Evaluation of the Public Health Agency of Canada’s Funding for ParticipACTION’s Let’s Get Moving Initiative 2018-19 to 2022-23

Prepared by the Office of Audit and Evaluation

Health Canada and the Public Health Agency of Canada

July 2023

Table of contents

• List of acronyms
• Executive summary
• Program description
• Evaluation description
• Evaluation findings
• Conclusions and recommendations
• Management Response and Action Plan
• Annex A – Evaluation methodology and limitations
• Annex B – End notes

List of acronyms

CPHO

Chief Public Health Officer

DART

Disability Advisory and Research Team

G&Cs

Grants and Contributions

NGO

Non-governmental organization

PHAC

Public Health Agency of Canada

WHO

World Health Organization

Executive summary

Background

Physical activity is critical for physical and mental health. Regular physical activity helps prevent and manage noncommunicable diseases like heart disease, stroke, diabetes, and several cancers. It also helps prevent hypertension, maintain healthy body weight, and can improve mental health, quality of life, and overall well-being. In Canada, many people are not meeting physical activity guidelines, and certain groups may experience greater barriers to physical activity because of factors like income, geographic location, age, culture, education, gender, and disability.

The objective of ParticipACTION's Let's Get Moving Initiative is to increase physical activity levels for people living in Canada who are less active. It also aims to reach diverse groups that may experience health inequalities due to social or economic disadvantage, including newcomers and ethno-cultural groups, people with disabilities, 2SLGBTQI+ groups, Indigenous groups, and older adults. The Let's Get Moving Initiative comprises five key components: public education campaigns, community events, national physical activity digital platform, thought leadership, and partnerships and coordination.

Conclusions and recommendations

The Let's Get Moving Initiative has increased awareness and knowledge related to physical activity, and helped some people get more active. However, it is not clear how much current interventions are engaging people who are less active, or if increases in physical activity are sustainable in the long term. Although the Initiative has increased its focus in recent years to reach diverse groups that may experience health inequalities, work remains to build on these efforts, while continuing to improve the public's physical activity.

Overall, the current delivery model appears to be appropriate. The ParticipACTION organization is a suitable funding recipient for initiatives like the Let's Get Moving Initiative due to its experience, reputation, expertise, and brand awareness. ParticipACTION has been able to secure a significant amount of matched funding through multi-sectoral partnerships, of which the majority are in-kind advertising and media value. Although this has enabled the Initiative to promote physical activity to the public, there are opportunities to build new partnerships and secure additional funding sources. Seizing these opportunities could enable the Initiative to better reach diverse groups and help improve their physical activity levels, while improving the sustainability of the Initiative in the long term.

Finally, performance measurement data should be streamlined and improved as there were challenges with the data that made it difficult to report on the overall impact of activities, and the value for people living in Canada.

The findings from this evaluation have resulted in the recommendations listed below.

Recommendation 1: PHAC should require ParticipACTION to increase the focus of the Let's Get Moving Initiative on reaching diverse groups who may be experiencing health inequalities

The evaluation found that certain groups may experience greater barriers to physical activity because of factors such as income, geographic location, age, culture, education, gender and disability, and are less likely to get the recommended levels of physical activity. Although PHAC has encouraged ParticipACTION to increase its focus on populations experiencing health inequalities, there are still gaps in addressing physical activity levels within these groups. The Initiative could benefit from more targeted and community-based programming to help address barriers, reach priority populations, and adapt messaging to target priority groups.

Recommendation 2: PHAC should encourage ParticipACTION to diversify its sources of funding and seek new funding partnerships to increase the potential for the Initiative to be sustained over time

The vast majority of leveraged funds are in the form of media value and software development. Increasing leveraged funds could assist in reaching more equity-seeking populations and help improve the overall sustainability of the Initiative.

Recommendation 3: PHAC should streamline and improve the Let's Get Moving Initiative's performance measurement and reporting, with a focus on improving disaggregated data

Although the Let's Get Moving Initiative collects a large amount of performance measurement data, there were some challenges with data to report on the reach of the Initiative, and its impacts on those who are less active and on target groups. There was some performance data collected in relation to groups that may experience health inequalities; however, there is an opportunity to improve the collection of disaggregated data, as it was not available for many of the initiative's activities.

Program description

Background

Physical activity in Canada

Physical activity is critical for physical and mental health. According to the World Health Organization (WHO), regular physical activity is proven to help prevent and manage noncommunicable diseases like heart disease, stroke, diabetes, and several cancers. It also helps prevent hypertension, maintain healthy body weight, and can improve mental health, quality of life, and overall well-being. Furthermore, the WHO also notes that physical inactivity is one of the leading risk factors for noncommunicable disease mortality, and that people who are insufficiently active have a 20% to 30% increased risk of death compared to people who are sufficiently active.^{Footnote 1}

In Canada, many people are not meeting the physical activity guidelines of at least 60 minutes per day of moderate to vigorous physical activity involving a variety of aerobic activities for children and youth, and 150 minutes per week of moderate to vigorous aerobic physical activities for adults.^{Footnote 2} Self-reported physical activity of 150 minutes per week for adults 18 and over shows limited changes from 2015 to 2021^{Footnote 3} (see Figure 1).

Figure 1 - Text description

Figure 1 shows a bar graph that represents the Percent of Adults reporting at least 150 minutes of physical activity per week, over the period of 2015 to 2021. Values are shown in blue vertical bars, with the numbers as follows:

• 2015 - 56.9%
• 2016 - 58.5%
• 2017 - 57.4%
• 2018 - 54.6%
• 2019 – no data available
• 2020 - 53.8%
• 2021 - 53.9%

Source: Statistics Canada. (2022). Self-reported physical activity of 150 minutes per week for adults 18 and over. Statistics Canada. (2022). Physical activity, self-reported, adult, by age group. No data was reported in 2019.

Levels of physical activity in Canada also vary across different population groups. For example, certain groups may experience greater barriers to physical activity because of income, geographic location, age, culture, education, gender, and disability. The Pan-Canadian Health Inequalities Tool, which uses data from the Canadian Community Health Survey, shows that racialized people are significantly less likely to report meeting recommended levels of moderate-to-vigorous physical activity.^{Footnote 4} Across racialized groups, the lowest physical activity levels were reported among Black Canadian youth (12-17) and adults, East/Southeast Asian Canadian youth and adults, Arab/West Asian Canadian youth, adults, and older adults (65+), and South Asian Canadian adults.^{Footnote 5} In addition, both recent and long-term immigrant adults and youth were less likely to report meeting recommended levels of physical activity as compared to non-immigrant adults and youth,^{Footnote 6} with an established pattern of lower activity being among racialized immigrants versus white immigrants.^{Footnote 7}

The Pan-Canadian Health Inequalities Reporting Tool's statistics suggest that physical activity levels are higher among Métis and First Nations Peoples off-reserve compared to non-Indigenous Canadians, while Inuit Peoples continue to self-report activity levels that are only slightly lower than non-Indigenous Canadians.^{Footnote 8} However, some studies have shown that Indigenous Peoples face increased barriers to healthy living and meeting physical activity guidelines^{Footnote 9}, as well as increased prevalence of chronic diseases like diabetes.^{Footnote 10}

