Qualitative Testing of New Health Information Messages, Including Placement Options, as well as the Thematic Linking of Labelling Elements – 2019 - Executive Summary

Health Canada

Executive Summary

October 2019

Prepared for:
Health Canada
Supplier Name: Quorus Consulting Group Inc.
Contract Award Date: June 13, 2019
Delivery Date: October 2019
Contract Amount (incl. HST): $145,661.24
Contract #: HT372-192561/001/CY
POR Number: 025-19

For more information, please contact:
hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

Qualitative Testing of New Health Information Messages, Including Placement Options, as well as the Thematic Linking of Labelling Elements – 2019
Executive Summary
Prepared for Health Canada
Supplier name: Quorus Consulting Group Inc.
October 2019

This public opinion research report presents the results of focus groups conducted by Quorus Consulting Group on behalf of Health Canada. The research study was done using qualitative focus groups. The research entailed a total of 15 in-facility focus groups conducted with people who smoke cigarettes daily or occasionally. The research was conducted between July 13 and 27, 2019.

Cette publication est aussi disponible en français sous le titre : Évaluation qualitative de nouveaux messages d'information sur la santé, y compris les options de placement, ainsi que la relation thématique des éléments d'étiquetage - 2019

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from the Health Canada. For more information on this report, please contact the Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca or at:

Department of Health
200 Eglantine Driveway
A.L. 1915C
Ottawa, Ontario
K1A 0K9

Catalogue Number:
H14-335/2020E-PDF

International Standard Book Number (ISBN):
ISBN 978-066-032511-8

Related publications (registration number: POR 025-19):
Catalogue Number H14-335/2020F-PDF (Executive Summary, French)
ISBN 978-0-660-32512-5

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2019

Political Neutrality Statement

I hereby certify as Senior Officer of Quorus Consulting Group Inc. that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Policy on Communications and Federal Identity and the Directive on the Management of Communications - Appendix C.

Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.

Signed:

Rick Nadeau, President
Quorus Consulting Group Inc.

Executive Summary

Background and Research Objectives

Health Canada is responsible for the administration and enforcement of the Tobacco and Vaping Products Act and its regulations. This includes displaying health-related information on tobacco product packaging which has been shown to be one of the best approaches in raising awareness on the health risks of tobacco use. The Tobacco Products Labelling Regulations (Cigarettes and Little Cigars) (TPLR-CLC) require Health Information Messages (HIM1) to be displayed on the inside of cigarette packages, specifically on the back of the sliding portion of "slide-and-shell" packages or on a leaflet inserted in flip-top packages. Each HIM includes two components: a teaser and the main HIM.

Health Canada is developing a new suite of HIMs, and once they are developed and regulatory processes are in place for them, the current suite of HIMs will retire. Health Canada commissioned Quorus to conduct qualitative research through a series of focus groups to gain clarity and understanding of new draft HIM mock-ups, identify the optimal location for noticeability, assess the relevance of thematic linking across the messages in and/or on packages and provide information on regulatory decisions.

Methodology

This report is based on 15 in-person focus groups that Quorus completed between July 13 and July 27, 2019. All participants were people who smoke cigarettes either daily or occasionally and were grouped according to the following segments: "Youth" 15 to 19 years old, "Young adults" 20 to 24 years old, and, "Adults" 25 years of age or older. In total, 132 individuals participated in the focus groups. English sessions were held in Toronto, Winnipeg, Edmonton, and St. John's and French sessions were held in Quebec City. More details can be found in the Methodology section of the report.

Qualitative research is designed to reveal a rich range of opinions and interpretations rather than to measure what percentage of the target population holds a given opinion. The results are directional in nature; and the results of qualitative research are not statistically projectable of a specific target audience.

Review of Health Information Messages

Very few participants said they pay attention to the HIMs when they purchase a new package of cigarettes. Furthermore, very few purchase "slide-and-shell" packages – most purchase "flip top" packages in which the HIMs are inserted as a card that many participants remove and throw out.

Participants were presented with eight draft HIMs and were asked to score each one using a scale from one to ten with respect to:

While there were specific comments for each HIM tested, a variety of reactions apply across all concepts. For starters, participants were more likely to react positively to concepts that conveyed a meaningful benefit of quitting over ones that focused mostly or entirely on tips to help them quit. As well, participants preferred short and impactful bullets over blocks of text.

From a design perspective, graphics and certain colours (especially those that deviated from what they usually see on their packages of cigarettes such as orange, light blue, and purple) can be useful in terms of getting someone's attention. However, images that lacked personal relevance or perceived authenticity weakened the HIM.

