This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
Mass-media campaigns have the potential to increase community awareness about physical activity. More localised campaigns target specific groups, or professionals, around this issue. Several campaigns, conducted by the Heart Foundation in 1990-91, and by Active Australia in 1998-99 have shown promising effects on community understanding (see chapter 1.3). The agenda-setting role of media seems to be complementary to other efforts promoting physical activity. New media, such as the Internet, remain to be tested in promoting physical activity.
2.5.1. Principles of media campaigns applied to physical activity
Media interventions have been defined as those interventions that reach groups of individuals using a medium other than personal contact, and offer means for reaching large numbers of people at less per-unit expense than that associated with face-to-face interventions (Marcus et al. 1998). Campaigns are specific uses of mass media, in purposive ways during defined time periods to increase the salience and community focus around specific issues, and to set the agenda for change (Flora et al. 1989). Research on print and other media-based interventions has not yet provided extensive data on long-term maintenance of change in physical activity behaviour.
For the impact of such media-based interventions to be maintained, support systems will be required to prompt and support participation over time.
Mass-media campaigns alone are unlikely to impact significantly on individuals' behaviour; campaigns to promote participation in physical activity in populations need to be combined with programs offered at the community level (Redman et al. 1990, Donovan and Owen 1994). In this way, mass-media campaigns can be used to increase awareness and motivation to participate in physical activity, while coordinated community-based programs provide opportunities to participate. Recent research has investigated the impact of tailoring mass-media messages to the different needs of individuals (Marcus et al. 1998). Theories that recognise the various levels of motivation, such as the Transtheoretical Model, may help to guide the design of more effective interventions that are tailored to the appropriate level of motivation. A consistent finding is that matching material content to individuals' stages of motivational readiness, particularly using the Transtheoretical Model, is helpful in media-based interventions (Marcus et al. 1998).
One of the first mass-media programs designed to promote physical activity in Australia was the 'Life. Be In It' campaign, which began in 1975 and was implemented until the early 1980s. One of its main objectives was to encourage people to do a little more exercise each day. This campaign used mass-media and other large-scale efforts but did not evaluate behaviour changes.
In the 1990s, two nation-wide physical activity campaigns conducted by the National Heart Foundation (NHF) provided an opportunity to examine the impact of serial, mass-media campaigns that were aimed at increasing levels of physical activity among people who had been inactive. In 1990, the first campaign used the slogan 'Exercise: make it part of your day' (Booth et al. 1992). In 1991 a second campaign was conducted, building on the previous campaign, using the slogan 'Exercise: take another step' (Owen et al. 1995). These campaigns were designed to promote increased physical activity that emphasised walking as the main activity, and were based on the Social Learning Theory and the Social Marketing Model.
Events were promoted through electronic and print news coverage, feature articles and editorials. Other local initiatives by the NHF were conducted in addition to the National media-based strategies. Face-to-face home based interviews were conducted using a representative National sample two weeks before, and three to four weeks after each campaign. After the first campaign, the prevalence of walking reported in the survey increased from 70 to 74 per cent (Booth et al. 1992). The changes in reported walking for exercise and in readiness to exercise found in 1990 were not repeated in 1991 (Owen et al. 1995). However, this is likely to be due in part to the increases observed the previous year having been maintained (Owen et al. 1995).
More recently, mass-media campaigns were developed through Active Australia in 1998 and 1999 that encouraged participation in activity among the general community. The first of these was 'Exercise. You only have to take it regularly, not seriously', conducted initially in February 1998. Most of the mass-media campaign activity occurred in NSW, with sizeable additional funding provided by the NSW State Government, through the NSW Health Department, but also through collaborations across sectors and agencies through the Premiers Taskforce on Physical Activity. Initial results showed increased awareness of the Campaign and improved understanding of the moderate physical activity message (Bauman et al. 2001). Short-term changes in physical activity behaviour in the campaign target population were also noted. The evaluation design allowed comparisons with other States where the media campaign had yet to be implemented; this revealed that the positive effects were confined to NSW and ACT. Whilst this might appear to be a 'common sense' finding, it is rare for an evaluation to be able to provide clear evidence that effects are directly attributable to a campaign.
