NICE Guidance on tobacco control communication campaigns: an effective approach for encouraging positive behaviour change and promoting Smoking Cessation Services?
Development, implementation and evaluation of a new anti-tobacco public information campaign in Northern Ireland
Paul Schofield, Research and Information Officer, Public Health Agency
Relating NICE guidance to the campaign - Development
DevelopmentCampaign
stage
Recommended NICE action
Action taken by PHA
- Be developed using audience research;- Consider tailoring campaigns toward low income
groups;- Use ‘why to’ and ‘how to’ quit messages that are
non-judgemental, empathetic, respectful.
- Primary focus on C2DE / routine and manual workers from early stages;
- Qualitative development research with proposed target audience;
- Refining of proposed concepts and campaign messages through feedback with target audience;
- Two strand approach to the campaign to incorporate ‘why’ quit and ‘how to’ quit messages.
• Qualitative research was undertaken with adult smokers. Total of 8 groups across Northern Ireland.
• Research participants consisted of adults smokers; recruitment on the basis of-
• Age (20-49 year olds);• Socio-economic group (emphasis on C2DE profile groups);• Intention to quit (not intending to quit v intention to quit in the
future).
• Group discussions were arranged by research participants with similar demographic characteristics and by similar quitting intention.
• Series of concepts were tested in each group; participants with no expressed intention to quit tested ‘Why’ quit approaches / participants with expressed intention to quit tested ‘How’ quit approaches.
Development – Overview
Participants indicated that the impact that a smoking related illness had on family and loved ones was motivating in terms of initiating a quit attempt. They were aware of the risks of smoking, but had not thought about the impact of a debilitating illness on the impact of others.
The concept selected for development was felt to be empowering, on-side and non-judgemental.
Campaign aimed at smokers with no explicit intention to quit, predominantly targeted at lower socio-economic groups and smokers aged 20-49 years old.
Development – Strand 1 ‘Why’ quit approach
Campaign summary
Message -‘Smokers. Things to do before you die’-Shows the long term health effects of smoking, personalising how it feels to experience a smoking related illness
Campaign focus
-Why smokers should quit and in particular, reinforcing the health risks and the consequences of their smoking-Highlights signposting support services
An approach which involved a long-term smoker relating their quit journey and the different support available was felt to be motivating and believable.
Approach was also considered to reinforce the message that quitting is achievable with the right support and motivation.
This strand of the campaign is predominantly aimed at smokers from lower SEGs, smokers aged 20-49 years old and smokers who feel that they would like to quit.
Development – Strand 2 ‘Why’ quit approach
Campaign summary
Diary approach – Story told backwards and recorded as if on home video camera (TV), other materials follow similar ‘stages of the journey’ approach- Challenges of quitting outlined and shown to have been overcome
Campaign focus
-Highlighting the range of support available-Focusing on the positive; that quitting is achievable.
Development – Services promoted within the campaign
Services promoted as part of the campaign
Relating NICE guidance to the campaign - Implementation
ImplementationCampaign
stage
Recommended NICE action
Action taken by PHA
- Coordinate strategy to support delivery of services / involve community pharmacy & professional groups;
- Ensure campaign is extensive and sustained;- Consider targeting campaigns towards low income
groups to address inequalities.
- Promotion of Stop Smoking Services (pharmacy, GP, community based providers), Quit Kit, Smokers’ Helpline;
- Multiple campaign elements (TV, radio, print, online), media booked at a sustained level throughout campaign period;
- C2DE / routine & manual workers identified as a key target audience group.
Implementation – Media
The campaign was launched on 5 January 2011 and ran throughout all of 2011 and early 2012 at a sustained level. Both strands of the campaign used the following media elements:
TV advertisingAdvertisements developed for each campaign strand and broadcast on the regional ITV and Channel 4 broadcast stations.
Radio advertisingFour radio advertisements developed; three focusing on Strand 1 ‘Why quit’ message, one advertisement focused on Strand 2 ‘How to quit’ message. Broadcast on regional radio channels.
Outdoor advertising
Outdoor advertising for each campaign strand displayed throughout Northern Ireland in 2011. Advertising shown in various formats and venues including advertisements on the side of buses (streetliners) and commuter cards, bus stop poster formats and washroom panels in pubs and clubs.