Beyond racial and ethnic identity, there is a correlation between reported physical activity levels and household income and education. As household income and education decrease, reported physical activity levels are shown to decrease as well.^{Footnote 11} Gender has also consistently been shown to influence physical activity levels, with females being less physically active than males, both overall and among all subpopulations discussed above. Based on available data, "male" and "female" are used here as traditional biological, cisgender terms. Gender differences are particularly pronounced among younger people living in Canada, with girls half as likely as boys to meet minimum physical activity guidelines.^{Footnote 12}

Conclusive data about physical activity levels among Canada's 2SLGBTQI+ population is not available, but various studies conclude that 2SLGBTQI+ people experience significant barriers, such as difficulty accessing gender appropriate locker space, and barriers to participating in sports teams, and gym classes, which both decrease participation in physical activity.^{Footnote 13}, ^{Footnote 14} Similarly, recent data for activity levels of people living in Canada with disabilities is not available, but international literature shows that people with disabilities experience poorer health outcomes that are associated with lower levels of physical activity when compared to the general population.^{Footnote 15}

Figure 2 - Text description

This figure shows a timeline for the history of ParticipACTION. It includes icons of a checklist, a computer, a dumbbell weight, a newspaper, four people holding hands, and a person hiking with a walking stick. Dates and associated events include:

Date	Event Text
1971	ParticipACTION launches as a physical activity communications/social marketing organization with financial support from the Government of Canada
1976	ParticipACTION launches newspaper (daily and weekly) PSA messages
1989	Body Break with ParticipACTION runs for 3 successful years
1991	The Canadian Public Health Association presents ParticipACTION with the Ortho Award for "outstanding contribution to health in Canada"
1999	ParticipACTION stops producing new national public service announcement campaign material.
2001	After 30 years of continuous service, ParticipACTION ceases operations in 2001 due to funding cuts
2007	Sport Canada and the PHAC announce funding for the resurrection and revitalization of a "new" ParticipACTION
2018	ParticipACTION receives $25 million per year from the Government of Canada for the Let's Get Moving Initiative
2019	ParticipACTION launches their in-house app
2020	ParticipACTION hosts their first Community Better Challenge

Program description

The Centre for Chronic Disease Prevention and Health Equity within the Health Promotion and Chronic Disease Prevention Branch is responsible for administering PHAC's funding for ParticipACTION's Let's Get Moving Initiative.

The objective of the Let's Get Moving Initiative is to increase physical activity levels for people living in Canada who are less active. It also aims to reach diverse groups that may experience health inequalities due to social or economic disadvantage, including newcomers and ethno-cultural groups, people with disabilities, 2SLGBTQI+ people, Indigenous groups, and older adults.

PHAC provided more than $25M in funding to ParticipACTION, from 2018 to 2023, to coordinate and implement this Initiative, in cooperation with community organizations, government bodies and corporate sponsors. PHAC funding is conditional on ParticipACTION matching it on a 1:1 ratio with cash or in-kind contributions.

The Let's Get Moving Initiative comprises five key components:

• Public education campaigns

A wide variety of public outreach, education, and media campaigns, including a focus on the benefits of physical activity, and promoting specific elements of the Initiative, such as the Community Challenges and the Report Cards on Physical Activity.

• Community events

The "Community Better Challenge", recently renamed the "Community Challenge", encourages people to move more and sit less. The challenges aim to provide accessible and low or no cost opportunities for participation in homes, community organizations, schools, sport clubs, and workplaces. Winning communities receive prize money to increase opportunities for residents to be active. These community events aim to reach, per year, up to 1.5 million people living in Canada.

• National physical activity digital platform

The Initiative includes a national physical activity digital platform that is accessible to people living in Canada of all backgrounds, abilities, genders, and regions. The platform collects data from all available sources using artificial intelligence and delivers customized content to the user. The Initiative aims to reach approximately 250,000 people living in Canada using this platform.

• Thought leadership

The Initiative produces Adult and Child and Youth Report Cards for use by researchers, decision makers and the public that reflect the most up-to-date scientific evidence in the fields of physical activity, sedentary behaviour and sleep research. These Report Cards aim to help to identify areas where further progress is needed.

• Partnerships and coordination

ParticipACTION aims to coordinate and implement this Initiative in cooperation with sport, physical activity, and recreation organizations, as well as governments and corporate sponsors. Additionally, activities are guided by groups like the ParticipACTION Advisory Network, the Research Advisory Group, and the Disability Advisory and Research Team, which consist of leaders from the physical activity, sport, recreation, academic, health and government sectors.

Evaluation description

Evaluation scope

This evaluation focuses on the relevance, effectiveness and efficiency of the Public Health Agency of Canada's (PHAC) funding for ParticipACTION's Let's Get Moving Initiative from 2018-19 to 2022-23.

Evaluation evidence reflected in this report includes a review of program documentation, performance information and financial information on Grants and Contributions funding, a focused literature review, a targeted comparative analysis, and interviews with 24 key informants, including seven internal to PHAC and 17 external stakeholders, such as non-governmental organizations, provincial representatives, and experts/academia. More information on the methods used can be found in Annex A.

Evaluation issues

The evaluation examined the following questions.

Relevance

• To what extent is the Let's Get Moving Initiative aligned with PHAC's and Government of Canada's mandates, roles and responsibilities, priorities and strategic outcomes in the area of physical activity?
• Are there other programs, stakeholders, government departments or non-governmental organizations that complement, overlap or duplicate the objectives of the Let's Get Moving Initiative?

Effectiveness

• To what extent has the Let's Get Moving Initiative resulted in increased physical activity levels for people living in Canada who are less active?
• To what extent has the Let's Get Moving Initiative reached diverse groups that may experience health inequalities due to social or economic disadvantage?

Efficiency

• Is the Initiative's current delivery model the best approach to address its objectives?
• Does the current approach to the Initiative provide value for money?

Evaluation findings

Question 1 – Relevance

ParticipACTION's Let's Get Moving Initiative is well aligned with current Government of Canada and PHAC priorities, including increasing physical activity and reaching populations experiencing health inequalities. The Initiative is complementary to other initiatives in Canada related to physical activity, including those focusing on issues such as active transportation and organized sports. Furthermore, there are formal and informal structures in place to help reduce the potential for duplication with other initiatives.

Alignment with government priorities and PHAC mandate

Over the past few years, physical activity has been featured in both government priorities and PHAC's mandate. This is also reflective of the views of Canadians, with a recent poll finding that 75% of people agree the Government of Canada should help improve physical activity levels of people living in Canada^{Footnote 16}.

Government of Canada

The Government of Canada has made various budget commitments to enhance physical activity in the country. Budget 2018 earmarked funding for ParticipACTION to increase participation in daily physical activity among people living in Canada. Budget 2021 further demonstrated the federal government's support for physical activity by providing funding to remove barriers to participation in sports programming and to help community organizations kick-start local organized sports that are accessible to all.

PHAC

Under its mandate of Health Promotion and Chronic Disease Prevention, PHAC focuses on increasing physical activity to help prevent chronic diseases like diabetes, cancer and cardiovascular disease. PHAC takes a population health approach to public health programming, which focuses on improving the health status of populations or sub-populations, rather than individuals.

