Using messages promoting descriptive norms to increase physical activity

Effects of group communication norms on daily steps in a team-based financial incentive mobile phone intervention in Shanghai, China

BACKGROUND

Mobile technology offers great potential for physical activity promotion, especially by facilitating online communication, however, the impact of group communication norms on intervention effectiveness remains unclear. This study aimed to evaluate the effect on daily steps of a team-based social norms-related intervention using a mobile application.

METHODS

The 13-week quasi-experimental study was conducted in Shanghai, China, from September to November 2019, involving 2,985 employees from 32 worksites. For the intervention group (n = 2,049), participants set a goal of 10,000 steps per day. The teams and individual members would receive points for meeting the daily goal, contributing to team-based rankings and financial rewards for the teams and their members. In addition, the intervention teams created dedicated WeChat groups to facilitate communication, which were also used to collect group chat messages. The communication type in these groups was classified into four types: (1) nudging - encouraging team members to be more active, (2) sharing - exchanging the completion of daily step goals, (3) feedback - providing responses or suggestions to team members, and (4) other -diverse topics that could not be classified otherwise. The control group only tracked their steps online.

RESULTS

The weekly average steps of the intervention group increased by 2,523 steps, while the control group increased by 470 steps. In the first 3 weeks of follow-up, the frequency of nudging of 7-18 times/week had a positive cumulative effect on the step counts. Sharing more than 3 times/week had a positive cumulative effect. Over 6 and 13 weeks of follow-up, nudging 19 times/week or more had a positive cumulative effect while sharing and feedback at any frequency negatively affected average weekly steps.

CONCLUSIONS

Communication types within a team affected team-based step counts in a financial incentive intervention. The team-level social norms related to communications might have different cumulative effects on team-level physical activity. 'nudging' messages had a significant association with the change in individual-level step counts in the medium or long term.

TRIAL REGISTRATION

Pilot Project of the application of walking incentive technology in occupational groups, 2019, ChiCTR1900023813. Registered 13 June 2019,  https://www.chictr.org.cn/showproj.html?proj=39858 .

Physical Activity and Public Health for Adults: Is the Glass Mostly Empty or Half Full?

ABSTRACT

Early observations that only a small proportion of U.S. adults were engaging in enough aerobic physical activity to provide substantial health benefit helped shape our public health messaging for physical activity. This messaging has consistently indicated that most adults should increase their activity levels. However, it has been difficult to accurately estimate the proportion of adults who engage in sufficient levels of aerobic activity in the population, with survey-based estimates ranging from 22% in 1994 to 54% in 2018 and widely differing estimates from device-based measures. Recent accelerometer-based studies of physical activity and mortality risk provide new evidence that at least 50% of U.S. adults engage in enough aerobic physical activity to be at low risk for premature mortality. We argue that this observation should lend greater confidence to our current survey-based surveillance estimates, which indicate that a large proportion of adults is physically active. This new insight may also provide clues that could further strengthen our public health messaging for physical activity by placing more emphasis on the maintenance of healthy activity levels throughout life and possibly by using descriptive social norms as an additional intervention element-while continuing current efforts to encourage the adoption of healthy activity levels for less active adults in the population.

Injunctive norms as social pressures: Does autonomy support moderate the relationship between injunctive norms and autonomy satisfaction in physical activity?

Objective: Despite the usefulness of social norms for changing behaviour, injunctive norms (i.e., perceptions of what others approve) from significant others tend to be a weak predictor of physical activity (PA) engagement. A potential explanation is that injunctive norms encompass pressuring social influence that undermines autonomous PA engagement. This study examined whether injunctive norms from significant others undermine individuals' autonomy satisfaction during the pursuit of PA engagement, and whether this effect is moderated by the degree to which significant others offer concurrent autonomy support. Design: Online questionnaires. Measures: Participants' perceptions of injunctive norms and autonomy support from significant others, autonomy satisfaction, behaviour regulation, PA intentions, and weekly PA frequency were assessed at baseline (N = 497) and after two weeks (N = 351). Results: Autonomy support positively related to autonomy satisfaction, whereas injunctive norms were negatively related to autonomy satisfaction. Though the statistical significance of interaction effects was inconsistent across results, simple slopes suggested that the negative relationship between injunctive norms and autonomy satisfaction was attenuated at higher levels of autonomy support in models focusing on influence from parents and friends. Conclusion: When promoting others' PA, communicating direct social expectations/pressures may be ineffective.

To move or not to move while on campus: Examining the influence of others

OBJECTIVE

To examine the influence of dynamic and trending descriptive norms on increasing physical activity and decreasing the sedentary behaviors of university students while on campus.

PARTICIPANTS

One-hundred fifty-six university students from a Canadian university completed this study.

METHODS

Participants were randomly assigned to receive one of four online messages containing normative information about the on-campus behavior of university students. On-campus physical activity and sedentary behavior were measured pre- and post-message.

RESULTS

The results revealed that students exposed to the trending norm reported a greater decrease in sedentary behavior than students in the control condition, p = .007.

CONCLUSION

Results provide preliminary experimental evidence that trending norm messages may serve to decrease the sedentary behavior of students while on campus.

