The What's Next Health series features leading thinkers and visionaries. Stanford social scientist & innovator BJ Fogg discusses his model f...
The American Association for Retired Persons (AARP) conducted a social marketing project from 2002 to 2004 to promote increased physical activity in Richmond, Va., and Madison, Wis., two demonstration sites under the Robert Wood Johnson Foundation's (RWJF) national program, Active for Life®: Increasing Physical Activity Levels in Adults 50 and Older.
AARP's project, called the Active for Life Campaign, was the marketing communications component of RWJF's national program. The campaign had two additional components: partnership/coalition-building and environmental change.
RWJF also contracted with two firms that conducted evaluations of aspects of the demonstration projects: Sutton Group on the partnership component in Richmond and Madison; and Princeton Survey Research Associates to conduct a multiyear, multiwave survey of the projects' impact in Richmond and Madison.
RWJF provided a $4.3 million grant from October 2001 to September 2005 to support AARP's Active for Life Campaign. The campaign in Richmond and Madison also received $2,545,000 from AARP.
RWJF provided the Sutton Group a contract of $223,624 for a focus group and two surveys of partners in Richmond and Madison.
RWJF provided Princeton Survey Research Associates with two contracts totaling $1,006,000 to conduct a multiyear, multiwave survey of the projects' impact in Richmond and Madison.
Physical inactivity is one of the greatest modifiable threats to health and functional independence in later life. A May 2001 report, the National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older, sponsored by RWJF and five partners American College of Sports Medicine, American Geriatric Society, Centers for Disease Control and Prevention (CDC) and the federal National Institute on Aging confirmed that scientific evidence increasingly shows that physical activity can extend years of active independent life, reduce disability and improve the quality of life for older persons. An October 2000 conference at which 50 interested organizations provided input and recommendations provided the basis for the blueprint.
By the time they reach age 50, most Americans know what experts say they should be doing to stay healthy and fit, but few are acting on their knowledge. As a result, many midlife and older adults pay a harsh price in terms of disease, disability, and premature death. Physical inactivity and related obesity and overweight are direct contributing factors to the most prevalent and disabling diseases and conditions such as diabetes, heart disease, stroke, some kinds of cancer, arthritis and osteoporosis. CDC has reported that at least 300,000 deaths a year in the United States are linked to obesity.
What remains unclear is the question of what motivates older adults to exercise. To change physical activity behavior requires individuals changing not only perceptions of age-appropriate behavior and willingness to integrate physical activity into busy lives but also that the communities where people live become more activity friendly. There is consequently a need for a range of effective interventions that promote physical activity for older adults.
Promoting healthy communities and lifestyles is an RWJF goal area. One of RWJF's strategies to meet this goal has been to find ways to increase physical activity through community design and redesign and to build a stronger knowledge base from which to promote active living. RWJF has four active living programs:
AARP's Active for Life Campaign was a social marketing project to increase the physical activity of people age 50 and older, funded under the Active for Life program. During the Active for Life Campaign in Madison and Richmond, AARP worked with a range of partners to increase physical activity among people age 50 and older in these communities. AARP is a nonprofit, nonpartisan membership organization dedicated to making life better for people 50 and over.
The goal of the population-based Active for Life Campaign was to increase awareness of the benefits of physical activity to adults and to increase physical activity levels in target populations. The campaign promoted the specific exercise goal for older adults of moderate physical exercise at least 30 minutes a day, five days a week, in accordance with the guidelines in Healthy People 2010, the health objectives issued by the federal Department of Health and Human Services. The Active for Life Campaign in Madison and Richmond received $2,545,000 from AARP in addition to funds from RWJF.
AARP project staff worked on three components of the Active for Life Campaign under grant ID# 042913:
RWJF contracted with the Sutton Group, a Washington consulting firm, to conduct 12 focus groups during May and June 2001 in Baltimore; Jackson, Miss.; and Chicago (supported by a portion of funds from grant ID# 040245). These focus groups explored how older adults thought, felt and talked about physical activity. The focus groups included adults aged 60 to 75. AARP had previously contracted with the Sutton Group to conduct a similar series of focus groups with adults aged 50 to 59. Participants in the focus groups all had physical activity levels below Healthy People 2010 guidelines. A key finding was that most participants expressed a high level of ambivalence about becoming more physically active. Many noted the competing time pressures of work and family while others mentioned a high degree of boredom from repetitive exercise routines. (For a more detailed description of the Sutton Group focus group findings, see Appendix 1.)
AARP contracted with RoperASW, a New York-based market research and consulting firm, to field a telephone survey of 1,000 adults between the ages of 50 and 79 in March and April of 2002. The survey was representative of 5079-year-olds living in the continental United States and included oversamples of African Americans and Hispanics. The survey probed respondents' current exercise behavior, their confidence in continuing to exercise when facing difficult situations and their interest and participation in community-based physical activity programs.
