Assessing the social climate of physical (in)activity in Canada

Physical inactivity is an important cause of chronic disease and is a major public health concern in Canada. Nevertheless, the prevalence of physical inactivity is growing [1]. According to the Canadian Health Measures Survey (CHMS; [2]), objectively measured physical activity data demonstrated just over 2 in 10 adults and 1 in 10 children and youth met the Canadian physical activity guidelines (www.csep.ca/guidelines). A holistic approach targeting structural and systemic change is recommended for reversing declines in physical activity and to influence behavior of an entire population [3]. Ecological models provide a framework that can guide the development of a comprehensive intervention targeting systematic mechanisms of change at each level of determinants from individual, social, environmental, to policy levels [4, 5].

Environments are multidimensional and can be described as social or physical, built or natural, actual or perceived, and can include constructs such as social climate – a psychological term that refers to the general feelings, attitudes, beliefs and opinions on a subject within society [6]. Thus, a means to achieve behavior change of whole populations may be to de-normalize physical inactivity and re-normalize physical activity through changing norms and beliefs and by providing direct support for modifying environments and policies to encourage physical activity [4]. Further, individuals’ unhealthy behaviors and lifestyles may be modified through the alteration of social climate [6, 7]. For instance, de-normalizing smoking has been one of the most effective strategies in reducing smoking prevalence through policies aimed at restricting smoking in public in combination with health advocacy and media efforts to shift the social acceptability of smoking [8–11]. Programs and policy actions that reinforced the message that tobacco use is not a normal activity have changed public perceptions of the social acceptability of smoking [12]. In turn, this decreased social acceptability of smoking has been shown to reduce tobacco use as well as build public support of tobacco control regulations. However, whether there is a comparable role for the social climate regarding physical (in)activity to influence policy enactment and population changes in behavior remains to be seen.

Based on a number of theoretical frameworks influencing health-related behaviors [13, 14] and a set of related studies exploring aspects of social climate related to tobacco control [15] and obesity [16, 17], a range of potential factors reflecting social climate can be identified, including: 1) the social norms and acceptability of physical (in)activity, 2) perceptions of the causes of physical inactivity, 3) perceptions of responsibility for preventing physical inactivity, and 4) the social acceptability of different policies and regulations in addressing physical inactivity.

As noted, social norms – a pattern of behaviors or beliefs generally held by ‘society’ – are one salient construct within a broader conceptualization of social climate. Conceptually, how serious a health issue is recognized in one’s society (c.f., Health Belief Model [18], Protection Motivation Theory [19]) is theorized to guide one’s behavior. Perceived seriousness of physical inactivity, compared to other public health issues, may reflect the degree and magnitude of social beliefs regarding physical activity as a public health concern [20]. Perceptions of how common it is to see people exercising in their environment (descriptive norms) and perceptions of whether others approve or disapprove of physical (in)activity (subjective or injunctive norms) are also proposed to reflect the social climate of physical (in)activity [21, 22]. Previous research applying social cognitive theories have posited that individuals are more likely to be physically active if they perceive that the social expectations are to be active [23]. However, it is important to note that social norms are commonly found to be weak predictors of physical activity behavior compared to risk behaviors such as drinking, smoking, and drug use [24–26]. Although speculative, this may be due to the potential harm to others of engaging in risky behaviors (e.g., drinking and driving, secondhand smoking) whereas physical (in)activity may not directly affect others’ health.

The social ecological approach further acknowledges that collective norms reflect one’s perceptions of political actors, social institutions, and causes of social issues [7]. Internal or external attributions of a public health issue (in this case, physical inactivity) and perceptions of individual or societal responsibility for solutions are linked to expectations of societal actions and acceptance of policies to address the issue [27]. Previous studies have proposed that societal solution attributions are positively associated with support for public policies [28]. People who hold internal causal attributions for health are more likely to perceive themselves responsible whereas those who hold external causal attributions of health problems are more likely to support societal actions including policy, legislation, and regulation [29, 30]. Public beliefs about what causes physical inactivity as well as who is responsible for addressing physical inactivity likely reflect the physical activity social climate at a population level.