Gender-Specific Impact of Self-Monitoring and Social Norm Information on Walking Behavior Among Chinese College Students Assessed Using WeChat: Longitudinal Tracking Study

BACKGROUND

Walking is a simple but beneficial form of physical activity (PA). Self-monitoring and providing information about social norms are the 2 most widely used "mobile health (mHealth)" strategies to promote walking behavior. However, previous studies have failed to discriminate the effect of self-monitoring from the combination of the 2 strategies, and provide practical evidence within Chinese culture. Some essential moderators, such as gender and group identity, were also overlooked.

OBJECTIVE

We aimed to investigate the effectiveness of social norm and self-monitoring interventions for walking behavior and assess the moderating effects of gender and group identity, which could guide optimal mHealth intervention projects in China.

METHODS

In 2 longitudinal tracking studies (study 1, 22 days; study 2, 31 days), Chinese college students wore trackers for at least 8 hours per day (MASAI 3D Pedometer and Xiaomi Wristband 2) to record their daily step counts in baseline, intervention, and follow-up stages. In each study, participants (study 1: n=117, 54% female, mean age 25.60 years; study 2: n=180, 51% female, mean age 22.60 years) were randomly allocated to 1 of the following 3 groups: a self-monitoring group and 2 social norm intervention groups. In the 2 intervention groups and during the intervention stage, participants received different social norm information regarding group member step rankings corresponding to their grouping type of social norm information. In study 1, participants were grouped by within-group member PA levels (PA consistent vs PA inconsistent), and in study 2, participants were grouped by their received gender-specific social norm information (gender consistent vs gender inconsistent). Piece-wise linear mixed models were used to compare the difference in walking steps between groups.

RESULTS

In study 1, for males in the self-monitoring group, walking steps significantly decreased from the baseline stage to the intervention stage (change in slope=-1422.16; P=.02). However, additional social norm information regardless of group consistency kept their walking unchanged. For females, social norm information did not provide any extra benefit beyond self-monitoring. Females exposed to PA-inconsistent social norm information even walked less (slope during the intervention=-122.18; P=.03). In study 2, for males, a similar pattern was observed, with a decrease in walking steps in the self-monitoring group (change in slope=-151.33; P=.08), but there was no decrease in the 2 social norm intervention groups. However, for females, gender-consistent social norm information decreased walking steps (slope during the intervention=-143.68; P=.03).

CONCLUSIONS

Both gender and group identity moderated the effect of social norm information on walking. Among females, social norm information showed no benefit for walking behavior and may have exerted a backfire effect. Among males, while walking behavior decreased with self-monitoring only, the inclusion of social norm information held the level of walking behavior steady.

The effect of descriptive norms and social identification on performance and exertion during a physical fitness task

Research suggests that people's perceptions of the typical physical activity behaviors of others-descriptive norms-shape their own physical activity. However, prior work has primarily used cross-sectional designs, focused on people's physical activity intentions or self-reported overall physical activity, and failed to attend to how the normative referent affects the norm-behavior relationship. In a pre-registered experiment, we manipulated the descriptive norm to explore its effect on perceived exertion during, and objectively assessed performance on, an exercise (running) task. We also measured the strength of participants' social identification as a member of the norm reference group as a potential moderator. Following a baseline trial, participants (N = 78) were either told that their baseline score on the running task was below average (high norm condition) or above average (low norm condition) compared to members of the reference group. Participants in both conditions tended to perform better in Trial 2 than Trial 1. However, participants in the high norm condition improved their performance significantly (2.5 times) more than participants in the low norm condition. Social identification moderated the effect of the norm manipulation on perceived exertion. High identifiers tended to exert themselves less than low identifiers during Trial 2 if they were told they were above average, whereas if told they were below average, high identifiers exerted themselves slightly more than low identifiers. Results provide evidence that descriptive norm messages can improve people's performance on physically demanding tasks, and indicate that descriptive physical activity norms may be more influential when the norm reference group is subjectively meaningful. Opportunities to fruitfully deploy norm messages in applied contexts are discussed.

Investigating the role of communication between descriptive norms and exercise intentions and behaviors: findings among fitness tracker users

This study investigates the relationship between fitness tracker users' communication of exercise information and their exercise intentions and behaviors among college students. Participants: Data were collected from 186 undergraduate students. Methods: A quantitative online survey was conducted. Descriptive norm (perceptions of prevalence of others' behaviors), communication (including exercise information giving and exercise information receiving), exercise behaviors, and exercise intentions were measured with reliable scales. Results: Both exercise information giving and information receiving were positively associated with exercise behaviors and intentions. Information giving moderated the association between descriptive norms and exercise intentions and behaviors, while information receiving moderated the association between descriptive norms and exercise intentions. Conclusion: The interaction effect between descriptive norm and communication suggests that health educators and campaign designers should focus on descriptive norm of exercise for college students who have limited communication activities. It is important to find innovative ways to promote positive health behaviors.

Examining the impact of weight bias on the association between exercise identity and maladaptive exercise behaviors

OBJECTIVE

Though exercise behaviors are typically viewed as health-promoting, certain forms of exercise (i.e., excessive exercise, unhealthy muscle-building behaviors) are considered maladaptive and are associated with negative physical and psychological outcomes. Psychosocial factors may put people at greater risk for engaging in maladaptive exercise. Based on deviance regulation theory, weight bias was examined as a potential moderator of the association between exercise identity and both excessive exercise and muscle-building behaviors.

