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MoveM8 Research Saturday @ University of Nottingham 9.4.2011


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MoveM8 Research Saturday @ University of Nottingham 9.4.2011

  1. 1. Persuasive communication strategies and technologies for physical activity promotion:The MoveM8 case study<br />Research Saturday, 9th April, 2011<br />School of Nursing, Midwifery & PhysiotherapyUniversity of Nottingham<br />Marco Bardus<br />Institute for Public Communication and Education (ICIeF)<br /><br />
  2. 2. Overview<br />BACKGROUND & RATIONALE<br />THE MOVEM8 PROJECT<br />RESEARCH QUESTIONS<br />METHODS<br />PRELIMINARY ANALYSIS & RESULTS<br />LIMITATIONS<br />DISCUSSION <br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />2<br />
  5. 5. The purpose of my dissertation<br />Testingthe use of persuasive communication strategies in promoting physical activity through new technologies (i.e. e-mail and SMS).<br />Evaluating the impact and effectiveness of a technology-based intervention(i.e. MoveM8).<br />Describing the reasons for participation.<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />5<br />
  6. 6. The research team<br />Prof. L. Suzanne Suggs, Dr. Carolina Gross &Marco Bardus1<br />Dr. Holly Blake2<br />Mr.Scott Lloyd3<br />1Università della Svizzera italiana<br />2 University of Nottingham, School of Nursing, Midwifery & Physiotherapy Nottingham, UK<br />3 NHS Stockton-on-Tees Public Health Directorate, Newtown Community Resource Centre<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />6<br />
  8. 8. The problem:physical inactivity<br />The context: physical activity in the workplace<br />Rationale of the project<br />BACKGROUND&RATIONALE<br />
  10. 10. Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />10<br />
  11. 11. The problem: physical inactivity<br />1 million deaths/year in Europe<br />2/3 of the adult population (15+ years) do not reach recommended levels of activity (30 minutes/day on most week days) – WHO, 2011<br />Loss of 5.3 million years of healthy lives(Cavill et al. 2006)<br />Leading health risk factor of: heart diseases, diabetes, cancer, depression<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />11<br />
  12. 12. Benefits of physical activity<br />INDIVIDUAL HEALTHprevent and manage chronic disease,reduce overweight and obesity, benefit other health problems (e.g. pain of arthritis, stress and anxiety, etc.)<br />HEALTHCARE SYSTEM<br />Fewer physician visits, hospitalizations and medications= less costs (Cavill et al., 2006; CDC, 2007) <br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />12<br />
  14. 14. Why workplaces?<br />Promising setting for WHPP (Pronk et al., 2009)<br />60% of waking hours spent at work<br />Key government policies (DH, 2004; Black, 2008)<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />14<br />
  15. 15. General benefits for workplaces<br />Improved overall health (reduced overweight & obesity)<br />Positive impact on stress, back pain, mental health<br />Increased productivity and lower rates of absenteeism<br />Quicker return to work after illness; fewer injuries, less illnesses<br />Improvements in communications, morale and working atmosphere<br />Positive corporate image<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />15<br />Confirmed by Buck Consultant’s 2nd Global Wellness Survey, November 2010<br />
  16. 16. Business case: Stockton-on-Tees employer<br />* Source: Lloyd, S. (2009). “The North East Better Health at Work Award”. Basesconference. Leeds, September 2009<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />16<br />
  17. 17. Tangible benefits of WHP programme<br />Predicted saving for organisation = £954,003<br />Predicted payback period = 0.2 years<br />Predicted benefit to cost ratio =19 to 1<br />Source: Lloyd, S. (2009). “The North East Better Health at Work Award”. Basesconference. Leeds, September 2009<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />17<br />This business case led the organisation’s boardto accept proposals around initiatinga workplace health programme<br />
  18. 18. RATIONALE<br />
  19. 19. Rationale of the MoveM8<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />19<br />
  20. 20. Evidence from the field<br />E-mail (Plotnikoff et al., 2005)<br />Mobile phones (Fjeldsoe, Marshall, & Miller, 2009)<br />TPB (Armitage & Conner, 2001)<br />PA promotion (Abraham & Graham-Rowe, 2009)<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />20<br />
  21. 21. THE MOVEM8PROJECT<br />
  22. 22. THE MOVEM8PROJECT<br />The two studies<br />Objectives & research Q<br />
  23. 23. THE TWO STUDIES<br />
  24. 24. The twostudies<br />STUDY 1“THE INTERVENTION”<br />September 2009-August 2010<br />STUDY 2“REASONS FOR PARTICIPATION”<br />May-June 2011<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />24<br />
