MESSAGING WORKBOOK

for the

PHYSICAL ACTIVITY INTERVENTION POLICY FRAMEWORK

Prepared for the Ontario Ministry of Citizenship, Culture, and Recreation

and the Ministry of Health

@ Queen's Printer for Ontario, 1995

INTRODUCTION

This workbook is for use by members of the Messaging Workgroup. Each member will complete the workbook in preparation for the January 30 and 31, 1996 consultation. Workgroup members may solicit feedback from people outside the workgroup and consolidate the input with their own.

Completed workbooks will be used as the basis for discussion on January 30th. The workbook is divided into the following sections:

A. Facts and Stats

This section provides a synopsis of the research and analysis undertaken as part of this project. The stats and facts provide background information to help you do the analysis and priority setting of strategies. Two types of information are included: what we know from research and analysis and where we are now.

B. Analysis

This section is for you to complete, using the information provided in Facts and Stats and your own knowledge and experience. This section begins with an analysis of the Messaging setting. After reviewing the examples provided, you are asked to identify other key restraining and supporting factors. What are the major factors or forces in the area of messaging which are preventing Ontarians from being active? What are key factors in the area of messaging that support the promotion of physical activity?

Once you have done this analysis, you are asked to review the Priority Strategies for feasibility, impact, pitfalls and supports needed for implementation.

C. Priority Strategies

Finally, using your analysis, please do a priority rating of the strategies and identify your top three choices.

The last page of the workbook contains the names and addresses of your colleagues in the Messaging workgroup. Your workgroup will reach agreement on strategies to be included in the Ontario Physical Activity Intervention Policy Framework at the January meeting. This information will be used by government officials to prepare a Cabinet Document to support physical activity. Your input is needed and appreciated.

A. FACTS AND STATS

What We Know: The Literature

Population Benefits

ù Physical activity contributes to optimal growth and development in children.

ù Childhood is an important time to lay the foundation for future health. Regular physical activity helps to maintain appropriate body weight, reducing the risk of childhood obesity. It also reduces the risk of coronary heart disease, rooted in childhood activity patterns.

ù Physical activity plays a significant role in primary and secondary prevention as well as in rehabilitation and treatment.

ù Physical inactivity is one of four primary risk factors of coronary heart disease. Physical activity is prescribed for rehabilitation of heart disease.

ù Physical inactivity represents the same degree of risk for coronary heart disease as smoking. A greater reduction in overall risk among Ontarians is expected if the inactive became active than if all smokers quit smoking, and all hypertensives became normotensive.

ù Physical inactivity is associated with increased risk of chronic disease and conditions: type II diabetes; site specific cancers, especially colon cancer, with emerging evidence for breast and lung cancers; back pain; osteoporosis; hypertension; obesity; anxiety; depression; and stress. It protects against the increased risk of cardiovascular disease associated with type II diabetes.

ù Physical activity plays a primary and secondary role in preventing acute back problems, and is effective in treating lower back problems.

ù Physical activity contributes to the management of other risk factors to poor health Ä particularly high blood pressure and obesity.

ù Physical inactivity increases the risk of premature death. Physical activity adds as much as two years to average life expectancy. Physical activity compresses the period of impairment and morbidity associated with aging, leading to increased quality of life. Furthermore, physical activity can increase vigour and clear-mindedness.

ù Older adults can achieve benefits from becoming physically active. They can increase their cardio-respiratory function, build muscular flexibility, strength, endurance, and mobility.

Behaviour

ù People are easier to reach at settings that are appropriate and convenient to them. Thus, settings have a key role in reaching inactives Ontarians.

ù For children and youth, physical activities should: include large muscle groups; cover a good range of motion; be dynamic, weight-bearing; be of moderate to high intensity and performed regularly.

ù Activities which build self-efficacy have been shown to have carry-over effects into other activities. Appropriate physical activities can build self-efficacy and self-esteem.

ù Activity patterns of children and youth is a determinant of future health, e.g., bone mass, propensity for obesity, some evidence role in breast cancer.

ù Daily physical activity may contribute to improved cognitive functioning. Positive social behaviours can be increased through participation in physical activities, designed to enhance life skills.

ù Parent's knowledge and motivation can limit the activity level of children and youth.

