Physical activity is a health habit that can be significantly modified if information is more widely disseminated.8 The strategies to fight physical inactivity, usually paired with diet recommendations, should include different intervention phases based on social marketing and in models and theories that originate from the social sciences. All these propositions entail a prior essential requirement, i.e., to properly advice the population9 in order to achieve behavioral change toward lifestyles that are sufficiently active.10

The use of the media might prove effective to enhance the health of the population.11 Agenda-setting theory attributes more influence to the written press than to television in determining the items that will feature in the media.12 However, the intermediation between scientists and the general population has disappeared in most cases in Spain and globally. Thus, the regulatory role of the press in the search for truth and objectivity appears to be missing.13 In Spain, the financial crisis that started in 2008 resulted in a lack of resources for quality journalism reporting on science and health.14,15

Nevertheless, there is still a high volume of news articles with specialized health contents in the Spanish press.16 The number of news stories on health-enhancing physical activity (HEPA) has also increased.17 However, serious research and significant advances in health and medicine still only feature in a small percentage of publications.18

To our knowledge, no study has applied the Oxman Index, specifically validated19 to measure the scientific quality of the news stories on health in the press. A study by Moynihan et al.20 is considered groundbreaking and was followed by various international initiatives (Australia, Canada, USA, Germany, China and Japan) that use criteria based on the Oxman Index.21 The most significant initiative in terms of number of news stories analyzed is the Health News Review, which started its activity in 2006 in the USA. After the analysis of approximately 3000 news stories, some of these initiatives22–24 reveal lack of rigor and thoroughness in relation to the original finding.

In consequence, we believe that this content analysis25–27 of news stories on HEPA published in the Spanish press is timely. The objective of the research is to assess the conformity to quality criteria with the aim to generate tools for journalists to create improved news stories. The research questions (RQ) raised are as follows:

• RQ1. – What is the quality of news stories on HEPA in Spain?

• RQ2. – From the media and scientific perspectives, to which degree are the quality variables of the news stories on HEPA in Spain satisfactory?

• RQ3. – To which degree are the quality variables satisfactory compared to the results of international quality analysis in health news stories?

• RQ4. – What is the correspondence between the topics in the news stories and government strategies to achieve change in the habits of the population?

• RQ5. – How are the topics explained in relation to the setting, age groups, risk factors and prevalence of non-communicable diseases?

Quality variables were selected according to criteria described in several essays and applied to various scientific articles. These criteria concern the media and scientific perspectives, namely: specialized journalism28–30; ethical principles of journalism31; emotional communication regarding health issues32; and rigor in reporting scientific and health topics.19,21 A total of 12 variables were defined for the quality analysis of these two perspectives (media and science) and 5 variables for the thematic description of the contents (Table 1).

The units of analysis are the news stories on HEPA published during 2013 and 2014 in the five general-interest newspapers with the largest readership in Spain: El País, El Mundo, La Vanguardia, ABC and El Periódico de Catalunya.

We used the news database MyNews Online, which provides the articles published in the written press (paper) in Portable Document Format (PDF), the news database LexisNexis and the online newspaper archive of ABC for the news stories not found in MyNews Online for the study period. The search keywords were “physical activity” and “physical exercise” for the period defined in the national editions of these five newspapers. All sections of the newspapers were screened, including opinion and sponsored articles,b and also the supplements and special features incorporated within the newspapers for a fixed price per unit. The inclusion criteria with regard to the topic of the news story were: recommendations on HEPA or HEPA plus diet, articles on HEPA or HEPA plus diet, studies on the prevalence of a specific condition or risk factor, prevention and/or health promotion programs and techniques, new fitness trends and technology applied to physical activity (PA).

• 1.

  Context: data to support that the main facts do not occur in isolation, but related to other facts, including past and present information.

• 2.

  Sources: the sources must have a citation in the article, including name, affiliation, specialty and lack of conflicts of interest; when more than a source exists, all of them should be mentioned. If there is a press release, it should only contribute toward the context of the story.

• 3.

  Accessible language: when there is specialized language, the scientific contents should be explained with plain language accessible to most readers without having to consult other sources.

• 4.

  Objectivity: facts and data should be clearly differentiated from opinions. Generally, in this type of news stories the opinion of the journalist should not be in the text.

• 5.

  Emotion: the inclusion of elements that stir emotion in the reader is one of the most promising areas of communication. These elements can be witnesses’ quotations and persuasive narrative.

• 6.

  Truthfulness: this variable depends on others such as context, sources, objectivity, credibility and magnitude. Truthfulness evaluates the rigor of the story in relation to the original source (scientific article or report).

• 7.

  Credibility: mention of scientific evidence. The study, journal or institution that publishes the scientific finding should be specified; also, that the personal sources are from experts on the matter.

• 8.

  Magnitude: the relevance or scope of the findings must be clearly stated, without exaggerating or lessening risks and benefits. Qualitative data are less informative because of their ambiguity and subjectivity, whereas numeric data (absolute and relative) provide specific information.

• 9.

  Medicalization: risk factors should not be equated to a disease and natural processes such as aging cannot be presented as a health issue; medication cannot be presented without the alternative of physical exercise when there is scientific evidence that favors exercise.

