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Stop Playing Games with Childhood Obesity--Part I: Communication Campaign Ad Development

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I Introduction

In December 2005, City of Hamilton Public Health Services hosted the first of three community forums to engage key stakeholders in developing a made-in-Hamilton obesity strategy. As a result of the forums, four key priorities were identified by the stakeholders, including the creation of a communication campaign to raise awareness and offer solutions to the rise in obesity rates. Community partners stepped forward to work collaboratively on the priorities. In September 2006, the Communication Campaign Subcommittee held its first meeting, and in October 2007, the campaign was launched. This article focuses on the development of the campaign ads.

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II Creating the Campaign

A Audience

Starting with the loosely defined task of creating a communication campaign, the subcommittee chose parents with children ages 4 to 12 years old as their audience. The overall goal was to help prevent future problems by increasing parents' awareness of their child's weight status and risk factors. Research indicates that many parents have poor awareness of their child's weight status.

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B Objectives

Based on literature and available community information, the subcommittee identified target nutrition and physical activity behaviours and focused on how small changes and daily actions can make a difference with obesity.

These behaviours formed the foundation upon which carefully crafted objectives were developed. Significant committee discussion focused on creating realistic, specific, measurable outcome objectives that could be impacted on with a communication campaign. The group made particular effort to avoid broad objectives that focused on overwhelming behaviours not likely to be achieved with simple communication. Efforts were also made to focus on specific parts or angles of the topics that had not already been heavily covered in the media.

The specific recommendations discussed in the campaign include:

  • Eating dinner at home together as a complete family at least three times a week,
  • Serving vegetables or fruit to their children at every meal and every snack time,
  • Giving their children water or milk instead of pop or other sugar-sweetened beverages most of the time,
  • Replacing some daily screen time with time together as a family doing something active outside, and
  • Replacing some of their child/ren's sedentary activity time with active time spent together as a family.The final objectives included
  1. To increase the number of parents who are actively thinking about the ways that their current family nutrition and physical activity behaviours may affect the chance that their child/ren will be one of the many who will have a problem with weight now or in the near future;
  2. To increase the number of parents who believe that their own children's risk of childhood obesity could be reduced by parents following these recommendations themselves;
  3. To increase the number of parents who believe that it is realistic for them to follow these recommendations;
  4. To increase the number of parents who are considering trying the recommendations in the next 30 days; and
  5. To increase the number of parents who go to http://www.dailythingscount.ca for more information about
  • Their child's current/future risk of weight problem;
  • The potential health problems that children/adults who are overweight may experience;
  • The things that can reduce/prevent their children's problem/potential problem with weight; and
  • Small, easy things they can do to reduce/prevent their children's problem/potential problem with weight.

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C Dissemination plan

Dissemination of the campaign message included eight weeks of paid advertising in local newspapers, pre-movie screening in two theatres, bus shelters, and back-of-the-bus ads. In addition, posters were placed in public spaces such as recreation centres, doctor offices, and schools. Postcards were distributed to parents via elementary school students. Resources were also allocated for the creation of a website.

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D Initial ad concept

The eight-person subcommittee developed the original concepts. Although assisted by a graphic designer, copywriter, and a health communication consultant, the subcommittee had difficulty relinquishing control, and thus initially used the support people in limited and prescriptive ways.

In the original concept, there were two slogans on each poster/ad: "It's the Daily Things that Count" and "Stop Playing Games with Obesity."

As a part of the "Stop Playing Games..." theme, each poster was purposefully ironic by linking one of the target behaviours with an ‘old fashioned' game. For example "Kick the Can" was the focus of a pop reduction ad; "What time is it, Mr. Wolf?" was the focus of a screen time ad.

Each poster/ad also contained a visual with a child demonstrating the undesirable activity, a fact or statistic demonstrating the extent of the problem, a link to the website and other information about recommended behaviours.

Although there was debate about the multiple themes on the ads, the amount of text and visual content overall, and the number of "calls to action" on each poster, it was difficult to reach consensus among subcommittee members. Thus the ads went forward in this way to focus testing.

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III Testing the Campaign

A Focus testing

The subcommittee hired a consultant to conduct focus testing on the initial ads. Four, one-hour focus groups were held. Each group consisted of individuals in the target audience that knew each other as neighbours. This approach was taken to see what kind of "buzz" (or real-life conversation with real friends or acquaintances) would be generated by the ads.