Online advertisingOnline advertising was also utilized in this campaign with interactive and display advertising used to promote each strand of the campaign across news / media and social media websites.
Jan-
11
Feb-1
1
Mar
-11
Apr-1
1
May
-11
Jun-
11
Jul-1
1
Aug-1
1
Sep-1
1
Oct-11
Nov-1
1
Dec-1
1
Jan-
12
Feb-1
2
Mar
-12
Apr-1
2
May
-12
Jun-
120
100
200
300
400
500
600
700
573
190 214
329
179
26105 107
16
118
31 7
216
298
409
8848 24
Helpline requests Helpline requests
Implementation – Helpline requests
Higher helpline requests during campaign period (Q2 2011 534 requests) v periods of non-campaign activity (Q2 2012 160 requests).
Sustained campaign period No campaign activity
TV
Radio
Outdoor
Online
Implementation – Quit Kit requests
Higher quit kit requests during campaign period (Q2 2011 2461 requests) v periods of non-campaign activity (Q2 2012 1466 requests).
Sustained campaign period No campaign activity
TV
Radio
Outdoor
Online
Jan-
11
Feb-1
1
Mar
-11
Apr-1
1
May
-11
Jun-
11
Jul-1
1
Aug-1
1
Sep-1
1
Oct-11
Nov-1
1
Dec-1
1
Jan-
12
Feb-1
2
Mar
-12
Apr-1
2
May
-12
Jun-
120
500
1000
1500
2000
2500
17111611 1535
1159
936
366
668821
492
797677
444
1666
2264 2349
712
482272
Quit Kit requests Quit Kit requests
Stop Smoking Services uptake 2010* - 2011.
Q1 Q2 Q3 Q40
2000
4000
6000
8000
10000
12000
14000
16000
9521
69496175 6201
15129
10405
79086832
2010 2011
Implementation – Overall uptake of Stop Smoking Services
During 2011 when the new campaign ran at a sustained level throughout the year, there was an increase in service uptake of 39.6% in comparison with the previous year which had limited campaign activity across Northern Ireland.
+58.9% v Q1 2010
+49.7% v Q2 2010
+28.1% v Q3 2010
+10.2% v Q4 2010
*Note: Some tobacco control public information campaign activity took place throughout 2010 with older campaign materials however campaign activity was not extensive or at a sustained level.
Implementation – Outcomes
Stop Smoking Services data monitoring during campaign period (Q1, Q2, Q3, Q4 2011 - Q1 2012):• Uptake – 54,333 clients set a quit date;• Not previously attended – 12,461 clients (22.9%)• Quit rate – 28,458 clients quit at 4 weeks (52.4% quit rate).
Total of 17,496 Quit Kit requests; survey of Quit Kit requesters indicated:• 74.7% made a quit attempt since receiving a Quit Kit;• 90.6% were regular smokers when they received a Quit Kit; 73.1%
regular smokers one month after receiving a Quit Kit.
• 2,818 helpline calls, mainly Quit Kit requests but with further information, advice and support provided on calls by helpline staff.
*PHA Quit Kit evaluation survey, conducted by Millward Brown Ulster, Dec 2011
Relating NICE guidance to the campaign - Evaluation
EvaluationCampaign
stage
Recommended NICE action
Action taken by PHA
- Evaluation using audience research
- Evaluation using a general population survey (n=1,512) to test awareness and impact of the campaign
Evaluation – Post campaign evaluation
A post-campaign evaluation was undertaken to establish the awareness, impact and outcomes of the campaign.
1,512 interviews secured via face to face interviews.• General population sample (1,012) secured;• Boost strategy of additional smokers (200 16-24 year olds,
300 25-49 year olds) principally to explore campaign impact on key target audience age groups.
Given the disproportionate sampling by age group and smokers, to establish impact at a population level, sample was weighted back to be reflective of the Northern Ireland population, (results presented by applied weights unless otherwise stated).