Among the findings were that only 15 percent of respondents currently participated in community classes; among the top reasons for exercising were to improve health and increase energy level; and 73 percent said they were interested in learning how to exercise safely. AARP used the results of the Sutton Group and Roper research in planning the social marketing projects in Richmond and Madison.
To better inform the environmental component of the campaign, AARP contracted with Bonney & Company, Virginia Beach, Va., to hold focus groups in Richmond, Va.; Madison, Wis.; and Birmingham, Ala., in October 2002 (two in each city). The focus groups explored consumer perceptions of the effect of the built environment on physical activity and their willingness to advocate for change in the environment.
The research indicated that barriers in the built environment were considered less important than such factors as lack of time or interest. The only issues that resonated with a large number of participants were concern for personal safety and a preference for physical activity in large public spaces such as malls and parks.
Preparations for the May 2002 launch began in late 2001. AARP project staff hired site coordinators in Richmond and Madison, formed working groups of community partners, developed community resource guides for each site and launched a Web site as part of the AARP Web site, which was operational for about two years.
The first advertising campaign in Richmond and Madison, launched in May 2002, lasted about one year and focused on physical activity in general. Messages to older adults encouraged them to call a toll-free number to receive a personal handbook for a self-directed 12-week physical activity program. Messages also directed people to the Active for Life Web site.
AARP contracted with Mapes & Ross, Princeton, N.J., to field a telephone survey in Madison and Richmond in April and May 2003, with a total of 800 people over age 45 to determine the effectiveness of the media buys on influencing viewers' awareness, knowledge, behavior and receptivity to the ads. Unaided awareness of the campaign was nonexistent, and aided recall was very low, with only 13 percent having heard of the campaign.
A second advertising campaign in Richmond and Madison began in September 2003 and ran for four months. Because of the disappointing results from the ad tests, a new television commercial and two print advertisements were developed with an emphasis on walking. This new focus on walking coincided with AARP's strategic decision to focus on walking and a communitywide walking campaign was launched in both cities and the second ad campaign supported this.
Walking campaign messages encouraged older adults to obtain free step counters at community events, at the facilities of campaign partners public health agencies, recreation and parks departments, health organizations, environmental groups, faith-based organizations, neighborhood associations, fitness facilities and clubs and major employers and by calling a toll-free number.
Just before the second media campaign started, AARP contracted with International Communications Research of Media, Pa., to field a telephone survey in Richmond and Madison among 800 adults age 50 and older to be used as a baseline for this campaign. The survey asked about the types of physical activity respondents engaged in and community conditions for walking, among other topics. International Communications Research conducted a second survey in December 2003 and a third in May 2004.
Results from the surveys indicated that during the course of the campaign Madison adults over 50 had increased the amount of time they walked while adults in Richmond had no significant increases. The survey results showed, nonetheless, that respondents found the walking campaign ads more meaningful, believable and persuasive than the first, more general ad campaign.
AARP spent most of the costs for both ad campaigns on television, with radio next and print insertions in newspapers and magazines third. Fleishman-Hillard, a public relations firm based in St. Louis, provided assistance in 2002 and 2003 with publicity such as spokespersons, interviews and articles that featured personal success stories and physical activity events. These stories were all on message.
AARP site coordinators in Madison and Richmond worked to engage local partners to strengthen local programming and outreach. The partnering organizations offered classes and activities, distributed physical activity community resource guides, the handbook and step counters for a walking program, promoted increased physical activity to their constituencies and helped form local coalitions to improve conditions for walking and biking.
Some of the partners in the physical activity business had not reached out to the 50+ before and began doing so; other partners who were reaching the 50+ age group, but not with physical activities, began adding "health" or "physical activity" to their "menus" of offerings.
To assist with the environmental change component, project staff hired public health consultants, contracting in 2002 and 2003 with the department of health behavior and health education at the School of Public Health, University of North Carolina at Chapel Hill. The public health consultants conducted workshops in Richmond and Madison to train volunteers to assess their communities' walking and bicycling suitability.
The consultants held one workshop in Richmond and one in Madison as well as one workshop for traffic engineers in Richmond. A small group of volunteers in each city worked with the consultants to conduct the assessments. The consultants also developed a model for evaluation based on public awareness, neighborhood audits and community activism as ways to measure the campaign's impact (see Results).
Project staff also held information briefings and "tours" for local officials, advocated for change and participated in pedestrian safety projects.
As part of its contract with the Sutton Group (ID# 040245), RWJF asked the firm to conduct interviews with project partners to provide baseline information about the state of the partnerships and marketplace prior to the Active for Life Campaign.
The Sutton Group conducted 48 interviews in September and October 2002 with 24 partners in each site. These interviews revealed many concerns by the partners, which project staff addressed by distributing a brochure to partners that described the project, emphasized the collaborative nature of the effort; holding networking meetings; and providing support materials and other resources.