  25. 25. OBJECTIVES & RQs<br />
  26. 26. Objectives and RQs<br />STUDY 1: THE INTERVENTION<br />To examine the effects of adding2 SMS to the email communication on:<br />perceived message relevance<br />TPBconstructs (Attitudes, Subjective Norms, Perceived Behavioral Control, or Intention)<br />physical activity behaviour<br />STUDY 2:REASONS FOR PARTICIPATION <br />To identify the reasons for participating in the programme (Reach). <br />To examine individual characteristicsimpacting on participation.<br />To identify organisational and environmental moderators (Implementation)<br />To assess the impact at the organisational level (Maintenance).<br />26<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />What effects?<br />How effective?<br />Why? How effective?<br />
  27. 27. METHODOLOGY<br />
  28. 28. METHODOLOGY<br />Design<br />Intervention development<br />Recruitment<br />Participants and Sampling<br />Assessments<br />
  29. 29. DESIGN<br />
  30. 30. Design<br />STUDY 1:THE INTERVENTION<br />RCT with twostudy groups<br />Semi-structured interviews+online survey<br />Group 1 (control)<br />1 weeklypersonalised e-mail<br />Group 2 (experimental)<br />1 weeklypersonalised e-mail+ 2 standard SMS/wk<br />STUDY 2:REASONS FOR PARTICIPATION <br />INT with employees (participants and non-participants)<br />INT with health advocates of participating organisations<br />Online survey: health advocates of non-participating organisations<br />30<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />
  32. 32. Intervention Development<br />ACSM=American College of Sports Medicine<br />AHA=American HeartAssociation<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />32<br />
  33. 33. Message schedule<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />33<br />
  34. 34. RECRUITMENT<br />
  35. 35. The MoveM8 identity<br />
  36. 36. The MoveM8 identity<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />36<br />
  37. 37. Recruitment strategy<br />Following best practices and suggestions from the literature (Robroek et al. 2009), we developed a two-step recruitment strategy<br />among UK organisations (done by our collaborators) +<br />within the organizations(doneby HR and OHA)<br /><ul><li>Flexibile enrolment period(6 waves total)
  38. 38. Incentives(Nike Sport kit lottery, benefits for the organisation)</li></ul>RECRUITMENT STEPS<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />37<br />
  40. 40. Participating workplaces<br /><ul><li>Avecia Biologics Ltd., Billingham
  41. 41. Dow Chemical Company Ltd., Middlesborough
  42. 42. Vopak Terminal Teeside Ltd., Middlesborough
  43. 43. Redcar & Cleveland BC, Middlesborough
  44. 44. Stockton Riverside College, Stockton-on-Tees
  45. 45. Cummins, Stockton-on-Tees
  46. 46. HMP Holme House, Stockton-on-Tees
  47. 47. 3M, Northalleton
  48. 48. Leeds Metropolitan University, Leeds
  49. 49. Age Concern Calderdale & Kirklees, Halifax
  50. 50. Astbury Digital, Asthon-under-Lyne
  51. 51. Tameside MBC, Asthon-under-Lyne
  52. 52. Two Trees Tameside Sport College, Tameside
  53. 53. Liverpool Chamber of Commerce, Liverpool
  54. 54. University of Nottingham, Nottingham
  55. 55. De Montfort University, Leicester
  56. 56. Equity Direct Broking Ltd., Colchester
  57. 57. Vodafone Group Services Ltd., Donnington
  58. 58. Zest People Ltd, Worthing</li></ul>Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />39<br />
  59. 59. Participants and sampling<br />STUDY 1:THE INTERVENTION<br />STUDY 2:REASONS FOR PARTICIPATION <br />ORGANISATIONS<br />Particip. =17<br />Potential non part. >1,500<br />EMPLOYEES<br />Enrolled employees =367<br />Non-enrolled employees =137<br />ORGANISATIONS<br />Contacted >1,500<br />Enrolled =19<br />Drop-outs =2<br />EMPLOYEES<br />Estimated reference pop. ~12,000<br />Experimental pop. =510<br />Participants =393<br />Drop-outs =26<br />40<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />Sampling: RCT<br />Sampling: Purposive<br />
  60. 60. ASSESSMENTS<br />
  61. 61. Assessments – Study 1<br />Increase in PA level: weekly time spent, frequency, intensity and type of activity<br />Reduction in time spent sitting<br />IPAQ-L: 14 items, 4 domains (Work, Domestic, Travelling, Leisure time)<br />Type of activity: Moderate/Vigorous/Walking<br />Changesin TPB constructs <br />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.) <br />Perceived message relevance<br />Satisfaction with the programme<br />Reach, efficacy, adoption, implementation, maintenance<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />42<br />