ù For adults, the total amount of energy expended in doing physical activity appears to be more important a factor in achieving health benefits than the frequency, intensity and duration of the activity.

ù Generally, participation in physical activity every other day for a total of 30 minutes is recommended to achieve benefits.

ù Many different types of activities achieve health benefits. These include taking the stairs over elevators, exercise breaks, active commuting, special events, fitness programs, home exercise routines and so on.

ù Changing behaviour is a complex task, involving an individual's decision making process and readiness to change.

ù Factors such as attitudes, behavioural control, self-efficacy, and behavioural intention are involved in an individual's decision-making process.

ù The change process has been characterized by five stages of readiness (precontemplation, contemplation, preparation, action, maintenance).

ù An individual may be at one stage for one type of behaviour, and at a different stage for another behaviour. For example, an individual may be at the maintenance stage for walking regularly, and be at contemplation stage for more intense activity.

Initiatives

ù A majority of strategies have developed a mass media component, targeted at the general public, supplemented by a variety of specific messages, targeted at specific groups, within specific settings. Research suggests that mass media campaigns may constitute an integral component of a balanced strategy designed to encourage behaviour change.

ù A variety of physical activity patterns should be encouraged, including those easily incorporated into daily living. Physical activities should be relatively easy to do so that they build self-efficacy.

ù Interventions to increase adherence to exercise classes were successful when geared to enhancing self-efficacy. These have had carry-over effects to other activities. The results can likely be generalized to any structured intervention.

ù Tailoring an intervention to the stage of readiness for the desired behaviour, increases the likelihood of adoption. Because activity adoption is cyclical, this model is also useful for preventing drop-outs.

ù Experiential processes are more appropriate in earlier stages of behavioural change, and behavioural processes in the latter stages.

ù In addition to changing individual behaviour, strategies are needed to make social and physical environments more supportive of physical activity. Community strategies can affect social systems that influence people's lives.

ù Messages should be tailored specifically to different population segments, be complementary and build on one another. To increase effectiveness, messaging should consider age, lifestage, demographics, ethnicity, and stage of change.

ù Incorporating a variety of models for changing behaviour into the design of initiatives, helps to develop comprehensive, well-integrated messages for various segments.

ù Information should be provided through multiple channels to increase synergy and opportunity for success. Mass media is important in early stages, becoming an effective adjunct for multi-faceted initiatives in latter stages.

ù Interventions based on the stages of change model have proven successful for providing targeted messages through doctor's offices. For interventions addressing tobacco use and nutrition, self-help materials are being developed using the stages of change. The target audience is selected by screening questions or by 'narrow casting' in the media.

ù Integrated strategies should be developed for communication (to change attitudes and levels of motivation), environmental changes (to create supportive social and physical environments), and provision of supports (to create community mobilization).

ù Information campaigns to improve knowledge of the benefits of physical activity and the development of positive attitudes have been successful in promoting behaviour change in the short term. Interventions geared to building a supportive social environment through increasing social support from family and friends have shown success.

ù Approaches should be integrated across levels and sectors since coordination enhances efficiency. Schools, workplaces, health units, recreation system and neighbourhoods should be linked through initiatives and these coordinated within broader initiatives.

ù Healthy public policy should be aimed at developing supportive social and physical environments, such as making stairways more convenient.

ù Strategies need the endorsement of Ministers and key leaders to add support and legitimacy.

ù Mobilizing community opinion leaders and organizing coalitions provides social and structural support.

ù Other strategies addressing risk factors should be linked to a physical activity strategy since changes in one behaviour can influence changes in another.

Where We Are: Current Status

Population

ù Inactivity is pervasive in Ontario, affecting individuals from all age groups, both genders, and all income and education levels. More women are inactive than men. Lower income earners and those with lower education levels tend to be inactive.

ù More children and youth are active than adults.

ù The majority of children and youth are not active enough to lay the foundations for life-long health. That is, they are not active at levels recommended for optimal growth and development.

Behaviour

ù Those who are inactive tend to be characterized by:

-negative attitude toward vigorous activity and do not intend to exercise

-physical activity is not that important to them

-lack encouragement from family and friends to be active; friends are inactive

-one of the strongest predictors of inactivity is participation of friends

-lack energy and self-discipline, lack ability, and feel ill at ease

-lack control over their choice to be active

-face time pressures due to family

-have unhealthy lifestyle behaviours, e.g., smoking, overweight, stress

-are less healthy than active Ontarians

-believe they will develop health problems later in life

-visit the doctor more frequently

-take more time off work or school

-are more likely to live in smaller communities (under 75,000)

-the greater the age, the lower the level of activity.

