ParticipACTION: awareness of the participACTION campaign among Canadian adults--examining the knowledge gap hypothesis and a hierarchy-of-effects model.

Abstract

ParticipACTION was a pervasive communication campaign that promoted physical activity in the Canadian population for three decades. According to McGuire's hierarchy-of-effects model (HOEM), this campaign should influence physical activity through intermediate mediators such as beliefs and intention. Also, when such media campaigns occur, knowledge gaps often develop within the population about the messages being conveyed. The purposes of this study were to (a) determine the current awareness of ParticipACTION campaigns among Canadians; (b) confirm if awareness of the ParticipACTION initiative varied as a function of levels of education and household income; and, (c) to examine whether awareness of ParticipACTION was associated with physical activity related beliefs, intentions, and leisure-time physical activity (LTPA) as suggested by the HOEM. Specifically, we tested a model including awareness of ParticipACTION (unprompted, prompted), outcome expectations, self-efficacy, intention, and physical activity status.
A population-based survey was conducted on 4,650 Canadians over a period of 6 months from August, 2007 to February, 2008 (response rate = 49%). The survey consisted of a set of additional questions on the 2007 Physical Activity Monitor (PAM). Our module on the PAM included questions related to awareness and knowledge of ParticipACTION. Weighted logistic models were constructed to test the knowledge gap hypotheses and to examine whether awareness was associated with physical activity related beliefs (i.e., outcome expectations, self-efficacy), intention, and LTPA. All analyses included those respondents who were 20 years of age and older in 2007/2008 (N = 4424).
Approximately 8% of Canadians were still aware of ParticipACTION unprompted and 82% were aware when prompted. Both education and income were significant correlates of awareness among Canadians. The odds of people being aware of ParticipACTION were greater if they were more educated and reported higher income. Awareness of ParticipACTION was also associated with outcome expectations, self-efficacy, intention, and LTPA status.
Awareness of ParticipACTION is associated with LTPA. Knowledge gaps in awareness are associated with level of education and household income. Thus, future promotion campaigns should include specific strategies to target different segments of the population, especially people who are living in deprived conditions with lower levels of education.

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BioMed Central
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International Journal of Behavioral
Nutrition and Physical Activity
Open Access
Research
ParticipACTION: Awareness of the participACTION campaign
among Canadian adults - Examining the knowledge gap hypothesis
and a hierarchy-of-effects model
John C Spence*1, Lawrence R Brawley2, Cora Lynn Craig3,4,
Ronald C Plotnikoff5, Mark S Tremblay6, Adrian Bauman4, Guy EJ Faulkner7,
Karen Chad8 and Marianne I Clark9
Address: 1Sedentary Living Lab, Faculty of Physical Education and Recreation, E-488 Van Vliet, University of Alberta, Edmonton, AB, T6G 2H9,
Canada, 2College of Kinesiology, PAC 300, 87 Campus Drive, University of Saskatchewan, Saskatoon, SK, S7N 5B2, Canada, 3Canadian Fitness
and Lifestyle Research Institute, 201-185 Somerset Street West, Ottawa, ON, K2P 0J2, Canada, 4School of Public Health, K25 - Medical Foundation
Building, The University of Sydney, Sydney NSW 2006, Australia, 5School of Public Health and Faculty of Physical Education and Recreation, E-
488 Van Vliet Centre, University of Alberta, Edmonton, AB T6G 2H9, Canada, 6Healthy Active Living and Obesity Research Group, Children's
Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada, 7University of Toronto, Faculty of Physical
Education and Health, 55 Harbord Street, Toronto, ON, M5S 2W6, Canada, 8College of Kinesiology, PAC 300, 87 Campus Drive, University of
Saskatchewan, Saskatoon, SK, S7N 5B2, Canada and 9Sedentary Living Lab, Faculty of Physical Education and Recreation, E-488 Van Vliet,
University of Alberta, Edmonton, AB, T6G 2H9, Canada
Email: John C Spence* - jc.spence@ualberta.ca; Lawrence R Brawley - larry.brawley@usask.ca; Cora Lynn Craig - ccraig@cflri.ca;
Ronald C Plotnikoff - ron.plotnikoff@ualberta.ca; Mark S Tremblay - mtremblay@cheo.on.ca; Adrian Bauman - adrianb@health.usyd.edu.au;
Guy EJ Faulkner - guy.faulkner@utoronto.ca; Karen Chad - karen.chad@usask.ca; Marianne I Clark - mclark1@ualberta.ca
* Corresponding author
Abstract
Background: ParticipACTION was a pervasive communication campaign that promoted physical
activity in the Canadian population for three decades. According to McGuire's hierarchy-of-effects
model (HOEM), this campaign should influence physical activity through intermediate mediators
such as beliefs and intention. Also, when such media campaigns occur, knowledge gaps often
develop within the population about the messages being conveyed. The purposes of this study were
to (a) determine the current awareness of ParticipACTION campaigns among Canadians; (b)
confirm if awareness of the ParticipACTION initiative varied as a function of levels of education
and household income; and, (c) to examine whether awareness of ParticipACTION was associated
with physical activity related beliefs, intentions, and leisure-time physical activity (LTPA) as
suggested by the HOEM. Specifically, we tested a model including awareness of ParticipACTION
(unprompted, prompted), outcome expectations, self-efficacy, intention, and physical activity
status.
