Tahir Turk – Senior Technical Advisor World Lung Foundation

1. A Regional Approach to Implementation and Evaluation of Strategic Health Communication Campaigns to support NCD Prevention in Pacific Island Nations Tahir Turk – Senior Technical Advisor World Lung Foundation World Marketing Congress-Melbourne, Australian July 2013

2. Presentation Format • Scale of the NCD Problem in the Pacific • The evidence for the efficacy of global/regional communication campaigns in high-middle-and low-income countries. • Strategic health communication approaches – challenges, opportunities and lessons learned. • A regional approach in the Pacific – Methodology. • Discussion.

3. The NCD Problem • Non-communicable diseases (NCDs) - cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, are leading causes of death globally. • Low-and middle-income countries (LMICs) carry the major burden of disease - 85% of the 77% total number of NCD deaths. • NCDs place a significant burden on health systems already struggling to cope, reducing workforce productivity and household income.

4. NCD Risk Factors • High rates of, NCD related mortality and morbidity In the Pacific region due to unhealthy lifestyles and environmental changes. • Changes in lifestyles have driven increased NCD risk factors - physical inactivity, unhealthy diet, tobacco and alcohol use. • Indications are that 70% or more of Pacific Island nations health budgets are now used to treat NCD related risk factors.

5. A Regional Approach to NCDs • United Nations General Assembly high-level meeting on the Prevention and Control of NCDs. • Need for concerted action and a coordinated response at national, regional and global levels to address the challenges posed by NCDs. • Urgent need for evidence based, best practice approaches to NCD prevention programs in the Pacific region. • Inherent resource efficiencies, across 22 Pacific Island nations.

6. Strategic Health Communication • Strategic Health Communication (SHC) has been identified as a priority for Pacific countries to support NCD prevention. • SHC incorporates a comprehensive range of audience-focused processes. • Insights from dialogue with stakeholders and research findings with program beneficiaries inform decisions about the best ways to affect behaviour change.

7. Strategic Health Communication “SC approaches include identification of problems and populations at most risk, defining of program objectives, identifying an overall strategic approach, articulating key messages, selecting communication tools and channels, and developing a management and monitoring system.” American Institutes for Research 2003

8. Evidence from LMICs Growing evidence and experience from LMICs shows that, when applied effectively and within the appropriate context, population level, strategic communication campaigns can provide powerful tools to change social norms for NCD risk factors • * Turk, T., Murukutla, N., Gupta, S., Kaur, J., Mullin, S., Saradhi, R., & Chaturvedi, P. (2012). Using a smokeless tobacco control mass media campaign and other synergistic elements to address social inequalities in India. Cancer Causes and Control, 23(S1):81-90. • Mullin, S., Prasad, V., Kaur, J., Turk, T. (2011). Increasing evidence for the efficacy of tobacco control mass media communication programming in low-and middle- income countries. Journal of Health Communication, (16), 1–10. DOI: 10.1080/ • 10810730.2011.601395

9. What Have We Learned? • Evidence-based mass media programs can rapidly set the public agenda for tobacco control and facilitate behavioural change • Graphic, emotional messages (TC) are most effective across all demographic groups • Adaptation of existing PSAs is an efficient use of campaign budgets • Evaluation is critical for measuring behavioural impact and guiding future campaigns

10. WLF Global Study*- Method • 2400 smokers, 18-34 yrs in 10 LMICs - Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam. • Groups viewed and individually rated the same five-best practice-tobacco control messages. • Ratings followed by structured group discussion about each message. • *Wakefield, M. Bayly, M. Durkin, S. et al. (2011). Smokers’ responses to television advertisements about the serious harms of tobacco use: pre-testing results from 10 low- to middle-income countries. Tobacco Control. doi:10.1136/tobaccocontrol-2011-050171

11. WLF 10 Country Study - Findings • Messages performed consistently across all countries. Higher ratings for those that graphically communicated the serious harms of tobacco • Messageswith complex medical terms or metaphors, or those that featured personal testimonials, were more variable • Graphic Messagescan be readily translated and adapted for local use. • Further 5 country study (TC) and another 5 country study road safety have since been operationalised.