DESIGN

The current study is a secondary analysis of a larger data set investigating associations between athletic identity, exercise behaviors, and disordered eating behaviors. Hypotheses were examined using moderation testing in multiple linear regression.

MAIN OUTCOME MEASURES

Participants (N = 225, 50.2% female) completed the Eating Pathology Symptoms Inventory as a measure of maladaptive exercise.

RESULTS

Controlling for sex, age, athlete status, and body mass index, weight bias moderated the association between exercise identity and both excessive exercise and muscle-building behaviors. Among individuals with high exercise identity, higher weight bias was associated with increased maladaptive exercise behaviors.

CONCLUSION

Individuals with higher exercise identity and higher weight bias may be at greatest risk of engaging in maladaptive exercise. Preventive interventions for maladaptive exercise behaviors may consider targeting exercise identity and weight bias.

Use of a Smartphone App to Increase Physical Activity Levels in Insufficiently Active Adults: Feasibility Sequential Multiple Assignment Randomized Trial (SMART)

Background

The sequential multiple assignment randomized trial (SMART) design allows for changes in the intervention during the trial period. Despite its potential and feasibility for defining the best sequence of interventions, so far, it has not been utilized in a smartphone/gamified intervention for physical activity.

Objective

We aimed to investigate the feasibility of the SMART design for assessing the effects of a smartphone app intervention to improve physical activity in adults. We also aimed to describe the participants’ perception regarding the protocol and the use of the app for physical activity qualitatively.

Methods

We conducted a feasibility 24-week/two-stage SMART in which 18 insufficiently active participants (<10,000 steps/day) were first randomized to group 1 (smartphone app only), group 2 (smartphone app + tailored messages), and a control group (usual routine during the protocol). Participants were motivated to increase their step count by at least 2000 steps/day each week. Based on the 12-week intermediate outcome, responders continued the intervention and nonresponders were rerandomized to subsequent treatment, including a new group 3 (smartphone app + tailored messages + gamification) in which they were instructed to form groups to use several game elements available in the chosen app (Pacer). We considered responders as those with any positive slope in the linear relationship between weeks and steps per day at the end of the first stage of the intervention. We compared the accelerometer-based steps per day before and after the intervention, as well as the slopes of the app-based steps per day between the first and second stages of the intervention.

Results

Twelve participants, including five controls, finished the intervention. We identified two responders in group 1. We did not observe relevant changes in the steps per day either throughout the intervention or compared with the control group. However, the rerandomization of five nonresponders led to a change in the slope of the steps per day (median −198 steps/day [IQR −279 to −103] to 20 steps/day [IQR −204 to 145]; P=.08). Finally, in three participants from group 2, we observed an increase in the number of steps per day up to the sixth week, followed by an inflection to baseline values or even lower (ie, a quadratic relationship). The qualitative analysis showed that participants’ reports could be classified into the following: (1) difficulty in managing the app and technology or problems with the device, (2) suitable response to the app, and (3) difficulties to achieve the goals.

Conclusions

The SMART design was feasible and changed the behavior of steps per day after rerandomization. Rerandomization should be implemented earlier to take advantage of tailored messages. Additionally, difficulties with technology and realistic and individualized goals should be considered in interventions for physical activity using smartphones.

Trial Registration

Brazilian Registry of Clinical Trials RBR-8xtc9c; http://www.ensaiosclinicos.gov.br/rg/RBR-8xtc9c/.

'If they do it, so can I': a test of a moderated serial mediation model of descriptive norms, self-efficacy, and perceived similarity for predicting physical activity

OBJECTIVE

Though engaging in physical activity (PA) is associated with several health benefits, physical inactivity rates remain high. Previous research revealed that descriptive norms (i.e., perceptions of others' PA) positively relate to PA intentions/behaviours. This study tested whether self-efficacy mediated the influence of descriptive norms on PA intentions and behaviours, and whether the relationship between descriptive norms and self-efficacy was moderated by perceived similarity with normative referents.

DESIGN

Online questionnaires were administered.Measures: Baseline measures included descriptive norms, perceived similarity, self-efficacy, and PA intentions. Weekly PA behaviour frequency was assessed at baseline and two weeks post-baseline.

RESULTS

Descriptive norms positively predicted PA behaviour frequency at time 2 indirectly via self-efficacy and PA intentions. These indirect effects were attenuated when baseline PA behaviour frequency was accounted for. There was no support for perceived similarity as a moderator, which may be attributed to a potential ceiling effect or the nature of items used to assess this perception.

CONCLUSION

The findings support the notion that individuals may feel more efficacious when they perceive that others are successfully engaging in the targeted task/activity. Future interventions may consider providing descriptive norm messages to individuals who lack self-efficacy or previous PA experience to promote their PA.

Get the message? A scoping review of physical activity messaging

BACKGROUND

Understanding how to create and deliver effective physical activity (PA) messages for and to various population subgroups may play a role in increasing population PA levels. This scoping review aimed to provide an overview of what is known about PA messaging and highlight key research gaps.

