Push Play media campaign � A key component of a comprehensive long term strategy to increase physical activity levels

Grant McLean, Senior Advisor (Research)

Sport and Recreation New Zealand (SPARC)



Introduction



This case study describes the social marketing component of a comprehensive long-term strategy to increase the level of physical activity among New Zealanders. The case study covers the Push Play media campaign promoting physical activity for health. The campaign aimed to raise awareness and concern about the need for physical activity. A number of integrated initiatives were progressively implemented to support physical activity behaviour change in the population.



The first phase of the Push Play social marketing campaign reported here delivered a generic message to a broad population target. The next phase, currently in development (2004/05), will focus more on priority target populations and deliver more tailored messages and initiatives. The generic messages will continue to be communicated to the broader population.



Background



Physical activity is a key factor in maintaining and improving health. A significant body of research, dominated by the United States Surgeon General�s report Physical Activity and Health (1996), clearly outlines the value of physical activity. The World Health Organization has identified physical inactivity as one of the biggest contributors to the global burden of disease. The National Health Committee Report Active for Life: A Call for Action (1998) and the report of the Physical Activity Taskforce (1998) recommended a multi-sectoral comprehensive approach to promoting physical activity for health. Physical inactivity was also identified as a health priority in the New Zealand Health Strategy (Ministry of Health, 2000).



Efforts to increase rates of physical inactivity are now seen to be just as important to population health as those to reduce blood pressure or control tobacco use (Bauman et al, 1999; US Surgeon-General, 1996).



The twin epidemics of obesity and diabetes are now affecting both developed and developing countries worldwide. These epidemics are thought to be largely due to the rapid changes in human lifestyles over the last century, which have lead to physical inactivity and unhealthy diets.



It is conservatively estimated that 2500 deaths in 1997 in New Zealand were attributable to physical inactivity (Ministry of Health, 2003). This is equivalent to 29,000 years of life lost per year, a figure five times the annual road toll.



One third of New Zealand adults (18+) and young people (5-17 years) are insufficiently physically active to protect their health, which equates to an estimated 200,000 young people and 900,000 adults at risk from physical inactivity. (SPARC Facts, 2003).





Formative research



The 1998 Physical Activity Taskforce recommended the development of a national mass media campaign to increase awareness of the health benefits of physical activity, as the first step in a comprehensive approach to increasing physical activity.



Subsequently, the campaign was developed in 1999. The aim was to model incidental and everyday forms of physical activity using ordinary New Zealanders.



Physical activity prevalence data (1997 and 1998 New Zealand Sport and Physical Activity surveys) helped guide the selection of the target populations for the Push Play campaign. These indicated that a broad generic focus was appropriate at this earlier phase of promoting physical activity.[1]



Target groups



1999-2000



� Primary: Males aged 30�54 years who are not currently doing enough physical activity and are conscious that they should be doing more (contemplators)

� Secondary: All adult New Zealanders



2001-2002



� Primary: All adult New Zealanders





Goals and objectives



The overall goal was to increase physical activity among the adult population from 64% to 70% by 2000.



The main objectives of the Push Play media campaign were to:

� increase awareness of the benefits of physical activity

� encourage people to think about becoming more physically active for 30 minutes per day

� ensure people understand that physical activity is fun, easy and can be built into daily life in many ways.



The campaign would be supported by a range of on the ground strategies that would provide the opportunity to increase physical activity levels.





Strategy



A media-led, community-wide intervention campaign was initiated by the Hillary Commission (now SPARC, Sport and Recreation New Zealand). The �Push Play� campaign recommends 30 minutes of daily, moderate-intensity physical activity as fun, part of community life, and easy to achieve for New Zealand adults. In addition, there were community-level and primary care supporting programmes and events.



The Push Play media campaign is just one strand of the overall umbrella strategy of the Push Play campaign which includes a number of national programmes that are also delivered regionally primarily through Regional Sports Trusts (effectively the delivery arm of the former Hillary Commission and SPARC). These include:



� Green Prescription (since 1999): Green Prescription involves general practitioners with the support of practice nurses, and encourages GPs to use a green prescription (written/verbal advice) to motivate patients to be more physically active. Patients are offered motivational support and access to programmes through regional sports trusts (RSTs).