ù There is a significant decrease in the general level of activity between younger and older teenagers.

ù Only a small percentage of youth are active enough to achieve the benefits associated with optimal growth and development.

ù About one in five children may be considered to be inactive. Significantly fewer girls are active compared to boys.

ù About one third of adults are active enough to benefit their cardiovascular health.

ù There is a clustering of healthy behaviours; i.e., increased levels of activity are associated with other healthy behaviours such as not smoking.

Initiatives

ù All Ontarians could benefit from an understanding of the benefits of physical activity, and the risks of inactivity.

ù Given the strong effect of friends' participation, it can be used in marketing physical activity.

ù It is important to deal with real barriers (e.g., environmental and policies) and perceived barriers (e.g., how to integrate physical activity into daily life, and that the benefits outweigh the costs).

ù In order to promote the benefits and the desirability of physical activity, three things would be useful: social marketing which targets individuals, decision makers, influencers (teachers, physicians), and settings (e.g., schools, workplaces); professional education and training materials; and policy and environmental supports.

ù Given the popularity of low-cost, unstructured activity, there is a need for a system of clear messages for individuals to gauge their activity levels. This will allow individuals to regulate their own activity level, increase their self-efficacy and provide feedback on their efforts.

ù Community-based interventions should link to other health promotion strategies and to the Healthy Communities movement.

ù All Ontarians could benefit from receiving information and self-help materials provided through initiatives at the community level.

ù All Ontarians could benefit from having information to help them assess their risk, and what to do to reduce risk

ù A wide variety of promotional and awareness-building activities are happening in Ontario, including:

- information articles on Quality Daily Physical Education

- media releases for pre-school physical activity awareness

- ParticipACTION public service campaigns

- safe boating campaign

- educational campaigns on risks for cardiovascular disease and stroke

- Summeractive information campaign.

B. ANALYSIS

i. Force Field Analysis

In analyzing the entire area of Messaging, identify those factors or forces which restrain or prevent physical activity, and those which support or sustain physical activity.

Restraining Factors

Sustaining Factors

e.g. many settings do not promote the benefits of activity and the risks of inactivity.

e.g. the information about the risks of inactivity are acknowledged by many health organizations

ii. Analysis of Priority Strategies

The following priority strategies have been suggested by the research and analysis phase, and by the November consultation. Please feel free to make additions and modifications.

1. That clear messages be developed so that individuals can gauge their activity levels. This will allow individuals to regulate their own activity level, increase their self-efficacy and provide feedback on their efforts.

2. That messages be appropriately targeted at different types of media; and these messages be consistent and reinforce each other.

3. That messages be tailored to specific audience segments, considering age, lifestage, demographics, ethnicity, and stage of change.

4. That the media be used for public education, to create synergy with other information strategies and provide reinforcement for face-to-face initiatives.

5. That the media be used to provide information that increases social support, assists in self-help and provides cues to action.

6. That the media be used as a precursor to policy change.

7. That, in addition to mass media, hotlines, direct mail, preprinted grocery bags, libraries, electronic information and other approaches be used.

8. That strategies be developed to link the health system with recreation and sport, so that health professionals can advise patients and clients of local programs and services related to physical activity.

9. That physical activity strategies be incorporated into existing health risk reduction strategies in Ontario.

10.

11.

Strategies should ensure a comprehensive approach to affecting change. When adding and analyzing strategies, keep the following information in mind:

CONSIDERATIONS FOR A COMPREHENSIVE APPROACH

Initiatives aimed at changing individual behaviour are insufficient for creating long-term behaviour change.

Integrated strategies should be developed for communication (to change attitudes and levels of motivation), environmental changes (to create supportive social and physical environments), and provision of supports (to create community mobilization). This can be accomplished through education, promotion, policy and legislation and capacity building strategies.

