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| Journal of the New Zealand Medical Association,
08-August-2003, Vol 116 No 1179
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Evaluation of the national ‘Push Play’ campaign
in New Zealand – creating population awareness of physical
activity
Adrian Bauman, Grant McLean, Deb Hurdle, Sue Walker, John
Boyd, Ingrid van Aalst and Harriette Carr
Efforts to increase rates of physical activity are now seen
to be just as important to population health as those to reduce blood pressure
or control tobacco use.1,2 A recent report
suggested that the population risk attributable to inactivity ranked second to
smoking among all preventable factors for New Zealanders, and was associated
with 8% of deaths.3 The most recent
epidemiological data suggest that it is regular, moderate-intensity physical
activity, not only vigorous activity, that confers most of the health benefits
for coronary heart disease and diabetes prevention, and for hypertension
control. Efforts to increase energy expenditure (as well as reduce energy
intake) are also required to stem the increasing population rates of obesity
seen in New Zealand and elsewhere.4
In New Zealand, efforts to address population levels of
inactivity have begun, with the establishment in 1998 of a national Physical
Activity Taskforce.5 The key population
recommendation was for adults to ‘accumulate at least 30 minutes of
physical activity on most, if not all, days of the week’. The Taskforce
recommended multi-sectoral strategies to increase physical activity, one of
which was to conduct a national media campaign to raise awareness of these new
guidelines. The Hillary Commission (now SPARC, Sport and Recreation New Zealand)
adopted this recommendation, and implemented the ‘Push Play’
campaign. This paper describes the impact of the first four years of this
initiative on proximal outcomes including campaign recognition, understanding,
and attitudes. Effort has also been made to examine the more distal outcomes of
contemplating and trialling the behaviour of being more physically
active.
MethodsCampaign
development The campaign was developed and focus tested in 1999 through
consultation with numerous population groups. The aim was to model incidental
and everyday forms of physical activity, through the portrayal of ordinary New
Zealanders. The main objective was to increase awareness of the benefits of
physical activity and to encourage people to think about becoming more
physically active. The messages used humour and illustrated people having fun
and enjoying various forms of activity, including playing with their families,
using the stairs, mowing the lawn and walking the dog. The campaign targeted all
adults, particularly the middle aged, and males (30–54 years) across New
Zealand.
The campaign 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’ (Phase 1a). These were followed by a longer message showing a variety of New Zealanders making choices to include physical activity in their lives (Phase 1b). 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 that built on previous ones (for instance, the man was now rowing a boat with the pig in the back of the boat) and had the message ‘Push Play 30 minutes a day’. ‘Push Play’ is a social marketing ‘brand’, designed to reflect positive values of being upbeat, fresh and clean, fun, Kiwi, and family based, and recommending lifestyle physical activity. The overall campaign design, development and implementation had an approximate total budget of $3 million over the four years 1999 to 2002. 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, and a national Push Play Day celebrated 9 November 2001 and 2002. Other national programmes were implemented under the umbrella of Push Play. These included the Green Prescription Scheme (since 1999) and He Oranga Poutama, a programme encouraging healthy, active lifestyles for Maori (since 1997). The Green Prescription Scheme 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). The geographically diverse RSTs worked with local public health agencies and non-government providers around local events, including Push Play Day. The Maori-specific programme, He Oranga Poutama, is delivered by kaiwhakahaere (coordinators) usually based within RSTs, and comprises sport and physical activities, including many traditional and culturally relevant Maori activities centred around the marae. Evaluation design, measurement and analysis Serial cross-sectional, population-based household surveys were used to assess the impact of Push Play. These are summarised in Table 1, which shows the specific Push Play messages used, the survey samples and the timing of surveys. The household surveys employed population sampling techniques, covering the 26 main urban areas, with 55 random start points being selected with a pre-set cluster of 9 to 10 interviews to be completed at each. An adult aged 18 years or above within each household was chosen (using the ‘adult with the last birthday’ to sample an individual within a household). The first survey was nested within the New Zealand Sport and Physical Activity Survey conducted by the Hillary Commission,6 and subsequent surveys were stand-alone household interviews. Response rates ranged from 64% to 70% across surveys. In addition, process evaluation data are shown in Table 1, which indicate the approximate media penetration, based on media marketing estimates of the number of times people are likely to have seen a particular message. For each phase, 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 suggests sufficient implementation of the mass media element of the campaign.7 Table 1. Phases of the Push Play (PP) campaign and
their evaluation
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 proximal or immediate
effects specifically of the advertising elements of the campaign. These were
measured using 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 (scored on a five-point Likert scale, from ‘love it’ to
‘hate it’). Open-ended questions were asked to clarify exactly what
had been seen or recalled. 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.
