Scottish Government

TNS System Three
Scottish Executive Social Research
17 ^th March 2005
ISBN 0 7559 2803 2 (Web only publication)
This document is also available in pdf format (288k)

Contents

Executive Summary
Chapter 1 - Background and Method
Chapter 2 - Main Findings
Spontaneous Awareness of Advertising
Sources of advertising recalled
Content recalled
Prompted Awareness of TV Advert
Perceived main message of TV advertising
Prompted Awareness of Newspaper/Press Adverts
Perceived main message of press advertising
Prompted Awareness of Radio Advert
Total Reach
Awareness of Pneumococcal
Vaccination Uptake
Reasons for not receiving vaccinations
Chapter 3 - Conclusions
Appendix - Questionnaire

Executive Summary

• The Scottish Executive has been running an advertising campaign to promote uptake of the flu vaccination for a number of years. In 2003 the campaign was extended to include the promotion of the pneumococcal vaccination. The key target audiences of the campaign are those aged 65+ and those "at risk" ¹.
• TNS System Three was commissioned to conduct research to monitor awareness and understanding of the campaign, as well as awareness of pneumococcal and uptake in vaccinations for flu and pneumococcal.
• The TNS System Three Scottish Opinion Survey ( SOS) was used as the vehicle for data collection. 1,047 adults aged 16+ across Scotland were interviewed at this latest wave over the period 4 - 12 January 2005. In addition:
• a pre advertising baseline was carried out in August 2003;
• a first post campaign evaluation was conducted following the initial campaign activity in November/December 2003.
• The level of spontaneous awareness of advertising about staying healthy in winter dropped from 62% in 2003 to 41% at this latest wave. Although higher than average among the key target groups (53% among those aged 65+ and 48% among those "at risk"), it has also dropped among each of these since 2003 (from 68% and 69% respectively).
• Overall, three quarters of respondents said they had seen an advert on TV or in the press or had heard a radio advert.
• TV remains the dominant source of advertising recalled, with 84% claiming to have seen the advertising they recalled on TV (compared to 80% in 2003).
• Mentions of newspapers as the source of advertising seen were lower at this latest wave (14% vs 21% of those who had seen advertising in 2003) and recall of leaflets and posters in doctors' surgeries also dropped (7% compared to 17% in 2003).
• Specific recall of the campaign at a spontaneous level was also lower than in 2003: 34% were able to spontaneously describe an aspect attributable to the latest adverts compared to 59% in 2003.
• Amongst those "at risk", spontaneous recall of the adverts was the same as among the general population, but was lower among those aged 65+.
• When respondents were prompted with the TV advert, 59% claimed to be aware of it. The comparative figure in 2003 was 66%. Amongst those aged 65+ and those "at risk", recall was higher (72% and 70% respectively).
• Respondents were shown stills from the TV advert and 65% of those aware of the adverts could describe at least one of the main messages from it.
• On prompting with the press advert, 41% recalled it. Again, the level was higher amongst those aged 65+ and those "at risk" (53% and 49% respectively).
• Message recall from the press advert was also high, with 75% of those aware able to describe an element of the campaign message.
• Respondents were also shown a description of a radio advert, and 22% claimed to have heard the advert. This level was higher amongst those "at risk" (29%) but lower amongst those aged 65+ (16%).
• Thirty three percent claimed to be aware of the term "pneumococcal" at this latest wave, compared with 50% at the 2003 post campaign evaluation and 21% at the 2003 pre campaign baseline.
• The vast majority of respondents who were aware of pneumococcal understood that it is an illness of some kind (85% in total), a similar level to 2003 although specific mentions of pneumonia had dropped.
• In terms of vaccination uptake, a similar proportion of those "at risk" had taken up a vaccination in 2004 as in 2003 (56% vs 57%) whilst amongst those aged 65+ the level was slightly lower at this latest wave (77% vs 83%).