On May 31, 2018, the Public Health Agency of Canada, along with federal, provincial and territorial ministers responsible for sport, physical activity and recreation released 'A Common Vision for Increasing Physical Activity and Reducing Sedentary Living in Canada: Let's Get Moving' policy framework, which was intended to guide and stimulate coordinated and collaborative policies and actions to increase physical activity and reduce sedentary behaviours among all people living in Canada across their lifetime. It should be noted that, although the Common Vision policy framework is also called "Let's Get Moving," it's not the same entity as the Let's Get Moving Initiative. The Common Vision policy framework was released in response to a call by the World Health Organization (WHO) for Member States to develop national policies in keeping with the WHO Global Action Plan for Physical Activity.

In terms of target populations, the 2021 Mandate Letter to the Minister of Health, as well as a recent Chief Public Health Officer's (CPHO) Report on the State of Public Health in Canada, indicated that equity, diversity and inclusion should be a priority for public health programs.^{Footnote 17},^{Footnote 18} Furthermore, the CPHO report supports reconciliation, self-determination, and cultural safety being prioritized, along with support for marginalized communities to leverage their assets and respond to local needs. The Let's Get Moving Initiative's aim to reach groups that may experience health inequalities due to social or economic disadvantage, including newcomers and ethno-cultural groups, people with disabilities, 2SLGBTQI+ people, Indigenous groups, and older adults, aligns well with these Agency priorities.

Complementarity or overlap with other initiatives

Overall, ParticipACTION's Let's Get Moving Initiative is complementary to other Canadian physical activity initiatives. Other national initiatives focus on issues that are outside of the Let's Get Moving Initiative's scope, including active transportation and organized sports. Furthermore, there are formal and informal structures in place to help reduce the potential for duplication, including networks of interested groups, ParticipACTION's partnership and coordination activities, and the Common Vision policy framework.

Other initiatives

The Government of Canada funds a variety of other national strategies related to physical activity, such as the National Active Transport Strategy and the Community Sport for All Initiative. However, these initiatives address different but complementary aspects of physical activity, such as creating built environments that are conducive to physical activity, and increasing opportunities for participation in sports activities. Many interviewees were supportive of a multi-pronged approach to encouraging people to be more active and creating environments that support accessible physical activity, and stressed that no single program or approach would be adequate.

Most internal and external interviewees saw the Let's Get Moving Initiative as complementary to other programs, including those at the national, provincial, territorial, and local levels. Most external interviewees indicated that without PHAC funding for ParticipACTION's Let's Get Moving Initiative, there would be gaps in physical activity promotion that would not be adequately filled by other initiatives.

The Let's Get Moving Initiative takes a broader, population level approach to reaching people in Canada compared to some other initiatives. This includes consistent messaging across the country, while still allowing regional customization with local input. Several interviewees noted ParticipACTION's strength in social marketing and public education, indicating there would be gaps in its absence.

There is potential duplication with the ParticipACTION App, given the abundance of physical activity tracking apps that are available, such as Optimity, Gigwalk, MayMyFitness and Sweatcoin. However, unlike other apps, the ParticipACTION App supports other components of the Let's Get Moving Initiative, such as the Community Challenges.

The ParticipACTION Report Cards are a unique resource that summarize and assess physical activity levels for adults, youth and children in Canada. This evaluation did not identify any comparable products from other groups in Canada.

The Community Better Challenge is also unique, as there are no other challenges of similar scope or scale available in Canada. Interviewees noted that the Challenge provided an elevated level of motivation, since communities can watch the results 'in real time' as they compete with others across Canada and within their own province.

Preventing duplication

There are several national-level organizations with a mission to improve physical activity and increase access to sport and recreation, such as Sports Canada, Active Aging Canada, and Physical and Health Education Canada. These organizations have a variety of target audiences, including children, women, seniors, and people living with disabilities. In addition, there are numerous organizations at the provincial, territorial, and local levels with an interest in physical activity, including provincial and territorial governments, and non-governmental organizations such as Réseau Accès Participation, Indigenous Sport, the Physical Activity and Recreation Council (iSPARC), and the Ontario Physical and Health Education Association. As a result, there is potential for duplication of activities, although it appears that duplication has been minimized through a variety of coordination and communication activities. In addition to publicly funded programs, there is an active private sector industry built on promoting and tracking physical activity.

The Common Vision policy framework was designed to complement and align with other relevant policies, strategies and frameworks. It is intended to provide a singular policy focus on physical activity and its relationship to sport, recreation, health, and other relevant policy areas, and a new, collective way forward to guide the country toward increased physical activity and reducing sedentary living.^{Footnote 19} Having a coordinated 'umbrella' framework that considers a variety of national, and provincial and territorial programs and initiatives, including federal funding for ParticipACTION, should help minimize overlap and duplication.

ParticipACTION's various advisory groups help coordinate physical activity initiatives with partners to minimize duplication. The ParticipACTION Advisory Network (PAN), which includes representatives from a variety of organizations with an interest in physical activity from across Canada has held several meetings over the last five years to share information, and provide ParticipACTION with input and advice.^{Footnote 20} In addition, ParticipACTION has a Research Advisory Group (RAG), which includes academics from a range of Canadian universities and research institutions, and, in 2021-22, ParticipACTION established the Disability Advisory and Research Team (DART). Each of these groups provides opportunities for those working in physical activity to gain awareness of each other's work. In 2018-19 ParticipACTION developed a communications kit to widely circulate to help stakeholders, including PAN, communicate with their networks.

Several interviewees noted that partnerships and communication between formal and informal groups and networks involved with physical activity are helpful in preventing duplication of work. Nearly half of interviewees mentioned how ParticipACTION built local relationships and partnerships that facilitated increased uptake of events, thereby enhancing impact of their events and activities.

However, several external interviewees expressed a desire for the Initiative to better support networking and sharing of best practices between communities or organizations. Although this is not necessarily part of what ParticipACTION was funded to do, it is something that could be considered moving forward.

Question 2 – Effectiveness

Overall, the Let's Get Moving Initiative increased awareness and knowledge related to physical activity and helped get some people moving in the short-term. This was achieved through national public education campaigns, annual Community Challenges, digital platforms with embedded resources and activities, and Report Cards on the state of physical activity in Canada. However, the impact on awareness and behaviour is less evident for people who are not meeting physical activity recommendations, nor over the long term.

Over the past five years, the Let's Get Moving Initiative has gradually improved its attention and reach to target groups, including older adults, Indigenous groups, people with disabilities, newcomers, and 2SLGBTQI+ communities. This was achieved through direct engagement and collaboration with representatives from those communities and by implementing formal measures, such as Equity, Diversity, and Inclusion and Accessibility Action Planning, and establishment of advisory groups like the Disability Advisory and Research Team.

There was an abundance of performance data, but there were challenges with this information, including the vast number of indicators, changes to reporting that may limit trend analysis, the approach used to track reach, and unclear extrapolation of survey results. This limited the evaluation's ability to report on the results of the Initiative and its value for people living in Canada.

Impact on awareness, knowledge, and action on physical activity for people living in Canada who are less active, including reaching diverse groups that may experience health inequalities

The key components of the Let's Get Moving Initiative, and their results, are described here:

Public education campaigns

The Let's Get Moving Initiative has included a wide variety of public outreach, education, and media campaigns that have been shared via social media, the ParticipACTION website, the ParticipACTION app, e-communications, outdoor billboards, and television ads. Campaigns have focused mainly on public outreach and education of the need and benefits of physical activity. Other campaigns have been in support of specific elements of the Initiative, such as promoting the Community Challenges and the Report Cards on Physical Activity.

