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EXECUTIVE SUMMARY
1. The Scottish Government has run an annual advertising campaign for the last six years to promote the uptake of the flu vaccination to the target groups of the elderly (those aged 65+) and the 'at risk' (defined as affected by a number of specified medical conditions). Until 2006/07, both audiences were addressed simultaneously by the same campaign, even though the additional message of encouraging the take-up of the pneumococcal vaccination introduced in 2003 applied only to those aged 65+.
2. For 2006/07 and 2007/08, the campaign was run in two phases - an initial phase targeting the 65+ group specifically, followed by a second phase addressing the 'at risk' group. The 2007 'at risk' phase involved outdoor posters, posters 1 and leaflets in GP surgeries and pharmacies, as well as pharmacy bags, reverse graffiti and publicity stunts and correspondence from GPs. The Scottish Government commissioned TNS System Three to evaluate the effectiveness of the 'at risk' campaign in communicating the key campaign messages to the 'at risk' target audience.
3. Previous research conducted by TNS System Three suggests that an estimated 14% of the population aged 16-64 qualify as 'at risk'. A sample of 332 adults defined as 'at risk' aged 16-64 were interviewed on street using Computer Aided Personal Interviewing ( CAPI) in thirty sampling points throughout Scotland over the period 15th to 29th December 2007. Quotas were imposed to ensure that the sample was representative of the 'at risk' population in terms of age, gender and Socio Economic Group ( SEG) 2 and data was weighted to match the 2006 sample.
4. All respondents were 'at risk' of flu, which was ascertained using a screening question. Asthma was the most prevalent condition amongst the 'at risk' group (39%), followed by diabetes (20%) and heart problem/disease (17%). Some respondents had multiple health issues. In 2007, neurological conditions was added to the 'at risk' definition used in the survey and 8% fell into this category.
5. Just over two thirds (67%) of the 'at risk' group were aware of advertising or publicity on the subject of flu, similar to the 65% recorded in 2006. This was highest amongst women and the older age group, although recall for the 16-34s improved since 2006.
6. Eight in ten (80%) people who recalled flu advertising or publicity said they saw it on television. Television is typically the dominant advertising medium recalled, plus the 65+ Chris Steele television advert also ran at this time.
7. Non- TV advertising recall was also good (49%), and levels of recall of all sources rose since 2006. In line with the campaign, 32% recalled posters, 28% mentioned GP surgeries, and 9% mentioned pharmacies.
8. When asked to describe the TV advertising they had seen, more than a third (37%) recalled elements which could be linked to the Chris Steele advert and 12% misattributed elements of the 'at risk' campaign to TV advertising.
9. When asked to describe the non- TV advertising seen, almost three in ten (29%) described elements that could be linked to the 'at risk' campaign. Again around three in ten (29%) of those who had seen advertising on the subject of flu felt that the main message of the advertising was to remember/get a flu jab. Additionally, 12% specifically mentioned that those at risk should get the flu jab and 5% mentioned that flu can be serious. At this wave, 41% of those who recalled the non- TV ads said that they did not know the message of the adverts.
10. Upon prompting with the poster adverts ( Lisa and Ben), around six in ten (61%) claimed to be aware of at least one of them. This was highest amongst the youngest age group (74%), ABC1s (67%) and women (64%). More than half (54%) recalled the Ben ad, and around a third (34%) recalled the Lisa ad so we can infer that Ben had a higher impact. The reach of the poster adverts in 2006 was 53% so this year's campaign was more highly recalled.
11. Around four in ten (41%) of those who claimed to have seen the poster advert said they saw it in a GP surgery. Around a quarter (26%) saw outdoor posters, and 18% saw the advert in a pharmacy.
12. Having been prompted with the poster adverts, the 'at risk' group were asked about their impressions of the campaign.
13. There were slight increases in agreement with the statements that the advertising helped me understand how serious getting flu can be (from 76% in 2006 to 81% in 2007) and the advertising helped me realise that the flu jab is not just for old people (from 78% in 2006 to 82% in 2007) indicating that the advertising was working well in communicating these key campaign messages. Agreement with the statement the advertising told me something I didn't know also rose, this time significantly from 33% in 2006 to 47% in 2007. New in 2007, 66% agreed that the advertising made me realise I am in an 'at risk' group.
14. There was a significant fall in agreement that the advertising is relevant to me from 82% in 2006 to 71% in 2007. As the 2006 campaign consisted of a person sneezing and the message that flu can spread easily, this may have felt more directly relevant to a wider audience than the person in intensive care shown in 2007.
15. Almost half (44%) of those 'at risk' had received communication from their GP on the subject of flu and levels of correspondence by both letter and phone have risen since 2006. Around seven in ten (71%) of those who received correspondence claimed to have had the flu jab as a direct result, indicating that GP correspondence is working well.
16. Patterns of uptake of the flu jab followed similar patterns to those observed in the advertising awareness. C2DEs, females and the older age groups were more likely to have had the jab or intend to have the jab in 2007. However, more than half of ABC1s (52%) and 16-34s (53%) did not intend to have the free flu jab in 2007. The main reasons given for not getting a flu jab in 2007 were that the respondents did not know they were eligible (32%) or did not feel it was necessary (31%).
17. At the 2007 wave, new questions were added to gauge whether the respondents would get a flu jab as a direct result of prompting by various sources of advertising and the health service.
18. Between seven to eight in ten claim that they would be very likely to get a flu jab as a result of receiving a letter or phone call from their GP. The response to advertising was more polarised, with about half saying leaflets, posters or TV ads would prompt them to get a flu jab. In our experience, people do not like to admit that they are affected by advertising, instead preferring to request a more personal approach as evidenced in these results.
19. Seen in isolation, this might imply that there is a case for proceeding with GP letters instead of advertising in the future. However, the advertising this year has played a major role as an information source with the GP letters working as a call to action. One therefore could not guarantee that each would be so successful without the other.
20. In 2007, 24% of the 'at risk' group said they were very or quite likely to visit the Scottish Government flu website, an improvement from 14% in 2006.
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