Testing Pathways from Awareness to Outcomes in the VERB Media Campaign, 2002–2003

Abstract

Evaluations of mass media campaigns used to increase community awareness about physical activity (PA) have not explored the mechanisms through which the campaigns exert their influence. The hierarchy of effects (HOE) model (conceptualized as a causal chain between awareness, understanding, attitudes, expectations, and behavior change) has been proposed to explain the immediate and media-specific effects of campaigns, but it has not been empirically tested. PURPOSE: To systematically test the HOE model, using data from a nationwide PA media campaign. METHODS: The VERB campaign was a large-scale, multi-strategy campaign developed by the Centers for Disease Control and Prevention, and targeting US youth aged 9–13. Survey data from a longitudinal sample (n = 2364), collected pre-campaign (2002) and post-campaign (2003), were used in structural equation modeling to test pathways and hierarchies of campaign effects. Variables considered were VERB campaign awareness, understanding of the VERB message, attitudes to PA, outcome expectations and change in PA participation. RESULTS: Among all participants, significant paths were identified between campaign awareness and message understanding (path coefficient 0.72, p<.001), and between message understanding and change in PA participation (path coefficient 0.11, p<.05). At baseline there was a high prevalence of positive attitudes and outcome expectations, and these were not influenced by message understanding or campaign awareness. Among the inactive participants only, the same paths were identified, except attitude was related to change in PA participation (path coefficient 0.13, p<.05) and campaign awareness was more strongly related to change in PA than in the total sample (path coefficient 0.14, p<0.01). CONCLUSIONS: These findings provided limited support for the “causal chain” HOE model, but demonstrate a distinct sequence of effects for pre-teens that goes directly from cognitive understanding to PA behavior, and bypasses attitudes and outcome expectations. These findings suggest that increased campaign awareness and understanding are key proximal impacts that lead to behavior change. This informs the design of future campaigns to address youth PA.