In terms of awareness and impact, ParticipACTION reported results from online surveys of a representative sample of the Canadian population. Based on responses to a 2021-22 survey, 30% of people living in Canada reported that they were aware of the campaign, a 21% increase from the previous fiscal year. Awareness was similar among males and females, across education and income levels, and across provinces. However, there were differences in awareness among age groups, with higher awareness among younger (<35) and older (55+) demographics, compared to those who were 35 to 54 years old. Of note, people living in Canada who self-reported as being physically active were significantly more likely to remember the campaign, compared to physically inactive people living in Canada. This is consistent with views expressed in interviews, with some suggesting that the people most impacted by ParticipACTION's activities may be those who were already active.

Of those people who were aware of the campaign, 64% reported taking immediate action because of campaigns and communications, compared to 62% the year before. Actions included, making physical activity a bigger priority, tracking physical activity, looking for more information on physical activity, visiting the campaign website to learn more, and sharing information with others. Those aware of the campaign were also more likely to report their intentions to be more active regularly in the next six months, as compared to those who were not aware (80% and 69%, respectively).

Overall, interviewees were supportive of ParticipACTION's public education activities, noting that such campaigns are a strength of ParticipACTION and that there is value in having public education messages be consistent and of national scope. However, while several external interviewees indicated that ParticipACTION's awareness campaigns have helped change people's attitudes towards physical activity, many others felt they were not enough on their own to drive behaviour change. Finally, a third of interviewees suggested opportunities for ParticipACTION to improve their communication strategy, particularly in diversifying or targeting their communications to reach priority or equity-seeking populations.

Community challenges

ParticipACTION organized month-long Community Challenges from 2019 to 2022, with a break in 2020 due to the onset of the COVID-19 pandemic. Community Challenges take place annually in June and encourage individual participants and community organizations to get active and become Canada's "Most Active Community." Physical activity is recorded through the ParticipACTION App or website, where users can opt into the Challenges and log their minutes of physical activity individually, and through community organizations that held Challenge-related events and recorded the number of attendees.^{Footnote 21} Participating organizations track total minutes of physical activity, while individual participants use the app or website to track activity using three metrics:

• 'Move Minutes,' activity of any intensity, which includes minutes of light or incidental physical activity as well as moderate-to-vigorous physical activity;
• 'Active Minutes,' which are minutes of physical activity that cause breathing and heart rate to increase (i.e., moderate-to-vigorous physical activity, or MVPA); and
• Number of steps taken.

Internal reporting was based on tracking by participating organizations and through the app or website, and showed that the past three Challenges cumulatively recorded nearly 1.7 million participants across every province and territory in Canada. In addition, based on a population survey using a representative sample of the Canadian population, as of the end of fiscal year 2021-22, the Challenges may have engaged as many as 8.2 million people in Canada, though not all of these participants were tracked.^{Footnote 22}

Around half of interviewees highlighted that the Community Challenge was effective in getting people to increase physical activity during challenge periods. Performance measurement results largely support this finding. During the most recent Community Challenge in June 2022, over 610,000 recorded participants tracked over 525 million minutes of physical activity, averaging about 201 minutes of total activity per person per week. For reference, the Canadian 24-Hour Movement Guidelines for Adults recommends at least 150 Active Minutes per week for adults aged 18 to 64.^{Footnote 23} While it is not possible to determine the intensity of activities recorded outside of the app or website, these results nonetheless suggest that being a part of the Community Challenges is associated with elevated levels of physical activity. Additionally, data analytics from the ParticipACTION App showed that during Challenges, users who opted into the Challenge recorded higher average Move Minutes, Active Minutes, and steps compared with all other users. App and website data also showed that, on average, app users' Active Minutes increased by 51% and number of steps taken increased by 29% during the Challenge period when compared to the previous month. Notably, the Challenges appear to have achieved this impact consistently, with reporting from the 2021 Challenge showing similar results.

Although there appear to be short-term successes, the impacts of the Challenges appear to taper off in the medium and long terms. In 2022, while active minutes logged increased during June, corresponding with the Challenge period, these minutes decreased again in July after the Challenge had concluded (see Figure 3). This is consistent with findings from 2021 and with views expressed in interviews, where some noted that impacts on physical activity from Challenges are difficult to sustain in the longer-term. It should be noted that these difficulties are associated with behaviour change and are not unique to the Let's Get Moving Initiative. Studies increasingly acknowledge that the physical, material, and social environments in which people live all play a role in informing behaviour. As a result, public health interventions are more effective when they focus on environmental change, rather than individual behaviour change that can be subject to various disparities and lived experiences that affect a person's intent and capacity to initiate change.^{Footnote 24}

Finally, the impacts of the Challenges may be restricted to those who are already active or well-resourced. To start, data analytics for the 2022 Challenge showed that Challenge participants not only reported greater average minutes of total activity during the Challenge, but they also reported higher levels before and after the Challenge period (see Figure 4). This suggests that Challenge participants are individuals who are already likely to move more when compared to non-participants, in line with observations from several interviews.

Moreover, while the Challenges saw participation from all over the country, involvement was heavily concentrated in a small handful of communities. For instance, in 2022, 70% of eligible communities in Canada (1,725 out of 2,466), had at least one person participating in the Challenge that year. Eligible communities are defined as any municipality or band in Canada with more than 1,000 residents. However, just five out of the 1,725 communities, representing approximately 4.3% of the overall Canadian population,^{Footnote 25} accounted for 40% of the total minutes tracked. Internal reporting suggested this was the result of those communities having large, organized events, which suggests higher levels of capacity or resourcing for physical activity programming.

Figure 3 - Text description

Figure 3 is a line graph depicting a blue line representing Total Move Minutes and a grey line representing Total Moderate-to-Vigorous Physical Activity Minutes for the 2022 Community Better Challenge, from left to right, over the period of April to July 2022. Data is as follows:

	April	May	June	July
Total Move Minutes	118,713,133	131,521,128	195,900,385	137,331,482
Total MVPA Minutes	23,027,179	24,117,096	45,988,950	25,393,222

Total Move Minutes and Moderate-to-Vigorous Physical Activity Minutes, 2022 Community Better Challenge [Source: Community Better Challenge Evaluation Report: July 2022]

Figure 4 - Text description

Figure 4 is an image of a line chart that was copied from another project evaluation report and is only available as a picture. The chart is comprised of purple and orange lines that approximate the mean of the weekly total activity minutes for Community Better Challenge participants and non-participants.

Weekly average minutes of total activity before, during, and after challenge conditional on participant status, 2022 Community Better Challenge [Source: Community Better Challenge Evaluation Report: July 2022]

Development of a national physical activity digital platform

The goal of the ParticipACTION App and website is to help people living in Canada meet national physical activity guidelines by facilitating increased physical activity through embedded individual and team movement challenges, educational content and resources, and activity tracking features. As described under Community Challenges, users could track their activity using the three metrics of 'Move Minutes,' 'Active Minutes,' and number of steps taken.