  62. 62. The TPB model<br />Normative Beliefs<br />ControlBeliefs<br />BehavioralBeliefs<br />Motivationtocomply<br />Control Power<br />Outcomeevaluations<br />Background factors<br />Past experience<br />Organisational factors<br />Environmental factors<br />Attitudestowardsbehavior<br />SubjectiveNorms<br />Intention<br />Behaviour<br />Perceived Behavioural Control<br />Actual behavioural control<br />Theory of Planned Behavior Model (adapted from: Ajzen, 2006; Montano & Kasprzyk, 2008 )<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />43<br />
  63. 63. Assessments – Study 2<br />EMPLOYEES<br />Reasons for participation and non-participation<br />Attitudes about benefits of doing PA Perceived barriers to PA<br />Personal preferences re: technology<br />HEALTH ADVOCATES<br />Organisational attitudes and predispositions towards WHPP<br />Presence or absence of barriers to PA<br />Past experiences with WHPP.<br />Reasons for participation.<br />Perceived benefits<br />Possible moderators of recruitment<br />Impact on organisational policies <br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />44<br />
  64. 64. RE-AIM Framework<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />45<br />Adapted from: Glasgow & Linnan, 2008<br />
  66. 66. Baseline description (N=393)<br />Mean age: 39.3 years (SD=11.7, min=18, max=63)<br />Gender: female(78.9%)<br />Education: higher degree (68.7%)<br />Work status: Full-time (84.5%)<br />Family status: Live with partner (67.7%), have kids (31.8%), single (29.5%), single parent (4.8%)<br />Health status: good(47.8%)very good-excellent (38.7)<br />BMI: mean=26.3 (SD=5.4; min=17.1; max=53.6)<br />BMI category: normal(45.3%), overweight(31.6%), obese(20.9%)<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />47<br />
  67. 67. Physical activity behaviour<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />48<br />
  68. 68. Baseline TPB Model (full SEM)<br />49<br />
  69. 69. Mainfindings: BL-FUP comparison<br />POSITIVE<br />Positive significant increase injob-related (p=.021) and leisure-time PA (p<.001) between pre- and post-test<br />Significant decrease in time spent sitting (p=.034), but only for control group<br />Low attrition (6%)<br />2/3 highly satisfied with the programme<br />Constant high motivation levels for PA participation <br />PROBLEMATIC<br />Low survey response rates, comparable with other studies<br />Low participation<br />Over-reporting in PA levels (IPAQ-L issue)<br />1/3 did not read all messages<br />50<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />Careful! Further investigation is needed!<br />
  71. 71. Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />52<br />
  72. 72. Problemsencountered<br />MAIN PROBLEMS<br />Low participation<br />Low survey response<br />POSSIBLE CAUSES<br />Environmental: H1N1, seasonality<br />Organisational: Other ongoing WHPP Low endorsement<br />Individual: time, workload, other priorities<br />Technical: firewalls, computer access<br />Promotion: low budget<br />53<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />HRA (i.e. high resp. burden)<br />Survey instrument<br />
  74. 74. Social Marketing Benchmark Criteria<br />
  75. 75. Possible improvements<br />1) Customer orientation. Design and develop the intervention with worksites. More thorough formative research<br />2) Exchange. Tangible incentives => fairer exchange<br />3) Competition. Thorough analysis of all forms of competition (competing behaviors, barriers, other programmes, etc.)<br />4) Segmentation. Appropriate target segmentation<br />
  76. 76. DISCUSSION<br />
  77. 77. Discussion: some open questions<br />Is the intervention reaching those most in need?<br />How much communication is needed?<br />Why some people subscribe (or not)?<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />58<br />
  78. 78. THANK YOUFOR YOUR ATTENTION!<br />Marco<br />
  79. 79. References – 1 <br />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.<br />Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50, 179-211. <br />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. <br />Cavill, N., Kahlmeier, S., & Racioppi, F. (2006). Physical activity and health in Europe. World Health Organization. Regional Office for Europe. Retrieved from<br />Centers for Disease Control and Prevention - CDC (2007). The importance of Physical Activity. Fact Sheet. Retrieved September 10, 2007 from: <br />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. <br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />60<br />
  80. 80. References – 2<br />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.<br />Lloyd, S. (2009). The North East Better Health at Work Award. Basesconference. Leeds, 1-3 September 2009.<br />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. <br />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. <br />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. <br />World Health Organization -WHO (2006). Physical activity and health in Europe: evidence for action. Available from:<br />Nottingham, 9/04/2011<br />© Marco Bardus, ICIeF<br />61<br />