METHODS

We followed a 5-stage protocol proposed by Arksey & O'Malley and the Preferred Reporting Items For Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews checklist. Stage 1: research questions were identified. Stage 2: we identified relevant studies by searching electronic databases, contacting existing networks and hand searching reference lists. Stage 3: studies were screened in Covidence™ software. Stage 4: study data were extracted and charted. Stage 5: findings from included studies were collated, summarised and reported in two ways: (1) a descriptive numerical analysis providing insight into extent, nature and distribution of the included studies, and (2) a narrative summary summarizing the evidence reviewed organised by messaging concepts and by population subgroup.

RESULTS

A total of 9525 references were imported into Covidence™ for screening. Of these, 123 studies were included in final analysis. We found that PA messaging evidence is complex and multidimensional in nature, with numerous concepts to consider when creating or evaluating messages. The extent to which these different PA messaging concepts have been researched is variable. Where research has accumulated and evidence is consistent, it supports the following: (1) PA messages should be framed positively and highlight short-term outcomes specifically relating to social and mental health, (2) message content should be tailored or targeted to intended recipient(s), and (3) when developing messages, formative research, psychological theory and/or social marketing principles should be used.

CONCLUSION

While it is unlikely to address global inactivity on its own, PA messaging may play a valuable role improving population PA levels. However, it is a complex and multidimensional concept and greater understanding is still needed. We present a synthesis of the existing evidence, highlighting key areas where evidence has accumulated and where gaps lie, as well as recommendations for PA messaging to different population subgroups.

Influence of Norm-Based Messages on College Students' Binge Drinking Intentions: Considering Norm Type, Regulatory Mode, and Level of Alcohol Consumption

This study examined the influence of norm-based messages on U.S. college students' binge drinking intentions, focusing on norm type, locomotion and assessment regulatory modes, and level of alcohol consumption as possible moderators. Results of an online experiment (N = 519) revealed significant three-way interactions among regulatory mode (assessment/locomotion), level of alcohol consumption, and norm type (i.e., descriptive vs. injunctive norms) on binge drinking intentions. The relative persuasiveness of descriptive vs. injunctive norm-based messages was contingent upon an individual's locomotion/assessment regulatory mode and overall alcohol consumption level. Findings from this study extend research on social norms and regulatory mode and provide useful suggestions for the norm-based college drinking intervention.

Haptic input and balance control: An exploratory study examining normative messaging

This study examined the effect of descriptive norm messaging information on the relationship between haptic input and balance control. Participants were randomly assigned to either a message group where they balanced with haptic input after receiving a descriptive norm message about the positive effect of haptic input or a control group. Findings from an analysis of covariance revealed a significant difference between the two groups. Those in the descriptive norm message group had better balance control than those in the control group. These findings suggest that efforts designed to improve balance control through haptic input may be enhanced through normative messaging.

The impact of descriptive norms on motivation to participate in cancer screening - Evidence from online experiments

OBJECTIVE

The current study tested in two online experiments whether manipulating normative beliefs about cancer screening uptake increases intention to attend colorectal screening among previously disinclined individuals.

METHODS

2461 men and women from an Internet panel (Experiment 1 N = 1032; Experiment 2, N = 1423) who initially stated that they did not intend to take up screening were asked to guess how many men and women they believe to get screened for colorectal cancer. Across participants, we varied the presence/absence of feedback on the participant's estimate, as well as the stated proportion of men and women doing the screening test.

RESULTS

Across the two experiments, we found that receiving one of the experimental messages stating that uptake is higher than estimated significantly increased the proportion of disinclined men and women becoming intenders. While, we found a positive relationship between the communicated uptake and screening intentions, we did not find evidence that providing feedback on the estimate has an added benefit.

CONCLUSION

Screening intention can be effectively manipulated through a high uptake message.

PRACTICE IMPLICATIONS

Communication of high screening uptake is an easy and effective way to motivate disinclined individuals to engage in colorectal cancer screening.

An Exploratory Study Examining the Interactive Effect of Descriptive Norm and Image Appeal Messages on Adults' Physical Activity Intentions: A Test of Deviation Regulation Theory

This exploratory study examined the interaction between messages conveying descriptive norms and image appeals on adults' physical activity intentions. Using a pre-post experimental design, insufficiently active adults (N = 204) were randomly assigned to receive one of four messages, which included both a descriptive norm (prevalence of physical activity: high vs. low) and an image appeal (personality attributes: positive vs. negative). The results from an analysis of covariance, controlling for baseline physical activity intentions, revealed a significant interaction. Post-hoc analyses indicated that when the image appeal was positive, those who received the low descriptive norm had greater physical activity intentions than the high descriptive norm condition. No significant interaction was found for negative image appeals. Results provide preliminary evidence that physical activity intentions can be positively influenced even when physical activity is not considered the norm. Messages that include low descriptive norm information may benefit from including positive image appeals of those who do engage in physical activity, if aiming to increase physical activity intentions in insufficiently active adults.