The 1999 campaign had a 'Rusty Tin Man' theme as part of the United Nations International Year of the Older Person. Increased awareness of this message was shown in NSW and Victoria, the two States that contributed most to the running of this media initiative during 1999. Results showed further increases in awareness, and some changes in behavioural intention to be more active, among adults aged over 55 in the population (NSW Health 2000). Ongoing maintenance of awareness of the Active Australia message was noted.
From a theoretical perspective, mass-media communication is most likely to be effective in influencing the knowledge and attitudes of people who are at the earlier stages of the exercise adoption process, particularly pre-contemplators and contemplators. Mass media have the potential to play a major role in promoting physical activity; however, more studies are needed, particularly systematic evaluations of physical activity programs in the community and long-term follow-up studies are warranted. In addition, the field would also benefit from studies investigating use of electronic mail, the Internet and other forms of interactive electronic communication to increase physical activity levels. The potential of such channels across the population is considerable.
The hierarchy of communication effects proposed by McGuire (1984) is illustrated as a hypothetical example in Figure 4 below. It is emphasised that whilst conceptually clear and useful for defining likely campaign effects, the hierarchical model has seldom been empirically tested in campaign evaluations. This hierarchy is based on the notion of a causal chain providing the links between input and output. The model acknowledges that success becomes more difficult to achieve as we move from measures of basic awareness through to attitudinal and behaviour change. An approximate 'rule of halves' is advanced. Given a certain target audience (100%), if 50 per cent are exposed to a message, approximately half may typically attend to it (25%); of that 25 per cent, half may typically understand what they have deigned to attend to - 2.5 per cent. Half of that proportion may accept the proposition they have understood (6.25%), which may lead to some intention to act in a little over 3 per cent. About half of that proportion may end up actually turning that intention into a trial of the behaviour - 1.57%, and assuming a 50 per cent success rate, then a little under 1 per cent (0.78%) of the original target audience may achieve the desired (behavioural) objective. This model illustrates the importance of succeeding 'upstream' in the hierarchy - getting good exposure and attention, with clear communication for consumer understanding of the message.
Figure 4. A hierarchy of effects in a mass-media campaign for
physical activity.
Adapted from McGuire 1984.
Arguments have been put forward about the potential uses of the new information technology to provide a variety of exercise adherence interventions to supplement, or possibly to replace, existing face-to-face counselling and social support mechanisms (Fotheringham et al. 2000a). The potentials of the Internet and email technologies to influence physical activity and other health-related behaviours are considerable, though largely untested. The potential advantages of website-based delivery of a self-help physical activity program include rapid, convenient access at networked worksites, cost-effective ways to reach large numbers, immediate feedback to participants through the interactive nature of this medium, and the capacity for specific tailoring of advice. Moreover, one recent study indicated that young adults prefer to obtain information through this medium than through more traditional print or broadcast media (Fotheringham et al. 2000b).
For a recent review, Marcus et al. (1998) screened over 200 published studies and identified seven that were mass-media campaigns at the State or National level, the main features and effects of which are summarised in Table 8. Only three of the seven studies that Marcus et al. identified as being State- or National-level, mass-media campaigns included a comparison group. To these three may be added the Active Australia campaign for which the evaluation included a comparison group and combination of longitudinal and cross-sectional surveillance. With these four exceptions, this type of campaign activity typically lacks robust evidence.
Well designed media campaigns can help to set the physical activity agenda, and inform the community and professional groups about the new moderate-intensity physical activity message. Media alone will only focus attention on the need for change, and additional supports are required for population change; for example, campaigns supported by community-based programs, primed health professionals, and environments which facilitate activity choices. Nonetheless, mass media has a clear role, as it did in the first two decades of tobacco control, when new messages and the mass dissemination of scientific evidence set the scene for later tobacco control work. In a similar vein, physical activity evidence is relatively new, and there is a role for organised public education, which, ideally, would be in the form of an integrated, multi-year, phased campaign.
The opportunities provided through Active Australia allow for campaigns to be developed in one location and run across diverse settings; the communication need is to orchestrate campaigns so that they are sequenced, build upon each other, and lead to a more informed community, with greater motivation to embark upon physical activity in organised and non-organised settings.
