The MoveM8 study evaluated strategies to promote physical activity in the workplace using email and SMS messages. Study 1 was a randomized controlled trial that involved sending weekly personalized emails plus two standard SMS messages per week to employees in the experimental group. Study 2 examined reasons for employee participation or non-participation through interviews. Preliminary results found a significant increase in job-related and leisure-time physical activity for the experimental group. However, the study also encountered problems with low participation and survey response rates. Overall, the MoveM8 intervention showed encouraging results but had limitations that could be addressed in a future version through improved formative research, incentives for participation, and consideration of competition from other programs or barriers.

1. Strategies to promote physical activityin the workplace: The MoveM8 study Stockton-on-Tees, June 2011 Marco Bardus Institute for Public Communication and Education (ICIeF) UniversitàdellaSvizzeraitaliana marco.bardus@usi.ch Scott Lloyd NHS Redcar & Cleveland Public Health Directorate scott.lloyd@northteespct.nhs.uk

2. BACKGROUND & RATIONALE

3. The research team Prof. L. Suzanne Suggs, Dr. Carolina Gross &Marco Bardus1 Dr. Holly Blake2 Scott Lloyd3 1Università della Svizzera italiana (University of Lugano) 2 University of Nottingham 3 NHS Redcar and Cleveland 3

4. 4

5. PHYSICAL ACTIVITYIN THE WORKPLACE

6. Why workplaces? Promising setting for health improvement(Pronk et al., 2009) 60% of waking hours spent at work (captive audience) Key Government policies (e.g. Dame Carol Black’s report) Employer benefits – e.g.physically inactive people are off work sick 27% more 6

7. RATIONALE

8. Rationale of the MoveM8 8

9. Evidence from the field E-health effectiveness (Bennett & Glasgow, 2009; Powell, 2010; Hurling et al., 2006; Ware et al., 2008) E-mail at workplace(Plotnikoff et al., 2005; van Wier et al., 2011) Mobile phones for behaviour change (Fjeldsoe, Marshall, & Miller, 2009; Krishna et al., 2009) TPB (Armitage & Conner, 2001; Armitage, 2007; Glanz, 2009; Montano & Kasprzyk, 2008) PA in workplaces (Abraham & Graham-Rowe, 2009; Merrill et al., 2011) 9

10. THE MOVEM8PROJECT

11. TWO STUDIES

12. The twostudies STUDY 1“THE INTERVENTION” September 2009-August 2010 STUDY 2“REASONS FOR PARTICIPATION” June 2011-July 2011 Stockton-on-Tees, 29/06/2011 12

13. OBJECTIVES & RQs

14. Objectives and RQs STUDY 1: THE INTERVENTION STUDY 2:REASONS FOR PARTICIPATION To examine the effects of addingtwo SMS to the email communication on: perceived message relevance TPB constructs (Attitudes, Subjective Norms, Perceived Behavioral Control, or Intention) physical activity behaviour To identify the reasons for participating in the programme (Reach). To examine individual characteristics impacting on participation. To identify organisational and environmental moderators (Implementation) To assess the impact at the organisational level (Maintenance). 14 What effects? How effective? Why? How effective?

15. METHODOLOGY

16. DESIGN

17. Design STUDY 1:THE INTERVENTION STUDY 2:REASONS FOR PARTICIPATION Group 1 (control) 1 weekly personalised e-mail Group 2 (experimental) 1 weekly personalised e-mail+ 2 standard SMS/wk FG-INT with employees (participants and non-participants) INT with health advocates of participating organisations Online survey: health advocates of non-participating organisations 17 RCT with twostudy groups Semi-structured interviews+online survey

18. INTERVENTION DEVELOPMENT

19. Intervention Development 19

20. Message themes and scheduling 20

21. Hi M8!The weekend is almost here. Y don't you plan for an activity you like doing? Just be sure to do it for at least 20-30 minutes. Get movin M8! (behaviour construct) Hi M8! Have u set a SMART goal for the week? SMART goals are Specific, Measurable, Attainable, Realistic, Time specific. Be SMART, start w/ small steps! (intention construct) Hi M8! There r many benefits of physical activity. Y don't u take advantage of 30 mins of moderate or 20 mins of vigorous activity almost everyday? (attitude construct) Hello, M8! How did u do over the weekend? Learn from what went well and what did not. Set yourself up for success this week. (perceived behavioural control)