How does anonymous online peer communication affect prevention behavior? Evidence from a laboratory experiment

While the importance of social networks for health behaviors is well-recognized, relatively little is known regarding the accuracy of anonymous online communication and its impact on health behavior. In 2012, we conducted a laboratory experiment in Boston, Massachusetts with 679 individuals to understand how anonymous online communication affects individual prevention decisions. Participants had to opt for or against investing in prevention over three sessions, each consisting of 15 experimental rounds. In the third session only, participants could share their experiences with a group of 1-3 other anonymous participants after each round. Groups exchanged an average of 16 messages over the 15 rounds of the third session. 70% of messages contained information about the subject's prevention decision and the resulting health outcome. Participants were more likely to communicate when they prevented than when they did not, with prevention failures resulting in the highest probability of sending a message. Nonetheless, receiving an additional message reporting prevention increased the odds a subject would prevent by 32 percent. We find that participants tend to adopt the prevention behavior reported by others, with less weight given to the reported outcomes of prevention, suggesting that social networks may influence behaviors through more than just information provision.

An exploratory experimental study examining the short-term effects of a public service announcement on parents' perceptions of the descriptive norm for children's outdoor play: A cautionary tale

ISSUE ADDRESSED

Public service announcements (PSA) targeting physical activity are not always effective at enacting behaviour change. One factor that may impact message effectiveness is whether the message matches its intent (ie, what norm is being portrayed and received). The current study explored the effects of two PSAs on parents' perceptions of outdoor play.

METHODS

Parents (N = 333) completed a pre/postexperimental online survey to examine the acute impact of a PSA on their perception of how often children play outdoors (ie, descriptive norms). Participants provided their descriptive norm perceptions and then were randomised to view one of two PSAs: (a) the Mr. Lonely PSA, which portrayed outdoor activity as not normative, and (b) a control message, which portrayed outdoor activity as the norm (VERB PSA). After viewing their PSA, descriptive norm perceptions were reported again.

RESULTS

A two-way mixed ANOVA indicated that participants who viewed the Mr. Lonely PSA (where outdoor play was not normative) perceived that children and youth played outdoors less frequently immediately after watching the PSA compared to before viewing it (P < 0.05). No significant change occurred in the control condition.

CONCLUSIONS

PSAs can alter individuals' perceptions of whether they perceive outdoor play as normative among children and youth. SO WHAT?: As individuals align their behaviour with what is typical, PSA developers should be wary of what message is being conveyed. In terms of activity, portraying that outdoor play is not normative may not have the intended outcome.

The RANI Project: A socio-normative intervention to reduce anemia in Odisha, India: A formative research protocol

Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women’s work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate.

Objectives: This protocol describes the formative research phase of a larger study, called the Reduction in Anemia through Normative Innovations (RANI) Project, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake.

Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method, multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. Before collecting the data, and after analyzing the results, we will hold convenings in India to engage key stakeholders in collaborative design. Following the intervention design, we will test components of the intervention, gather user feedback and fine-tune as necessary.

Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach.

Designing a socio-normative intervention to reduce anemia in Odisha India: A formative research protocol

Background: More than half of women of reproductive age in India are anemic. Anemia is associated with increased risk of preterm delivery, higher maternal mortality and contributes to fatigue, which affects women’s work productivity. The World Health Organization (WHO) recommends daily oral iron and folic acid (IFA) supplements during pregnancy and weekly supplements for women of reproductive age. Government programs and global donors have distributed and promoted IFA supplements in India for over four decades. However, initial intake and compliance remain inadequate. Objectives: This protocol describes the formative research phase of a larger study, which will test, through a randomized controlled trial, the hypothesis that a social norms-based behavioral intervention in Odisha, India will improve uptake of IFA supplements and reduce anemia among reproductive age women as compared to usual care. The focus of this paper is on the formative research required to develop a sound intervention. We will examine socio-normative barriers to and facilitators of IFA supplement uptake. Methods and analysis: Based on the Theory of Normative Social Behavior, we will adopt a mixed-method, multilevel approach. We will collect data using focus groups, in-depth interviews, observations, Rapid Participatory Ethnographic Evaluation and Research (PEER) techniques, and perceptual mapping methods. Our sample includes reproductive age women (pregnant and not pregnant), their husbands, their mothers/in law and key stakeholders. After analyzing the results, we will hold a convening in India to collaboratively design the intervention. Following the intervention design, we will test components of the intervention, gather user feedback and tweak as necessary. Additionally, to improve adoption and sustainability of the intervention, we will conduct policy dialogue with stakeholders throughout the formative research. Impact: This study will contribute to the social norms and behavioral intervention research and inform policymakers about the value of adopting a socio-normative approach.

Promoting Physical Activity Among University Students: A Systematic Review of Controlled Trials

OBJECTIVE

University study is often accompanied by a decline in physical activity (PA) levels but can offer the opportunity to promote a lifelong active lifestyle. This review aims to summarize controlled trials of interventions promoting PA among university students, describing the quality of the evidence, effective strategies, and deficiencies in the interventions employed, to provide directions for future research and for practical implementations.

DATA SOURCE

PubMed, PsychINFO, Cochrane Library, Education Source, and SPORTDiscus. Study Inclusion Criteria: Randomized or nonrandomized controlled trial, describing an intervention to promote PA in university students, where PA was one of the outcomes and results were published in English.

DATA EXTRACTION

Country, study design, participants' inclusion criteria, participation rate and characteristics, randomization, blinding, theoretical framework, intervention characteristics, participant retention rate and withdrawal reasons, measures employed, data analysis, PA results, and findings regarding PA correlates.