Methods: A population-based survey was conducted on 4,650 Canadians over a period of 6
months from August, 2007 to February, 2008 (response rate = 49%). The survey consisted of a set
of additional questions on the 2007 Physical Activity Monitor (PAM). Our module on the PAM
included questions related to awareness and knowledge of ParticipACTION. Weighted logistic
models were constructed to test the knowledge gap hypotheses and to examine whether
awareness was associated with physical activity related beliefs (i.e., outcome expectations, self-
Published: 9 December 2009
International Journal of Behavioral Nutrition and Physical Activity 2009, 6:85doi:10.1186/1479-5868-6-85
Received: 20 February 2009
Accepted: 9 December 2009
This article is available from: http://www.ijbnpa.org/content/6/1/85
© 2009 Spence et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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efficacy), intention, and LTPA. All analyses included those respondents who were 20 years of age
and older in 2007/2008 (N = 4424).
Results: Approximately 8% of Canadians were still aware of ParticipACTION unprompted and
82% were aware when prompted. Both education and income were significant correlates of
awareness among Canadians. The odds of people being aware of ParticipACTION were greater if
they were more educated and reported higher income. Awareness of ParticipACTION was also
associated with outcome expectations, self-efficacy, intention, and LTPA status.
Conclusion: Awareness of ParticipACTION is associated with LTPA. Knowledge gaps in
awareness are associated with level of education and household income. Thus, future promotion
campaigns should include specific strategies to target different segments of the population,
especially people who are living in deprived conditions with lower levels of education.
Background
While leisure-time physical activity has increased in Can-
ada over the past 20 years [1], approximately 50% of the
Canadian population does not achieve the recommended
minimum physical activity [2]. Physical inactivity thus
constitutes a major public health concern [3] with related
social and economic costs [4]. Mass media campaigns are
an initial strategy for increasing awareness about physical
activity at a population level [5-8]. Though mass media
interventions alone are not expected to be effective for
increasing physical activity [9], evidence exists to support
the role of media campaigns in changing beliefs and
knowledge about physical activity [6,10]. In light of this,
identifying and examining both the potential contribu-
tions and limitations of such interventions is required to
fully determine the role of media campaigns for increas-
ing physical activity. Thus, a further understanding of
communication or media campaigns to promote physical
activity would make an important contribution to the lit-
erature and assist the inception of campaigns elsewhere.
ParticipACTION was an innovative and pervasive com-
munication campaign and integrated social marketing
strategy [11] that promoted physical activity in the Cana-
dian population over three decades. Built on the princi-
ples of social marketing and health communication,
ParticipACTION aimed to increase awareness of the bene-
fits of active living and develop supportive environments
for physical activity [12]. ParticipACTION's campaigns
were characterized by creative marketing techniques, stra-
tegic partnerships and emphasis on community mobiliza-
tion [12,13]. Launched in 1971 with seed money from a
federal government concerned by rising health care costs
and declining health and fitness standards, the Partici-
pACTION campaign evolved over 29 years before its offi-
cial conclusion in 2000. Its stated purpose was two-fold:
to motivate all Canadians to be more active and to
improve population levels of fitness over the long term
[12].
Formal evaluation techniques designed to appraise public
health programs were limited at the time of ParticipAC-
TION's inception [14]. Therefore, specific logic models
were not implemented to either design or evaluate the
campaign. However some evidence exists to suggest sig-
nificant population awareness and support of ParticipAC-
TION. A review by Bauman et al. [14] synthesized results
from six national surveys and revealed high levels of
unprompted and prompted recall of ParticipACTION
among Canadian adults over the course of two decades.
When asked to list fitness and physical activity organiza-
tions (unprompted recall) ParticipACTION was consist-
ently mentioned by between one-sixth and one-third of
Canadians between 1978 and 1994. Prompted recogni-
tion rates of the ParticipACTION logo or messages ranged
from 77% in 1977 to over 80% from 1980 through to
2002. Of those aware of the organization, 83% to 95%
thought it useful in promoting physical activity participa-
tion. A review of physical activity campaigns around the
world suggested that prompted recall rates of campaigns,
logos or messages post-campaign were on average 70%
from population surveys [10]. The prompted recall rates
of 80% across ParticipACTION surveys indicate a persist-
ent and pervasive impact on knowledge and awareness.
According to the hierarchy-of-effects model (HOEM)
[10,15] awareness of campaigns should influence behav-
iour by changing targeted intermediate mediators such as
beliefs (e.g., outcome expectations and self-efficacy) and
intentions for the behaviour among the target group.
Thus, evaluations of mass media campaigns should first
establish if there are proximal (immediate) effects, such as
awareness of the campaign and understanding of the mes-
sage on the part of individuals, prior to evaluating the
more distal goals of perceived relevance, changes in
beliefs or intentions, and ultimately behaviour change. In
evaluating awareness it is important to first measure
unprompted awareness (e.g., what are important sources
of physical activity information?) followed by prompted

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awareness (e.g., are you aware of ParticipACTION?).
Awareness, understanding, and perceptions of an initia-
tive and its messages, and the formation of social norms
are examples often the focus of mass media campaign
evaluations [5]. During
increases in physical activity levels were observed among
Canadians between 1981 and 1995 [1,6]. However, these
changes cannot be uniquely linked to ParticipACTION as
other policy, environmental and public health factors
may have also played a role.