Chapter 1 - Background and Method

1.1 Over the last few years, The Scottish Executive has been running an advertising campaign promoting the flu vaccination. In 2003, the campaign was extended to include the promotion of the pneumococcal vaccination. The key target audiences for the campaign are those aged 65+ and those in the ''at risk'' group (defined in this research as those who have diabetes, asthma, chronic heart or chest complaints, chronic kidney disease, lowered immunity due to disease or treatment such as steroid medication or cancer treatment, or any other serious medical condition).

1.2 The Scottish Executive Office of Chief Researcher ( OCR) commissioned TNS System Three to conduct research to monitor awareness and effectiveness of the campaign.

1.3 The aim of this research was to evaluate awareness and understanding among the general public and the key target audiences of the latest phase of the Scottish Executive's flu and pneumococcal immunisation campaign. It followed on from two earlier stages of quantitative research:

• In August 2003, to measure awareness before an initial burst of advertising took place (namely a pre campaign baseline);
• In November/December 2003, to evaluate the effectiveness of the initial advertising (that is, post campaign evaluation).

1.4 The specific objectives of this research were:

• To monitor awareness and understanding of the campaign;
• To measure any impact the campaign has on awareness and understanding of pneumococcal; and
• To monitor any shifts in the uptake of the flu and pneumococcal vaccinations.

Both the pre campaign and post campaign research findings are used here to track levels of campaign awareness.

1.5 The latest campaign used the following media:

• TV (Channel 4 and Channel 5);
• National and regional press (Sunday Post, Daily Record, Evening Times, Scot's Magazine);
• Radio (Clyde 1 and 2, Forth One and 2, Tay AM and FM, Northsound 1 and 2, West Sound, Moray Firth, Borders and Central).

1.6 It should be borne in mind throughout this report that the TV advert was shown only on Channel 4 and Channel 5 and not on the ITV channels as it was in 2003 and this is likely to be a factor affecting advertising awareness.

1.7 As with the two previous stages of research, the TNS System Three CAPI (Computer Assisted Personal Interviewing) omnibus, Scottish Opinion Survey ( SOS), was used to collect quantitative data. For this latest wave, 1047 adults aged 16 and over were interviewed in their homes. The interviews were carried out during 4-12 January 2005 and took place in 44 constituencies throughout Scotland. To ensure that the sample was representative of Scotland's adult population in terms of age, sex and socio-economic group ( SEG) ², it was weighted to match population estimates from the National Readership Survey of January - December 2002. The sample profile, both unweighted and weighted, is shown in Table 1. A copy of the questionnaire used in the survey is appended.

1.8 Weighting is often used in surveys to adjust data so that the people interviewed are a truly representative sample of the population or to correct any slight under/over representations that can occur during a survey. In this case, to allow the results of each stage to be directly comparable and to remove any possibility that the variation in profile was influencing any changes in findings, the sample was weighted by demographics to match Scotland's population.

Table 1.1 - Sample profile (%)
Base: All respondents - 1047

Notes on report

1.9 This report presents the findings, for the sample as a whole but also specifically focuses on the campaign's target audiences of those aged 65+ and those "at risk". Other subgroups of the sample, such as different age groups, social classes, geographical regions ³ and men and women are split out in the data tabulations but have not been reported on in the body of this report.

1.10 The main findings are summarised in the next chapter. Where applicable, results are compared to previous waves of research.

1.11 Throughout the report, the figures referred to are weighted figures. Where significant results are referred to within the report, these are significant at the 95% confidence level or above. All other differences noted are not statistically significant.

1.12 Where "*" appears in the report and data tables, this represents a percentage greater than zero but less than 0.5%. Within the tables in the report, the term 'N' refers to the unweighted base sample size.

Chapter 2 - Main Findings

Spontaneous Awareness of Advertising

2.1 Respondents were asked initially whether they had recently seen or heard any advertising or publicity about staying healthy in the winter. Table B1 shows the results on this measure, compared to the 2003 post advertising evaluation.