DATA SYNTHESIS

Data were synthetized considering study characteristics, strategies used, and outcomes.

RESULTS

Two thousand five hundred eighty-five articles were identified. Twenty-seven studies met the inclusion criteria. Sixteen studies reported an increase in PA levels.

CONCLUSION

Physical Activity promotion interventions should address a range of behavioral determinants. Personalized approaches and PA sessions should be considered in future studies. The high risk of bias of many studies (mainly due to attrition and poor reporting) and missing information about intervention components limit the strength of conclusions about the most effective strategies and the evidence of effectiveness, highlighting the need for further high-quality studies.

Effect of Manipulating Descriptive Norms and Positive Outcome Expectations on Physical Activity of University Students During Exams

This experimental study examined the interaction between messages conveying different levels of descriptive norms and positive outcome expectations on university students' engagement in moderate and vigorous physical activity over an exam period. Using a pre-post design, university students entering a final examination period (N = 74) were randomly assigned to one of four message conditions, receiving a message motivating them to exercise over the exam period. Messages included both a descriptive norm (how many others reported being active during a previous exam period; high vs. low) and a positive outcome expectation (those who exercise during exams report better grades; high vs. low). The results from an analysis of covariance (ANCOVA), controlling for baseline levels of daily physical activity, revealed a significant interaction. Post hoc analyses indicated that when the descriptive norm was high, those who received a high positive outcome expectation reported being more active during the exam period compared to those receiving the low positive outcome expectation. Results provide preliminary support for the idea that activity during an exam period can be positively influenced if individuals are presented with normative messages that (a) many others are being active during the exams and (b) many of those being active also are benefiting academically.

Using a descriptive social norm to increase vegetable selection in workplace restaurant settings

Objective: Recent work has shown that exposure to social norm messages may enhance the consumption of vegetables. However, the majority of this work has been conducted in laboratories, often with student populations. Little is known about whether this approach can be successfully used in other contexts. In this study, a poster featuring a message based on social norms was tested to examine whether it could increase and maintain the purchase of meals with vegetables in workplace restaurants. Method: A pretest–posttest design with 3 phases was used in 3 workplace restaurants in the United Kingdom. The first 2 weeks formed the preintervention phase, the second 2 weeks the intervention phase, and the last 2 weeks the postintervention phase. During the intervention phase only, posters containing a social norm message relaying information about vegetable purchases of other diners were placed in each restaurant. The main outcome measure was the percentage of meals purchased with vegetables, which was analyzed using Pearson’s chi-squared test. Results: Participants were judged to be male (57%), not overweight (75%), and under the age of 60 (98%). The intervention was positively associated with the percentage of meals purchased with vegetables: baseline versus intervention (60% vs. 64% of meals purchased with vegetables; p < .01); intervention versus postintervention (64% vs. 67% of meals purchased with vegetables; p < .01); and baseline versus postintervention (60% vs. 67% of meals purchased with vegetables; p < .001). Conclusions: Social norm messages may increase the purchase of vegetables in workplace settings.

Tracing How Normative Messages May Influence Physical Activity Intention

Normative messages have been shown to increase intention to do physical activity. We traced how "positive" and "negative" normative messages influenced physical activity intention by comparing constructs of the model of goal-directed behavior with descriptive norms (MGDB + DNs) across control and treatment groups in an experiment. For this purpose, 16-24-year-old respondents (n = 1,200) in Bulgaria, Croatia, and Romania were asked about their age, sex, and levels of physical activity before being exposed to positive and negative normative messages and completing a questionnaire with MGDB + DNs scales. Different MGDB + DNs constructs were influenced by the normative messages: compared with the control, the negative message group showed stronger attitudes (p = .003) and the positive message group showed higher positive anticipated emotions (p = .005). The positive message's effect is consistent with the literature on conformity to social norms. The negative message's effect lends itself to interpretations based on social identity and deviance regulation theories.

Impact of Workplace Physical Activity Interventions on Physical Activity and Cardiometabolic Health Among Working-Age Women: A Systematic Review and Meta-Analysis

BACKGROUND

Cardiovascular disease is the leading cause of death among women in high-income Organization for Economic Co-operation and Development countries. Physical activity is protective for cardiovascular disease. The realities of modern life require working-age women to address work-related, family, and social demands. Few working-age women meet current moderate-to-vigorous-intensity physical activity (MVPA) recommendations. Given that working-age women spend a substantial proportion of their waking hours at work, places of employment may be an opportune and a controlled setting to implement programs, improving MVPA levels and enhancing cardiometabolic health.