22. RECRUITMENT

23. The MoveM8 identity

24. The MoveM8 identity 24

25. PARTICIPANTSAND SAMPLING

27. Dow Chemical Company Ltd., Stockton-on-Tees

28. Vopak Terminal Teeside Ltd., Stockton-on-Tees

29. Redcar & Cleveland BC, Redcar

30. Stockton Riverside College, Stockton-on-Tees

31. Cummins, Darlington

32. HMP Holme House, Stockton-on-Tees

33. 3M, Northalleton

34. Leeds Metropolitan University, Leeds

35. Age Concern Calderdale & Kirklees, Halifax

36. Astbury Digital, Asthon-under-Lyne

37. Tameside MBC, Asthon-under-Lyne

38. Two Trees Tameside Sport College, Tameside

39. Liverpool Chamber of Commerce, Liverpool

40. University of Nottingham, Nottingham

41. De Montfort University, Leicester

42. Equity Direct Broking Ltd., Colchester

43. Vodafone Group Services Ltd., Donnington

44. Zest People Ltd, Worthing26

45. 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 27 Sampling: RCT Sampling: Purposive

46. ASSESSMENTS

47. 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 > Change in 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 29

48. 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 (HR, H&S, OH etc.) 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 30

49. PRELIMINARY RESULTS

51. Gender: female (78.9%)

52. Education: higher degree (68.7%)

53. Work status: Full-time (84.5%)

54. Family status: Live with partner (67.7%), have kids (31.8%),single (29.5%), single parent (4.8%)

55. Health status: good (47.8%) very good-excellent (38.7)

56. BMI: mean=26.3 (SD=5.4; min=17.1; max=53.6)

58. Total PA decrease? One-way repeated measures ANOVA Non significant effect for time: Wilk’s Lambda = .915, F (2, 93) = 4.3, p = .16 34

59. Leisure-time and job-related PA Work. Statistically significant difference in PA scores at work across the three time periods for the experimental group. Chi square (2, n = 55) = 6.280, p = .043 Leisure time. Statistically significant difference in PA scores in leisure time across the three time periods for the experimental group. Chi square (2, n = 55) = 5.833, p = .054 35

60. DISCUSSION

61. Main findings: BL-FUP comparison ENCOURAGING RESULTS LIMITATIONS Positive significant increase injob-related and leisure-time PA between pre- and post-test for experimental group 2/3 highly satisfied with the programme Constant high motivation levels for PA participation Low survey response rates, (but in line with other studies) Low participation Over-reporting in PA levels (IPAQ-L issue, self report vs objective measures) 1/3 did not read all messages 37

62. Problems encountered MAIN PROBLEMS POSSIBLE CAUSES Low participation Low survey response Environmental: H1N1, seasonality Organisational: Other ongoing WHPP Low endorsement Individual: time, workload, other priorities Technical: firewalls, computer access Promotion: low budget 38 Survey fatigue Survey instrument Limited workplaces signing up (possible fear of research…)

63. Possible improvements to MoveM8 v2? 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 behaviours, barriers, other programmes, etc.) 4) Segmentation. Appropriate target segmentation 39

64. Discussion: some open questions Is the intervention reaching thosemost in need? How much communication is needed (dose response)? Why some people subscribe (or not)? How could SMS and/or emails improve traditional services/interventions (e.g. weight loss groups) 40

65. Potential interventions MoveM8 v2 Other behaviours Weight loss 5-a-day / diet Smoking Integrate with existing services -> more than appointment reminders Community based – using Mosaic market segmentation?

66. Communication channels: mobile phone

67. Communication channels: email

68. THANK YOUFOR YOUR ATTENTION!