Opioids Overdose Crisis Brand and Message Focus Testing
Final Report

Prepared for Health Canada

Prepared by Narrative Research
PSPC Contract Number: HT372-214993/001/CY
Contracted Value: $70,173.00
Contract Date: 2021-12-29
Delivery Date: 2022-03-02
POR number: 77-21

For more information, please contact: cpab_por-rop_dgcap@hc-sc.gc.ca

Ce rapport est aussi disponible en français

Opioids Overdose Crisis Brand and Message Focus Testing
Final Report

Prepared for Health Canada
Supplier Name: Narrative Research
March 2022

This public opinion research report presents the results of focus groups conducted by Narrative Research on behalf of Health Canada. The research entailed a total of 12 online focus groups, namely two groups in targeted communities located in each of six regions: British Columbia, Alberta/Prairies, Ontario, Quebec, Atlantic, and Northern territories/regions. In each region, one session included males in physically demanding professions, while one session included members from the general public. Male group participants had current or past employment in designated physically demanding occupations and those groups included a mix of ages (skewing 20-49 years old). General population focus groups included a mix of gender, age, employment status, occupation, education and household income. All sessions included a mix of cultural background, and only those living in market for at least two years were invited to take part. Groups in Quebec were conducted in French while all other groups were conducted in English. The research was conducted between February 2 and 7, 2022.

Cette publication est aussi disponible en français sous le titre :
Mise à l'essai de la marque et du message sur la crise des surdoses d'opioïdes.

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at: cpab_por-rop_dgcap@hc-sc.gc.ca

Catalogue Number:
H14-391/2022E-PDF
International Standard Book Number (ISBN):
978-0-660-42140-7

Related publications (registration number: POR-77-21):
Catalogue Number H14-391/2022F-PDF (Final Report, French)
ISBN 978-0-660-42141-4

©Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2022

Table of Contents

Executive Summary
Introduction
Research Methodology
Research Findings
Advertising Recall
Terminology
Concept Testing
Preferred Concepts
Channels
Conclusions
Direction

Appendices:
Appendix A – Recruitment Screener
Appendix B – Moderator's Guide
Appendix C – Materials Tested

Executive Summary

Narrative Research Inc.
Contract Number: HT372-214993/001/CY
POR Registration Number: 77-21
Contract Award Date: 2021-12-29
Contracted Cost: $70,173.00

Background and Research Methodology

With the significant increase in apparent opioid toxicity deaths since the beginning of the COVID-19 pandemic, Health Canada is in the process of developing a new creative concept and visual identity as part of the Department's multi-year marketing campaign to address the growing opioid overdose crisis. In this context, Health Canada was interested in testing creative concepts developed as part of this marketing campaign, to determine which concept resonates most with the targeted audiences. More specific research objectives included:

To achieve these objectives, a qualitative research approach was undertaken. This entailed a total of 12 online focus groups conducted between February 2 and 7, 2022 in specific communities located across six regions: British Columbia (Vancouver, Thompson-Caribou, Fraser), Prairies (Medicine Hat, Edmonton, Calgary, various communities in Saskatchewan and Manitoba), Ontario (Thunder Bay, Sudbury, Toronto, Guelph, Ottawa), Quebec (Montreal and Québec City), Atlantic Canada (Fredericton, Moncton, Halifax), and various communities in Northern Territories or northern regions of provinces. In each region, one focus group was conducted with members from the general public, including a mix of ages, gender, household type, employment status, occupation and education level, while one group was conducted with males working in, or on leave from, physically-demanding professions (predominantly in the construction sector). All 12 sessions included a mix of cultural backgrounds.

Each session lasted approximately 90 minutes and all group discussions were held in English with the exception of those in Quebec which were conducted in French. Participants were provided an incentive of $100 (general public) or $125 (males in physically demanding professions). Across all groups, a total of 119 individuals were recruited and 98 participated.

All participants were recruited per the recruitment specifications for the Government of Canada. Recruitment was conducted through qualitative panels stored on Canadian servers, with follow up calls to confirm the details provided and to ensure quotas were met. This report presents the findings from the study. Caution must be exercised when interpreting the results from this study, as qualitative research is intended to be directional only. Results cannot be attributed to the overall population under study, with any degree of confidence.

Political Neutrality Certification

I hereby certify as a Representative of Narrative Research that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Directive on the Management of Communications. 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
Margaret Brigley, CEO & Partner | Narrative Research
Date: March 2, 2022

Key Findings and Conclusions

The following summarizes the key findings and conclusions from the Opioids Overdose Crisis Brand and Message Focus Testing research study.