METHODS AND RESULTS

Eight electronic databases were searched to identify all prospective cohort and experimental studies reporting an MVPA outcome of workplace interventions for working-age women (mean age, 18-65 years) in high-income Organization for Economic Co-operation and Development countries. Risk of bias was assessed using the Cochrane risk of bias tool; quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A qualitative synthesis was performed for all studies, and meta-analyses were conducted where possible. Twenty-four studies met the inclusion criteria; 20 studies were included in the meta-analyses. Workplace interventions significantly increased minutes per week of metabolic equivalents (4 studies; standardized mean differences, 2.07; 95% confidence interval [CI], 1.44 to 2.69), but not minutes per week of MVPA (13 studies; standardized mean differences, 0.38; 95% CI, -0.15 to 0.92) or metabolic equivalents per week (3 studies; standardized mean differences, 0.11; 95% CI, -0.48 to 0.71). Workplace interventions also significantly decreased body mass (7 studies; mean differences, -0.83 kg; 95% CI, -1.64 to -0.02), body mass index (6 studies; mean differences, -0.35 kg/m²; 95% CI, -0.62 to -0.07), low-density lipoprotein (4 studies; mean differences, -0.11 mmol/L; 95% CI, -0.17 to -0.04), and blood glucose (2 studies; mean differences, -0.18 mmol/L; 95% CI, -0.29 to -0.07). These workplace interventions targeting MVPA levels and known beneficial cardiometabolic health sequelae were of lower quality evidence.

CONCLUSIONS

Workplace interventions variably improve MVPA levels and related cardiometabolic health sequelae of working-age women in high-income Organization for Economic Co-operation and Development countries. Our findings underscore the need for ongoing research in this area but also increased dissemination of the existing programs and knowledge.

Promoting Physical Activity With Group Pictures. Affiliation-Based Visual Communication for High-Risk Populations

Past research in social and health psychology has shown that affiliation motivation is associated with health behavior, especially for high-risk populations, suggesting that targeting this motivation could be a promising strategy to promote physical activity. However, the effects that affiliation appeals (e.g., pictures depicting companionship during physical activities) and accompanying slogans have on motivating physical activity have been largely unexplored. Hence, our two studies experimentally tested the effects of exposure to affiliation-based pictures for overweight or less active people, as well as the moderating effect of affiliation motivation. The results of these two studies give some indication that group pictures (with or without an accompanying slogan) can be an effective strategy to improve high-risk populations' attitudes, self-efficacy, and intentions to engage in physical activity. Affiliation motivation as a personality trait did not interact with these effects, but was positively associated with attitudes, independent of the group picture effect.

A novel method to promote physical activity among older adults in residential care: an exploratory field study on implicit social norms

Background

Physical activity (PA) levels of older adults living in a care setting are known to be very low. This is a significant health(care) problem, as regular PA has many health benefits also at advanced age. Research on automatic processes underlying PA behaviour in physically inactive older adults is yet non-existing. Since people are unconsciously influenced by people around them (i.e. by ‘social norms’) automatic processes could be used to promote PA. We developed an explorative intervention method to assess the effects of automatically processed (implicit) descriptive social norms (‘What most people do’) on behavioral intention and participation in PA offered in a local residential care setting.

Methods

Forty-seven care clients met the inclusion criteria. Participants (response 45%; unaware of the intention of the research) were randomly assigned to an experimental (N = 10) or a control group (N = 11). The experimental group was exposed to photos and text heading on active peers (physically active implicit descriptive norm) using a draft newsletter article they were asked to comment on, whereas the control group was exposed to a newsletter with photos and text heading of inactive peers (physically inactive implicit descriptive norm). Subsequently, we tested (Fishers exact p < 0.10) whether this unaware exposure predicted intention (implicit and explicit) to participate in PA offered and organized by the care center (e.g. walking, gymnastics) and self-reported participation in organised PA at three months follow-up. Participants were debriefed later.

Results

Mean age was 87 years (SD = 3.6; range 80–95) and 53% of the participants were male. At baseline, there were no significant differences in self-rated health and PA between the experimental and control group. Results indicated that implicit descriptive norm information was associated with implicit PA intention (p = .056, Fisher’s exact test). No significant effects were found on explicit intention. At 3 months follow-up the experimental group self-reported 80% participation in PA versus 22% in the control group (Fisher’s exact test p = 0.027).

Conclusion

Implicit descriptive social norm information could indeed be a potentially effective way to encourage inactive older adults in residential care to engage in organized PA.

Social influences on eating and physical activity behaviours of urban, minority youths

OBJECTIVE

Social relationships can impact youths' eating and physical activity behaviours; however, the best strategies for intervening in the social environment are unknown. The objectives of the present study were to provide in-depth information on the social roles that youths' parents and friends play related to eating and physical activity behaviours and to explore the impact of other social relationships on youths' eating and physical activity behaviours.

DESIGN

Convergent parallel mixed-methods design.

SETTING

Low-income, African American, food desert neighbourhoods in Baltimore City, MD, USA.

SUBJECTS

Data were collected from 297 youths (53 % female, 91 % African American, mean age 12·3 (sd 1·5) years) using structured questionnaires and combined with in-depth interviews from thirty-eight youths (42 % female, 97 % African American, mean age 11·4 (sd 1·5) years) and ten parents (80 % female, 50 % single heads of house, 100 % African American).

RESULTS

Combined interpretation of the results found that parents and caregivers have multiple, dynamic roles influencing youths' eating and physical activity behaviours, such as creating health-promoting rules, managing the home food environment and serving as a role model for physical activity. Other social relationships have specific, but limited roles. For example, friends served as partners for physical activity, aunts provided exposure to novel food experiences, and teachers and doctors provided information related to eating and physical activity.