12. Sponge Global Adaptations

13. Sponge – A Global Campaign

14. Challenges to Evidence Based Communication Campaigns in the Pacific • Scarce financial and human resources across the small island communities – 22 island nations total:10 million people. • Focus on outputs with few outcome evaluations of public health interventions and poor evidence base to shed light on most effective means of reducing health inequalities. • Little attention given to clarifying the problem and developing high impact messages to elicit desired behavioural responses.

15. Opportunities for development of Evidence Based Communication Campaigns in the Pacific • Development of a more expedient, cost effective and academically rigorous approach to communication campaign design. • Ability to easily adapt communication messages across country settings and establish a standardised evaluation procedure to measure behavioural impact. • Scaling-up of NCD prevention programs to stem the tide of chronic diseases and rising health care costs.

16. Regional Study Approach • Aim- To assess the comprehension, acceptability, and potential effectiveness of communication materials to support NCD prevention activities in the Pacific. • Objectives- Increase awareness and build risk perceptions of the health harms of NCDs. • Change attitudes and beliefs toward NCD risk behaviours. • Increase self-efficacy/perceived behavioural control (skills, competence and perceived ability) to engage in health promoting activities. • Increase behavioural intentions and preventive NCD health related behaviours.

17. Regional Study Method Target Populations Males/Females 16-49 years, of different social classes (A-B, C-D), geographic location (Urban/Rural) and Pacific Island setting. Study Locations Fiji and Tonga (Polynesia), Papua New Guinea, and Solomon Islands (Melanesia), Pulau and Marshall Islands (Micronesia).

18. Communication Stimuli and Instruments • Expert panel of selectors identify worlds best practice messages (5 PSAs each) for NCD risk factors – Physical Inactivity, Nutrition and Alcohol. • Messages are rendered into storyboard animatics and dubbed into study site local languages. • Campaign brands and straplines explored as a separate component. • 8-10 item, 5 point rating scales developed using internationally recognised behavioural indicators supported by qualitative discussion agenda.

19. Animatic Message Pre-Test Stimuli -

20. Fieldwork Approach • Local suppliers contracted and trained to conduct the fieldwork. • 16 focus groups conducted in each of the 6 countries • Each spot played twice and then respondents rate according to the 8-10 rating criteria. • Following completion of the ratings discussions are conducted with groups to identify other issues. • Each NCD area to be covered comprehensively prior to the next set of stimuli being presented.

21. Data Analysis and Advocacy Approach • Data analysed by central agency and triangulated with qualitative findings across all 6 country settings. • Results collated and advocacy of findings conducted with country counterparts. • Regional contractor commissioned to produce final regional communication materials TV/Radio/Print/ • Outdoor spots and language adaptations.

22. Staged NCD Communication Program Roll-out

23. Conclusion • NCD pandemic requires an urgent need to institutionalize ‘population level’ NCD strategic communication campaigns in the Pacific. • A regional approach to message design, adaptation, implementation and evaluation is the most expedient and cost effective. • Capacity building will be required to build the evidence base and monitor program outcomes.

24. ASOP Tonga Ph2 Campaign: Surgeon

25. Acknowledgements • World Lung Foundation – New York, USA (funded by Bloomberg Philanthropies) • Centre for Behavioural Research in Cancer – Cancer Council, Victoria, Australia. • Australian Sports Outreach Program (ASOP) Pacific Country Programs Research project in Tonga, managed by Australian Sports Commission – Canberra, Australia (funded by AusAID)

26. Thank You For Further Information: Tahir Turk, PhD MComm Senior Technical Advisor – World Lung Foundation Senior Partner – Communication Partners International tturk@cpimail.net