The ParticipACTION App was developed using a theoretical behaviour change framework and in collaboration with commercial app industry partners. To maximize the behaviour change potential of the app, the development approach referred to literature, surveys, and market research, and then applied a validated app behaviour change scale throughout development.^{Footnote 26}

As of spring 2022, the app had over 282,000 registered users, although most people who registered for an account do not use the app regularly, which is defined as a user who engages with the app at least once a month. In fiscal year 2021-22, an average of 31,000 registered users engaged with the app at least once a month, which was a significant increase from the previous fiscal year's average of 22,000 monthly users.

There is evidence to show that the ParticipACTION App has led to behaviour change among users, at least in the short term. According to internal reporting, during users' first four weeks on the app, new users reported a median increase in 'Move Minutes' of 270 minutes between the first and fourth weeks.

Furthermore, a 2022 survey of app users found the app may have also improved knowledge and behaviour among users. Among the 4,125 respondents, who represent around 1.5% of total users registered or 13% of regular app users who engage with the app at least once a month, around a quarter (23%) reported improved skills to support physical activity after using the app. Additionally, nearly half of respondents reported decreased sedentary behaviour (43%) and improved health-related fitness (48%) after using the app. Finally, about a quarter of respondents reported improved mental health and wellbeing (25%) and improved social wellbeing (24%) after using the app.

Several interviews supported this finding, describing how digital resources and events on the app and the ParticipACTION website helped engage people and got them moving, particularly during the COVID-19 pandemic. Interviewees noted how ParticipACTION pivoted quickly to expand virtual resources and continued to facilitate physical activity at home when other options were shut down due to the pandemic.

One notable expansion since the pandemic was the addition of in-app challenges. These are physical activity challenges hosted throughout the year that users of the ParticipACTION App could opt into, in addition to the annual Community Challenge. The in-app challenges, such as the 'True North' Challenge throughout February, the 'Great Big Move' in October, or the 'December Dash,' were intended to keep users engaged throughout the year. Users who opt in could form teams to tackle physical activity milestones together for a chance to win large prizes. App data analytics showed that these in-app challenges were an important driver of app engagement, including increased consumption of in-app content like informative articles and exercise videos. In 2022, around 65,000 unique app users opted into at least one challenge, which is equal to just under a quarter of registered users.

The ParticipACTION App also engaged people through regular opportunities to win rewards. According to a 2018 poll, 42% of people living in Canada think incentives and rewards that celebrate both small and big milestones would be a motivating factor to get them engaged in physical activity.^{Footnote 27},^{Footnote 28} The app leverages this strategy by offering a range of external incentives for users that are working toward their physical activity goals and consuming in-app content. The more activity that users track, and the closer they get to meeting their physical activity goals, the more opportunity there is to collect badges and accumulate entries toward weekly, monthly, and quarterly prizes consisting of gift cards.

Report Cards

The ParticipACTION Report Cards on Physical Activity are intended to provide a comprehensive summary of the research and assessment of physical activity, recreation, and sport in Canada. They synthesize data from multiple sources, including peer-reviewed literature and national-level surveys, to assign evidence-informed grades across a variety of physical activity-related indicators for adults, children, and youth. Indicators include overall physical activity, active play, active transportation, organized sports, physical education, sleep, sedentary behaviours, and 24-hour movement behaviours. The most recent Report Cards also examined the impacts of the COVID-19 pandemic and highlighted related challenges and opportunities for people living in Canada in being more physically active. Lastly, Report Cards are also meant to serve as a communication and advocacy tool by increasing awareness and advancing knowledge of the state of physical inactivity and sedentary behaviour of people in Canada.^{Footnote 29}

Over the last five years, ParticipACTION released two Adult Report Cards on Physical Activity (2019 and 2021), and three Report Cards on Physical Activity for Children and Youth (2018, 2020, and 2022). According to internal reporting, there were high levels of awareness and use of the Report Cards with stakeholder groups, while awareness levels were lower with the general public.

For the 2020 Child and Youth Report Card, three-quarters (75%) of 946 survey responses from stakeholders indicated they had learned something new about physical activity in Canadian children and youth, and the vast majority (86%) reported that they had used or intend to use the Report Card. Stakeholder groups surveyed included representatives of organizations in the physical activity, sport, or health-related sectors, as well as respondents not representing an organization, such as students or parents. A survey of people living in Canada, comprising 1507 responses, found that just over half of respondents (54%) were aware of at least one key message from the Child and Youth Report Card. Parents with children under 18 were more likely be aware of the Report Card and its key messages than those without.^{Footnote 30}

For the 2021 Adult Report Card, promotional activities like e-communications, social media, and targeted partnerships reached more than 27,000 stakeholders. Related results of a survey of stakeholder organizations and of people living in Canada are shown in the 2021 Adult Report Card highlights. The stakeholder survey included 551 responses from groups, such as schools, community and social groups, governments, municipalities, Band authorities, recreational groups, the health sector, local sport organizations, workplaces, and Indigenous groups. The survey of people living in Canada included 1000 survey responses.

Nearly half of internal and external interviewees spoke of how the Let's Get Moving Initiative helped increase knowledge and capacity among external stakeholders, including through the Report Cards. Some interviewees spoke of the value of the Report Cards to their work, for example, as a tool for advocacy for physical activity content, and to influence physical activity policy at other levels of government and in other organizations. They noted that there would be a knowledge gap if the Report Cards were no longer produced.

Reaching groups that may experience health inequalities

Inequitable barriers to physical activity

Research has shown that certain groups experience more barriers to physical activity and participation in programming than others, and that addressing these barriers can have a large impact on physical activity levels among equity-seeking populations.^{Footnote 31}, ^{Footnote 32} Barriers can be personal, including perceived health status and perceived benefits of physical activity. They can also be cultural, such as a lack of safe spaces for women and girls or differing notions of what counts as physical activity. Structural and environmental barriers, such as availability, accessibility, and cost can also prevent different communities from participating in physical activities. For example, for some rural or remote Indigenous communities, barriers can include a lack of access to recreational facilities, lack of sidewalks, poor lighting, wildlife, and inclement weather.^{Footnote 33}

Many interviewees noted social and environmental factors that have contributed to an increase in sedentary lifestyles. Furthermore, many external interviewees, including most non-governmental organization (NGO) representatives, described how the limited resources available to support the physical activity and recreation sector from other levels of government is a significant barrier to improving physical activity levels of people living in Canada. A few interviewees talked about how smaller, rural, and northern communities often lack the capacity, funding, and infrastructure to adequately support physical activity participation. For example, one NGO representative described how most small communities only have one person overseeing recreation, and they are "expected to do everything: run programs, apply to grants, take meetings…".

Physical activity may also be defined differently for various groups experiencing health inequalities, such as Indigenous peoples, newcomers to Canada, and racialized communities.^{Footnote 34}, ^{Footnote 35} Therefore, it is important for physical activity education and interventions to incorporate a more inclusive definition of physical activity, such as traditional activities like berry picking and fishing^{Footnote 36}.

Efforts to reach groups experiencing health inequalities

Through the Let's Get Moving Initiative, PHAC has encouraged ParticipACTION to better target populations experiencing health inequalities (including newcomers, ethnocultural groups, people with disabilities, 2SLGBTQI+ people, Indigenous groups, and older adults). For instance, PHAC has required explicitly including these groups as part of the reach of the Initiative in funding agreements. Nearly all interviewees described how ParticipACTION has made efforts to reach diverse and priority populations. Notably, several interviewees indicated that these efforts represent a recent improvement in the past few years and is a focus that the organization will be prioritizing moving forward, which aligns with when PHAC began its funding to ParticipACTION for the Let's Get Moving Initiative.

