04/2011 © Marco Bardus, ICIeF 5

6. The research team Prof. L. Suzanne Suggs, Dr. Carolina Gross &Marco Bardus1 Dr. Holly Blake2 Mr.Scott Lloyd3 1Università della Svizzera italiana 2 University of Nottingham, School of Nursing, Midwifery & Physiotherapy Nottingham, UK 3 NHS Stockton-on-Tees Public Health Directorate, Newtown Community Resource Centre Nottingham, 9/04/2011 © Marco Bardus, ICIeF 6

7. BACKGROUND & RATIONALE

8. The problem:physical inactivity The context: physical activity in the workplace Rationale of the project BACKGROUND&RATIONALE

9. PHSYICAL INACTIVITY:WHY SHOULD WE CARE?

10. Nottingham, 9/04/2011 © Marco Bardus, ICIeF 10

11. The problem: physical inactivity 1 million deaths/year in Europe 2/3 of the adult population (15+ years) do not reach recommended levels of activity (30 minutes/day on most week days) – WHO, 2011 Loss of 5.3 million years of healthy lives(Cavill et al. 2006) Leading health risk factor of: heart diseases, diabetes, cancer, depression Nottingham, 9/04/2011 © Marco Bardus, ICIeF 11

12. Benefits of physical activity INDIVIDUAL HEALTHprevent and manage chronic disease,reduce overweight and obesity, benefit other health problems (e.g. pain of arthritis, stress and anxiety, etc.) HEALTHCARE SYSTEM Fewer physician visits, hospitalizations and medications= less costs (Cavill et al., 2006; CDC, 2007) Nottingham, 9/04/2011 © Marco Bardus, ICIeF 12

13. PHYSICAL ACTIVITYIN THE WORKPLACE

14. Why workplaces? Promising setting for WHPP (Pronk et al., 2009) 60% of waking hours spent at work Key government policies (DH, 2004; Black, 2008) Nottingham, 9/04/2011 © Marco Bardus, ICIeF 14

15. General benefits for workplaces Improved overall health (reduced overweight & obesity) Positive impact on stress, back pain, mental health Increased productivity and lower rates of absenteeism Quicker return to work after illness; fewer injuries, less illnesses Improvements in communications, morale and working atmosphere Positive corporate image Nottingham, 9/04/2011 © Marco Bardus, ICIeF 15 Confirmed by Buck Consultant’s 2nd Global Wellness Survey, November 2010

16. Business case: Stockton-on-Tees employer * Source: Lloyd, S. (2009). “The North East Better Health at Work Award”. Basesconference. Leeds, September 2009 Nottingham, 9/04/2011 © Marco Bardus, ICIeF 16

17. Tangible benefits of WHP programme Predicted saving for organisation = £954,003 Predicted payback period = 0.2 years Predicted benefit to cost ratio =19 to 1 Source: Lloyd, S. (2009). “The North East Better Health at Work Award”. Basesconference. Leeds, September 2009 Nottingham, 9/04/2011 © Marco Bardus, ICIeF 17 This business case led the organisation’s boardto accept proposals around initiatinga workplace health programme

18. RATIONALE

19. Rationale of the MoveM8 Nottingham, 9/04/2011 © Marco Bardus, ICIeF 19

20. Evidence from the field E-mail (Plotnikoff et al., 2005) Mobile phones (Fjeldsoe, Marshall, & Miller, 2009) TPB (Armitage & Conner, 2001) PA promotion (Abraham & Graham-Rowe, 2009) Nottingham, 9/04/2011 © Marco Bardus, ICIeF 20

21. THE MOVEM8PROJECT

22. THE MOVEM8PROJECT The two studies Objectives & research Q

23. THE TWO STUDIES

24. The twostudies STUDY 1“THE INTERVENTION” September 2009-August 2010 STUDY 2“REASONS FOR PARTICIPATION” May-June 2011 Nottingham, 9/04/2011 © Marco Bardus, ICIeF 24

25. OBJECTIVES & RQs

26. Objectives and RQs STUDY 1: THE INTERVENTION To examine the effects of adding2 SMS to the email communication on: perceived message relevance TPBconstructs (Attitudes, Subjective Norms, Perceived Behavioral Control, or Intention) physical activity behaviour STUDY 2:REASONS FOR PARTICIPATION To identify the reasons for participating in the programme (Reach). To examine individual characteristicsimpacting on participation. To identify organisational and environmental moderators (Implementation) To assess the impact at the organisational level (Maintenance). 26 Nottingham, 9/04/2011 © Marco Bardus, ICIeF What effects? How effective? Why? How effective?