Most preferred teasers that featured a question or an image, especially when compared to teasers that only featured contact information.

With the exception of a few terms (e.g. NRT, coronary), the concepts were easy to understand.

The quitline information was almost always seen as relevant, however, few participants seemed to agree that it should be prominently shown in the teaser. The preference was for the website and the telephone number to always be shown together and, in that format, the website always be shown ahead of the telephone number. While the quitline information is noticeable at the bottom of the main HIM, some did concede that they probably would not open their cigarette pack that far and would miss it. Finally, short text such as "Connect now" and "For non-judgmental support" that accompanied the quitline information were often considered clutter and adding limited value.

Reactions to HIMs on Vaping

Three HIMs suggested that switching completely to vaping can reduce exposure to harmful chemicals in cigarette smoke and could be a potential method to quit smoking cigarettes. A good number of participants could relate to using vaping as a strategy to quit smoking cigarettes entirely. However, many felt that these HIMs either did not have enough information about vaping or that they have heard too many bad things about vaping (e.g. the chemicals it contains, exploding devices, popcorn or bubble lung, etc.) for it to be considered a viable alternative to smoking cigarettes. While most could appreciate that vaping may be different from smoking cigarettes, most also felt it was like replacing one addiction or "evil" for another. In the end, most would agree that the "jury is still out" and that the long-term effects of vaping have yet to be understood.

As such, very few felt comfortable with the idea of replacing cigarette smoking with vaping and most were also quite uncomfortable, even upset, with what they perceived as Health Canada recommending, endorsing, or promoting vaping. In the end, only a few felt that it was a strategy worth suggesting, especially coming from Health Canada.

Review of Health Information Message Placement

Five mock-up packages were shown to the participants to see how noticeable the HIM was on each one. The packages were all the same except for the placement of the HIM. Option A (which is the current HIM placement on "slide-and-shell" packages) had the HIM on the back of the slide. Option B had the HIM as an interior insert, located in front of the cigarettes in the package. Option C was very similar to "B", however the HIM was a sticker covering the foil of the cigarettes. The HIM in Option D was an extension of the interior tab. Finally, Option E was an extension of the top flap that went over top of the cigarettes.

Option E was by far the most noticeable approach. Participants explained that seeing the HIM was considered inevitable and that the contrast with today's format, in terms of noticeability, is significant. Some also explained that they would tear or cut off the extended flap.

Option B was very similar to what they currently see in their packs (flip top packages) and as such most stated they would discard the insert the same way they do today. The fact that the insert is not attached to the pack and that it can be easily discarded hindered how noticeable it was.

Options C and D were considered equally noticeable and much less "annoying" as E since nothing got in the way of accessing the cigarettes.

Option A was by far the least "noticeable" approach, mostly because participants did not believe they would ever turn their pack around to look at the information. Many participants were flip top users, therefore, while this option was the status quo, this format was still new to them.

Thematic Linking

Three series of HWs, HIMs and toxic statements (TS) were presented to participants who were then asked to rate how effective each series was in terms of helping them understand the link between tobacco use and the particular health conditions shown. Series A contained information in the HW, HIM and TS that was linked by a theme (in this case the respiratory system). Series B contained information in the HW and TS that were linked by theme (again, the respiratory system) with a different HIM (related to the quitline services). The three labelling elements in Series C were unrelated by theme.

Although many indicated they had noticed that Series A followed a theme, they did not necessarily flag this as the reason they felt this series was effective. For that series, participants were more likely to flag the quality of the HIM as the main reason behind its effectiveness. More precisely the image of the lungs, the red text next to the lungs and the timeline approach to the supporting text.

The specificity in the TS in Series C was considered more impactful than the general information in the other two series.

When prompted, most participants believed that having all three types of messages linked by a theme would be preferred over one that does not follow a theme. They believed it would be more impactful since it addressed the same issue from different perspectives.

When the moderator challenged participants by reminding them that they said they rarely read one of the messages, let alone all three, participants reinforced the following:

The few in favour of touching on a variety of topics in the 3 message formats explained that this variety increased the odds of at least one of the messages being relevant to them. Others simply agreed that they would not read all three so any value in a linked theme would be lost on them.

Supplier Name: Quorus Consulting Group Inc.
Contract number: HT372-192561/001/CY
Contract Award Date: June 13, 2019
Contract Amount (including HST): $145,661.24
For more information, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca