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CHAPTER TWO MAIN FINDINGS

2.1 Data tabulations with detailed breakdowns are enclosed within the report. The main findings are summarised below.

Health issues of sample

2.2 In order to qualify for the survey, potential respondents were shown a list of conditions which would qualify them as being 'at risk' of flu, and they were asked to indicate whether any of them applied. If they answered 'yes', they continued with the survey. At the end of the survey, respondents were asked to indicate which of the specific 'at risk' health issues they experience. The results are shown in figure 2.1 below.

Figure 2.1: Health issues
Base: All respondents (2006:317, 2007:332)

2.3 Similarly to the 2006 survey, asthma was the most prevalent condition amongst the 'at risk' group (39%), followed by diabetes (20%). Some respondents had multiple health issues.

2.4 In 2007, a new health issue - neurological conditions - was added to the 'at risk' definition used in the survey and 8% fell into this category. The inclusion of those with neurological conditions is likely to account for the reduction in the proportion of people with asthma in our sample, as the people with neurological conditions tended not to claim any other conditions, and their inclusion may offset the numbers collected in other categories.

2.5 This slight change in sample composition is no real concern as the sample still comprised 'at risk' respondents only, but it is something to bear in mind when considering subsequent results.

Advertising awareness

Spontaneous awareness

2.6 At the start of the survey, respondents were asked whether they had seen or heard any advertising or publicity on the subject of flu recently. The results are shown in table 2.1 below.

Table 2.1: Spontaneous awareness of advertising
Base: All 'at risk' respondents

2.7 In 2007, just over two thirds (67%) of the 'at risk' group claimed to be aware of advertising or publicity on the subject of flu. This is a very similar level to the 65% recorded in 2006, and in TNS' opinion is a good level of spontaneous awareness.

2.8 A demographic breakdown of 2007 spontaneous awareness is shown overleaf in figure 2.2.

Figure 2.2: Spontaneous awareness of advertising by key demographic groups
Base: All respondents (2007: 332)

2.9 As in 2006, the level of awareness increased with age (from 62% amongst 16-34s to 71% amongst 55-64s) and women (71%) were slightly more aware of the publicity than men (63%). This year no difference was recorded by social grade, although awareness was slightly higher amongst C2DEs in 2006.

2.10 Although the 16-34s remained the least aware, spontaneous awareness rose amongst this group from 51% in 2006 to 62% in 2007. Campaign awareness amongst this group was a cause for concern in 2006, and this is the first indication that progress has been made in improving this.

Sources of advertising

2.11 All those who claimed to recall advertising on the subject of flu were then asked where they had seen or heard it. The responses are shown in figure 2.3 below.

Figure 2.3: Source of advertising
Base: All those who recall advertising (2006:205, 2007:222)

2.12 Overall, eight in ten (80%) of those who claimed to have seen advertising or publicity on the subject of flu cited television advertising as the source. Television is typically the dominant advertising medium recalled - whether it forms part of a campaign or not - due to misattribution. Additionally, the 65+ Chris Steele television advert ran this winter (see Appendix 1), as did numerous adverts for cold and flu remedies, so this high level of television recall is no surprise.

2.13 Non- TV advertising recall was also good (49% overall), and levels of recall of all sources rose since 2006. In line with the 'at risk' campaign, 32% recalled posters in some form, with 21% mentioning posters in GP surgeries specifically, and 5% respectively mentioning posters inside a pharmacy and outside a pharmacy. Overall, 28% mentioned GP surgeries in some form, and 9% mentioned pharmacies in some form.

2.14 In terms of age, those aged 55-64 were most likely to recall a non- TV source (53%) however amongst those aged 16-34 the level was very similar at 50% and amongst those aged 35-54 it was lower (at 45%). Awareness of poster advertising specifically as the source correlates directly with age, at 29% amongst those aged 16-34, 31% amongst those aged 35-54 and 37% amongst those aged 55-64.

Content recalled

2.15 Those who recalled TV advertising were then asked to describe the adverts they recalled. Figure 2.4 shows the descriptions given.

Figure 2.4: Description of TV advertising seen
Base: All aware of advertising about flu on TV (2007: 178)

2.16 Although no TV advert was aimed specifically at the 'at risk' group or concentrated on the 'at risk' campaign message, more than a third (37%) of the 'at risk' group recalled elements which could be specifically linked to the current campaign for the over 65s (including telling you to get a flu jab if you are over a certain age, Dr Chris Steele, and a doctor telling you to come in for a flu jab). Although base sizes were low, males (43%) and the youngest age group (40%) had the highest recall for the Chris Steele campaign.

2.17 A further 12% recalled elements of the 'at risk' campaign ( telling you to get a flu jab if you have health problems and a man with a ventilator on his face), caused by respondents misattributing where they had seen this message, again a common finding in advertising research.

2.18 Additionally, 17% mentioned the generic call to action - you should remember to go for your flu jab.

2.19 The respondents were then asked to describe the adverts that they had seen outwith the medium of television. Results are shown in figure 2.5 overleaf.

Figure 2.5: Description of advertising seen (not TV)
Base: All aware of advertising about flu excluding TV (2007: 108)

2.20 When asked to describe the non- TV advertising they recalled, almost three in ten (29%) described elements that could be linked to the 'at risk' campaign ( telling you to get a flu jab if you have health problems, telling you how serious flu can be, and a man with a ventilator on his face). The 'at risk' campaign was also described more amongst people with asthma (36%) than it was amongst the 'at risk' people without asthma (24%).

2.21 Again, some mentioned generic elements such as that you should remember to get your flu jab (14%) or the sources of advertising they had seen (7%).

Main message recalled from non- TV advertising

2.22 Those who claimed to have seen advertising other than on TV were also asked what they felt was the main message of the advertising. Table 2.2 shows the descriptions given.

Table 2.2: Main message of advertising seen (not TV)
Base: All aware of advertising about flu excluding TV (2007: 108)

2.23 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 that 5% mentioned that flu can be serious as shown in the recent campaign.

2.24 At this wave, 41% of those who spontaneously recalled the non- TV ads said that they could not recall the message of the adverts, rising from only 23% in 2006. This is 0an indication that the message of the 2007 advert did not cut through as strongly as the 2006 advert, either in terms of clarity or how memorable it is.

Prompted awareness

2.25 Following questions measuring spontaneous awareness, all respondents were shown pictures of the poster adverts ( Lisa and Ben) from the current campaign.

2.26 In 2007, around six in ten (61%) claimed to be aware of at least one of the adverts when prompted. This can be referred to as 'total reach' - the total recognition of the campaign.

2.27 Although this is slightly lower than the 68% recorded in 2006, again it should be noted that the content of campaigns differed from year to year. In particular, in 2006 radio was used as part of the campaign, therefore in TNS' experience this level of reach is very positive. Indeed, the reach of the poster adverts specifically in 2006 was 53% so this year's campaign was much more highly recalled. A demographic breakdown of the 2007 information is shown in figure 2.6 below.

Figure 2.6: Prompted awareness of adverts by demographics
Base: All respondents (2007: 332)

2.28 The total reach of the adverts was highest amongst the youngest age group (74%) and lowest amongst the oldest age group (48%). It was also higher for women (64%) than for men (58%), and for ABC1s (67%) than for C2DEs (55%).

2.29 Although the level of spontaneous recall of the adverts was lowest for the 16-34s, when prompted with pictures of the posters, levels of recall were highest amongst this group. Indeed, total reach for this group rose from 63% (below average) in 2006 which shows a further improvement in recognition amongst the demographic which had been a cause for concern.

2.30 In terms of specific execution recall, more than half (54%) recalled the Ben ad, and around a third (34%) recalled the Lisa ad. Although we might expect women to recognise Lisa and men to recognise Ben, both were more recognised by women. Ben was recognised by 52% of men and 56% of women, and Lisa by 29% of men and 40% of women. The spend on these adverts was roughly the same, and although we cannot accurately discern actual coverage, we would expect levels of recall to be similar for each. In fact, although 31% had seen both ads, only 3% had seen Lisa in isolation. From these points, we can infer that Ben had a higher impact.

Where poster advertising seen

2.31 Those who recalled seeing the poster advertising were asked where they had seen it. The responses are shown in figure 2.7.

Figure 2.7: Where poster advertising seen
Base: All those who recall poster advertising (2007: 200)

2.32 Poster awareness was driven by a variety of sources, demonstrating the value and contribution of each within the overall coverage. 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.

Attitudes to advertising

2.33 Having now been prompted with the poster adverts, the 'at risk' group were asked about their impressions of the campaign. The responses are shown in figure 2.8.

Figure 2.8: Impressions of the campaign
Base: All (2006:317, 2007:332)

2.34 Although not significant, slight increases have been observed 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). Males and the older age groups were more likely to agree with these statements.

2.35 This indicates that the advertising was working well in communicating the key campaign messages following direct prompting, although as observed earlier these messages have not necessarily remained top of mind.

Figure 2.9: Impressions of the campaign
Base: All (2006:317, 2007:332)

2.36 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. Although it is unknown exactly what it is that respondents claim not to have known prior to having seen the advertising, very high levels of agreement with the previous two statements indicate that they are learning that flu can be serious, and that the flu jab is not just for old people. Males and the older age groups were more likely to agree with this statement.

2.37 There was a significant fall in agreement that the advertising is relevant to me from 82% in 2006 to 71% in 2007. Females and the younger age groups were more likely to agree with this statement. Although the overall agreement has decreased over the two waves, if the 2007 figure was looked at separately, one would conclude that agreement is high and the advertising is relevant. However, in comparison to the 2006 campaign it is not as successful. 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. This could also help explain why the advert is not so well recalled at a spontaneous level.

Figure 2.10: Impressions of the campaign
Base: All (2007:332)

2.38 A new statement in 2007, 66% agreed that the advertising made me realise I am in an 'at risk' group. Females and the younger age groups were more likely to agree with this statement. Consideration should be given to the fact that we cannot say whether the remaining 34% did not understand the advertising, or already knew they were in an 'at risk' group.

2.39 Mean scores were calculated ⁵ based on these attitude statements, and comparisons between those who recalled seeing the ads before were compared to those who did not, and results are shown in figure 2.11.

Figure 2.11: Impressions of the campaign
Base: All (2007:332)

2.40 Those who had seen the ads before were statistically more likely to agree that the advertising made me realise how serious getting flu could be and for this group agreement with the other statements tended to be directionally more positive. Those who had not seen the ads before were more likely to say that the advertising told me something I didn't know, although this may literally be a result of seeing the adverts for the first time.

2.41 Looking at the statements in combination, we can infer that although the message of the adverts is reasonably clear, the respondents are unsure as to whether it applies to them - either because the adverts do not feel directly relevant or linked to this because the respondent does not realise they are in an 'at risk' group. Indeed, the advert does not include prominent details of the 'at risk' information which may explain why the posters work as an information campaign about the dangers of flu, but not as a call to action encouraging the 'at risk' group to actually get a flu jab.

2.42 Comparisons between those who have asthma and those who do not are shown in figure 2.12 overleaf.

Figure 2.12: Impressions of the campaign
Base: All (2007:332)

2.43 No significant difference was observed between those who have asthma and those who do not, although people with asthma tended to be more likely to agree that the advertising made me realise how serious getting flu could be, the advertising was relevant to me, and the advertising told me something I didn't know.

2.44 As the poster campaign showed a person in intensive care wearing a ventilator over their face, this may well be an image that struck a chord amongst people with asthma, perhaps doing more to make the link that flu could be serious for them specifically.

Communication received from GP

2.45 The 'at risk' group were asked whether they had received a letter or telephone call from their GP this year regarding receiving a flu vaccine. The responses are shown in table 2.3.