Additionally, nearly all interviewees agreed that ParticipACTION's collaboration with local and regional partners helped ensure or increase the reach and relevance of its programming for diverse group, suggesting this is a best practice.

ParticipACTION has also improved its focus on target groups through formal engagement with relevant representatives. In 2018-19, ParticipACTION developed partnerships to better engage target populations, including older adults, Indigenous groups, and people with disabilities, as well as recruiting additional members to the ParticipACTION Advisory Committee to represent newcomer and 2SLGBTQI+ communities. In 2021-22, ParticipACTION established the Disability Advisory and Research Team (DART) to "provide insight, support, direction, and advice to assist ParticipACTION in becoming an organization that models accessibility and inclusion of persons with disability."^{Footnote 37}

In addition, ParticipACTION reported that the organization has begun undertaking Equity, Diversity and Inclusion and Accessibility (EDIA) Action Planning in 2020-21. This has led to updates to the ParticipACTION App to include functionality and content targeted to people with disabilities and to the development of an EDIA action plan. Some interviewees highlighted these new app features, such as the option to track movement in wheelchairs, and expressed support for these types of changes.

Also starting in 2020-21, ParticipACTION reported that Community Challenge outreach efforts were focused specifically on engaging equity-seeking groups. These efforts have had a noticeable impact, as the Community Challenges were the most cited way that the ParticipACTION reached priority populations, which was mentioned in nearly half of interviews. In particular, several interviewees spoke of how the grants for participation in the Community Challenges were especially effective in encouraging participation among target populations, such as Indigenous populations and newcomers). For the 2021 Challenge, ParticipACTION provided over 1,000 micro-grants to local organizations to overcome barriers and support participation and for the 2022 Challenge, ParticipACTION distributed over 600 micro-grants. According to program documents, ParticipACTION assessed grant applications using a scoring metric that prioritized efforts to reduce barriers to participation and develop partnerships with health-equity seeking populations.

In addition to the Community Challenges, most external interviewees, including many from local organizations and governments, described ways that other programming and content through the Let's Get Moving Initiative have also been adapted to various local contexts or needs of specific populations. For example, interviewees observed how digital resources contained images that were inclusive of people with varying abilities and from various cultural groups or geographic regions. Others talked about increased discussion of some disaggregated data in the ParticipACTION Report Cards.

ParticipACTION collected some performance data on the Let's Get Moving Initiative's reach to groups that may experience health inequalities. For example, based on data from the ParticipACTION App users survey, of those app users who provided demographic information, 40% reported having a disability, 4% identified as 2SLGBTQI+, and 6% identified as Indigenous.^{Footnote 38} Meanwhile, during the most recent Community Challenge in June 2022, numerous participating organizations hosted events that targeted one or more priority populations, including 918 events targeting Indigenous groups, 752 events targeting 2SLGBTQI+ groups, and 1,243 events targeting people with disabilities. Some events also targeted more than one priority group.

There is still an opportunity to improve the Initiative's efforts to reach groups experiencing health inequalities and collect associated performance data. According to many interviewees, the broad, national scope of ParticipACTION limits the Initiative's ability to target priority populations. As such, more than half of interviewees suggested that the Let's Get Moving Initiative could implement more targeted programming to address barriers, reach priority populations, and adapt messaging in communication materials to target priority groups. Furthermore, many interviewees discussed ways in which the ParticipACTION App was not accessible or 'user friendly' for various groups. They cited examples like people living with limited internet or mobile data access, individuals with limited technology skills, people from low-income communities, and individuals from various cultural backgrounds for whom the content may not be relevant. Additionally, several external interviewees noted that there was a gap in initiatives targeting Indigenous populations and for low-income communities.

Finally, half of the interviewees suggested that ParticipACTION could use more community-based or community-driven approaches to improve the reach of its activities including working with community representatives to better understand local needs and barriers.

Challenges with reporting on reach and impact

ParticipACTION collects a large amount of data based on many indicators. Due to the considerable number of indicators being measured through each component of the Initiative and more broadly, there is the risk that the most meaningful and useful data will be lost among the vast volume being collected and reported.

The evaluation encountered several challenges with ParticipACTION data. For example, indicators changed frequently, sometimes annually, taking away opportunities for trend analysis. In addition, the annual reports submitted to PHAC described the "actual reach" of the Community Better Challenges over the past four years as over nine million people. However, when broken down, it was revealed that most of that number (8.2 million) was based on extrapolation of results from a small survey of the Canadian population, and not the actual number of participants recorded.

Other challenges included some indicators being reported inconsistently. For example, with the social media engagement for the Everything Gets Better Campaign, the types of media impressions are reported differently each year. Reporting ranged from information on engagements and link clicks to unique page views, and then none of this data was provided for 2021-22. Throughout the evaluation period, there was a reliance on reporting media impressions, but little data on media reach. Reach is the total number of people who choose to see and engage with content. Impressions are the number of people to whom content is displayed, no matter if it was clicked or not.^{Footnote 39} The meaning behind each of these data types is important for understanding and use, yet is not clearly defined in reports. In addition, it is not possible to estimate how many people or unique users were exposed to the information.

Question 3 – Delivery approach

The ParticipACTION organization is seen as an appropriate funding recipient for initiatives like the Let's Get Moving Initiative due to factors such as its experience, reputation, expertise, and brand awareness. The Initiative aims to reach as many people in Canada as possible through its education and digital content, while also targeting priority populations through its Community Challenges, and this approach aligns with the public health principle of proportionate universality. However, it is not clear if the Initiative has optimized the balance between these national and targeted activities.

ParticipACTION leveraged the funding provided by PHAC ($25M) to secure and initiate partnerships with other groups. Over the five-year evaluation period, this included $6.5M in matched funds and $40M in the form of services like media value and software development. Increasing leveraged funds could assist in reaching more equity-seeking populations and help improve the overall sustainability of the Initiative.

Current delivery model

The Let's Get Moving Initiative includes many of the essential elements as recommended by the WHO, including consultation with key stakeholders, development of coalitions across government, non-government, and private sectors, implementation at various levels (community, state and national), special consideration for subpopulation groups (children, women, people with disabilities, Indigenous peoples), and plan identity (logos, branding, and slogans).^{Footnote 40}

This evaluation explored physical activity plans for several comparable countries including the United States, Australia, New Zealand, United Kingdom, and Denmark. None had approaches that were directly comparable with PHAC's funding for the Let's Get Moving Initiative. Contexts vary, and in some countries, physical activity initiatives are channeled through the health sector, whereas in other countries, sport or recreation agencies seem to be the central advocates for the physical activity agenda by encouraging community-level participation. Several programs offer funding opportunities for smaller, local initiatives, such as the United Kingdom, Denmark, and New Zealand. The federal counterparts of most countries have developed physical activity guidelines that reflect the WHO's guidelines for physical activity. All countries except Australia and Denmark included explicit consideration of vulnerable populations, including racialized groups, Indigenous populations, children and young people and people with disabilities.