A final component of social climate measured in the current study is public support for different policy solutions for physical inactivity. Here, policy interventions vary in their level of intrusiveness [31]. Policies targeting individual responsibility for behaviors (e.g., media campaigns promoting the benefits of physical activity and/or harms of physical inactivity) are less intrusive and less forceful while modifying community environments (e.g., quantity and quality of green spaces, safe areas for physical activity, and the design of neighborhoods to encourage informal physical activity) or economic level supports (e.g., providing incentives, subsidies and tax credits around physical activity) are more intrusive. Public resistance to policy may cause problems with implementation and adherence, and ultimately result in its withdrawal from consideration [32]. Conversely, public support for different policy interventions may be a prerequisite for policy makers in developing and implementing those policies. Social climate may therefore indirectly influence population level physical activity through the implementation of more effective policy approaches that have public support.

In other health domains, research has included monitoring beliefs about smoking, perceived harm, social influences, and attitudes to regulations (e.g., International Tobacco Control Policy Evaluation Project [33]). This work provided guidance in the development and implementation of policies to reduce tobacco use. Similarly, the body of research assessing aspects of social climate with regard to obesity has grown in the last decade. For example, Raine et al. [17] examined perceptions among Canadian ‘policy influencers’ of the causes of, responsibility for, and levels of support for different policies addressing obesity. They found that most policy influencers viewed all risk behaviors as personal responsibilities (47.0% for alcohol, 55.5% for obesity, 59.3% for tobacco, 69.1% for physical activity, and 63.1% for healthy eating), while one-fifth (for healthy eating and physical activity) to one-third (for obesity, alcohol, and tobacco) viewed the responsibility to be both personal and societal. Most policy influencers indicated their organization has at least some responsibility for obesity prevention programs and policies (i.e., approximately 70% for encouraging healthy eating and 90% for physical activity). Policies with very strong overall support were those aimed at individual responsibility for behaviors, such as providing programs to educate the general public and implementing programs aimed at changing school environments. However, policies to change the design of workplaces and communities to encourage informal physical activity and those that affect economic measures and legislations received weak overall support [17].

Similar results have also been reported among the general public in the UK, USA, and Germany such that being overweight or obese was mainly perceived to be an individual’s own fault [34–36]. Furthermore, less intrusive policies targeting individuals through school-based programs and campaigns are generally more supported than more intrusive actions such as restricting unhealthy foods at restaurants and increasing taxes on the sale of unhealthy foods. Most recently, both public (38.7%) and health professionals (32.2%) in Canada viewed obesity as a community problem of bad food and inactivity followed by a personal problem stemming from bad choices (31.7% for public and 28.7% for health-care professionals [37]). Bhawra et al. [38] reported that Canadian youth and young adults strongly supported menu labelling in restaurants and schools, and food package symbols whereas taxation, zoning restrictions, and bans on marketing to children received relatively lower levels of support.

Past empirical measurement and analysis of social climate has paid less attention to the context of physical (in)activity. We are not aware of studies directly assessing the social climate of physical (in)activity beyond the context of obesity. Rather, previous research has largely applied social cognitive models focused on normative beliefs and not a broader conceptualization of social norms. This study seeks to address this gap. As social climate change is often central to public health policy agendas, the purpose of this study was to assess the social climate of physical (in)activity in Canada and to examine whether the social climate dimensions were related to individuals’ behavior. Such an improved understanding will allow for the identification of a benchmark that can be reassessed over time to determine if social climate changes in response to broader policy and programmatic initiatives, or whether changes in the social climate precede consideration and implementation of greater policy and legislative innovation to facilitate a more active Canada.

The respondents rated “not enough physical activity” (55.1% reported very or moderately serious) as serious as “unhealthy diets” (57.7%) and “tobacco use” (56.8%). “Alcohol misuse” (50.3%) was also rated fairly serious followed by “lack of sleep” (41.4%) and “sitting too much” (38.7%). “Cannabis use” was rated the least serious issue (33.3%).