ParticipACTION's tenure
A recent survey suggests that ParticipACTION has main-
tained its presence in the vocabulary of Canadian adults
despite the lack of new national public service messages
since 1999 and the fact that it ceased all operations in
2001 [16]. The survey assessed awareness of ParticipAC-
TION, its taglines and usefulness using the Canadian Fit-
ness and Lifestyle Research Institute's Physical Activity
Monitor (PAM). The study, which was conducted from
November 2004 through to January 2005, determined the
degree of population attention to and recall of ParticipAC-
TION and its perceived usefulness among adult Canadi-
ans. Participants were asked questions such as "When you
think of physical fitness, what group or organization pro-
moting fitness in Canada comes to mind?" (unaided
recall) and "Have you ever heard of ParticipACTION?"
(prompted recall). In response to the unaided recall ques-
tion, 15% cited ParticipACTION, third behind private
exercise clubs and organizations (29%) and public facili-
ties such as YMCA's (20%). More than three quarters of
Canadians (78%) indicated they had heard of ParticipAC-
TION when prompted. Furthermore, the majority of
adults who were aware of ParticipACTION considered its
efforts to be either somewhat useful (47%) or very useful
(29%) in promoting physical activity. In general, Canadi-
ans with higher levels of education and income were more
likely to report hearing of ParticipACTION and more
likely to cite it when answering the unaided recall ques-
tion. Adults between the ages of 25-64 demonstrated
greater awareness of ParticipACTION than those 18 years
of age or younger.
While these findings suggest the ParticipACTION cam-
paign was recognized by the majority of the Canadian
adult population, they are also evidence of the knowledge
gap hypothesis [17] in which it is proposed that people of
higher socioeconomic status (SES) benefit more from
information flowing into a social system (e.g., through
media campaigns) than do people of lower SES. Thus,
public health campaigns and initiatives such as Partici-
pACTION may actually exacerbate existing differences
between SES groups in both behaviour and health.
Though empirical research has confirmed the existence of
the knowledge gap for many phenomena [18,19] little is
known about the origin of this gap or how the gap devel-
ops in time in relation to physical activity campaigns.
Much evidence exists to support the claim that beliefs
such as the outcomes people expect from being physically
active (i.e., outcome expectations) and confidence in their
ability to be physically active (i.e., self-efficacy) are strong
correlates of physical activity [20,21]; however, it is less
clear whether these constructs can be influenced by media
campaigns and then subsequently influence physical
activity as suggested by the HOEM, especially in the Cana-
dian context. If awareness is influenced by SES and associ-
ated with motivational factors, then these are potentially
important to consider in the logic model(s) for develop-
ing and evaluating any new campaigns. More impor-
tantly, if the campaign itself contributes to gaps in
knowledge then specific dissemination strategies should
be developed to target those groups not receiving the
knowledge. Therefore, the purposes of this study were to
(a) determine the current awareness of ParticipACTION
among Canadians; (b) confirm if awareness of the Partic-
ipACTION initiative among Canadians varied as a func-
tion of education and income levels; and, (c) to examine
whether awareness of ParticipACTION was associated
with physical activity related beliefs, intentions, and phys-
ical activity as suggested by the HOEM. Specifically, we
tested a model including awareness of ParticipACTION
(unprompted, prompted), outcome expectations, self-
efficacy, intention, and physical activity status. We
hypothesized people who were aware of ParticipACTION
would be more likely to be physically active and to hold
more positive beliefs about being physically active.
Methods
Participants
To assess awareness of ParticipACTION on the part of
Canadians, a population-based survey was conducted on
a monthly basis over a period of 6 months from mid-
August 2007 to February, 2008. The survey consisted of a
set of additional questions on the 2007 Physical Activity
Monitor (PAM) conducted by the Institute for Social
Research (ISR) at York University on behalf of the Cana-
dian Fitness and Lifestyle Research Institute (CFLRI). The
sample was selected on a probability basis proportional to
the size of the population in the provinces and territories,
with an over-sample in small provinces. For the 2007
PAM, 333 Canadians, 15 years of age and older, were
cross-sectionally sampled per month across all provinces
and territories except Nunavut. This on-going rolling sam-
pling process yielded a nationally representative sample.
To allow for more in-depth comparisons (e.g., regional
and demographic), an additional 470 Canadians on aver-
age were sampled per month resulting in a total monthly
sample of about 800. Therefore 4,650 Canadians were ini-
tially involved in the survey on ParticipACTION with a

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response rate of 49%. Because the ParticipACTION cam-
paign ceased in 1999, the sample was limited to those
respondents who were 20 years of age and older in 2007/
2008. Therefore, our final sample included 4424 respond-
ents.
In the past, the response rate for the PAM has been
approximately 50% [1]. This is comparable to other sur-
veys conducted by the ISR and exceeds that of many other
surveys (e.g., Garcia Bengoechea et al. [22]). Non-
response has not been related to the particular subject
matter and non-response bias has been minimal since
prevalence rates for key variables have not varied between
those responding and those converted from initial refus-
als (p = 0.9) [1].
Measures
This study is part of a larger ongoing evaluation of Partic-
ipACTION communications in which physical activity,
beliefs about physical activity (e.g., outcome expectations,
self-efficacy, intentions), perceptions of the built environ-
ment, and awareness of ParticipACTION among Canadi-
ans are being measured. For the purposes of this study, we
will describe and report on the awareness, beliefs, and
physical activity variables.
Demographics
Information was collected on participants' sex, age,
household income, and level of education (high school or
less, college, university).