The current delivery model for the Let's Get Moving Initiative involves using a variety of interventions, including public education campaigns, community events, digital resources, research, and partnerships to reach people living in Canada who are less active and to target diverse groups that may be experiencing health inequalities due to socioeconomic disadvantages. This approach, which aims to reach as many people in Canada as possible through its education and digital content, while also targeting priority populations through its community-led challenges, aligns with the public health principle of 'proportionate universality.' Proportionate universality refers to how social programs need to provide universal supports while also incorporating targeted programming for groups facing greater disadvantages, in order to reduce health inequalities and benefit the greatest number of people possible. As most people in Canada do not currently meet recommended physical activity levels, people all along the spectrum of socioeconomic situations are facing at least some kind of barrier to physical activity. Physical activity programs that only target the most disadvantaged will not reach most people in Canada and will also miss many of the people facing some disadvantages at higher ends of the socioeconomic spectrum.^{Footnote 41}, ^{Footnote 42}

Almost all interviewees expressed positive sentiments toward the current delivery model for the Let's Get Moving Initiative and did not recommend an alternative approach. The population level approach to reaching people in Canada was cited as being important for consistent messaging across the country, while still allowing regional customization and enabling local groups to leverage information. Furthermore, a few internal and external interviewees from the health and private sectors indicated that the ParticipACTION organization was an appropriate funding recipient for this Initiative thanks to its longstanding work in the recreation and physical activity sector, its reputation, and its professionalism and expertise.

ParticipACTION's well-established brand awareness was seen as an important facilitator to increasing the reach and credibility of its messages around movement and physical activity. A 2018 study found that approximately 20% of people living in Canada reported unprompted awareness of ParticipACTION and 82% reported prompted awareness. However, the odds of people being aware of ParticipACTION were greater if they were more educated, reported higher income, and had children. This study concluded that future activities should attempt to target other segments of the population, especially people who are experiencing health inequalities.^{Footnote 43} 

Interviewees felt the Community Better Challenges were particularly effective because they engaged and supported communities directly and allowed for programming to be adapted to local contexts and populations. Furthermore, grants associated with the Challenges or the financial prizes for Challenge winners allows communities to address their local barriers to physical activity (e.g., need for childcare, lack of infrastructure). Several external interviewees praised the current approach of the Let's Get Moving Initiative for supporting smaller communities that had limited capacity. According to representatives of regional governments and NGOs, the Initiative was able to provide them with the resources, evidence, and content to implement or expand their physical activity programming. Similarly, an external interviewee shared, "This is the best model we were able to find. Any smaller communities have limited resources and the infrastructure to support physical activity can be precarious… The incentives, the backdrop of friendly competition, the pride people take in the community were all factors in why the program is valuable [for communities like ours]."

Some interviewees suggested adjustments to the current delivery model, including more co-development of programming with local organizations, and more meaningful engagement with the ParticipACTION Advisory Network to strategically guide activities.

Value for money

ParticipACTION reported that they continued to leverage the funding provided by PHAC to develop partnerships with corporate supporters and provincial and territorial governments to amplify existing initiatives, exceeding the matched funding requirements.^{Footnote 44} Approximately $6.5M over the five-year period was in matched funds, and approximately $40M was in the form of media value and software development from several private sector partners. The media value allowed for a greater level of public outreach and education.

Assessments done for evaluations of other grants and contributions (G&Cs) programs have notionally pointed to lower operational costs for PHAC, such as personnel and operations and maintenance (O&M) costs, and to the benefits of leveraged or matched funding. For example, a similar program was found to have been cost-effective, and by working with the outside organization, the program had made good use of resources, maintained low administrative costs, and leveraged significant amounts of funding, both in-kind and private.^{Footnote 45} Another evaluation pointed to the benefits of matched funding, including improved sustainability of a project once federal funding ends, encouragement of a broader base of community support for the project, and better federal program support for more projects using its resources.^{Footnote 46}

Most interviewees felt ParticipACTION provided value for money, although a few noted that a judgement of value for money may vary by community and Initiative component. Many interviewees discussed how ParticipACTION was able to leverage significant additional funding. However, some expressed concerns that most of the matched funding was for incremental media value, which they noted would not independently sustain programming and activities under the Initiative in the absence of PHAC funding. Increasing leveraged funds could assist in reaching more equity-seeking populations and help improve the overall sustainability of the Initiative.

Program spending

Information on program spending was for G&Cs funding only, given that the program doesn't track other resources separately across initiatives for which they are also responsible. Over the period of 2018-19 to 2022-23, the program spent approximately $2.95M more than originally planned. Regular surplus funds from the Healthy Canadians and Communities Fund, previously called the Multi-sectoral Partnerships to Promote Healthy Living and Prevent Chronic Disease program, were used to top-up funding and expand activities. Associated amendments to the contribution agreement related primarily to expanding digital engagement, community engagement, communications, partnerships, and evaluation.

Table 1: Planned versus actual G&C spending (2018-19 to 2022-23)

Fiscal year	Planned spending	Actual spending	Variance	% of planned budget spent
2018-19	$5M	$5.69M	-$0.69M	114%
2019-20	$5M	$7.00M	- $2.00M	140%
2020-21	$5M	$5.79M	- $0.79M	116%
2021-22	$5M	$4.77	$0.23	95%
2022-23	$5M	$4.70	$0.30	94%
TOTAL	$25M	$23.25M	-$2.95M	112%

Source: Chief Financial Officer and Corporate Management Branch

Some G&Cs programs find it challenging to distribute funds in their first year due to the logistics associated with multiple funding recipients; however, because ParticipACTION was the single funding recipient, this was not an issue.

Conclusions and recommendations

Conclusions

The Let's Get Moving Initiative has increased awareness and knowledge related to physical activity and helped some people get more active. However, it is not clear how much current interventions are engaging people who are less active, or if increases in physical activity are sustainable in the long term. Although the Initiative has increased its focus in recent years to reach diverse groups that may experience health inequalities, work remains to build on these efforts, while continuing to improve the public's physical activity levels.

Overall, the current delivery model appears to be appropriate. The ParticipACTION organization is a suitable funding recipient for initiatives like the Let's Get Moving Initiative due to its experience, reputation, expertise, and brand awareness. ParticipACTION has been able to secure a significant amount of matched funding through multi-sectoral partnerships, of which the majority are in-kind advertising and media value. Although this has enabled the Initiative to promote physical activity among the public, there are opportunities to build new partnerships and secure additional funding sources. Seizing these opportunities could enable the Initiative to better reach diverse groups and help improve their physical activity levels, while improving the sustainability of the Initiative in the long term.

Finally, performance measurement data should be streamlined and improved as there were challenges with the data that made it difficult to report on the overall impact of activities, and the value for people living in Canada.

Recommendations

The findings from this evaluation have resulted in the recommendations listed below.

Recommendation 1: PHAC should require ParticipACTION to increase the focus of the Let's Get Moving Initiative on reaching diverse groups who may be experiencing health inequalities

The evaluation found that certain groups may experience greater barriers to physical activity because of factors such as income, geographic location, age, culture, education, gender and disability, and are less likely to get the recommended levels of physical activity. Although PHAC has encouraged ParticipACTION to increase its focus on populations experiencing health inequalities, there are still gaps in addressing physical activity levels within these groups. The Initiative could benefit from more targeted and community-based programming to help address barriers, reach priority populations, and adapt messaging to target priority groups.