CONCLUSIONS

Obesity prevention programmes should consider minority youths' perceptions of social roles when designing interventions. Specifically, future research is needed to test the effectiveness of intervention strategies that enhance or expand the supportive roles played by social relationships.

Scientific uncertainty as a moderator of the relationship between descriptive norm and intentions to engage in cancer risk-reducing behaviors

This study examined motivational factors underlying six behaviors with varying levels of scientific uncertainty with regard to their effectiveness in reducing cancer risk. Making use of considerable within-subjects variation, the authors examined the moderating role of the degree of scientific uncertainty about the effectiveness of cancer risk-reducing behaviors in shaping relationships between constructs in the Integrative Model of Behavioral Prediction (Fishbein & Yzer, 2003 ). Using cross-sectional data (n = 601), the descriptive norm-intention relationship was stronger for scientifically uncertain behaviors such as avoiding BPA plastics and using a hands-free mobile phone headset than for established behaviors (e.g., avoiding smoking, fruit and vegetable intake, exercise, and applying sunscreen). This pattern was partially explained by the mediating role of injunctive norms between descriptive norm and intentions, as predicted by the extended Theory of Normative Social Behavior (Rimal, 2008 ). For behaviors more clearly established as an effective means to reduce the risk of cancer, self-efficacy was significantly more predictive of intentions to perform such behaviors. The authors discuss practical implications of these findings and theoretical insights into better understanding the role of normative components in the adaptation of risk-reduction behaviors.

Mechanisms underpinning use of new walking and cycling infrastructure in different contexts: mixed-method analysis

Background

Few studies have evaluated the effects of infrastructural improvements to promote walking and cycling. Even fewer have explored how the context and mechanisms of such interventions may interact to produce their outcomes.

Methods

This mixed-method analysis forms part of the UK iConnect study, which aims to evaluate new walking and cycling routes at three sites — Cardiff, Kenilworth and Southampton. Applying a complementary follow-up approach, we first identified differences in awareness and patterns of use of the infrastructure in survey data from a cohort of adult residents at baseline in spring 2010 (n = 3516) and again one (n = 1849) and two (n = 1510) years later following completion of the infrastructural projects (Analysis 1). We subsequently analysed data from 17 semi-structured interviews with key informants to understand how the new schemes might influence walking and cycling (Analysis 2a). In parallel, we analysed cohort survey data on environmental perceptions (Analysis 2b). We integrated these two datasets to interpret differences across the sites consistent with a theoretical framework that hypothesised that the schemes would improve connectivity and the social environment.

Results

After two years, 52% of Cardiff respondents reported using the infrastructure compared with 37% in Kenilworth and 22% in Southampton. Patterns of use did not vary substantially between sites. 17% reported using the new infrastructure for transport, compared with 39% for recreation. Environmental perceptions at baseline were generally unfavourable, with the greatest improvements in Cardiff. Qualitative data revealed that all schemes had a recreational focus to varying extents, that the visibility of schemes to local people might be an important mechanism driving use and that the scale and design of the schemes and the contrast they presented with existing infrastructure may have influenced their use.

Conclusions

The dominance of recreational uses may have reflected the specific local goals of some of the projects and the discontinuity of the new infrastructure from a satisfactory network of feeder routes. Greater use in Cardiff may have been driven by the mechanisms of greater visibility and superior design features within the context of an existing environment that was conducive neither to walking or cycling nor to car travel.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0185-5) contains supplementary material, which is available to authorized users.

Is anybody doing it? An experimental study of the effect of normative messages on intention to do physical activity

Background

The study explores whether messages about the physical activity levels of the majority (i.e. normative messages) affect young adults' intention to engage in regular physical activity.

Methods

An experimental survey among 16 to 24 year-olds in Bulgaria, Croatia and Romania (n = 1200) was conducted in March 2013. A control group received no message; one treatment group was told that the majority was physically active (positive message); and another treatment group was told that the majority was not physically active (negative message).

Results

Both the positive and (unexpectedly) the negative normative messages showed a significant and positive effect on intention to be physically active. There was no difference between the effects of the messages.

Conclusions

Normative messages affect intention, which is encouraging for public health campaigns. The effect of the positive message confirms previous findings on conformity to the norm; the effect of the negative message is unexpected and requires further research to be understood.

A daily process analysis of intentions and physical activity in college students

Social-cognitive theories, such as the theory of planned behavior, posit intentions as proximal influences on physical activity (PA). This paper extends those theories by examining within-person variation in intentions and moderate-to-vigorous physical activity (MVPA) as a function of the unfolding constraints in people's daily lives (e.g., perceived time availability, fatigue, soreness, weather, overeating). College students (N = 63) completed a 14-day diary study over the Internet that rated daily motivation, contextual constraints, and MVPA. Key findings from multilevel analyses were that (1) between-person differences represented 46% and 33% of the variability in daily MVPA intentions and behavior, respectively; (2) attitudes, injunctive norms, self-efficacy, perceptions of limited time availability, and weekend status predicted daily changes in intention strength; and (3) daily changes in intentions, perceptions of limited time availability, and weekend status predicted day-to-day changes in MVPA. Embedding future motivation and PA research in the context of people's daily lives will advance understanding of individual PA change processes.