Physical Activity Beliefs
Outcome expectations were measured with three items
asking about beliefs that regular physical activity will help
reduce stress, prevent heart disease, and maintain activi-
ties of daily living. On a 7-point scale, response options
ranged from 'do not agree' to 'agree very strongly'. These
items were then aggregated to create a mean score (Cron-
bach's alpha = .70). Self-efficacy was measured with a sin-
gle question asking "how confident are you that you can
regularly do a total of 30 minutes or more of moderate
physical activity per day at least three or four times a
week?" On a 5-point scale, response options ranged from
'not at all confident' to 'very confident'. Intention to be
physically active was measured with a single question ask-
ing "thinking ahead over the next six months, to what
extent do you intend to be physically active?" On a 7-
point scale, response options ranged from 'no intention at
all' to 'fully intend'.
Awareness of ParticipACTION
Two categories of ParticipACTION awareness were
assessed: unprompted awareness and prompted aware-
ness. First, for unprompted awareness, participants were
asked "When you think of physical fitness, what group or
organization promoting fitness in Canada comes to
mind?" For prompted awareness, participants were then
asked if they were aware of the following programs and/
or campaigns as potential sources of physical activity
information including Canada's Food Guide to Health Eat-
ing, Body Break, Canada on the Move, Canada's Physical
Activity Guide to Health Active Living, and ParticipACTION.
A similar methodology was adopted in a previous evalua-
tion of ParticipACTION [16] and by Craig et al. [23,24] to
assess the impact of the Canada on the Move initiative.
Physical Activity
Leisure time physical activity (LTPA) over the past 12
months was assessed using an adaptation of the Minne-
sota Leisure Time Physical Activity Questionnaire [25].
Participants indicated which activities they had under-
taken in the previous year (up to 22 activities), and the fre-
quency, and the average time spent in each. Average daily
LTPA was calculated as follows: LTPA (MET hours) = Σ
(N_i × D_i × METs_i/365) where N is the number of times
the activity was performed in the past 12 months, D is the
average duration in hours, and METs is the estimated
energy cost (kJ×kg^-1 ×hr^-1). Respondents were classi-
fied as being sufficiently active if they achieved 1.5 MET-
hours or more per day of LTPA [1] which is roughly equiv-
alent to accumulating 30 minutes of moderate physical
activity on most days of the week.
Procedures
Individuals were selected using the PAM/ISR two-step-
design beginning with a random digit dialling protocol to
select an eligible household telephone number. The indi-
vidual, 15 years of age and older, with the closest birth
date was then selected. Once a potential respondent
within a household was chosen, no other person within
that same household could participate in the survey.
Interviews were administered by the ISR using Computer
Assisted Telephone Interviewing (CATI) technology.
Respondents were interviewed in either French or English.
The CATI system was programmed to check responses for
appropriateness of range and logical consistency at the
time of data entry. According to the ISR, this approach
substantiated reliability and validity for telephone inter-
viewing protocols.
The PAM was reviewed by a departmental Research Ethics
Board (REB) at York University. For the purposes of this
project, the survey also received ethics review at the Uni-
versity of Alberta.
Analysis
Analyses were performed using SPSS 16. Frequencies were
calculated for the awareness variables and associations
between the sociodemographic variables (including LTPA

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status) and awareness were determined by calculating chi
square statistics with significance assessed at p < 0.05
(purposes a and b). Two binary logistic regression mod-
els were then constructed to test the knowledge gap model
in which awareness of ParticipACTION (unprompted or
prompted) was regressed on education and income, while
controlling for gender and age (purpose b). To test the
HOEM (purpose c), we first conducted a series of one-
way between-subjects ANCOVAs for outcome expecta-
tions, self-efficacy, and intention with type of awareness
for ParticipACTION (unprompted, prompted) as the
independent variable and gender and age as covariates.
Then LTPA status (active, inactive) was regressed on the
beliefs and awareness variables in two hierarchical logistic
regressions. Specifically, age, gender, education, income,
and awareness of ParticipACTION (unprompted or
unprompted) were entered on the first step, followed by
outcome expectations, self-efficacy on step 2, with inten-
tion entered on the last step. Finally, all covariates in the
analyses were centered to reduce the possibility of multi-
collinearity [26] and all analyses were weighted to reflect
the sample design, and age and gender distribution of
Canadians.
Results
Frequencies of the sociodemographic characteristics along
with their unadjusted associations with ParticipACTION
awareness are presented in Table 1. Approximately 56% of
respondents were categorized as being sufficiently active,
8% were aware of ParticipACTION unprompted in that
they cited it as the organization they identified when
thinking of physical activity, while 82% were aware when
prompted. When prompted about other programs and
campaigns, 90% of Canadians were aware of Canada's
Food Guide to Healthy Eating, while 67%, 34%, and 22%
indicated they were aware of Body Break, Canada's Physi-
cal Activity Guide to Healthy Active Living, and Canada
on the Move respectively.