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. Analyses were performed of sample data weighted to the New Zealand adult population, and then reduced to effective sample sizes of 665, 506, 504 and 507 in each year (Tables 1 and 2). Analyses used SPSS 10.0, and included contingency and multi-way table analysis, and forced entry logistic regression to calculate adjusted odds ratios. Chi-square analyses and z-tests were used to measure the difference between independent proportions. Table 2. Demographic data (unweighted) from each
evaluation survey
ResultsThe demographic data in the
unweighted survey samples are shown in Table 2. There were slightly fewer males
in the 1999 survey (not significant). There were some ethnic-group differences
in the samples, with more European respondents in 2000, and more Maori in the
1999 sample (p <0.001).
Table 3. Impact of Push Play (PP) on proximal
outcomes*
*proximal outcomes are
those influenced early by mass communications and
messages,24,25 and are: awareness of the
generic and specific message, campaign recognition, and perceptions of the
campaign;
†adjusted
for age, sex, cultural group (European versus others);
‡percentage
of the total who saw any message, recognised specific Push Play messages and the
logo and liked them. NB samples were smaller than the totals in Table 2;
1–2% of data were missing for combined variables in these adjusted
models.
Table 3 shows the impact of the campaign on proximal
variables. There was a significant increase in awareness of any advertisement or
message about physical activity after adjustment for the influence of
confounding demographic differences, with between a 1.5 and twofold increase in
awareness in 2000 onwards, compared with 1999. Specifically, Push Play
recognition was three to four times as likely from 2000 onwards compared with
1999 levels. Overall, rates of recall of any physical activity message were
similar for Maori and European New Zealanders, and similar by gender. For the
Push Play logo, recognition increased from 13.5% in 1999 to 52% in 2002, with a
consistent increment in recognition each year. Between half and three quarters
of those who had seen the message reported that they liked it (‘liked
it’ or ‘loved it’ responses), with only slight differences
between 1999 and subsequent years, reaching significance only for the comparison
between 2001 and 1999. A summary of the maximal positive exposure to all facets
of the communication is shown in the far right-hand column of Table 3; it
demonstrates a nine- to fourteen-fold increase in ‘exposure’ to the
campaign in all years compared with 1999.
The more distal outcomes were categorised in two ways, by
‘intention to be more active’ (thought about it, talked about it and
trialled activity), and organised sport responses (including contacting an RST,
other organisation, web site or calling the 0800 phone number), Table 4.
Combining all four survey samples, intention to be more active consisted of the
4% who thought about being more active; 1.2% talked about it, and 2.0% started
to increase their activity levels. Comparing across the four survey years, the
proportion of adult New Zealanders who ‘thought about being more
active’ increased significantly (1.1%, 6.1%, 6.0%, 3.9% p <0.001), as
did those who started being more active (0.5%, 2.0%, 3.1%, 3.2%, p <0.01),
with no significant increase in those talking about it (0.5%, 1.6%, 1.2%, 2.0%
respectively). Overall, only 0.1% of survey responders called an 0800 telephone
number, 0.1% contacted a sports trust, and less than 0.1% of those sampled
reported they had contacted another organisation or accessed the web site. Data
were pooled into the two categories, ‘intention’ and ‘accessed
an organisation (organised sport)’, and are shown in Table 4. There was a
significant increase from 1.8% to 9.0% of ‘any intention to be more
active’ between 1999 and 2000, with levels remaining at around 10% of New
Zealanders thereafter (Table 4). There were much lower rates of respondents who
contacted an organisation, and adjusted odds ratios were not estimated (as the
reference year, 1999, had zero responses). Physical activity levels, as measured
by 5+ active days in the past week, showed a slight and significant increase
only between 1999 and 2000 (Table 4).
Table 4. Impact of Push Play on distal
outcomes*
*those in the later
stages of a population change process – intention to be more active and
actual physical activity
behaviour
†talked about being more active, thought about it, tried to be more active ‡adjusted for age, sex, cultural group (European versus others) §called 0800 number or contacted RST or other sports organisation Data were stratified by generic message recall (any
advertisement recalled) and specific Push Play logo recall, and examined in
relation to any intention and physical activity days per week (Figures 1 and 2).
There was a significant increase in intention among those who recalled any
message, or the Push Play logo specifically, for data from 2000 to 2002.