In addition, review the initiatives section of Where We Are and your restraining and sustaining factors, before answering the following questions on each strategy:

a. Is this feasible and realistic to implement? Yes ___ No ___ Why?

b Will implementation of this strategy make a significant difference in making Ontarians more active? Yes ___ No ___ Why?

c. What are potential pitfalls in implementation of this strategy?

d. What supports will be needed for effective implementation of this strategy?

e. Add any thoughts you have about roles and responsibilities for implementing this strategy.

Strategy 1: That clear messages be developed so that individuals can gauge their activity levels. This will allow individuals to regulate their own activity level, increase their self-efficacy and provide feedback on their efforts..

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 2: That messages be appropriately targeted at different types of media; and these messages be consistent and reinforce each other..

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 3: That messages be tailored to specific audience segments, considering age, lifestage, demographics, ethnicity, and stage of change..

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 4: That the media be used for public education, to create synergy with other information strategies and provide reinforcement for face-to-face initiatives..

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 5: That the media be used to provide information that increases social support, assists in self-help and provides cues to action.

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 6: That the media be used as a precursor to policy change..

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 7: That, in addition to mass media, hotlines, direct mail, preprinted grocery bags, libraries, electronic information and other approaches be used.

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 8:. That strategies be developed to link the health system with recreation and sport, so that health professionals can advise patients and clients of local programs and services related to physical activity.

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 9: That physical activity strategies be incorporated into existing health risk reduction strategies in Ontario.

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 10:

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

Strategy 11:

a. feasible? Yes ___ No ___ Why?

b. significant difference?

c. potential pitfalls?

d. supports needed?

e. roles and responsibilities?

C. PRIORITY STRATEGIES

Using your analysis on feasibility, impact, pitfalls and supports, rate each strategy according to priority. At the end of this section, identify your top three priority strategies.

Strategic Options

1 Highest priority

2 High priority

3 Middle priority

4 Low priority

5 Lowest priority

6 Not a priority

1. That clear messages be developed so that individuals can gauge their activity levels. This will allow individuals to regulate their own activity level, increase their self-efficacy and provide feedback on their efforts.

1 2 3 4 5 6

2. That messages be appropriately targeted at different types of media, and these messages be consistent and reinforce each other.

1 2 3 4 5 6

3. That messages be tailored to specific audience segments, considering age, lifestage, demographics, ethnicity, and stage of change.

1 2 3 4 5 6

4. That the media be used for public education, to create synergy with other information strategies and provide reinforcement for face-to-face initiatives.

1 2 3 4 5 6

5. That the media be used to provide information that increases social support, assists in self-help and provides cues to action.

1 2 3 4 5 6

6. That the media be used as a precursor to policy change.

1 2 3 4 5 6

7. That, in addition to mass media, hotlines, direct mail, preprinted grocery bags, libraries, electronic information and other approaches be used.

1 2 3 4 5 6

8. That strategies be developed to link the health system with recreation and sport, so that health professionals can advise patients and clients of local programs and services related to physical activity.

1 2 3 4 5 6

9. That physical activity strategies be incorporated into existing health risk reduction strategies in Ontario.

1 2 3 4 5 6

10.

1 2 3 4 5 6

11.

1 2 3 4 5 6

Your Top Three Priority Strategies

1. ______________________________________________

2. ______________________________________________

3. ______________________________________________

D. Messaging Workgroup

Dawn MacDonald, OPHEA

1185 Eglinton Ave E

North York, Ontario. M3C 3C6

O (416) 426-7120; Fax (416) 426-7373

Elizabeth Thorsen

SPHE, University of Toronto

320 Huron St., Toronto. M5S 1A1

O (416)978-5805;Fax (416)978-4384

e-mail: [email protected]

Roger Passmore

2039 Elmhurst Avenue, Oakville,

Ontario, L6J 1W9

O (905)844-1523

Charles Clayton

Health Promotion Branch

5700 Yonge St., 5th floor,

North York, Ontario. M2M 4K5

O (416)314-5487 Fax(416)314-5497

Francois Lagarde **

159, rue Meaney, Kirkland, Quebec H9J 3M8

Ms. Patty Clark **

Executive Director

O.A.S.E.S.

Ontario Sports & Recreation Centre

1185 Eglinton Avenue East

North York M3C 3C6

Dr. Art Salmon **

Participaction

40 Dundas Street W. Suite 220

TORONTO, ON

M5G2C2

** To Be Confirmed