Higher awareness of ParticipACTION was reported by
men (12%) than women (7%) unprompted. No gender
differences, however, existed for prompted awareness. The
youngest group of respondents were much less likely to be
aware of the organization regardless of the awareness con-
dition. If respondents were deemed to be sufficiently
active they were more likely to be aware of ParticipAC-
TION. Finally, similar patterns of awareness were
observed for both household income and level of educa-
tion with those at the lowest levels being less aware of Par-
ticipACTION than those at higher levels. These patterns
occurred for both types of awareness and support the idea
of a knowledge gap. After controlling for age and gender,
both education (OR = 1.31, 95% CI 1.11-1.55; OR = 1.13,
95% CI 1.00-1.28) and income (OR = 1.75, 95% CI 1.40-
Table 1: Associations between Sociodemographic Factors and Awareness of ParticipACTION among Canadian Adults (weighted
percentages)
Awareness of ParticipACTION
Total Sample
n
Prompted awareness
%
Unprompted awareness
%%
n
p
n
p
Overall
Gender
4424---3800 81.6 3898.2
****
Male
Female
1923
2501
48.2
51.8
1670
2130
82.6
80.6
210
179
12.2
6.7
Age (years)
********
20-24
25-44
45-64
65+
230
1707
1811
676
7.3
41.5
33.4
17.7
130
1466
1657
547
46.6
82.2
90.0
78.6
4 0.8
10.2
12.6
4.4
154
206
25
Household income ($)
********
< 30,000
30,00-59,999
60,000+
723
1135
1794
16.0
30.4
53.5
558
970
1634
67.9
80.6
87.9
28
83
212
3.3
7.2
12.8
Level of education
********
High school or less1557
1355
1445
35.2
30.7
34.1
1261
1200
1290
75.8
86.0
84.2
80
122
183
6.4
8.9
13.0
College
University
LTPA status
*****
Inactive
Active
1932
2488
44.1
55.9
1591
2205
77.1
85.1
139
250
7.5
10.9
LTPA = leisure time physical activity.
* p < .05
*** p < .001.
**** p < .0001.

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2.19; OR = 1.94, 95% CI 1.71-2.22) were significantly
associated with unprompted and prompted awareness of
ParticipACTION respectively.
As a first step in examining the utility of the HOEM in rela-
tion to LTPA status, we conducted a series of one-way
ANCOVAs to determine if outcome expectations, self-effi-
cacy, and intention for physical activity varied with level
of awareness for ParticipACTION. After adjustment by
covariates, outcome expectations (F [1, 2527] = 6.01, p =
.014, partial eta squared = .002), self-efficacy (F [1, 2513]
= 7.89, p = .005, partial eta squared = .003), and intention
(F [1, 2504] = 9.32, p = .002, partial eta squared = .004),
varied significantly with unprompted awareness of Partic-
ipACTION. Similarly, outcome expectations (F [1, 2531]
= 92.62, p < .0001, partial eta squared = .04), self-efficacy
(F [1, 2517] = 46.42, p < .0001, partial eta squared = .02),
and intention (F [1, 2508] = 27.29, p < .0001, partial eta
squared = .01), varied significantly with prompted aware-
ness of ParticipACTION. The adjusted marginal means, as
displayed in Table 2, show that higher levels of outcome
expectations, self-efficacy, and intention for physical
activity were held by those who were aware of ParticipAC-
TION regardless of the type of awareness.
When LTPA status was regressed on the beliefs and aware-
ness variables associated with the HOEM (see Table 3),
both self-efficacy and intention were significant covariates
regardless of the awareness condition. Awareness was a
significant covariate of LTPA status too; however the asso-
ciation appeared to be stronger and more consistent in the
prompted condition. In that case, if a person was aware of
ParticipACTION, the odds of he/she being physical active
increased by a factor of 1.53 to 1.81 depending on
whether the beliefs were included in the model or not.
Given the reductions in size of both the Wald statistic and
beta at step 2 for both awareness conditions, it appears
outcome expectations and self-efficacy accounted for
some of the association between awareness and LTPA.
Outcome expectations were associated with LTPA status
for the unprompted condition only.
Discussion
ParticipACTION was a social marketing and communica-
tions organization that promoted physical activity in Can-
ada for approximately 30 years before its official
conclusion in 2001. We found that approximately 8% of
Canadians were still aware
unprompted and 82% were aware when prompted. In
comparison to rates of unprompted awareness of 30% in
1989 and 17% in 1994 [14] and 15% in 2004 [15], this
reflects a definite decay in "top of mind" awareness of Par-
ticipACTION between 1994 and 2007. This is also
reflected by the fact that middle-aged and older Canadi-
ans were more aware of ParticipACTION than younger
Canadians. Even when prompted, only 47% of people
between the ages of 20-24 years were aware of the organi-
zation compared to 90% awareness among those 45-64
years of age.
of ParticipACTION
The second purpose of this study was to determine if
knowledge gaps in awareness of ParticipACTION existed
and if these gaps were differentially related to household
education and perhaps income. Both education and
income were significant correlates of awareness among
Canadians. The odds of people being aware of ParticipAC-
TION were greater if they were more educated and
reported higher income. These findings are consistent
with the deficit model of knowledge gap phenomena [27]
which suggests that the higher the education of an indi-
vidual, the higher his/her motivation to attend to and
comply with health messages.
The final purpose of this study was to determine if aware-
ness of ParticipACTION was associated with physical
activity related beliefs, intentions, and physical activity.