Sutton Group staff members conducted follow-up telephone interviews in late February to mid-March 2004 with 20 partners in each city in Madison: 14 partners from health and recreational sectors and six environmental-design partners; in Richmond: 13 partners from health and recreational sectors and seven environmental-design partners.
Follow-up interviews indicated partners' perception of the Active for Life Campaign and the AARP had changed for the better and that they felt a part of a larger movement to promote physical activity. (For a more detailed description of the Sutton Group partner interviews, see Appendix 1.)
To document the project's impact on the exercise behavior of adults age 50 and older, RWJF contracted with Princeton Survey Research Associates, Princeton, N.J., an independent research company (ID#s 041911 and 046220). Between 2002 and 2004, the survey firm administered four separate waves of telephone interviews in Madison and Richmond as well as in two cities of similar size, geography and sociodemographic characteristics: Lincoln, Neb., and Greensboro/Winston-Salem, N.C.
The survey focused on knowledge/awareness of exercise information, attitudes toward exercise and physical fitness, current exercise behavior and exposure to exercise information. The survey showed that before the campaign began, both Madison and Richmond had moderately active older adult populations who were generally aware of the overall benefits of regular physical activity but unsure how to implement appropriate exercise programs in their own lives. See Results for the findings from Princeton Survey Research Associates.
Results of marketing communications, based on the Princeton Survey Research Associates' survey findings (see Appendix 2 for further details):
The key results of partnership and coalition-building, according to the project director, were:
Results of the environmental change efforts, according to the project director, were:
The program distributed over 17,000 community resource guides in Madison and 20,000 in Richmond. Project staff distributed 5,000 self-guided physical activity handbooks in Richmond and 3,000 in Madison. Staff also distributed almost 5,000 brochures that integrated health and pedestrian safety messages in Madison. There were over 20 partner events in Madison and 44 in Richmond, reaching some 2,500 and 4,700 people, respectively.
During the grant, AARP staff made over 22 presentations about the Active for Life Campaign in Richmond and Madison. AARP staff also presented information about Active for Life at conferences and meetings throughout the United States and Canada, including presentations at the Governor's Summit on Healthy Virginians, University of Virginia, Charlottesville, Va., the National Congress of Pedestrian Advocates, Silver Spring, Md., and the American Public Health Association Conference, also in Silver Spring.
The AARP project staff published handbooks, guides or tools for the Active for Life social marketing project. Project staff continues to share information with grantees of RWJF's Active for Life national program. See the Bibliography for details of available items.
AARP established a collaboration with CDC to promote healthy aging. In 2003, leadership from AARP and CDC formed a team to identify ways to extend the reach and effectiveness of both organizations. The team agreed on four initial areas of focus: walking, driver safety, preventive services (such as screening) and research. As part of its collaboration with CDC, AARP is applying the lessons learned gained from this social marketing project to help other communities throughout the country. AARP has developed toolkits on walking campaigns for its state offices, including kickoff ideas, consumer tip sheets and other how-to guides.
Improving Physical Activity Levels of Mid-Life and Older Adults through a Social Marketing Project in Richmond, Va., and Madison, Wis.
AARP (formerly American Association of Retired Persons) (Washington, DC)
Princeton Survey Research Associates (Princeton, NJ)
Sutton Group (Washington, DC)
Results of Sutton Group Focus Groups and Partner Surveys ID#40245)
On Reaching Age 50
Current Patterns of Physical Activity
Reactions to AARP Program Concepts
Suggestions for Helping People to Be More Active
The Sutton Group Project Partner Baseline Interviews Generated the Following Findings
The Sutton Group's Summary of Major Themes
Results of Princeton Research Survey Associates Survey (ID#s 041911 and 046220)
Wave 1 (March 12 to May 7, 2002)
Wave 2 (September 12 to November 12, 2002)
Wave 3 (March 18 to June 1, 2003)
Wave 4 (March 16 to May 25, 2004)
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Be Active for Life Handbook. Washington: AARP, 2002.
Be Active for Life Guide Madison. Washington: AARP, 2002.
Be Active for Life Guide Richmond. Washington: AARP, 2002.
Active for Life Motivational Letters 4 week, 8 week and 12 week. Washington: AARP, 2002.
Implementation Manual. Washington: AARP, 2002.
Model Program Guide. Washington: AARP, 2002.
10K-A-Day Coordinator's Guide. Washington: AARP, 2002.
Fleishman-Hillard, Inc. Active for Life Media Report Overview. Washington, AARP, 2003.
Emery J and Crump C. Active for Life Pilot Campaign, Process Evaluation of the Environmental Component. Chapel Hill, N.C.: University of North Carolina at Chapel Hill School of Public Health, March 15, 2004.