Table 2.1: Spontaneous awareness of advertising
Base: All respondents

2.2 Spontaneous awareness of advertising on the subject of staying healthy in the winter dropped from 62% in 2003 to 41% at this latest wave. Amongst the two key target groups, the levels were also low. Amongst those aged 65+, 53% were aware of advertising compared to 68% at the previous wave. Indeed, this is the only subgroup examined within the data tabulations that achieves over 50% awareness at this latest wave. Amongst those 'at risk', the level at this latest wave was 48% compared to 69% previously.

2.3 These levels are clearly lower than previously. However, as mentioned previously, the fact that the TV advert was shown only on Channel 4 and Channel 5 and not on the ITV channels as it was in 2003 is likely to be a factor driving down awareness.

Sources of advertising recalled

2.4 All those who claimed to have seen advertising were then asked where they had seen or heard it. The responses are shown in Table B2.

Table 2.2: Where advertising seen
Base: All those who recalled advertising

2.5 Out of the 62% and 41% of respondents (in 2003 and 2004 respectively) who claimed to have come across advertising about staying healthy in the winter, a large majority said they had seen it on television (80% in 2003 and 84% in 2004). Typically, television tends to be the dominant advertising medium, and the levels seen here are comparable to other government campaigns. In this instance, this may also be in part due to the use of the term 'staying healthy in winter' used in the question wording which allows respondents to recall other campaigns not necessarily about flu/pneumococcal (see page 7).

2.6 Awareness of advertising in newspapers was slightly lower at this latest wave with 14% of respondents claiming that this was where they had seen advertising, compared to 21% in 2003. Although the results for local and national newspaper advertising can be split out, there was very little difference between the two sources (8% for local and 9% for national newspapers).

2.7 Radio remained at a similar level as in 2003 (4% vs 5%). Again, local and national radio were split out but there was very little difference between the two (3% local and 1% national radio). Leaflets and posters in doctors surgeries dropped considerably over the course of the 2 waves: 7% in 2004 compared with 17% at the previous wave.

Content recalled

2.8 Those who claimed to have seen some advertising (that is 41% of the sample) were then asked what they recalled about it. Table B3 shows the main descriptions given.

Table 2.3: Description of advertising seen
Base: All those aware of advertising about staying healthy in winter

2.9 At the latest wave, less detail was recorded that related specifically to the flu/pneumococcal advertising campaign than at the previous wave. As shown in Table B3, individual mentions relating to the current campaign dropped, and overall only a third (34%) were able to recall any detail relating to the adverts, compared to 59% in 2003. Overall, this equates to 14% of adults describing advertising in the open-ended question that can be attributed to the flu/pneumococcal advertising.

2.10 As the question referred to advertising/publicity about staying healthy in the winter generally, issues relating to campaigns other than the flu/pneumococcal campaign were mentioned. Indeed, this is the one area where mentions increased at this latest wave. For example, 26% mentioned keeping warm (vs 20% in 2003) and 20% mentioned healthy eating (compared to 11% in 2003).

2.11 Those aged 65+ showed a lower level of recall of the specific adverts in the campaign than the general population. They, however, had a higher level of recall of keeping warm and healthy eating than the overall sample. A similar pattern has been seen amongst this age group in the past, thus indicating that this group's general advertising awareness is dominated by other adverts, not related to the flu/pneumococcal campaign. Amongst those ''at risk'', recall is very similar to that of the total population.

Prompted Awareness of TV Advert

2.12 In order to verify awareness of the campaign, all respondents were shown pictures from the current TV advert as a prompt. Overall, 59% said they had seen the TV advert. This was higher amongst the key target groups of those aged 65+ (72%) and those 'at risk' (70%). Indeed, these were the highest levels across all of the subgroups examined within the data tabulations. In 2003, two TV adverts were shown and 66% of respondents said they had seen one or both of them, 7 percentage points higher than in 2004.

Perceived main message of the TV advertising

2.13 All those who claimed to have seen the TV advert were asked what they understood the main message of the advertising to be. The results are shown in Table B4.