We found good support for the use of HOEM [15] in that
outcome expectations, self-efficacy, and intention varied
significantly by awareness regardless of the awareness
condition (unprompted, prompted). However, the sizes
of the effects in the ANCOVAs were very small suggesting
that other factors are influencing the beliefs and intention
for physical activity apart from awareness. We also found
that awareness of ParticipACTION was associated with
LTPA status. However, this association was more apparent
for the prompted condition. Consistent with the HOEM
and other social cognitive models [28,29], self-efficacy
and intention were strong correlates of LTPA status. In
fact, much of the association between awareness and
LTPA status appeared to be attenuated with the addition
Table 2: Estimated Marginal Means (standard error)a for Physical Activity Related Outcome Expectations, Self-efficacy, and Intention
by Type of Awareness for ParticipACTION
Unprompted Awareness Prompted Awareness
UnawareAware UnawareAware
Outcome expectations
Self-efficacy
Intention
6.51 (0.02)
4.00 (0.03)
5.93 (0.3)
6.64 (0.05)
4.24 (0.08)
6.22 (0.09)
6.22 (0.04)
3.67 (0.06)
5.67 (0.06)
6.59 (0.02)
4.10 (0.03)
6.03 (0.03)
a Adjusted for gender and age.

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of these constructs into the model for both awareness con-
ditions. Thus the relationship between awareness and
physical activity may be mediated by beliefs about physi-
cal activity. However, given the cross-sectional nature of
the current data, this observation can only be verified in a
longitudinal design (e.g., Bauman et al. [30]). We are not
certain why awareness of ParticipACTION was independ-
ently associated with LTPA status in the prompted condi-
tion but not in the unprompted condition. By prompting
people, it is possible that ParticipACTION was made a
more salient behavioural target for people. Alternatively,
it is possible that some individuals who were aware of Par-
ticipACTION prior to its demise in 2001 were also aware
of other organizations that continued to be in operation
over the period (e.g. fitness studios like Curves, Heart and
Stroke Foundation). In that case the other organizations
may be more salient to those respondents at the time of
the survey, which could influence their propensity to
recall ParticipACTION relative to others without prompt-
ing, thereby attenuating the relationship between
unprompted recall of ParticipACTION and current LTPA.
ParticipACTION was recently re-launched thus presenting
a unique opportunity to better understand its potential to
influence beliefs, intentions and behaviour through stra-
tegic evaluation [31]. Our findings have both theoretical
and practical importance for the new campaign. First, the
HOEM is a useful theoretical framework for evaluating the
mechanisms of influence of media campaigns on popula-
tion-level physical activity and related beliefs. It appears
that awareness of such campaigns is a central initial indi-
cator of campaign effectiveness. But it was also apparent
that, while awareness and knowledge of ParticipACTION
and its messages on the part of the Canadian population
is necessary, it is not sufficient if the campaign is to be
effective in changing beliefs and behaviour [5,6]. Second,
education and income are critical determinants of knowl-
edge about physical activity messages. Thus, levels of edu-
cation and income are important factors to consider when
designing and investigating population-based health pro-
motion campaigns for physical activity. In particular, the-
oretical-based interventions that include information
campaigns to influence knowledge and beliefs about
physical activity should be tailored to be more salient for
the intended audience [30]. Tichenor and colleagues [17]
identified communication skills, prior knowledge, rele-
vant social contact, selective exposure and information
storage, and the nature of the mass media system as expla-
nations for education-related knowledge gaps. Thus, peo-
ple with higher levels of education are more likely to
expose themselves to mass media (e.g., read the newspa-
per), comprehend the information provided, and then
have the social networks within which the messages are
reinforced and valued. Therefore, attempts to lessen the
knowledge gap about ParticipACTION could target spe-
cific segments of the population [32] and take into con-
sideration these underlying processes.
In the past, the more information-rich media was con-
sumed by better educated people while television was the
source of information for the less educated segment of the
population [33]. Bonfadelli [34] suggests that knowledge
gaps that occur in relation to 'old media' such as television
and print news appear to stem largely from differences in
interest to the topic. However, when considering the
knowledge gap and internet use, there are new factors to
consider. For example, compared to traditional media
forms, the supply of information is conceivably unlimited
on the internet and is more heterogeneous than the infor-
mation journalists have access to. Additionally, internet
use requires more technical savvy and is more dependent
on access than old media. Therefore, the internet could act
Table 3: Adjusted and Weighted Oddsa Ratios for Factors Associated with Physical Activity (LTPA) Status by both Prompted and
Unprompted Awareness of ParticipACTION
Step 1
OR
Step 2
OR
Step 3
ORbWald95%CIbWald95%CIbWald95%CI
Unprompted Awareness
Awareness0.405.481.49 1.07-2.08*0.31
0.13
0.55
3.20
3.84
1.37
1.14
1.73
0.97-1.93
1.01-1.31*
1.59-1.88****
0.29
0.09
0.43
0.27
2.59
1.61
88.48
35.46
1.33
1.09
1.54
1.31
0.94-1.88
0.95-1.25
1.41-1.69****
1.20-1.43****
Outcome expectations
Self-efficacy 168.87
Intention
Prompted Awareness
Awareness0.5619.401.741.36-2.23****0.39
0.12
0.55
8.55
2.67
1.48
1.11
1.72
1.14-1.92**
0.97-1.28
1.59-1.87****
0.39
0.06
0.43
0.27
8.68
0.85
86.79
35.74
1.49
1.07
1.54
1.31
1.14-1.94**
0.93-1.23
1.40-1.68****
1.20-1.43****
Outcome expectations
Self-efficacy 166.80
Intention
aAdjusted for gender, age, education, and income.