� He Oranga Poutama (since 1997): is delivered by kaiwhakahaere (coordinators) usually based within RSTs, and comprises sport and physical activities, including many traditional and culturally relevant Māori activities centred around the marae.



The geographically diverse RSTs work with local public health agencies and non-government providers around local events, including Push Play Day (an annual day set aside to promote physical activity).





Implementation



Push Play Brand



The Hillary Commission brief for the Push Play media campaign was to make active living a part of the Kiwi lifestyle. The initial idea behind the Push Play brand was to give inactive people a �jolt� out of their comfort zone so they would be more receptive to the message. Once the brand had peoples� attention it would provide a range of motivators and solutions to get people more active. The key notion was that �daily physical activity is easy, fresh, fun, family-based, good for you and part of the Kiwi lifestyle, therefore �be a part a of it.�





Campaign launch

The �Push Play� campaign was launched in 1999 with two fifteen-second silent commercials that showed a person in sedentary pose with signal distortion lines across the screen and a written message �Do not adjust your set, adjust your life�.



These were followed by a longer message showing a variety of New Zealanders making choices to include physical activity in their lives. Humour was used and illustrated people having fun and enjoying various forms of daily life physical activity; including playing with their families, using the stairs, mowing the lawn and walking the dog. One image that gained particular attention was a large man walking a pig on a leash. The consistent campaign logo was �Push Play� with the green play button logo modelled on a �play� button of a video recorder, suggesting people make a start to become more active. Each activity reflected a part of daily life, but showed an exercise title that could be associated with it, such as �aerobics� for a group of Tongan women dancing and �weightlifting� for a man picking up his children.



In 2001, the campaign featured new commercials, some that built on earlier stories (for instance, the man was rowing a boat with the pig in the back of the boat) and had the message �Push Play 30 minutes a day�.



The Hillary Commission and, more recently, SPARC coordinated the campaign, which comprised major media, as well as specific resources and merchandising supporting the campaign. In major cities there were Push Play billboards, and, nationally, there were radio elements, magazine promotions, billboards and a national Push Play Day celebrated on the first Friday of November 2001, 2002 and 2003.





Measurement



At the conclusion of each media campaign national surveys were conducted to measure the level of awareness of the advertisements. In the early phases the emphasis was on awareness of the brand, and in the later phases both awareness and levels of understanding of the message.



Annual cross-sectional population surveys (1999�2002) monitored the impact of the campaign on message awareness, recognition of the Push Play logo, intention to be active, and recent activity.



In addition, process evaluation data were analysed to assess media penetration, based on media marketing estimates of the number of times people are likely to have seen a particular message. For each phase of the campaign, there were sufficient media purchased to reach almost all adults at least once, and for them to have seen a Push Play message approximately five to eight times. This level of penetration suggests sufficient implementation of the media element of the Push Play campaign.




A) Process evaluation results



Initial campaign analysis provided on the basis of Saatchi & Saatchi media reports.



1999 Post analysis



For the first phase of the Push Play television campaign the target market was primarily middle-aged males (30-54 year olds) and secondly the general adult population.



The launch of the campaign in this first phase (1a) involved a �flight� of 2 x 15� �teaser ads� which ran for eight days and then (phase (1b) five weeks of a 60� ad Push Play 1 (with the main Push Play messages). The adverts were �dog walking� and �pig walking�. They were played on national television channels TV One and Two (83% and 17% respectively). 90% of broadcasts were during peak hours. A total of 185 spots were run during flights in April/May and September/October. There were minimal supporting activities in the first year.



Total TARPs (Target Audience Ratings Points) for the first wave were 649 with 87% of the target audience reached one or more times, 78% three or more times with the average frequency of viewing being 7.4.