27. METHODOLOGY

28. METHODOLOGY Design Intervention development Recruitment Participants and Sampling Assessments

29. DESIGN

30. Design STUDY 1:THE INTERVENTION RCT with twostudy groups Semi-structured interviews+online survey Group 1 (control) 1 weeklypersonalised e-mail Group 2 (experimental) 1 weeklypersonalised e-mail+ 2 standard SMS/wk STUDY 2:REASONS FOR PARTICIPATION INT with employees (participants and non-participants) INT with health advocates of participating organisations Online survey: health advocates of non-participating organisations 30 Nottingham, 9/04/2011 © Marco Bardus, ICIeF

31. INTERVENTION DEVELOPMENT

32. Intervention Development ACSM=American College of Sports Medicine AHA=American HeartAssociation Nottingham, 9/04/2011 © Marco Bardus, ICIeF 32

33. Message schedule Nottingham, 9/04/2011 © Marco Bardus, ICIeF 33

34. RECRUITMENT

35. The MoveM8 identity

36. The MoveM8 identity Nottingham, 9/04/2011 © Marco Bardus, ICIeF 36

38. Incentives(Nike Sport kit lottery, benefits for the organisation)RECRUITMENT STEPS Nottingham, 9/04/2011 © Marco Bardus, ICIeF 37

39. PARTICIPANTSAND SAMPLING

41. Dow Chemical Company Ltd., Middlesborough

42. Vopak Terminal Teeside Ltd., Middlesborough

43. Redcar & Cleveland BC, Middlesborough

44. Stockton Riverside College, Stockton-on-Tees

45. Cummins, Stockton-on-Tees

46. HMP Holme House, Stockton-on-Tees

47. 3M, Northalleton

48. Leeds Metropolitan University, Leeds

49. Age Concern Calderdale & Kirklees, Halifax

50. Astbury Digital, Asthon-under-Lyne

51. Tameside MBC, Asthon-under-Lyne

52. Two Trees Tameside Sport College, Tameside

53. Liverpool Chamber of Commerce, Liverpool

54. University of Nottingham, Nottingham

55. De Montfort University, Leicester

56. Equity Direct Broking Ltd., Colchester

57. Vodafone Group Services Ltd., Donnington

58. Zest People Ltd, WorthingNottingham, 9/04/2011 © Marco Bardus, ICIeF 39

59. Participants and sampling STUDY 1:THE INTERVENTION STUDY 2:REASONS FOR PARTICIPATION ORGANISATIONS Particip. =17 Potential non part. >1,500 EMPLOYEES Enrolled employees =367 Non-enrolled employees =137 ORGANISATIONS Contacted >1,500 Enrolled =19 Drop-outs =2 EMPLOYEES Estimated reference pop. ~12,000 Experimental pop. =510 Participants =393 Drop-outs =26 40 Nottingham, 9/04/2011 © Marco Bardus, ICIeF Sampling: RCT Sampling: Purposive

60. ASSESSMENTS

61. Assessments – Study 1 Increase in PA level: weekly time spent, frequency, intensity and type of activity Reduction in time spent sitting IPAQ-L: 14 items, 4 domains (Work, Domestic, Travelling, Leisure time) Type of activity: Moderate/Vigorous/Walking Changesin TPB constructs validated TPB survey: 38 items(INT=3 dir.; ATT=3 dir., 5+5 ind.;PBC=3 dir.; 4+4 ind.; SN=3 dir.; 4+4 ind.) Perceived message relevance Satisfaction with the programme Reach, efficacy, adoption, implementation, maintenance Nottingham, 9/04/2011 © Marco Bardus, ICIeF 42

62. The TPB model Normative Beliefs ControlBeliefs BehavioralBeliefs Motivationtocomply Control Power Outcomeevaluations Background factors Past experience Organisational factors Environmental factors Attitudestowardsbehavior SubjectiveNorms Intention Behaviour Perceived Behavioural Control Actual behavioural control Theory of Planned Behavior Model (adapted from: Ajzen, 2006; Montano & Kasprzyk, 2008 ) Nottingham, 9/04/2011 © Marco Bardus, ICIeF 43

63. Assessments – Study 2 EMPLOYEES Reasons for participation and non-participation Attitudes about benefits of doing PA Perceived barriers to PA Personal preferences re: technology HEALTH ADVOCATES Organisational attitudes and predispositions towards WHPP Presence or absence of barriers to PA Past experiences with WHPP. Reasons for participation. Perceived benefits Possible moderators of recruitment Impact on organisational policies Nottingham, 9/04/2011 © Marco Bardus, ICIeF 44