Table 2.4: Main message of TV advertising
Base: All who have seen the advert

2.14 Just under two thirds of those aware of the advertising (65%) showed some understanding of it and were able to describe a message which was related to the TV advert. Thirty seven percent of those who had seen the advert described the main message as have a flu jab/vaccination. Just over a fifth (22%) specifically mentioned that older people / the elderly should have the flu jab. It should be noted, however, that the TV stills shown clearly displayed the phrase 'Or over 65' which will be, at least in part, responsible for the relatively high mentions of older people. Only 5% mentioned that people in 'at risk' groups should have a flu vaccination and pneumococcal was only mentioned specifically by 1%.

2.15 As was noted at the previous wave, older respondents themselves are less likely to recognise that the advert is targeted at them: only 11% of those aged 65+ mentioned older people/the elderly.

Prompted Awareness of Newspaper/Press Adverts

2.16 Following on from being prompted with the TV advert, respondents were then shown a press advert and asked whether or not they recalled having seen it recently. Forty one percent of the sample said they had seen the advert. This figure was higher for the two target audiences: 53% for the 65+ group and 49% for the ''at risk'' group.

Perceived main message of the press advertising

2.17 All those who claimed to have seen the press advert were asked what they understood the main message of the advertising to be.

Table 2.5: Main message of press advertising
Base: All who have seen the press advert

2.18 The main message taken from the press advert was very similar to the TV advert. 75% of respondents accurately described the message or part of it. Thirty nine percent stated that the message was to have a flu jab/vaccination whilst 19% mentioned that it was telling elderly people to have a flu jab/vaccination.

2.19 Free flu jabs was also cited as a message by 17% of those who had seen press advertising.

Prompted Awareness of Radio Advert

2.20 In addition to the TV and press adverts, respondents were also shown a description of one of the radio adverts and asked if they recalled hearing it. The exact text of the showcard was as follows:

"A voiceover says that if you suffer from asthma, diabetes, heart disease or any medical condition that puts you 'at risk', you're more vulnerable to the serious effects of flu. That's why you're entitled to a free flu jab. Contact your GP today and arrange for an appointment, and don't let the flu bug bite."

2.21 Twenty two percent of respondents remembered hearing the radio advert. Perhaps disappointingly, this level was lower amongst those aged 65+ (16%), although it was higher amongst those 'at risk' (29%).

Total Reach

2.22 Once all of the figures are combined for the various advertising awareness questions, a 'total campaign reach ⁴' figure can be derived which enables the total effect of the campaign to be seen. Overall, the campaign reach at this latest stage was 75%.

Awareness of Pneumococcal

2.23 A baseline measure of awareness of the term pneumococcal was taken in August 2003, prior to any advertising activity. Comparisons can therefore be made across all three waves of research.

2.24 Prior to being prompted with any advertising, respondents were asked if they were aware of the term pneumococcal: in 2004, 33% said they were, compared with 50% at the post advertising evaluation in 2003. Although lower than the 2003 post campaign evaluation measure, the 2004 figure is higher than at the pre campaign stage when only 21% claimed to be aware of the term pneumococcal.

2.25 Details of what pneumococcal is thought to be are shown in Table B6.

Table 2.6: Description of pneumococcal
Base: All aware of pneumococcal

* NB - no other mentions given by 3% or more.

2.26 Across all three waves of research, the vast majority of respondents aware of pneumococcal understood that it is an illness of some kind. However, the level of understanding of the illness was lower at this latest wave than at the 2003 post evaluation, with only 20% of those aware of the term mentioning pneumonia compared to 31% previously. However, the most widely mentioned aspect of the illness continues to be pneumonia (20%), followed by meningitis (15%) and then flu (11%). The level of those unaware of what pneumococcal is increased marginally at this latest wave to 15%.

Vaccination Uptake

2.27 Only those aged over 65 and those considered 'at risk' are entitled to receive the flu and pneumococcal vaccinations for free. The following section therefore focuses purely on these two subgroups.