Table 8. Summary of physical activity campaigns
| Campaign (duration) | Evaluation design | Activity target* | Theoretical basis(es)# | Results |
| Heart Week 1990 (NHF Australia) (1 week) | Quasi-experimental (pre & post) | Moderate activity - walking | SMT | 71% (v 46% baseline) recall; no change in beliefs about benefits; increased walking among 50+ and less educated. |
| Heart Week 1991 (NHF Australia) (1 week) | Comparison of results with 1990 | Moderate activity - walking | SMT | 73.5% (v 62.5% baseline) recall; no change in intention; non-significant increase in physical activity from 1990 to 1991 |
| Pawtucket Heart Health Program (USA sub-study) (6 weeks) | Pre & post test; no comparison group | LTPA; part of larger CVD risk reduction program | TTM / SCT | Majority of subjects increased motivational readiness for physical activity |
| Slangerup - a Heart Healthy Town (Denmark) (1 year) | Comparison community | LTPA | SCT | No change in knowledge; small increases in motivational readiness and physical activity intervention and controls |
| Minnesota Heart Health Program (USA) (5-6 years) | Three matched pairs of communities - one education and one comparison site in each pair | Low-moderate LTPA; as part of larger CVD risk reduction program | SMT | Accelerated secular trend for increased physical activity (years 1-3); small increases in EE LTPA early phase; small reduction EE later phase |
| Stanford Five-City Project (USA) (6 years) | Two pairs of matched communities; fifth community with surveillance only | LTPA and incidental (e.g. walking / taking stairs); part of larger CVD risk reduction program | SMT | Little consistent evidence of effect on knowledge, attitudes, self-efficacy. Small increases in vigorous physical activity (males) and moderate physical activity (females) |
| HEBS Walking Campaign (Health Education Board for Scotland) (1 year) | Omnibus survey Pre (Jun 95); Post (Jun 96) Tracking surveys Oct 95, Feb 96, Jun 96. Fitline (telephone) Callers surveyed at baseline, 10 weeks, 12 months |
Walking >= 30 minutes / day on most days of the week | SMT SCT |
Recall peaked at 70%; increase in knowledge and beliefs; no change in intention or physical activity behaviour. Average 670 calls / wk; increased intention & walking among callers at 4 weeks and 1 year (0.1% used line) |
* LTPA, Leisure time physical activity
# SMT, Social Marketing Theory; TTM, Transtheoretical Model; SCT, Social Cognitive Theory.
Source: Adapted from Marcus et al. (1998)
Bauman A, Bellew B, Owen N, et al. (2001). Impact of an Australian mass media campaign targeting physical activity in 1998. American Journal of Preventive Medicine 21:41-7.
Booth M, Bauman A, Oldenburg B, et al. (1992). Effects of a national mass-media campaign on physical activity participation. Health Promotion International 7:241-7.
Donovan RJ, Owen N. (1994). Social marketing and mass interventions. In Dishman RK (Ed). Exercise adherence: its impact on public health (second edition). Champaign, Illinois: Human Kinetics.
Flora JA, Maibach EW, Maccoby N. (1989). The role of media across four levels of health promotion intervention. Annual Review of Public Health 10:181-201.
Fotheringham MJ, Owies D, Leslie E, et al. (2000a). Interactive health communication in preventive medicine: Internet-based strategies in teaching and research. American Journal of Preventive Medicine 19:113-20.
Fotheringham M, Wonnacott RL, Owen N. (2000b). Computer use and physical inactivity in young adults. Public health perils and potentials of new information technologies. Annals of Behavioral Medicine 22:269-75.
Marcus BH, Owen N, Forsyth LH, et al. (1998). Interventions to promote physical activity using mass media, print media and information technology. American Journal of Preventive Medicine 15:362-78.
McGuire WJ. (1984). Public communication as a strategy for inducing health-promoting behavioral change. Preventive Medicine 13(3):299-319.
NSW Health Department. (2000). The Active Australia / International Year of Older People public education campaign to promote physical activity among older people. State health Publication HP 000016. Sydney: NSW Health Department.
Owen N, Bauman A, Booth M, et al. Serial mass-media campaigns to promote physical activity: reinforcing or redundant? American Journal of Public Health 85:244-8.
Redman S, Spencer EA, Sanson-Fisher RW. (1990). The role of mass media in changing health-related behavior: a critical appraisal of two models. Health Promotion International 5:85-101.
Next: Part 2 (cont.) - 2.6 Environmental, policy and intersectoral approaches to physical activity
Previous: Part 2 - 2.4 Promoting physical activity in worksites
This is an archive copy of a document originally located at http://www.nphp.gov.au/sigpah/gaa/index.htm. All copyright remains with the creator.
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