64. RE-AIM Framework Nottingham, 9/04/2011 © Marco Bardus, ICIeF 45 Adapted from: Glasgow & Linnan, 2008

65. PRELIMINARY RESULTS

66. Baseline description (N=393) Mean age: 39.3 years (SD=11.7, min=18, max=63) Gender: female(78.9%) Education: higher degree (68.7%) Work status: Full-time (84.5%) Family status: Live with partner (67.7%), have kids (31.8%), single (29.5%), single parent (4.8%) Health status: good(47.8%)very good-excellent (38.7) BMI: mean=26.3 (SD=5.4; min=17.1; max=53.6) BMI category: normal(45.3%), overweight(31.6%), obese(20.9%) Nottingham, 9/04/2011 © Marco Bardus, ICIeF 47

67. Physical activity behaviour Nottingham, 9/04/2011 © Marco Bardus, ICIeF 48

68. Baseline TPB Model (full SEM) 49

69. Mainfindings: BL-FUP comparison POSITIVE Positive significant increase injob-related (p=.021) and leisure-time PA (p<.001) between pre- and post-test Significant decrease in time spent sitting (p=.034), but only for control group Low attrition (6%) 2/3 highly satisfied with the programme Constant high motivation levels for PA participation PROBLEMATIC Low survey response rates, comparable with other studies Low participation Over-reporting in PA levels (IPAQ-L issue) 1/3 did not read all messages 50 Nottingham, 9/04/2011 © Marco Bardus, ICIeF Careful! Further investigation is needed!

70. PROBLEMS& LIMITATIONS

71. Nottingham, 9/04/2011 © Marco Bardus, ICIeF 52

72. Problemsencountered MAIN PROBLEMS Low participation Low survey response POSSIBLE CAUSES Environmental: H1N1, seasonality Organisational: Other ongoing WHPP Low endorsement Individual: time, workload, other priorities Technical: firewalls, computer access Promotion: low budget 53 Nottingham, 9/04/2011 © Marco Bardus, ICIeF HRA (i.e. high resp. burden) Survey instrument

73. A POSSIBLE FRAMEWORKFOR ANALYSIS

74. Social Marketing Benchmark Criteria

75. Possible improvements 1) Customer orientation. Design and develop the intervention with worksites. More thorough formative research 2) Exchange. Tangible incentives => fairer exchange 3) Competition. Thorough analysis of all forms of competition (competing behaviors, barriers, other programmes, etc.) 4) Segmentation. Appropriate target segmentation

76. DISCUSSION

77. Discussion: some open questions Is the intervention reaching those most in need? How much communication is needed? Why some people subscribe (or not)? Nottingham, 9/04/2011 © Marco Bardus, ICIeF 58

78. THANK YOUFOR YOUR ATTENTION! Marco Bardusmarco.bardus@usi.ch

79. References – 1 Abraham, C., & Graham-Rowe, E. (2009). Are worksite interventions effective in increasing physical activity? A systematic review and meta-analysis. Health Psychology Review, 3(1), 108. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211. Armitage, C. J., & Conner, M. (2001). Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology, 40(4), 471-499. Cavill, N., Kahlmeier, S., & Racioppi, F. (2006). Physical activity and health in Europe. World Health Organization. Regional Office for Europe. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0011/87545/E89490.pdf Centers for Disease Control and Prevention - CDC (2007). The importance of Physical Activity. Fact Sheet. Retrieved September 10, 2007 from: http://www.cdc.gov/nccdphp/dnpa/physical/importance/index.htm. Fjeldsoe, B. S., Marshall, A. L., & Miller, Y. D. (2009). Behavior change interventions delivered by mobile telephone short-message service. American Journal of Preventive Medicine, 36(2), 165-173. Nottingham, 9/04/2011 © Marco Bardus, ICIeF 60

80. References – 2 Glasgow, R. E., & Linnan, L. A. (2008). Evaluation of Theory-Based Interventions. In K. Glanz, B. K. Rimer, & K. V. Viswanath (Eds.), Health Behavior and Health Education (4th ed., pp. 487-505). San Francisco, CA: Jossey-Bass. Lloyd, S. (2009). The North East Better Health at Work Award. Basesconference. Leeds, 1-3 September 2009. Plotnikoff, R. C., McCargar, L. J., Wilson, P. M., & Loucaides, C. A. (2005). Efficacy of an E-mail intervention for the promotion of physical activity and nutrition behavior in the workplace context. American Journal of Health Promotion, 19(6), 422-429. Pronk, N. P., & Kottke, T. E. (2009). Physical activity promotion as a strategic corporate priority to improve worker health and business performance. Preventive Medicine, 49(4), 316-321. Robroek, S., van Lenthe, F., van Empelen, P., & Burdorf, A. (2009). Determinants of participation in worksite health promotion programmes: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 6(1), 26. World Health Organization -WHO (2006). Physical activity and health in Europe: evidence for action. Available from: http://www.euro.who.int/InformationSources/Publications/Catalogue/20061115_2. Nottingham, 9/04/2011 © Marco Bardus, ICIeF 61