Sutton Group. AFL Partnership Evaluations Wave 2 Findings. Washington: Sutton Group, April 8, 2004.
An Evaluation of the Effects of a Pilot Social Marketing Campaign in Madison, WI and Richmond, VA. Princeton, N.J.: Princeton Survey Research, Wave 1 and Wave 2, July 2003; Wave 3, September 2003; Wave 4, August 2004.
DeZern P. Richmond Active for Life: Sustainability Plan Narrative January June 2004. Washington: AARP, 2004.
Bauer J. Madison Active for Life Sustainability Plan for 2004. Washington: AARP, 2004.
Keenan TA. Active for Life: Summary of Research and Evaluation. Washington: AARP, August 2004.
Keenan TA. Health & Wellness Research, 2003: Active for Life Research. Washington: AARP, May 2004.
Keenan TA. Highlights from Walking Campaign Surveys: Madison. Washington: AARP, March 2004.
Keenan TA. Highlights from Walking Campaign Surveys: Richmond. Washington: AARP, February 2004.
Keenan TA. Synthesis of AARP Research in Physical Activity: 19992003. AARP, Washington: January 2004.
AARP and RoperASW. Exercise Attitudes and Behaviors: A Survey of Midlife and Older Adults. Washington: AARP, May 2002.
AARP and RoperASW. Exercise Attitudes and Behaviors: Results from Over-Samples among African-Americans and Hispanics. Washington: AARP, May 2002.
"AARP Pilot Survey on Physical Activity." RoperASW fielded October 22November 11, 2001.
"AARP National Survey on Physical Activity." RoperASW, fielded March 17April 28, 2002.
"Active for Life Survey: Wave One." Princeton Survey Research Associates, fielded March 12May 7, 2002.
"Active for Life Survey: Wave Two." Princeton Survey Research Associates, fielded September 12November 12, 2002.
"Active for Life Survey: Wave Three." Princeton Survey Research Associates, fielded March 18June 1, 2003.
"AARP Baseline Survey on Walking." International Communications Research, fielded September 319, 2003.
"AARP Post-Campaign Survey on Walking." International Communications Research, fielded December 930, 2003.
"AARP Final Post-Campaign Survey on Walking." International Communications Research, fielded May 1024, 2004.
"Active for Life Survey: Wave Four." Princeton Survey Research Associates, fielded March 16May 25, 2004.
Teresa A. Keenan. Motivating Midlife and Older Adults to be Active for Life. Presented at the 57th Annual Meeting of the Gerontological Society of America, Washington, November 20, 2004.
John Bauer and Teresa A. Keenan. It's as Easy as Walking: Highlights from a Walking Campaign in Two U.S. Cities. Symposium at the 6th World Congress on Aging and Physical Activity, London, Ontario, Canada, August 6, 2004. Proceedings available for purchase online.
Teresa A. Keenan. Physical Activity and Constraints in the Built Environment. Presented at the 6th World Congress on Aging and Physical Activity, London, Ontario, Canada, August 4, 2004. Proceedings available for purchase online.
John Bauer and Teresa A. Keenan. Walking, Who Knew? Highlights from a Walking Campaign in Two U.S. Cities. Presented at the National Congress of Pedestrian Advocates, Silver Spring, Maryland, May 8, 2004. Available online.
Report prepared by: Nanci Healy
Reviewed by: Janet Heroux
Reviewed by: Molly McKaughan
Program Officer: Terry Bazzarre
Program Officer: Robin Mockenhaupt
The What's Next Health series features leading thinkers and visionaries. Stanford social scientist & innovator BJ Fogg discusses his model f...
Hear from social scientist BJ Fogg, RWJF’s Entrepreneur-in-Residence Thomas Goetz, a team with a vision for creating a social epidemic of sa...
Executive Nurse Fellow Jerry Mansfield explains why the University Hospital and the Richard M. Ross Heart Hospital do not have a BSN-only hi...
We create new opportunities for better health by investing in health where it starts—in our homes, schools, and jobs.
Team members, grantees, and guests discuss breakthrough ideas that will allow us to move toward solving challenges in health care.
Imagine a shared national culture of health in which being healthy and staying healthy are esteemed social values.
NewPublicHealth spoke with Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids, about “A Broken Promise to Ou...
Patrick M. Krueger recently co-authored a study that examines the characteristics and mortality risks of nondrinker subgroups to explain why...
2013 America’s Health Rankings Finds Significant Progress in National Health - FDA to Phase Out Use of Certain Antimicrobials in Food Animal...
Developing small community homes as alternatives to nursing homes, this radical, new national model for skilled nursing care returns control...
This fall, RWJF held its first ever Pitch Day event with the goal of discovering visionary ideas from a variety of thinkers.
America is not getting good value for its health care dollar. These resources explore issues of cost and value of health care.