• 10.

  Alternatives: to evaluate a new treatment or HEPA recommendation available alternatives of proven efficacy should be presented. Even better if advantages and disadvantages are compared.

• 11.

  Availability: the article should mention if the program, treatment or HEPA recommendation are available in the country, if professional monitoring and specific gear are required and costs incurred.

• 12.

  Novelty: explains if the HEPA recommendation method, program or treatment are really new and if it is a reformulation of an old concept or a variation of an existing idea.

We used content analysis, a quantitative technique based on the objective reading and coding of the information contained in each news story (unit of analysis). Coding ascribes one unit of analysis within a specific category of a variable.27 Next, these variables were successively computed, described, analyzed and given a dichotomous value: satisfactory=1; non satisfactory=0; or “not applicable” according to the criteria (quality variables). The total number of applicable items is not the same for all news stories and therefore the results are not comparable if they are not standardized, for instance with a scale from 0 to 10. The formulae applied are as follows:

For each news story:

For each quality variable:

The result is a score (0-10) for each news story of the sample and 12 scores (0-10) for each quality variable observed.

The database was created with the program Filemaker Pro Advance (version 14.0.6) and the data were processed with Microsoft Excel for Mac (version 14.7.1) and IBM SPSS Statistics (version 21).

The sample analyzed (n=100) presents a similar annual distribution, 46% (n=46) for 2013 and 54% (n=54) for 2014. More stories were published during the first half of the year, peaking in May for both 2013 (21%; n=21) and 2014 (13%; n=13). The frequency according to the day of the week is also very similar in the two years of the study. The newspaper La Vanguardia contributes almost half of the news stories (n=45; 45%), while the remaining 55% (n=55) is similarly distributed among the other four newspapers with percentages ranging from 11% to 17%. Most articles feature in the section “Society-Trends”, followed by the supplements (35%; n=35). These two sections accumulate 81% (n=81) of the news stories published.

The total quality of the whole sample (n=100) is 6.3 (s=1.9) on a scale of 0-10 (0=lowest score; 10=highest score). We did not find differences between 2013 (x¯=6.3; s=1.8) and 2014 (x¯=6.3; s=2.0) or between the first (x¯=6.2; s=2.0) and second (x¯=6.4; s=1.7) half of the year. The differences observed in relation to the days of the week are not significant, since 75% (n=75) of the sample is accumulated in three days which present scores close to the mean. However, El País (x¯=7.0; s=1.7) and La Vanguardia (x¯=6.8; s=1.8) obtained higher scores, followed by El Periódico (x¯=5.6; s=2.3), ABC (x¯=5.6; s=1.7) and El Mundo (x¯=5.4; σ=1.5).

Figure 1.

Quality of the news stories by categories.

(0.08MB).

As a whole, 72% news stories obtained a score of 5.0 or over. Fig. 1 shows the distribution by categories (low=0-4.9; intermediate=5-6.9; high=7-8.9; very high=9-10).

Table 3 shows the satisfactory scores obtained by the quality variables and the percentage of stories to which the criteria have not been applied due to different reasons. The scores (scale 0-10) calculated for comparison and the results according to categories of quality are as follows: very high: Objectivity (9.7) and Medicalization (9.6); high: Sources (8.0), Truthfulness (7.5) and Credibility (7.4); intermediate: Availability (6.6), Novelty (6.5) and Context (6.2); low: Accessible Language (4.2), Alternatives (3.8), Emotion (2.0) and Magnitude (2.1).

The themes of the stories are represented in similar frequencies. At the highest end we found “Recommendations on HEPA or HEPA plus diet” (19%; n=19) and at the lowest end (4%; n=4) the stories on “Technology applied to physical activity”.

The settings are only mentioned in 44% of stories (n=44), with a prominent first place for “Leisure” (28%; n=28). In relation to the age group of the target population, 63% (n=63) of stories do not specify any.

Obesity is the disease that features most frequently (25%; n=25) as the main condition. However, 62% (n=62) of articles do not focus on any specific disease. The remaining news stories (13%; n=13) correspond to various diseases with percentages that range from 1% to 3%.

Finally, we have observed that while there are specific recommendations on health-enhancing physical activity in 65% (n=65) of news stories, a decrease of 16.5% occurred in 2014 (57.4%; n=31) compared to 2013 (73.9%; n=34).

The quality of the news stories analyzed (2013-2014) is very homogeneous. For the whole study period, the average score obtained is of intermediate quality, i.e., 6.3 (s=1.9) on a scale from 0 to 10. Specifically, 79% have either intermediate (n=40), high (n=32) or very high quality (n=7), with the remaining 21% obtaining low quality scores (n=21). This variability underscores that readers are frequently exposed to vague and incomplete recommendations on HEPA.

