Before the COVID-19 pandemic, tuberculosis (TB) had the tragic distinction as the leading infectious disease killer in the world, and India is was the center of this global epidemic. India accounted for a quarter of the word’s TB cases in 2019—about 2.6 million— and 445,500 of the 1.4 million deaths around the world.
One reason for so many cases: the public in India lacks knowledge and awareness about TB, including its signs and symptoms, hindering efforts for TB prevention, care seeking and treatment adherence.
Public health mass media campaigns can be a powerful strategy for addressing the TB epidemic. As with any media campaign, message testing with audiences is an essential step to help ensure that campaigns are effective as well as cost-effective.
On March 24, 2021, in recognition of World TB Day, Vital Strategies released a new white paper “Responses to Public Service Announcements About Tuberculosis and Its Comorbidities: Findings from a Message Testing Study in India,” which describes the results of a study in India that tested communication concepts for TB campaigns.
To learn more, we spoke to Meena Maharjan, Research Assistant at Vital Strategies.
What is the importance of message testing for mass media campaigns and what gap does this white paper fill?
Mass media campaigns featuring public health messages on television, radio, social media, print, and on out-of-home channels such as billboards or posters, can deliver information, raise risk perceptions, shift attitudes and encourage behavior change about a range of issues, including TB. To control the spread of TB, people need to recognize the signs and symptoms of the disease, seek care and treatment, and mass media campaigns can help to make that happen.
Effective mass media campaigns need well-designed messages that are delivered to their intended audience with sufficient exposure. To design effective messages, pre-testing can help to solicit feedback from audiences, identifying which messages are most likely to resonate and be perceived as credible. Message testing can also help uncover any problematic content and language and identify features that need to be modified to make them relevant for the audience.
At Vital Strategies, we undertake these kinds of message testing studies often, on a range of topics: tobacco control, road safety, salt reduction and many more. However, to the best of our knowledge, to date, there is no published study on message testing of a TB campaign. Our TB message testing study, described in this white paper, fills this research gap by assessing the comprehension, acceptability and potential effectiveness of four different PSA concepts about TB prevention and treatment.
Can you tell me more about the PSA concepts and methods used during message testing research?
Vital Strategies developed four TB-related PSA concepts: Annu, Cough, Sunil, and Manoj. Each concept had a different execution style, message and images, but the same objectives: to deliver information about TB and its symptoms, reduce TB-related stigma, and encourage people to seek care for TB. The four concepts address: (1) multidrug-resistant TB (Annu); (2) smoking and secondhand smoke and TB (Cough); (3) HIV and TB (Manoj); and (4) TB only (Sunil). The concepts Annu, Manoj, and Sunil used testimonials as the style to convey key messages, whereas Cough used strong graphic images and negative emotions.
For this study, we used a mixed quantitative and qualitative methodology, conducting 20 focus groups with a total of 234 participants ages 18 to 40. Participants were shown animated versions of the four potential PSAs, and, after viewing each of the concepts, they rated and discussed them.
Collecting both quantitative data from ratings and qualitative data from open-ended discussions offers researchers a more complete picture of the audience reactions than either method can provide on its own. Participants were asked to rate each concept by agreeing or disagreeing with statements such as, “the PSA was easy to understand” and “the PSA motivated me to visit a doctor in case of TB symptoms.” Based on these results, each concept was analyzed on five key measures: message credibility and persuasive ability; message acceptance; perceived effectiveness; understanding; and negative emotion. The open-ended discussion focused on efficacy, message comprehension, acceptability and cultural appropriateness.
What did the study find and what can we learn from it?
Participants rated all four PSA concepts highly on message effectiveness. Cough, which focused on TB and tobacco and used a graphic image and negative emotion execution style, was most highly rated by participants, and made participants feel more concerned about TB. Manoj, which focused on TB and HIV and used a testimonial execution style, received generally low ratings.
- Clear explanations of medical concepts and terminologies are needed so that the audience can easily understand them. For instance, participants didn’t understand the term “MDR-TB” in Annu; unsurprisingly, participants rated this PSA lowest for understanding.
- Visualizations can help to present complex information to the audience. While participants reported that Sunil imparted new information, some suggested adding more pictures so that it can be better understood.
- PSAs should feature personally relevant and relatable stories to connect and engage the audience. Participants did not find Manoj—the lowest rated PSA—personally relevant or relatable to their own lives. On the other hand, for the highest rated PSA, Cough, participants said they related to the PSA’s featured character, since they had friends and family members who were tobacco smokers.
- The number of messages in a single PSA should be limited; too many messages can interfere with delivering the intended message to the audience. Most of the participants felt that Manoj was confusing because it discussed two diseases (HIV and TB) together.
To our knowledge, this first-of-its kind study provides insight into what kinds of messages and execution styles work well for TB mass media campaigns.
Were any PSA concepts in the message testing research eventually produced?
Vital Strategies has been providing technical assistance for tobacco control mass media campaigns in India since 2007, supporting the Ministry of Health and Family Welfare’s National Tobacco Control Program. We developed the four concepts that were tested in our messaging study as part of this work.
Cough, which was rated highest in our study, was developed into a 30-second television PSA and was launched by the ministry in May 2017 and again in March 2018. The Cough campaign, which aired nationally to warn people of how smoking and secondhand smoke exposure increase the risk of TB, was the first campaign we are aware of to link tobacco with TB.
Can results from this study be applied to TB campaigns in general and in other countries?
Definitely. Our findings are consistent with other literature on mass media campaigns public health messaging and likely to apply to TB campaigns in general, as well as other public health campaigns. Governments, communication experts, and public health professionals can incorporate findings from our research into future campaigns that will be important in addressing the TB epidemic.
To access the report please visit: https://bit.ly/3cSQpYn and follow us on Twitter at @VitalStrat