* p < .05
** p < .01
**** p < .0001

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to promote individualized information seeking and
increase heterogeneity within the audience [34]. Data
from two Swiss studies [34] found that internet use was
associated with education level, income, sex and age. The
author also found that diffusion and adoption of internet
took place earlier and faster in high SES groups than in
lower SES groups. Gaps in the usage of internet were
related to variations in internet access and variations in
content specific use. Gaps in the way the internet was used
were primarily based on education. For example, people
with higher education used the internet more for informa-
tion seeking while people with lower levels of education
used the internet significantly more for entertainment
purposes. Therefore, physical activity promotion cam-
paigns that use the internet will not be immune to the
knowledge gap. If future ParticipACTION campaigns are
planned for the internet, then strategies need to be put
into place to overcome the potential knowledge gap phe-
nomenon.
Strengths of the study include the validated survey and
sampling methodology from an existing surveillance sys-
tem (i.e., PAM) and the application of theoretical frame-
works to guide the selection of questions and data
analysis. However, this study is not without limitations
that should be acknowledged. The use of single-item
measures for self-efficacy, outcome expectations, inten-
tion, and the awareness variables, along with the lower
response rate, may limit the reliability of our findings. As
mentioned previously, the cross-sectional design prevents
any discussion of cause and effect and limits the formal
testing of the hierarchy of effects in the HOEM. While we
were able to control for some demographic factors that
may have accounted for the observed associations, other
variables such as perceived health status and immigrant
status may have been confounders for associations
between intention and, or, LTPA and awareness. For
instance, recent immigrants to Canada may be unaware of
ParticipACTION regardless of their intentions to be phys-
ically active and levels of education or income. Exposure
to media and media consumption are important variables
to consider with regard to the effectiveness of a media
campaign and the knowledge gap. Unfortunately, we had
no such measures in our study. Finally, Kang [19] suggests
that both awareness knowledge (i.e., the existence of the
campaign) and depth of knowledge (i.e., actual message
and contents) should be assessed when evaluating health
media campaigns. With our items, we measured aware-
ness knowledge but not depth knowledge. Future studies
on the topic are advised to measure both types of knowl-
edge while exploring the context in which campaign mes-
sages are received, interpreted, and used by audiences
[35].
In summary, Canadians remain aware of ParticipACTION
even though its campaigns have not been running for
approximately 10 years. Those Canadians who are aware
of ParticipACTION are more likely to hold positive beliefs
about physical activity and to be physically active. How-
ever, a definite decay in awareness has occurred and
younger adults are less likely to be aware of the campaign
even when prompted. Knowledge gaps in awareness are
associated with levels of education and household
income. Thus, future physical activity promotion cam-
paigns (i.e., the new ParticipACTION) need specific strat-
egies to target different segments of the population,
especially people who are living in deprived conditions
with lower levels of education. Otherwise, such cam-
paigns will actually increase the knowledge gap between
these groups resulting in less opportunity to take advan-
tage of programs and information [27].
Competing interests
Four of the authors (CLC, LRB, JCS, MST) have been
involved on various committees and advisory groups for
both the previous and 'new' ParticipACTION including
the Board of Directors (MST). The Canadian Fitness and
Lifestyle Research Institute (CFLRI) is contracted by the
'new' ParticipACTION to perform ongoing research and
surveillance - CLC is President of CFLRI but receives no
personal compensation for the contracted work. This
project was completed before the contract between Partic-
ipACTION and CFLRI was in place.
Authors' contributions
JCS conceived of the study, participated in its design, con-
ducted the statistical analysis, and drafted the manuscript.
MT and LB conceived of the study and contributed to the
manuscript. CC oversaw the data collection and provided
input on the manuscript. AB, GF, KC, and RP helped to
draft the manuscript and contributed to the grant pro-
posal that funded the study. MC assisted with drafting the
manuscript. All authors read and approved the final man-
uscript.
Acknowledgements
We are grateful to the Canadian Fitness Lifestyle and Research Institute
(CFLRI) for allowing us to include questions about ParticipACTION on
their Physical Activity Monitor (PAM). This study could not have been
undertaken without financial support from the Canadian Institutes of
Health Research (CIHR), Institute of Nutrition, Metabolism and Diabetes.
References
1. Craig CL, Russell SJ, Cameron C, Bauman A: Twenty-year trends
in physical activity among Canadian adults. Canadian Journal of
Public Health 2004, 95:59-63.
2. Cameron C, Craig CL, Paolin S: Local opportunities for physical
activity and sport: Trends from 1999-2004. Ottawa, ON: Cana-
dian Fitness and Lifestyle Research Institute; 2005.
3. U.S. Department of Human Services: Physical activity and health: A
report of the Surgeon General Atlanta, GA: U.S. Department of Health

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International Journal of Behavioral Nutrition and Physical Activity 2009, 6:85 http://www.ijbnpa.org/content/6/1/85
Page 9 of 9
(page number not for citation purposes)
and Human Services, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promo-
tion; 1996.
Katzmarzyk PT, Gledhill N, Shephard RJ: The economic burden of
physical inactivity in Canada. Canadian Medical Association Journal
2000, 163:1435-1440.
Bauman A, Smith BJ, Maibach EW, Reger-Nash B: Evaluation of
mass-media campaigns for physical activity. Evaluation and Pro-
gram Planning 2006, 29:312-322.
Bauman A, Murphy N, Lane A: The role of community pro-
grammes and mass events in promoting physical activity to
patients. British Journal of Sports Medicine 2008, 43:44-46.