Recommendation 2: PHAC should encourage ParticipACTION to diversify its sources of funding and seek new funding partnerships to increase the potential for the Initiative to be sustained over time.

The vast majority of leveraged funds are in the form of media value and software development. Increasing leveraged funds could assist in reaching more equity-seeking populations and help improve the overall sustainability of the Initiative.

Recommendation 3: PHAC should streamline and improve the Let's Get Moving Initiative's performance measurement and reporting, with a focus on improving disaggregated data.

Although the Let's Get Moving Initiative collects a large amount of performance measurement data, there were some challenges with data to report on the reach of the Initiative, and its impacts on those who are less active and on target groups. There was some performance data collected in relation to groups that may experience health inequalities; however, there is an opportunity to improve the collection of disaggregated data, as it was not available for many of the initiative's activities.

Management Response and Action Plan

Recommendation 1

PHAC should require ParticipACTION to increase the focus of the Let's Get Moving Initiative on reaching diverse groups who may be experiencing health inequalities.

Management response

Management agrees with the recommendation. An increased focus on reaching diverse groups experiencing health inequalities is fully aligned with the priorities of the Healthy Canadians and Communities Fund (HCCF).

Action plan for recommendation 1

Action plan	Deliverables	Expected completion date	Accountability	Resources
1.1 As part of the requirements set out in the Contribution Agreement, PHAC will require ParticipACTION to undertake and report annually on: · identifying and setting targets for the participation of specific priority populations · how they are engaging priority populations throughout the project.	1.1 Contribution Agreement – Appendices (workplan and evaluation plan)	August 31, 2023	Executive Director, Centre for Chronic Disease Prevention and Health Equity	No additional resources required
1.2 PHAC will require ParticipACTION to commit resources to support an increased number and value of Community Challenge grants which have been shown to effectively engage priority populations.	1.2 Contribution Agreement – Appendices (workplan, budget and evaluation plan)

Recommendation 2

PHAC should encourage ParticipACTION to diversify its sources of funding and seek new funding partnerships to increase the potential for the Initiative to be sustained over time.

Management response

Management agrees with the recommendation. It is consistent with HCCF efforts to encourage organizations to seek multiple-level partners that will provide financial and in-kind support in order to sustain the activities of the project after the PHAC funding has ended.

Action plan for recommendation 2

Action plan	Deliverables	Expected completion date	Accountability	Resources
2. To support the potential for sustainability of the initiative, PHAC will encourage ParticipACTION to seek and secure funding partners for both cash and in-kind sources outside of the media realm, including reporting on sustainability efforts.	2. Contribution Agreement – Appendices (workplan and budget). Project reporting template (annual and final)	August 31, 2023	Executive Director, Centre for Chronic Disease Prevention and Health Equity	No additional resources required.

Recommendation 3

PHAC should streamline and improve the Let's Get Moving Initiative's performance measurement and reporting, with a focus on improving disaggregated data.

Management response

Management agrees with the recommendation. It is consistent with HCCF efforts to ensure performance data is collected consistency to effectively measure program impact. In addition, current efforts to better understand barriers to disaggregated data collection as well as promising approaches will be of benefit to ParticipACTION.

Action plan for recommendation 3

Action plan	Deliverables	Expected completion date	Accountability	Resources
3.1 PHAC will ensure that performance measurement requirements are precisely defined in the Contribution Agreement with ParticipACTION, with a focus on fewer, more meaningful indicators that can be measured consistently over time and disaggregated data for priority populations.	3.1 Contribution Agreement – Appendices (workplan and evaluation plan)	August 31, 2023	Executive Director, Centre for Chronic Disease Prevention and Health Equity	No additional resources required.
3.2. ParticipACTION's Evaluation Plan will require formal approval from PHAC program officials before ParticipACTION can proceed to implement it, thus ensuring performance measurement expectations have been met.	3.2 Documented evidence of PHAC approval of ParticipACTION's Evaluation Plan	December 1, 2023
3.3. PHAC will share with ParticipACTION evaluation guidance documents and resources including emerging research on best practices for improving data disaggregation.	3.3 Documented evidence that Evaluation and Knowledge Mobilization Guide, Scoping Reviews and other commissioned reports have been shared with ParticipACTION.	August 31, 2023

Annex A – Evaluation methodology and limitations

The scope of the evaluation included PHAC activities related to ParticipACTION's Let's Get Moving Initiative. The evaluation team collected data using various sources and methods, including:

Document and performance information review

OAE undertook a review of key program documents and performance information. This included, but was not limited to, annual reports, annual update meetings, annual work plans, contribution agreements, external evaluations of components of the Initiative, administrative documents, and briefing materials.

Interviews

OAE undertook interviews with a total of 24 key informants. This included:

• Seven PHAC representatives; and
• 17 external stakeholders, including non-governmental organizations, provincial representatives, and experts and academia.

Financial analysis

Available financial information for the period 2018-19 to 2022-23 (Grants and Contributions funding only) was analyzed.

Literature review

OAE conducted a focused literature review, which included academic papers and grey literature. This review included a brief comparative analysis of the approach to physical activity programming taken by five comparable countries (United States, Australia, New Zealand, United Kingdom, and Denmark).

The evaluation team used triangulation to analyze data collected by these various methods in order to increase the reliability and credibility of the evaluation findings and conclusions. The evaluation considered the SGBA+ lens in its assessment of the Let's Get Moving Initiative, including a discussion of equity issues in terms of outcome achievement. Although official languages were not specifically examined, they did not emerge as an issue for the program's activities. Furthermore, an examination of the Sustainable Development Goals was not applicable for this evaluation.

In conducting the evaluation, a single window was identified from the Health Promotion and Chronic Disease Prevention Branch, with whom the Office of Audit and Evaluation worked closely throughout the evaluation. The scope for this evaluation was shared with the Performance Measurement and Evaluation Committee (PMEC) in September 2022. The preliminary findings were presented at PMEC in March 2023, and the final report was presented at PMEC in July 2023.

Limitations are described below.

Table 2: Limitations, impacts, and mitigation strategies

Limitations	Potential impact	Mitigation strategies
Key informant interviews are retrospective in nature, providing only a recent perspective on past events.	This could influence the validity of respondents' assessment of activities or results that may have changed over time.	The other lines of evidence were triangulated with the data received from interviews to substantiate or provide further information. Document review also provided corporate knowledge.
There were challenges with performance data, including the overwhelming number of indicators, frequent changes to reporting that may limit trend analysis, the approach to tracking reach, and unclear extrapolation of survey results.	This limited the evaluation's ability to report on the results of the Initiative and its value for people living in Canada.	Data provided was checked with other documents, with the program, and a portion of data that was consistent was used to inform the evaluation findings.
Direct comparator programs were not found to be used for the comparative analysis.	Without direct comparisons, it is difficult to determine if a program is working well within its context and to find already tested alternative approaches and means of improving.	Programs with similar goals were found in other countries, and a literature review of best practices was conducted to provide a picture of the context within which ParticipACTION operates.
Complete planned and actual financial data for the program was not available. Only planned and actual contribution expenditures were provided between 2017-18 and 2021-22.	There is a limited ability to assess efficiency quantitatively to support the discussion of value of PHAC's activities.	Triangulation of other lines of evidence was used to substantiate or provide further information on program value.