2000 Post analysis



In the second phase the Push Play media campaign continued with flights of the 60� second commercial in January/February, April/May and September/October (during the Olympics). Again Push Play 1 was aired. 30-54 year old males were the primary media target. 88% of the target audience were reached on one or more times and 61% three or more times. The Push Play campaign was reviewed during the 2000 year and the addition of radio and community service billboard placement were considered.





2001 Post analysis



For the third phase of the Push Play media campaign the general adult population was targeted. In 2001 the campaign included a mixture of the existing 60� and 15� ads, which ran between January and April, and a new 60� ad run in October/November and a 15� ad developed for national Push Play Day in November. New adverts were developed including the �pig in a boat� and Pacific aerobics. In 2001 the television advertising was supported by the placement of Push Play advertising in major magazines with national coverage, radio adverts and also billboards in Auckland, Wellington and Christchurch (three of the major cities). Total TARPs for the third phase were 296 with 61% of the target audience reached one or more times, 39% three or more times with the average frequency of viewing being 4.9. All adverts were played on TV One.



2002 Post analysis



For the fourth phase the target market was again the broad adult population. Total TARPs were 576 with 84% of the target audience reached one or more times, 64% three or more times with the average viewing frequency of 6.8. The adverts were played on TV One and TV Two (85%, 15%).



B) Population awareness survey evaluation



A scientific review of the impact of the entire media campaign was undertaken by an international researcher, SPARC and other researchers involved in Push Play to provide a robust assessment of the post-campaign awareness survey data from 1999-2002.



The key elements of the analysis are summarised below and the detailed evaluation is available on the SPARC website: http://www.sparc.org.nz/research/pushplay.php





Components of survey analysis



Awareness

In measuring the impact of media campaigns, the most important initial elements are to establish community awareness of the campaign, understanding of the message, and specific �tagline� or logo recognition.8,9 These are referred to as proximal or immediate effects directly related to the advertising elements of the campaign. This was assessed through standard questions for media campaign evaluations, including whether respondents had seen �any message on TV about getting more active�, whether they specifically recalled the Push Play advertisement (prompted recall), whether they recalled the Push Play logo, the green �play� button, and whether they liked the media messages they had seen (from �love it� to �hate it�). In addition, open-ended questions were asked to clarify exactly what had been seen or recalled in the ads. A summary �positive exposure� measure was constructed from the responses of those who had seen a message, had seen Push Play, recognised the logo, and liked the message.



Intention/behaviour change

The next levels of measurement included what respondents had thought or done in response to the campaign.8 These were divided into two categories: (1) responses that related to intending to or preparing to get more active (thought about, talked about or started getting more active in response to the messages); and (2) responses that involved contacting an organisation (phoned 0800 number, contacted an RST, contacted another organisation or visited web site). Finally, respondents were asked the number of days in the previous week that they were physically active for at least 30 minutes; responses were categorised into those reporting less than or at least 5 days in the past week.



Results



� The campaign was successful in increasing awareness - the main objective of the campaign. There were substantial increases in awareness of the Push Play message (30% in 1999 to 57% in 2002, p <0.001, and of the Push Play logo (14% to 52%, p <0.001)

� In addition to the main objective there were significant increases in the intention to be more physically active (1.8% in 1999 to 9.4% in 2002).

� While there were no sustained changes in physical activity levels there were some increases within years (changes in physical activity level were not an explicit objective of the mass media campaign):

o Across the surveys, in 1999 38.6% of the 1999 sample reporting 5+ days activity per week, increasing to 44.5% in 2000, but declining to 38.0% in 2002. The difference in physical activity levels from 1999 to 2000 only was significant (difference 5.8%, 95% CI 0.1% to 11.6%). In an unrelated, much larger population survey, a 3% increase in physical activity participation was noted among adults between 1997 and 2001.



The national Push Play campaign resulted in increases in message recognition, and in intention to become more active. If sustained, efforts like this may have a long-term impact on adult activity patterns, leading to improved health outcomes and reduced health costs. The international norm for media campaigns is that approximately half the viewing audience may recall seeing the campaign message and only half of those may understand it. On this basis alone the campaign to date can be classified as successful.