A minority (N = 706, 28%) of the respondents believed that society disapproves of physical inactivity. Older respondents and those living in semi-urban settings were more likely to agree with the statement that society disapproves of physical inactivity (see Table 3). Overall, participants perceived that 35% of Canadians their age met physical activity guidelines. Participants who were younger (β = − 0.19, p < .001, η² = 0.07), had lower income (β = − 0.08, p < .01, η² = 0.04), or were active (β = 0.07, p < .01, η² = 0.02) reported a higher percentage of Canadians their age to be meeting the guidelines.

In terms of injunctive norms, 2.5% of the respondents reported all, and 10.8% of the respondents (total 13.3%) reported most, people important to them engage in 150 min of MVPA per week (i.e., meet the guidelines). Physical activity participation was the only predictor of injunctive norms such that active participants had higher odds of reporting more people important to them engaging in physical activity compared to those in the inactive group (see Table 3).

The current study assessed the social climate of physical (in)activity in Canada and to the best of our knowledge, represents the first focused evaluation of a range of indicators that potentially reflect this construct. As an initial benchmark, interpreting the findings remains speculative until longitudinal tracking is completed to identify whether social climate changes over time. One positive finding is that Canadians perceive physical inactivity as a serious public health issue comparable to tobacco use and unhealthy diets. Perhaps reflecting the impending legalization of cannabis in Canada and fewer campaigns highlighting potential health risks [46, 47], cannabis use was rated as the least serious public health issue. In contrast, descriptive norms regarding physical activity could be considered low. This identifies room for improvement over time that may be tracked concurrent with changes in physical activity at a population level resulting from the implementation of new policies, programs or broader geopolitical events including climate change.

Complementary to using social climate as an indicator of changes at the population-level, is the future consideration of interventions targeting these social climate indicators. From the social norms perspective [21, 22], individuals may be more likely to participate in physical activity when they believe society or people important to them expect them to do so [23, 48]. There has been ongoing efforts to change social norms regarding physical activity through community-wide media campaigns (e.g., ParticipACTION’s campaigns in Canada [49], VERB in the USA [50], ACTIVE for LIFE in England [51]). Media campaigns have been proposed as a potential influencer of physical activity of the whole population by reframing the salience of social norms around the behavior into campaign messages [52]. Yet, the effectiveness of such campaigns is likely to be modest without increases in access and opportunities to be physically active. Ironically, support for media campaigns in our study was relatively weaker compared to other policy options and this may reflect broader acknowledgement of the limits of education only approaches to physical activity promotion.

The majority of participants viewed physical inactivity as a result of both personal and societal factors and that both private and public health approaches are needed to solve the inactivity problem. This indicates the importance of emerging social ecological approaches for interventions to concurrently tackle individual- as well as societal-level influencers of physical activity. This contrasts with a previous finding that the majority of Canadian policy influencers perceived physical activity to be a personal responsibility [17]. It may be that the differences are due to the target behavior – physical inactivity in the present study and physical activity in the previous study [17]. Public health policy support depends on public attribution on the problem [9, 30]. Decreases in internal attributions and increases in external attributions of physical inactivity revealed in the present study may reflect a shift in Canadians’ views on accepting societal support and policy interventions for addressing physical inactivity.

Though most policy actions to promote physical activity were well supported by the respondents, the level of support varied by the type of policy actions. Policies targeting individual responsibility for behaviors, modifying the environment including the built environment and school settings, and targeting economic levers were highly supported whereas legislative actions were much less supported. This is consistent with the previous research that public support for policy interventions generally tends to decrease as their level of “intrusiveness” or “force” increases [31]. However, such tendency can also be different by the target behavior (e.g., intrusive interventions for tobacco control being more supported than those for addressing unhealthy diet and physical inactivity) [31].