Table 2.3: Communication received from GP
Base: All (2006: 317, 2007: 332)

2.46 Overall, almost half (44%) of those 'at risk' had received communication from their GP on the subject of flu. This was most often in the form of a letter (40%), although levels of correspondence by both letter and phone have risen since 2006.

2.47 Those who had received correspondence from their GP were asked whether they got a flu jab as a direct result. The responses, by demographics, are shown in figure 2.13.

Figure 2.13: Whether got flu jab as a result of correspondence
Base: All who received correspondence from GP (2007:150)

2.48 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 as a prompt to getting the jab. There was little difference by gender or prevalence of asthma, however C2DEs and the older age groups are more likely to have been prompted by their GP to get the jab.

Flu jabs in 2007

2.49 In total, 60% of respondents said they had received a flu jab at some point - that is 42% in 2007 and 37% in previous years. Almost one in five (19%) had the jab both in 2007 and previously.

2.50 Those who had not had the flu jab in 2007 were asked whether they intend to do so, although it should be noted that the fieldwork took place at the end of December 2007. From this we can observe the broad intentions of the 'at risk' population regarding the flu jab in 2007. The responses, by demographics, are shown in figure 2.14.

Figure 2.14: Intentions to have free flu jab this winter
Base: All (2007:332)

2.51 Patterns of uptake 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.

2.52 Of concern however, more than half of ABC1s (52%) and 16-34s (53%) did not intend to have the free flu jab.

2.53 Those who had not had a free flu jab in 2007 were asked to state the reasons they had not done so. The responses are shown in table 2.4 overleaf.

Table 2.4: Why have not had a free flu jab in 2007
Base: All who have not had free flu jab in 2007 (2007: 131)

2.54 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%). This links directly to the conclusions drawn from the attitude statements - that many people who are 'at risk' still do not understand that the flu jab is a requirement for them.

Prompting to get the flu jab

2.55 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. The responses relating to the health service are shown in figure 2.15 below.

Figure 2.15: Likelihood of getting flu jab as a result of prompting by health service
Base: All (2007: 332)

2.56 Around half of respondents 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, or a letter from the NHS. A further one in five said they would be fairly likely to do so, bringing the total to between seven and eight in ten who said they would be prompted by this type of correspondence.

2.57 Males and those in the older age groups tended to claim to be more likely to get a jab as a result of prompting by the health service.

2.58 The responses relating to advertising are shown in figure 2.16 below.

Figure 2.16: Likelihood of getting flu jab as a result of prompting by advertising
Base: All (2007: 332)

2.59 The response to advertising was more polarised, with about half saying leaflets, posters or TV ads would prompt them to get a flu jab, and around a third saying this type of advertising was unlikely to prompt them.

2.60 Those in the older age groups tended to claim to say they would be more likely to claim they would get a jab as a result of prompting by advertising, and females tended to say they would be more likely to get a jab as a result of prompting by posters and TV adverts.

2.61 We advise that these results should be considered as part of the broader campaign picture. In our experience, people do not like to admit that they are affected by advertising when asked outright, instead preferring to request a more personal approach as evidenced in these results. However, an expression of preference does not always translate into behaviour.

2.62 In the case of this campaign, we know that the advertising has been seen and certain elements have been well understood, and we also know that prompting from GPs has been successful. Looking at the measures in figure 2.16 in isolation, this might imply that there is a case for proceeding with GP letters instead of advertising in the future. However, the relatively low levels of preference for advertising should be treated with caution and it must be borne in mind that the advertising this year has played a role as an information source with the GP letters working as a call to action. It may well be the case that the 'at risk' groups have seen the posters and understood that flu can be serious, and then when they have received the GP letter they have understood that this actually applies to them. One therefore could not guarantee that each would be so successful without the other.

Visiting the Scottish Government flu website

2.63 The 'at risk' group was asked how likely it was that they would visit the Scottish Government Flu website to find out further information on flu vaccinations

Table 2.5: Likelihood of visiting the Scottish Government website
Base: All (317)

2.64 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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