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
Campaign
stage
Development
Recommended
NICE action
- 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.
Action taken by
PHA
- 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.
Development – Overview
• 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 – Strand 1 ‘Why’ quit approach
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 nonjudgemental.
Campaign summary
Campaign focus
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
-Why smokers should quit
and in particular,
reinforcing the health risks
and the consequences of
their smoking
-Highlights signposting
support services
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 2 ‘Why’ quit approach
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.
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.
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 – Services promoted within the campaign
Services promoted as part of the campaign
Want2stop.info
Quit Kit selfhelp initiative
Campaign
Smokers
Helpline
Stop Smoking
Services – GP,
Pharmacy,
Community
Settings
Relating NICE guidance to the campaign - Implementation
Campaign
stage
Implementation
-
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 advertising
Advertisements developed for each campaign strand and broadcast
on the regional ITV and Channel 4 broadcast stations.
Radio advertising
Four 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 advertising
Online 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.
Implementation – Helpline requests
Higher helpline requests during campaign period (Q2 2011 534 requests) v
periods of non-campaign activity (Q2 2012 160 requests).
Helpline requests
Helpline requests
700
600
573
500
409
400
329
300
200
190 214
298
216
179
0
118
105 107
100
26
16
88
31
7
48
TV
Radio
Outdoor
Online
Sustained campaign period
No campaign
activity
24
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).
Quit Kit requests
Quit Kit requests
2500
2264
2349
2000
1711
1500
1611
1666
1535
1159
1000
936
821
797
668
500
366
492
712
677
444
482
272
0
TV
Radio
Outdoor
Online
Sustained campaign period
No campaign
activity
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.
16000
Stop Smoking Services uptake 2010* - 2011
.
15129 +58.9% v Q1 2010
14000
12000
10000
8000
9521
6000
4000
10405 +49.7% v Q2 2010
7908 +28.1% v Q3 2010
6832 +10.2% v Q4 2010
6949
6201
6175
2000
0
Q1
Q2
2010
Q3
Q4
2011
*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
Campaign
stage
Evaluation
Recommended
NICE action
- Evaluation using audience research
Action taken by
PHA
- 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
Sample profile compared with NI population profile by gender, age and social class (NI
population aged 16+) for achieved sample
NI* population profile %
Sample % (n)
Weighted
Gender
Male
Female
48
52
48.6 (734)
51.4 (777)
Age
16-24
25-49
50-64
65+
17
45
21
18
16.7 (252)
43.9 (664)
23.4 (354)
16.0 (242)
Social class
ABC1
C2DE
47
53
45.5 (686)
54.5 (822)
Smokers / non-smokers
Smoker
Non-smoker
24
76
24.4 (369)
75.6 (1143)
*Population profile source: NISRA mid-year population
estimates 2009/10 / NI Health Survey 2010/11
Evaluation – Overall awareness across general population
High overall awareness across the general population for both campaign strands
(74.8%, Strand 1 ‘Why’ / 64.5% Strand 2 ‘How’).
Overall awareness (%)
80
70
Strand 1 (Why)
75.8
64.5
60
63.1
49.7
% 50
35.6
40
25.3
30
30.7
22.2
20
16.7
11.2
Strand 2 (How)
10
0
Overall
awareness
(seen at least
one
advertisment)
TV
Radio
Poster
Online
Base=1,512
Q. Have you seen this TV/radio/poster/online advertisement?
Evaluation – Awareness by groups
Strand 1 Overall awareness by key demographic
groups
%
Gender
Male
Female
73.7
77.7
Strand 2 Overall awareness by key demographic
groups
n
541
604
Gender
Male
Female
%
n
62.8
66.4
460
515
Age (X2[4] = 25.356, p<0.001, unweighted)
16-24
62.1
157
25-29
78.4
87
30-49
79.2
438
50-64
81.4
288
65+
72.7
176
Age (X2[4] = 14.076, p<0.01, unweighted)
16-24
57.0
143
25-29
67.9
74
30-49
69.5
383
50-64
66.7
236
65+
57.0
138
Social class
ABC1
C2DE
518
627
Social class
ABC1
C2DE
267
879
Smokers / non-smokers
Smoker
60.3
Non-smoker
66.0
75.5
76.4
Smokers / non-smokers
Smoker
72.4
Non-smoker
76.8
64.6
64.6
442
531
222
752
Evaluation – Impact and outcomes
Respondents 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.
40
35
% who indicated behaviour change (quit or reduction in smoking)
as a result of seeing campaign strands
33.8
30
%
22.5
25
20
16.3
15
10
5
0
Awareness - Seen both
Awareness - Seen TTDBYD
campaign
Awareness - Seen
NGUOGU campaign
Base=551 (smokers who saw TV and/or radio ads in either
campaign strand [unweighted])
Q. Did you do anything as a result of seeing this TV/radio
advertisement? (Prompted)
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.
% who indicated behaviour change as a result of seeing campaign (quit
or reduction in smoking)
Overall
33.8
Under 20
Age
group
22.2
20 - 49 years old (target age
group audience)
34.0
50+
Smoker
target group
35.4
Smokers target DE, 20-49 years
old
27.3
Smokers, other
36.4
0.0
Base=370 (smokers who saw TV and/or radio both
campaign strands [unweighted])
10.0
20.0
30.0
40.0
%
Q. Did you do anything as a result of seeing this TV/radio
advertisement? (Prompted)
Summary
Summary findings
Future challenges
Emotive messages which place an emphasis
on the effects of their smoking on others can
stimulate reflection and changed behaviour
How we can embrace message further
– focus on parental aspect affecting
lives of their children, universal effective for targeting DE smokers?
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