Huhman M, Potter L, Wong F, Banspach S, Duke J, Heitzler C: Effects
of a mass media campaign to increase physical activity
among children: Year-1 results of the VERB campaign. Pedi-
atrics 2005, 116:e277-e284.
Maibach E: The influence of the media environment on physi-
cal activity: Looking for the big picture. American Journal of
Health Promotion 2007, 21:S353-62.
Kahn E, Ramsey L, Brownstone R, Heath G, Howze E, Powell K, Stone
EJ, Rajab MW, Corso P: Task Force on Community Preventa-
tive Services. American Journal of Preventive Medicine 2002,
22(Suppl 4):73-107.
Cavill N, Bauman A: Changing the way people think about
health-enhancing physical activity: Do mass media cam-
paigns have a role? Journal of Sports Science 2004, 22:771-790.
Grier S, Bryant CA: Social marketing and public health. Annual
Review of Public Health 2005, 26:319-339.
Edwards P: No country mouse: Thirty years of effective mar-
keting and health communications. Canadian Journal of Public
Health 2004, 95(Suppl 2):S6-S13.
Costas-Bradstreet C: Spreading the message through commu-
nity mobilization, education and leadership: A magnani-
mouse task. Canadian Journal of Public Health 2004, 95(Suppl
2):S25-S29.
Bauman A, Madill J, Craig CL, Salmon A: ParticipACTION: This
mouse roared, but did it get the cheese? Canadian Journal of Pub-
lic Health 2004, 95(Suppl 2):S14-S19.
McGuire WJ: Public communication as a strategy for inducing
health-promoting behavioral change. Preventive Medicine 1984,
13:299-319.
Canadian Fitness and Lifestyle Research Institute: Awareness of Partici-
pACTION: Prevalence data from November 2004 to January 2005
Ottawa, ON: CFLRI; 2005.
Tichenor PJ, Donohue GA, Olien CN: Mass media flow and differ-
ential growth in knowledge. Public Opinion Quarterly 1970,
34:159-170.
Gaziano C: The knowledge gap: An analytical review of media
effects. Communication Research 1983, 10:447-486.
Kang Y: Knowledge gap effect in health campaign evaluations.
Paper presented at the annual meeting of the International Communica-
tions Association, New York, NY 2008 [http://www.allacademic.com/
meta/p11702_index.html].
Culos-Reed C, Gyurcsik NC, Brawley LR: Using theories of moti-
vated behaviour to understand physical activity. In Handbook
of Sport Psychology Edited by: Singer, RN, Hausenblas HA, Janelle CM.
New York: John Wiley & Sons; 2001:695-717.
Spence JC, Burgess J, Cutumisu N, Lee J-G, Moylan B, Taylor L,
Witcher CS: Self-efficacy and physical activity: A quantitative
review [Abstract]. Journal of Sport and Exercise Psychology 2006,
28:S172-S173.
Garcia Bengoechea E, Spence JC, McGannon K: Gender differences
in perceived environmental correlates of physical activity.
International Journal of Behavioral Nutrition and Physical Activity 2005,
2:12.
Craig CL, Tudor-Locke C, Bauman A: Twelve-month impact of
Canada on the Move: A population-wide campaign to pro-
mote pedometer use and walking. Health Education Research
2007, 2:406-413.
Craig CL, Cragg SE, Tudor-Locke C, Bauman A: Proximal impact
of Canada on the Move. Canadian Journal of Public Health 2006,
97:S21-S27.
Taylor HL, Jacobs DR, Schucker B, Knudsen J, Leon AS, Debacker G:
A questionnaire for the assessment of leisure time physical
activities. Journal of Chronic Diseases 1978, 31:741-755.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.Bickel R: Multilevel analysis for applied research. New York:
The Guilford Press; 2007.
Kwak N: Revisiting the knowledge gap hypothesis: Education,
motivation, and media use. Communication Research 1999,
26:385-413.
Connor M, Norman P: Predicting health behaviour 2nd edition. Bersk-
shire, England: Open University Press; 2005.
Ajzen I: The theory of planned behaviour. Organizational Behav-
iour and Human Decision Processes 1991, 50:179-211.
Bauman A, Bowles HR, Huhman M, Heitzler CD, Owen N, Smith BJ,
Reger-Nash B: Testing a hierarchy-of-effects model: Pathways
from awareness to outcomes in the VERB campaign 2002-
2003.
American Journal of
34(6S):S249-S256.
Tremblay MS, Craig CL: ParticipACTION: Overview and intro-
duction of baseline research on the "new" ParticipACTION.
Int J Behav Nutr Phys Act 2009, 6:84.
Brawley LR, Latimer AE: Physical activity guides for Canadians:
Messaging strategies, realistic expectations for change and
evaluation. Canadian Journal of Public Health 2007, 32:s170-s184.
McLeod D, Perse EM: Direct and indirect effects of socioeco-
nomic status on public affairs knowledge. Journalism Quarterly
1994, 71:433-442.
Bonfadelli H: The internet and knowledge gaps: A theoretical
and empirical investigation. European Journal of Communication
2002, 17:65-84.
Finlay SJ, Faulkner G: Physical activity promotion through the
mass media: Inception, production, transmission and con-
sumption. Preventive Medicine 2005, 40:121-130.
27.
28.
29.
30.
Preventive Medicine 2008,
31.
32.
33.
34.
35.