Table 2.7: Vaccination Uptake
Base: All respondents in each group

2.28 Within the 'at risk' group, a similar percentage claimed to have received at least one vaccination in 2003 and 2004 (57% and 56% respectively). Given that the pneumococcal jab is only required once every 10 years, it is to be expected that the level of those receiving both vaccinations should fall, and indeed it did (from 38% to 22%).

2.29 Among those aged 65+, however, the proportion having at least one vaccination has fallen over the two waves, from 83% in 2003 to 77% in 2004. As with those 'at risk', we might expect the level of those receiving both to have fallen but is perhaps disappointing that those receiving any has also fallen. This may be linked to the drop in awareness of the advertising.

Reasons for not receiving vaccinations

2.30 All those who had not received a vaccination where asked why not. A number of reasons for not having a vaccination were given by those who had not received one. There were considerable differences between the two groups as shown in Table B8.

Table 2.8: Reasons have not received vaccination
Base: All who have not received a vaccination (2004 only)

2.31 The main reasons given by those in the 'at risk' group were simply that they are too young (11%) or had already had one in previous years (10%). For a number of 'at risk' respondents, time was an issue, with 9% of those who had not been vaccinated stating that they'd just never got around to it. Eight percent claimed to have only received the flu jab, not the pneumococcal jab which ties in with the results recorded in Table B7. In 2003, a number of respondents said they did not know they were eligible for the free jabs. This was not the case this year, which is an improvement.

2.32 In the 65+ group, one in ten respondents said that they didn't want a jab. Thirteen percent stated that they had only been given the flu jab, whilst 19% claimed that they had already had one in the past.

Chapter 3 - Conclusions

3.1 Awareness of the campaign was lower than seen in the 2003 post evaluation, both at a spontaneous level and in terms of prompted awareness of the TV adverts. This is likely to be due, at least in part, to the use of only Channel 4 and Channel 5 for TV advertising and not the ITV channels.

3.2 The messages of the advertising continued to be communicated well to those who recalled seeing the advertising but at a spontaneous level, the 65+ group was more likely than previously to think of other advertising such as keeping warm in winter and healthy eating than flu/pneumococcal.

3.3 Awareness of the term pneumococcal also dropped back considerably at the latest wave, although it remains higher than recorded in the pre campaign baseline. This does indicate the importance, however, of continued reminders of what it is.

3.4 The proportion of those aged 65+ and those "at risk" having both vaccinations had, not surprisingly, dropped at the latest wave, as the pneumococcal vaccination is only required every 10 years. Without knowing whether the pneumococcal vaccination has been had previously, however, it is difficult to evaluate whether this is of concern.

3.5 Uptake of any vaccination among the 65+ group has decreased at this latest wave, which is certainly of concern and may be linked to the drop in awareness of the advertising.

Appendix - Questionnaire

Footnotes

1. Defined in this research as those who have diabetes, asthma, chronic heart or chest complaints, chronic kidney disease, lowered immunity due to disease or treatment such as steroid medication or cancer treatment, or any other serious medical condition
2. The standard six social grades, commonly used in research, are based on the current or previous occupation of the chief income earner in the household. ABC1 includes professional, managerial and non-manual occupations, while C2DE includes manual and unskilled occupations and the long-term unemployed.
3. Geographic regions are defined by the constituencies in which interviews were conducted. Each constituency is then assigned into one of 4 broad geographic areas: north, south, east or west.
4. Campaign reach is the combined figure of those claiming to have seen the TV ad, heard a radio ad or seen at least one of the press/poster ads when prompted.

The views expressed in this report are those of the researchers and do not necessarily represent those of the Department or Scottish Ministers.

Limited extracts from the text may be produced provided the source is acknowledged. For more extensive reproduction, please write to the Chief Researcher at Office of Chief Researcher, 4th Floor West Rear, St Andrew's House, Edinburgh EH1 3DG