Summary of evaluation: Phases of the Push Play (PP) campaign and their evaluation



Year/

phase
Main media elements (month, year)
Supportive activities
Process evaluation � measures of TARPS (media density)* � percentage who saw at least one message and mean number seen
Population surveys sample size and timing

1999

Phase 1a

Phase 1b
Teaser ads

Mar/Apr 99;

Main PPI messages

May 99 and Sept�Nov 99
Minimal
1a: 87% of target audience reached at least once, mean 7.8 times

1b: 78% reached at least once, mean 7.4 times
n = 665 randomly sampled adults 18+ years

Survey in two halves May and June 1999

2000

Phase 2
PP1 ad �dog walking/pig walking� message

Jan�Feb, Apr, Sept�Nov 00
Ancillary events and additional components throughout year
88% of target audience reached at least once
n = 506 adults 18+ years

May 2000

2001

Phase 3
PPII message with Pacific aerobics/pig in boat

Jan�April, Sept�Nov 01
Ancillary events Jan�Feb, Nov�Dec 01

Push Play Day 9 Nov
61% reached at least once, mean 4.9 times
n = 504 adults 18+ years

February 2001

2002

Phase 4
PPII ad repeated

Jan�Apr, Nov 02
Ancillary events Jan�Feb 02

Push Play Day 9 Nov
84% reached at least once, mean 6.8 times
n = 507 adults 18+ years

March 2002


Note: the full results of the evaluation of the Push Play mass media campaign have been published in the New Zealand Medical Journal at this link: http://www.sparc.org.nz/research/pushplay.php. Also details of the Obstacles to Action study are also available at the SPARC website.



Lessons learned



Over the first four years of the Push Play mass media campaign the social marketing initiative has been successful in reaching the general adult population and increasing awareness in this broad population group.



The evaluation has reflected that mass media campaigns complemented by on the ground programmes can be effective in raising and maintaining community awareness of the importance of physical activity to health, along with increasing the intention to do more physical activity.



The evaluation highlights that it is important to run media campaigns over a number of years to keep the message in the public consciousness.



Lastly, the findings of the evaluation underline that it is critical to commit to comprehensive evaluation of social marketing campaigns to assess and track their effectiveness over time.



Where to from here?



Raising awareness (supported by on the ground strategies) among the more general adult population was a useful first step in working to increase the physical activity levels of New Zealanders. While a generic component will continue to be delivered (and monitored) the next phase has been to identify harder to reach populations and develop social marketing and other strategies to support these groups to be more physically active.



As noted the evaluation had suggested that the generic Push Play campaign was able to move people (the early adopters � or low hanging fruit) from contemplation to intention, and in some cases trialing the behaviour (although was not sustained). Now the focus needs to turn towards (a) both getting to the harder to reach sections of the population and; (b) to move those who have already begun the dynamic journey through the stages of behaviour change model to the trialing and maintenance stages.



This is what SPARC�s next phase of media advertising will build on, although there will be a need to build awareness for those who are yet to reach the contemplative stage.



SPARC has already begun this next phase. The comprehensive Obstacles to Action study conducted in 2003 provided the research base for this next phase and will be reported in a separate case study Obstacles to Action.



Agencies used



Saatchi & Saatchi, television campaign development (1999 to 2001)

National Research Bureau (NRB) surveys (1999 to present)

PS Services, survey analysis and reporting (2002 to present)

Young and Rubicam advertising (September 2003 to date)





More information



SPARC (Sport and Recreation New Zealand)



Contacts:



Information on the Push Play programme:



Jo Cheatley

Advisor, Active Communities

Participation Unit

SPARC ihi Aotearoa

DDI: (04) 496 3979

www.sparc.org.nz





Evaluation of Push Play:



Grant McLean, Senior Advisor (Research)

Policy & Research Unit

SPARC ihi Aotearoa

DDI: (04) 498 2951

www.sparc.org.nz