Moving messages: building the evidence base on physical activity messaging to inform research and policy, and improve practice
Physical activity (PA) is a leading cause of non-communicable disease, and global PA trends are not improving. To address this, a systems approach has been advocated. Such an approach acknowledges that, alongside changes to the physical environment and policy, we must also target social and individual factors, such as social norms, perceptions, and awareness of PA benefits. The importance of such approaches is reflected in the World Health Organization’s Global Action Plan on Physical Activity (2018-2020). PA messaging is one approach that can target individual and social factors. PA messaging can be defined as “the overall process of creating and delivering physical activity messages”. PA messaging is a promising and scalable action that can be used to reach large numbers of people at a relatively low cost, help augment dissemination of PA research findings and guidelines, and may play an important role in a systems approach to improving population PA levels. Yet, existing evidence shows that PA messaging interventions to date have had limited effects on PA behaviour. Therefore, research to further our understanding of how to utilise PA messaging effectively is imperative to inform research and policy, and improve practice. This thesis aimed to (1) further our understanding of PA messaging and its role in improving population PA levels, and (2) contribute towards improving the PA messaging evidence base and practice. The first study was a scoping review that summarised what is known about PA messaging and highlighted research gaps by collating findings from 123 studies. Key findings included that PA messaging is complex and multidimensional in nature, with numerous concepts to consider when creating messages. Findings also supported (1) the use of positive and gain-framed messages, particularly focusing on social and mental health benefits, (2) the use of tailoring or targeting to individuals or groups, and (3) the use of formative evaluation, psychological theory, and social marketing principles. The first study also identified a need to organise the various PA messaging concepts into a usable format to encourage further understanding of this area and facilitate improved messaging practice. The second study therefore involved development of the Physical Activity Messaging Framework (PAMF) and Checklist (PAMC): tools which allow researchers, practitioners, and policymakers to design and plan evaluation for evidence-based and target audience-focused PA messages. Through a modified Delphi process, the PAMF and PAMC were revised and improved before ultimately gaining international expert consensus from a panel of 40 government officials and policymakers, healthcare and other professionals, and academics. The third and final study involved applying the PAMF and PAMC in a real world setting to develop targeted messaging recommendations to a specific population subgroup. In collaboration with a stakeholder (Northumberland Healthcare Trust, England), qualitative interviews were conducted with seven postpartum women to explore messaging preferences in line with the PAMF and PAMC. Potential message pathways and preferences in new mothers were identified, alongside key future directions for the PAMF and PAMC. Although unlikely to change PA behaviour on its own, PA messaging has an important role to play in a systems approach to improving population PA levels. There is clear evidence that this research has contributed to our understanding of PA messaging and informed PA messaging research, practice, and policy in the UK and beyond. Findings from study 1 informed communication of the UK Chief Medical Officer PA guidelines and was cited in the International Society for Physical Activity and Health’s eight investments that work for PA. The PAMF developed in study 2 has guided formative research for UK guideline communications and the dissemination strategy of the Canadian 24-hour movement guidelines. If the PAMF and PAMC are used consistently, they could improve PA messaging practice by encouraging evidence-based and target population-focused messages with clear aims and considerations of working pathways. They could also enhance the research base by harmonising key messaging terminologies, improving quality of reporting and aiding evidence synthesis.