The document summarizes a workplace health promotion program called MoveM8 that uses email and SMS messages to encourage employees to be more physically active. It is a 12-week randomized controlled trial involving 19 UK organizations. The program aims to examine the effects of additional SMS on physical activity levels and psychological constructs related to behavior change. Preliminary data on the 393 participants found moderate baseline physical activity levels but also high sedentary behavior. Recruitment and retention of participants proved challenging. Open questions remain about how much and what type of communication is needed to effectively change physical activity behaviors.

1. E-mail and SMS forWorkplace Health Promotion:the MoveM8 programme EpiDay 2010, 26 May - Lugano Marco Bardus Institute for Public Communication and Education (ICIeF) marco.bardus@usi.ch

2. Overview E-mail and SMS for Workplace Health Promotion: the MoveM8 programme BACKGROUNDPhysical inactivity, workplace health promotion what is MoveM8, why is set and where? METHODSStudy design, recruitment strategies PRELIMINARY DATA Sample description, baseline data LIMITATIONS Recruitment challenges DISCUSSIONQ&A FOCUS ONCommunication& promotion strategies 2 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

3. Physicalinactivity Whyshouldwe care? © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 3

4. 4 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

5. Problems related to physical inactivity 600,000deaths/year in Europe - 5.3 million years of healthy lives + healthcarecosts Leading risk factor of: heart diseases, diabetes, cancer, depression (WHO, 2006; CDC, 2007) 5 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

6. Physicalactivityin workplaces Whyisitimportant? © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 6

7. 7 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

8. Physicalactivitity in workplaces Workplaces are a promising setting for health promotion (Pronk et al., 2009) Promoting physical activity in the workplace is advocated by key government policies (e.g. Choosing Health White Paper, DoH, 2004) Engagement in workplace health programmes varies from 10% to 64%, with a median of 33% (Robroek et al., 2009) © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 8

9. Business case for an employerin Stockton-on-Tees * * Source: Lloyd, S. (2009). “The North East Better Health at Work Award”. Basesconference. Leeds, September 2009 9 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

10. 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 This business case led the organisation’s boardto accept proposals around initiatinga workplace health programme 10 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland * Source: Lloyd, S. (2009). “The North East Better Health at Work Award”. Basesconference. Leeds, September 2009

12. positive impact on stress, back pain, mental health

13. increased productivity and lower rates of absenteeism

14. quicker return to work after illness

15. fewer injuries, less illnesses

16. improvements in communications, morale andworking atmosphere

17. positive corporate image© Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 11

18. Whatis MoveM8? The programme in a nutshell © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 12

19. The programme in a nutshell MoveM8 is a 12-weeks e-mail and SMS programme aimed at encouraging employeesof participating UK organisations to becomemore physically active. It is part of research project approved by the University of Nottingham (UK) Medical School Ethics Committee. The programme started in September 2009 and will end in August 2010. © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 13

21. Dow Chemical Company Ltd., Middlesborough

22. Vopak Terminal Teeside Ltd., Middlesborough

23. Redcar & Cleveland BC, Middlesborough

24. Stockton Riverside College, Stockton-on-Tees

25. Cummins, Stockton-on-Tees

26. HMP Holme House, Stockton-on-Tees

27. 3M, Northalleton

28. Leeds Metropolitan University, Leeds

29. Age Concern Calderdale & Kirklees, Halifax

30. Astbury Digital, Asthon-under-Lyne

31. Tameside MBC, Asthon-under-Lyne

32. Two Trees Tameside Sport College, Tameside

33. Liverpool Chamber of Commerce, Liverpool

34. University of Nottingham, Nottingham

35. De Montfort University, Leicester

36. Equity Direct Broking Ltd., Colchester

37. Vodafone Group Services Ltd., Donnington

39. MoveM8 asresearch project © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 16

40. Study objectives Examine the effects of additional Short Messaging Service (SMS) to the weekly e-mail communication on physical activity behavior and Theory of planned behavior (Ajzen, 1991) main constructs. © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 17

41. Theoretical basis Positive effects of e-mail in workplace health promotion (Plotnikoff et al., 2005) Mobile phones have been used to promote PA (Fjeldsoe, Marshall, & Miller, 2009) The Theory of Planned Behavior is adequate for describing physical activity behavior (Armitage & Conner, 2001) 18 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

42. Study design RANDOMIZED CONTROLLED TRIAL WITH TWO STUDY GROUPS: GROUP 11 weekly standardized & personalized e-mail. GROUP 21 weekly e-mail + 2 SMS. The e-mail and SMS are standardized & personalized. 19 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

43. Study design 2 RANDOMIZED CONTROLLED TRIAL WITH 4 STUDY GROUPS: GROUP 11 weeklypersonalisede-mail. GROUP 21 weeklypersonalised e-mail + 2standardised SMS. GROUP 31 weeklypersonalisede-mail – told to be tailored. GROUP 41 weeklypersonalised e-mail + 2personalised SMS. 20 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

44. Anticipated outcomes PRIMARY OUTCOME Increase in PA level: time spent, frequency and intensity[full IPAQ questionnaire] SECONDARY OUTCOMES Changes in the TPB constructs (Attitudes, Subjective Norms, Perceived Behavioral Control and Intention) and the level of perceived message relevance[validated TPB questionnaire] Outcomes will be measured by comparing baseline assessments with the 4 follow-up assessments (by the end of August 2010) © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 21

45. Letus focus on Recruitment © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 22

46. The MoveM8 identity © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 23

47. 24 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

49. Incentives(Nike Sport kit lottery, benefits for the organisation)25 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland RECRUITMENT STEPS

50. Recruitmentresults Some data toleadourdiscussiontoday © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 26

51. Sample description(abstractfrombaseline data) Organisations: 19 (of different size) Sample size: 393 Average age: 39.4 yrs Gender: female (78.9%) Health status: good (47.8%),very good-excellent (38.7%) Motivation to increase PA*: mean=7.3 Self-efficacy*: mean=6.4 * Measured through a 10-point scale 27 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland

52. Physicalactivitybehaviour* JOB-RELATED PA (n=189) 78.4% no vigorous , 71% no moderate, 50.1% no walking Median energy expenditure: 573 MET-min/week (IR=1276.75) LEISURE TIME PA (n=321) 56.5% no vigorous, 71.8% no moderate, 65.1% report walking. Median energy expenditure: 600 MET-min/week (IR= 1647.25)=> moderate level SEDENTARY BEHAVIOR (n=362) 7 hours/day (average sitting time=421.7minutes/day) * IPAQ guidelines for data processing and analysis © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 28

53. Drop-outrates © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 29

54. Is communication enough? Some problems & limitations © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 30

55. Problemsencountered Participation rate Survey response rate: 61%-29% (1st-4th FUP) SOME POSSIBLE EXTERNAL MODERATING FACTORS Swine Flu (death in Nottingham)=> less participation Health Risk Assessment before programme=> increased respondent burden Other ongoing health programmes=> less recruitment effetiveness Low budget for promotion © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 31

56. MoveM8ing forward Whatcouldhavebeendonebetter? © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 32

57. Some open questions Howmuchcommunicationisneededbeforewechange? Why some people subscribetotheseprogrammes and othersnot? Whatpromotionalstrategieswould work better? © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland 33

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

59. REFERENCES 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. 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. 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. 35 © Marco Bardus, ICIeF, Università della Svizzera italiana, Lugano Switzerland