The performance of journalists in relation to objectivity and avoiding medicalization is excellent. The variables with a high quality (score=7-8.9) show that most stories maintain the scientific rigor of the source study or report and also that they include information on the sources, which adds scientific credibility to the news story. The variables with an intermediate quality (score=5-6.9) show that the stories could be greatly improved by a greater contextualization of the main topic of the article, by specifying the availability of the method or technique and by clarifying the novelty factor. Low quality scores (<5) imply the following shortcomings:

• -

  The language of these stories is not sufficiently accessible to be understood by most people. Frequently, the technicalities included are ill-explained.

• -

  The main information is insufficiently contextualized, in particular in relation to the presentation of available alternatives.

• -

  Very few news stories use narrative resources that stir emotion in the reader while informing. Emotion contributes to enhance understanding and recollection of the information.

• -

  Most writings do not show data that quantify benefits and possible risks related to the HEPA.

If we take into account that our study only analyses news stories on HEPA, we believe that it is of value to compare these results with the scientific perspective of other studies of content analysis in the press which include also articles on HEPA. Table 5 shows the main characteristics of the articles and the results of criteria satisfaction. The characteristics of these three studies on the USA, Australia and Canada initiatives are very similar. In relation to quality, they find the same trends observed in our study. With the exception of the criterion “Novelty”, which has the highest variability (intermediate, high or very high), the quality grading of the remaining four criteria coincides in the four studies:

• 1)

  Very high quality: Medicalization (96–70%).

• 2)

  High quality: Availability (70–54%).

• 3)

  Intermediate quality: Alternatives (51–26%).

• 4)

  Low quality: Magnitude (31–19%).

Over two thirds (68%) of the stories originate in studies on the prevalence of a disease or risk factor, mainly sedentarism and overweight/obesity, studies on the effects of HEPA or HEPA plus diet and recommendations on HEPA or HEPA plus diet. This high proportion corresponds to the fundamental and priority contents of strategies aimed at behavioral change,10 which start by raising awareness on the severity of physical inactivity (prevalence studies) followed by information on how to fight this problem (recommendations and/or benefits of HEPA plus diet) while explaining the adaptive processes that take place in the body with scientific studies.

The distribution of settings within the news stories shows that in 56% of cases there is no mention of any specific setting that the reader can identify with and therefore understand the implications of the information for herself. When a setting is mentioned (44%), it mainly refers to leisure time (28%) and the remaining 16% is distributed between household, transport and work or education (school and university). This is relevant, since the reader might interpret that these recommendations can only be followed during leisure time. Moreover, if we consider that there are only clear recommendations on HEPA in 65% of news stories, the possibilities for the reader to locate her own reality in the information that she reads decreases even further. Similarly, the age group of the population targeted by the information and recommendations should be clearly specified, since the activities vary in accordance with age.6

Correspondingly, we only find references to diseases in 38% (n=38) of texts. Obesity is the main condition, with 25% (n=25) of stories, while other diseases are distributed in the remaining 13% (n=13). It is obvious that this distribution does not represent the diversity and importance of diseases and risk factors in Spain and globally. Hypertension and hyperglycemia are risk factors that cause more mortality than obesity1 and they only feature in 4% of news stories, in contrast with 25% of overweight and obesity. We should also highlight the scant information on prevention of breast and colon cancer (1%), taking into account that scientific evidence shows that HEPA could help prevent between 21% and 25% of these types of cancer.1

1) When the origin of the news story is a scientific study or a report, data must be provided to identify the source, i.e., the full title, the main author and the journal. The date of publishing must always be included.

2) Whenever possible, the reader must identify with the story: witnesses can be the backbone of the news story featuring as information sources or telling their personal stories.

3) When the text includes scientific terms and technicalities these should be clearly explained. In these cases the use of rhetorical resources is very effective, namely:35 metaphor, example, definition, synonymy, analogy, personification, anecdote, experts’ quotations and explanatory apposition.

4) When the text includes a method, technique or recommendation on HEPA it is crucial to mention availability, need for monitoring and specific gear and also accessibility (costs); the article should mention if it is a new idea or the remake of an existing concept, and compare it with existing alternatives.

5) The positive effects on health and risks of a method, technique or recommendation on HEPA should be expressed in quantitative instead of qualitative terms and always better in absolute, not only relative, terms. Examples for the same recommendation on HEPA are as follows:

• a)

  Qualitative: “Daily physical activity increases life expectancy”;

• b)

  Quantitative relative: “30minutes of daily physical activity increases life expectancy by 4.2%”;

• c)

  Quantitative absolute and relative (with accessible language for the technicalities): “30minutes of daily moderate physical activity (you should be able to talk but not sing during the activity) increases life expectancy by 4.2%, i.e., 3.4 years for a person with the Spanish average life expectancy of 80 years.”

6) When writing on HEPA we should remember to include at least the general recommendations to achieve the minimum physical activity (see Background). In addition, the story should include some tips to incorporate HEPA in our daily lives, such as those available in programs of prevention of sedentarism and promotion of physical activity.36

7) When defining the topics of the news stories on HEPA

• a)

  Always mention the everyday life setting from the source study, because each setting offers different possibilities for exercising;

• b)

  Specify the target age group of the information: children (preschool and school ages), adolescence, adults and the elderly;

• c)

  and include information on specific diseases taking into account prevalence,1 avoiding just focusing on overweight and obesity.