Participants were asked a series of questions to determine their reactions to the draft posters after both short (10 second) and longer viewing times. Questions were designed to determine whether campaign objectives were likely to be met in real-life viewing conditions. The Health Communication Unit's Message Review Tool was used in conjunction with campaign objectives to construct the focus questions.

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B Findings and recommendations

Reactions to individual posters were mixed; however, the overall reaction was very positive. "Clever," "catchy," and "surprising" were words frequently used to describe individual posters.

The statistics, though presented in small text near the bottom of the ads, turned out to be of great interest to participants, generating surprise, dismay, and frequent comments such as "I can't believe it, I am going to add up my children's time/amount/etc."

Response to visuals was generally very positive, though some comments focused on situations when:

  • children looked "too happy" doing the undesirable behaviour;
  • it was not clear what the visual was trying to communicate (e.g., child reaching for a bowl of candy that was intended to be a "candy salad");
  • the visual seemed to conflict with the text;
  • the visual was not believable (e.g., one visual of a child sitting and listening to an iPod was not believable because a number of parents said their children are more likely to be dancing/bopping around when listening to their iPod); and
  • the visual pitted one good behaviour against another (e.g., some parents did not want listening to music or other sedentary activities with benefits (such as reading or sitting around together as a family) villianized).

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IV Challenges and Recommendations

Key challenges identified across all concepts are shown with consultant recommendations below.

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1 Length of time required to fully understand each message

At first glance (10-15 second preview), many details of the visual and messaging were missed. Longer examinations resulted in the desired "a-ha" moments and many more positive reactions.

Reason

There were many competing elements in each poster. While each poster was filled with valuable visual or textual information that interested the focus group participants, this dramatically increased the amount of time it took people to fully process the poster. In real-world communication situations, time is often the enemy, where health communication messages compete with big business for audience attention.

Recommendations

  • Substantially cut down text of most posters by using the "What," "So What," "Now What" health communication guideline. This guideline indicates that the most effective health communication messages include
    • one fact (What?);
    • one incentive (So what?, Why should I care?); and
    • one call to action (Now what do I do?).
  • The overall campaign theme should be limited to one concept, including only one slogan. This will significantly decrease the amount of time required to understand the main message of each poster. Many of the posters had potentially several calls to action, including two campaign slogans. However valuable, the presence of so many audience "requests" diluted the overall impact. Prioritizing among a series of very good ideas is the most challenging part of message development. However, it is very rewarding in terms of overall campaign effectiveness.

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2 Specificity of call to action (the "Now What")

Some posters provided general recommendations that left focus group participants wondering how they might make that happen in their lives. Some focus group participants doubted that they could take such action in their lives.

Reason

Some of the calls to action were too general or too ambitious (unrealistic) for the audience. For example, a statement such as "Make dinner time quality time" is very ambiguous. Audience members sometimes wondered, "What does quality time mean?" or "How could I do that?"

Recommendations

  • Make sure that each call to action is specific and realistic.
  • When accompanied with startling or alarming statements that catch attention, a recommended action that is too vague or overly ambitious usually results in the audience ignoring the statement or going into denial about their own current behaviour. This decreases the effectiveness of the communication.

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3  Lack of awareness (or possible denial) about the relevance of obesity to their own family

Focus group participants were not open about their struggles with their own children's weight. They tended to focus on obesity as other parent's problems - namely those "bad parents" who feed their kids bad things. Only because focus group members knew each other were facts about weight struggles about their neighbours' children revealed. Even when weight struggles were revealed, the term obesity was vigorously avoided in place of euphemisms such as "heavy," "solid," etc.

Reason

Parents often think of obesity as a parenting problem. They do not want to be cast as bad parents. In addition, many simply appear to be in denial about the degree to which their children may have a weight problem.

Recommendation

  • Develop a poster that emphasizes the difficulty most parents have in identifying their own children's potential weight problem and give them the tools to both assess their own child and help their child.

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V Revisions to the Ads

The focus testing findings mirrored information in the literature showing that parents think that their children are already eating well and are physically active, and regularly underestimate their own children's risk for obesity.

Confirmation of this literature caused the subcommittee to further refine the ad foci so that the most significant call to action on each poster was to "assess your own child objectively," by getting the tools on the website.           

Some ads were completely reworked.

Many were slightly refined, with substantial culling of text, and greater focus on the "buzz"-generating statistics.

One tagline and a standard formula (statistic, incentive/so what, now what) were applied to the entire set of ads.

The final ads appear at http://www.dailythingscount.ca.

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NEXT WEEK...In part II of Stop Playing Games with Childhood Obesity, we describe the evaluation findings.