Overall, adjusting for year, age, gender and ethnicity, those who had seen any
message were over four times as likely (adjusted OR 4.27, 95% CI
2.59–7.02), and those who recognised the Push Play logo nearly three times
as likely (adjusted OR 2.71, 95% CI 1.89–3.86), to think about
being/intend to be/start to be more active (Figure 1). Further, those who were
in the maximal campaign exposure group were much more likely to intend to be
more active than those with lesser degrees of Push Play exposure (24.5% compared
with 4.2%, adjusted OR 5.53, 95% CI 3.87–7.93).
Figure 1. Intention to be more active stratified by
message exposure
 An exploration of those who had maximal campaign exposure
and physical activity on at least five days per week is shown in Figure 2,
confined to the 2000 to 2002 surveys. Although there were consistent slightly
greater proportions in the exposed categories, these were not significant. For
2000 data, these proportions were 46.8% active in the exposed group, compared
with 43.6% in the unexposed; this difference (3.2%) was not significant (95% CI
-7.6% to 14.3%). The power of the sample size available here was 0.4, and a
threefold increase in sample size would be required to detect this as
statistically different.
Figure 2. Active 5+ days stratified by maximal campaign
‘exposure’* across each survey
year†
 *ie, saw any message and recognised the specific Push
Play message and the logo and liked
them
†data from 1999 excluded, as maximal exposure reported by 16 people only (spuriously, in 1999 pre-campaign) DiscussionThe Push Play initiative increased
awareness of physical activity and intention to be active among adults in New
Zealand. This innovative campaign used culturally salient messaging, and,
through the use of social marketing principles, packaged the messages, events
and programmes under the ‘Push Play’ brand. There was consistent and
increasing recognition of this ‘brand’ of physical activity, which
represented the 30-minute physical activity message that physical activity is
fun, and had a clear ‘Kiwi’ orientation. The impact of this
intervention was at least as great as recent campaigns in Australia and Scotland
9,10 and greater than efforts
elsewhere.11,12
The campaign provided a generic message to all adults to
consider enjoyable, lifestyle-related forms of physical activity as contributing
to fun, a sense of community, and to their health. The campaign had an impact on
non-organised activity and recreation (as measured through the intention
variable) rather than directly increasing population access to organised
services. In recent years, rates of sporting club membership and organised team
participation have fallen.13 These changes
reinforce the ongoing public health importance of the concepts of active living
and active recreation, which are central emphases of Push Play.
Social marketing campaigns need to develop a clear
‘brand’ of behaviour or attitude of interest, and need to be
sustained over many years to achieve culture
change.12,24,25 This is important in efforts to
change sedentary lifestyles. The required behaviour change is multi-faceted, and
the reinforcement of sedentary modern living poses an additional challenge. Many
Canadian physical activity and recreation campaigns were conducted under the
brand of ‘Participaction’ between 1971 and
1999,14 and are still recalled by almost 90% of
all Canadians. It will take much longer than the brief public education
campaigns in Australia9 and the United
Kingdom11 to achieve long-term influence on
community understanding, message awareness and ‘brand’ recognition.
Push Play fostered this awareness, and even influenced the proportion of adults
who thought about, talked about or started getting more active.
The Push Play initiative reached most population groups for
the outcomes assessed. Another study examined a small, selected sample of 69 New
Zealand adults, and showed that those already meeting the physical activity and
nutrition guidelines did not always recognise public health messages and
guidelines, and obtained health information from other
sources.15 Nonetheless, for hard-to-reach
sedentary and socially disadvantaged groups, physical-activity-related mass
media campaigns appear effective in message
dissemination.10,16
Despite a clear impact upon the antecedent variables, the
campaign evaluation did not detect sustained shifts in physical activity
behaviour (although this was not a key goal given that it was an awareness
campaign), as measured by the proportion achieving five days per week of 30
minutes of moderate-intensity physical activity. This was not surprising for a
number of reasons. First, the measure of physical activity was a single
question, rather than a developed set of questions to reflect behaviour. Second,
media campaigns may not influence behaviour directly and immediately, and acute
increases at the population level are unusual for complex
behaviours.12 Nonetheless, serial
epidemiological surveys, using detailed questions, and including large samples
(n = 12 000) carried out by the Hillary Commission and SPARC between 1997 and
2001 have shown a 3% increase in the proportion of adults who are active for at
least 150 minutes per week (approximate 95% CI
1.7–4.2%),13 which does suggest that
adult New Zealanders are becoming significantly more active. This trend in New
Zealand is contrary to recent trend data from Australia and the United Kingdom,
which have shown declines in adult physical activity
participation,17,18 and United States and
Canadian data, which have shown no change in activity prevalence in recent
years.19,20 The link between the Push Play
campaign and these trends is not definitively causal, although the evidence for
impact upon proximal variables and intention is reasonably strong. It is
recognised that media elements need to be sustained and to be combined with
health-professional training, and with community events and resources in order
to achieve population behaviour change.21 The
overall initiative in New Zealand met these criteria for an integrated campaign,
and was noteworthy in that it was mostly sustained by the Hillary
Commission/SPARC, which are outside the mainstream health sector.