Evaluation – Post campaign evaluation
NI* population profile %Sample % (n)
Weighted
GenderMale 48 48.6 (734)Female 52 51.4 (777)
Age16-24 17 16.7 (252)25-49 45 43.9 (664)50-64 21 23.4 (354)65+ 18 16.0 (242)
Social classABC1 47 45.5 (686)C2DE 53 54.5 (822)
Smokers / non-smokersSmoker 24 24.4 (369)Non-smoker 76 75.6 (1143)
Sample profile compared with NI population profile by gender, age and social class (NI population aged 16+) for achieved sample
*Population profile source: NISRA mid-year population estimates 2009/10 / NI Health Survey 2010/11
Evaluation – Overall awareness across general population
Overall awareness
(seen at least one advertis-
ment)
TV Radio Poster Online0
10
20
30
40
50
60
70
80 75.8
63.1
35.630.7
11.2
64.5
49.7
25.3 22.216.7
Base=1,512
Strand 1 (Why)
Strand 2 (How)
Overall awareness (%)
%
High overall awareness across the general population for both campaign strands (74.8%, Strand 1 ‘Why’ / 64.5% Strand 2 ‘How’).
Q. Have you seen this TV/radio/poster/online advertisement?
Evaluation – Awareness by groups
% n
Gender
Male 73.7 541
Female 77.7 604
Age (X2[4] = 25.356, p<0.001, unweighted)
16-24 62.1 15725-29 78.4 8730-49 79.2 43850-64 81.4 28865+ 72.7 176
Social class
ABC1 75.5 518
C2DE 76.4 627
Smokers / non-smokersSmoker 72.4 267
Non-smoker 76.8 879
% n
GenderMale 62.8 460Female 66.4 515
Age (X2[4] = 14.076, p<0.01, unweighted)
16-24 57.0 14325-29 67.9 7430-49 69.5 38350-64 66.7 23665+ 57.0 138
Social classABC1 64.6 442C2DE 64.6 531
Smokers / non-smokersSmoker 60.3 222Non-smoker 66.0 752
Strand 1 Overall awareness by key demographic groups
Strand 2 Overall awareness by key demographic groups
Evaluation – Impact and outcomesRespondents who had seen TV advertisement and/or heard the radio advertisement for any campaign strand were asked if they had done anything to change their smoking behaviour.
Behaviour change (either quit or reduced the amount they smoked) was highest for those smokers who had been exposed to both campaigns.
Q. Did you do anything as a result of seeing this TV/radio advertisement? (Prompted)
% who indicated behaviour change (quit or reduction in smoking) as a result of seeing campaign strands
%
Base=551 (smokers who saw TV and/or radio ads in either campaign strand [unweighted])
Awareness - Seen both Awareness - Seen TTDBYD campaign
Awareness - Seen NGUOGU campaign
0
5
10
15
20
25
30
35
4033.8
22.5
16.3
Smokers, other
Smokers target DE, 20-49 years old
50+
20 - 49 years old (target age group audience)
Under 20
Overall
0.0 10.0 20.0 30.0 40.0
36.4
27.3
35.4
34.0
22.2
33.8
Evaluation – Impact and outcomes
For those exposed to both campaigns, no significant differences in terms of change behaviour by target groups or by age group, however variations observed.
Q. Did you do anything as a result of seeing this TV/radio advertisement? (Prompted)
% who indicated behaviour change as a result of seeing campaign (quit or reduction in smoking)
Age group
Smoker target group
%Base=370 (smokers who saw TV and/or radio both campaign strands [unweighted])
Summary
How we can embrace message further – focus on parental aspect affecting lives of their children, universal - effective for targeting DE smokers?
Emotive messages which place an emphasis on the effects of their smoking on others can stimulate reflection and changed behaviour
Summary findings Future challenges
Campaign approaches which show the challenges but also show strategies for how
these can be overcome are empowering, motivating
Moving from reduction in the amount smoked to a (sustained) quit attempt. Possible learning from the ‘Mass participation’ approach, e.g. Stoptober?
Public information campaigns act as a key driver in promoting stop smoking support
services. Should be considered as one part of an overall tobacco control programme.
Using multiple strands in campaigns to differentiate smokers by type can help tailor
messages and promote services more effectively
Which services and for whom?-Possible further engaging smokers through new approaches – text, social media, online chat