A normative approach to reducing tobacco use was a successful example of changes in public perception that tobacco use is neither mainstream nor socially acceptable, helping to reduce smoking prevalence [12]. Compared to unhealthy diet and physical inactivity, a high level of awareness exists regarding the harm from tobacco and the effects of second- and third-hand smoke; this likely led to greater public acceptance of intrusive regulations restricting tobacco use. Or, it could be that public acceptability of restrictions on smoking is increased once these restrictive policies are introduced [53, 54]. A longitudinal assessment of changes in the social climate of physical activity including different policy approaches will be needed to guide population-level physical activity interventions. However, without a similar side-effect and public health concern as environmental tobacco smoke, there may be limits to how much the social climate for physical (in)activity can be modified.

The present research is the first attempt to assess social climate using a large representative sample of Canadians and it addresses an important gap in knowledge needed for advocating for, and implementing population-level physical activity interventions. The measures utilized in the present study generally demonstrated strong test-retest reliability. One measure assessing social acceptability of physical inactivity did not. It may be speculated that the double negative nature of the statement may have caused confusion in its interpretation. In addition, it may not measure social climate but another construct –stigmatization [55] – whether people who are physically inactive are socially devalued and negatively appraised if they do not meet society’s normative expectations.

Suggesting some evidence of construct validity, the social climate indicators were associated with other demographic variables in directions that could be hypothesized. The associations of sex and age with social climate are consistent with previous research in that being female and older age were positively associated with higher support for all alcohol policy approaches [32] and obesity prevention policies [36, 56, 57]. Where people live was also differentially associated with social norms: urban and semi-urban residents were more likely to report seeing people walking, exercising, and kids being active outdoors in their neighborhood compared to those living in rural settings. Importantly, respondents’ level of physical activity participation predicted most of the social climate dimensions. People who met the Canadian physical activity guidelines perceived physical inactivity more seriously as a health problem than those who did not meet the guidelines. Active respondents perceived higher social norms of physical activity and their level of policy support was higher than inactive respondents. Our findings are consistent with other research such that public support for policies addressing health issues is associated with behavior. For example, those who exercised regularly are more likely to support obesity policy [16] and heavy drinkers were less likely than non-drinkers and ex-drinkers to be supportive of all alcohol policies, especially restrictive actions that limited their own access to alcohol [32]. Overall, the social climate of physical activity was predicted by respondents’ demographics and behavioral factors including physical activity participation.

Despite the noted strengths of the present study, it is not without limitations. Due to the cross-sectional design of the research, causal relationships cannot be inferred, and generalizability cannot be assumed. Given the self-report nature of the study, there is also the possibility of social-desirability bias. For example, given the choices of the cause of the solutions for physical inactivity, the most socially desirable choice is one where everyone is partly to blame (i.e., both individual and society), which was the most common response. In the future, using a forced choice without hybrid choices or at least a measure that presents a continuum score for respondents is recommended to attenuate social desirability bias. The physical activity assessment itself is likely a source of bias, although in comparison to other self-report tools, there is evidence of satisfactory criterion validity [44]. As the survey was administered in winter there is a possibility that the responses reflect seasonal effects even though respondents were asked to consider their answers based on spring or fall seasons. Finally, although our focus was on physical (in)activity, understanding the social climate of physical (in)activity is less clear without the simultaneous and comparative measurement of social climate for other health behaviors such as alcohol use or healthy diets. Such comparisons would be beneficial and suggest a possible need for further measurement development in comparing and contrasting the social climate of different chronic disease risk factors.

The outcome of the current assessment provides a baseline for tracking the impact of future system-level interventions on social climate in Canada as it pertains to physical (in)activity. When “being active needs to be the Canadian norm, not the exception” [58] then surveillance mechanisms are needed to track progress toward this goal. Our study addresses this measurement gap and provides a snapshot of the social climate in Canada in 2018. There are some promising findings in the acknowledgement of physical inactivity as a serious public health issue and attributions for physical inactivity that go beyond individual blame. This in turn forecasts public acceptability for innovative policy intervention to address the problem. In contrast, descriptive and injunctive norms for exercise and physical activity were low. Future tracking is needed to identify any temporal (in)stability of these constructs over time and explore the likely bidirectional relationship between physical activity participation and its related social climate.