There were some methodological limitations in the evaluation
of this initiative. First, the sampling in 1999 was not a true pre-campaign
measure, and reflected awareness of some of the initial Push Play messaging.
Subsequent increases in awareness and recall suggested that there was continued
building on these 1999 levels, so actual campaign effects, had there been a true
pre-campaign survey, are likely to have been even greater. Second, the survey
sampling methods were slightly different for 2000 and subsequent surveys, but
these demographic differences were controlled for in analysis. Third, all
surveys were only of around 500 to 600 respondents, which may have led to
reduced power to detect some changes. Finally, the measures used were standard
for media campaign evaluation, but the physical activity question was only a
single item; trends in physical activity rates were better demonstrated in the
larger, representative epidemiological surveys conducted by
SPARC.13 The single question, as an imperfect
measure, may underestimate true effects (in relation to associations with
campaign exposure, or in terms of change), and this measurement error may have
led to an underestimation of the extent of the effect of the campaign on
activity outcomes.26
The Push Play initiative had been developed with an initial
private-sector partnership with funding from an electricity company, and
recognition in the media messages of that funding. Sponsor logo recall rates
were low in 1999 and 2000 (10–14%)22 and
the private-sector sponsorship was not maintained beyond 2000. The initiative
was more strongly linked to the New Zealand Government, Hillary Commission/SPARC
or to health agencies. Another social advertising initiative (conducted by Roche
Pharmaceuticals in 2001 and 2002, to promote a weight-loss agent, XENICAL) also
developed a media campaign (also using humour), and was confused with Push Play
by some responders to our surveys, who referred to the content of the XENICAL
ads. Consistent increases specifically in the Push Play ‘brand
recognition’ suggest that these extraneous campaigns and other factors did
not substantially influence the consistent increase in Push Play
awareness.
The total cost of the media campaign over the four years
amounts to approximately $3 million. This includes development of the messages,
filming, management of the campaign by the advertising company, placement of the
messages in the media, and other supportive events. Substantial in-kind support
was provided by the RSTs and other collaborating agencies. The Push Play
campaign had a relatively modest budget when compared with other New Zealand
social marketing campaigns such as tobacco control and road safety, which have
budgets approximately three and ten times as large per annum respectively.
Further, both these campaigns in New Zealand have a 20-year history of concerted
intervention, campaigning, and environmental change, eventually resulting in
noteworthy public health gains.23 Compared with
that level of investment and public health effort, attempts to reduce obesity
and increase physical activity are at an early stage.
In conclusion, Push Play is an example of effective use of
the mass media in setting the agenda for community
change.24 A key element of its success has been
the supportive role played by community programmes, GP education, and regional
events. The World Health Organization suggests that effective campaigns need to
be sustained over many years and to reinforce messages many times to the
community, as well as target specific
populations.25 Ongoing efforts, under the
established umbrella of Push Play, are likely to further increase rates of
physical activity among adult New Zealanders and reduce the population morbidity
and mortality attributable to sedentary lifestyles.
Author information:
Adrian Bauman, Professor of Public Health and Director, Centre for Physical
Activity & Health, School of Public Health, University of NSW, Sydney,
Australia; Grant McLean, Senior Advisor (Research); Deb Hurdle, Senior Advisor
(Environments), SPARC (Sport and Recreation New Zealand), Wellington; Sue
Walker, Research and Information Manager, John Boyd, Communications Manager,
Hillary Commission, Wellington; Ingrid van Aalst, Consultant to Hillary
Commission/SPARC; Harriette Carr, Senior Analyst, Public Health Policy Group,
Public Health Directorate, Ministry of Health, Wellington
Acknowledgements: We
thank the National Research Bureau (NRB) for conducting the four surveys
evaluating the Push Play campaign and Saatchi & Saatchi for their work in
designing the Push Play campaign.
Correspondence:
Grant McLean, SPARC; Senior Advisor (Research), Level 4, 78 Victoria Street, P O
Box 2251, Wellington. Fax: (04) 471 0813; email: grant.mclean@sparc.org.nz
References:
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