Terminology

The term "substance use" in English is most commonly seen as speaking of the consumption of substances such as alcohol, drugs and medication for recreational purposes, but in a way that affects someone's capacity or judgement. By contrast, the term "consommation de substances" in French elicited more negative connotations associated with overconsumption of illegal substances. Nonetheless, both terms are considered adequate to speak about the use of substances such as drugs and alcohol, socially, recreationally and occasionally, for lack of a better expression.

Overall Reactions

Three concepts for a campaign were examined and discussed during the focus groups. While reactions to the three creative concepts tested varied, a number of areas elicited similar comments and should be considered when developing the final campaign concept:

The following provides specific comments about each of the three concepts reviewed.

Let's Build Solutions Concept

Overall reactions to the "Let's Build Solutions" concept were modestly positive, notably for the message's positivity and wider-reaching appeal. The concept was felt to target men working in physically demanding jobs, as well as their coworkers and supervisors. That said, the concept's call to action was only moderate.

Positive elements included that it implies that everyone plays a role in addressing substance use, that substances to be considered include drugs, medication and alcohol, and the positive tone of the message focusing on support, solutions and collaboration. The overall message of this concept was most appreciated and consideration should be given to include it in the final campaign concept. While presenting naloxone as one of the tools to address the situation is appreciated, there lacks information on where to get it and how or when to use it.

Care should be taken, however, in ensuring that the messages or headlines of each individual campaign component do not send mixed messages. For example, the headline from one of the social media posts ("If you are going to use drugs, don't use alone") could be misinterpreted as implying that it is acceptable to do drugs at work, or that others should be involved in doing drugs if one person is. Consideration should be given to reword the statement to "If you are going to use drugs, let someone else know to keep safe."

Despite the tone and overall message being appealing, this concept lacked visual appeal, with a graphic design that is considered bland, generic, cluttered, and what is expected of a government advertisement or public education campaign.

Make Sure You Have the Right Tools

Reactions to the "Make Sure You Have the Right Tools" concept were mixed, with perceptions of an attractive design but a weaker message. Prominently featuring men in the construction industry in images and making industry-specific references in the text clearly identified them as the primary target audience. It also sends the message that substance use is an issue among this group. Showing racialized individuals on their own, rather than in a group, may also pose the risk of stigmatizing people of colour.

Positive aspects of the concept included the simplicity of the design, stressing the importance of addressing the issue of substance use, and the focus on naloxone as safety equipment. Placing responsibility on workers to carry and use naloxone is questioned, however, as information is not provided on where it can be found, when and how to use it.

While the overall message is specific to opioids, the headlines are more generically speaking of safety, and when combined with the visuals and colours, are reminiscent of a workplace safety campaign. Further, referring to a "safe space" at work was felt to be overused or not aligned with commonly-used workplace terminology. By contrast, the action-oriented term "gear up to help" held appeal, though associated by some as referring to obtaining drugs. The headers, "Talking. Listening. Supporting" and "Naloxone is safety equipment" were felt to be compelling reminders of the concept's main message.

From a design standpoint, some liked the vibrancy of the colours that would grab their attention, spoke to the construction sites, and was reminiscent of safety messages, while others found the colours to be too jarring and making the material unattractive.

Even Tough Guys Need Support

Reactions to the concept "Even Tough Guys Need Support" were more polarized, with some finding the concept to be attention-grabbing and the message to be clear, direct and concise, while others found that the imagery and the wording lacked credibility or personal relevance.

The message was understood as men who display strong and confident behaviours are sometimes in need of assistance and should reach out for support. While some appreciated the myth busting, others felt that the message is oversimplified and over generalized thus affecting its credibility. The stereotypes were further reinforced by the use of the term "tough guys" in English with terms such as "strong men", or "strong people" felt to be more appropriate. Some of the terminology in the French version such as "dur à cuire", "hommes forts", "hommes robustes", "crée un espace sûr", and "personnes confrontées" were felt to be too formal to be compelling, although no alternative suggestions were made.

Despite issues with the wording, the concept was effective for some in articulating the need for those who may not appear to be struggling to reach out for help. That said, the concept's imagery, colours and expressions clearly identified men in the construction industry as being the concept's target audience, notably those affected by substance use.

From a graphic standpoint, colours are eye-catching, but the use of drawings rather than images elicits mixed feelings. The use of illustrations was felt to be more relatable by some, while it lacked seriousness for others. Illustrating only men wearing beards was puzzling to many. While some felt that showing a male construction worker touching another man's shoulder illustrated caring, others felt that it lacked credibility based on their own worksite experience. Across components, the last social media post lacked clarity, especially for those who are not familiar with naloxone.

Preferred Concepts

Findings suggest that none of the three concepts examined outperforms the others on all aspects evaluated. In terms of concept preference and general strength, as well as the concept that is best at addressing the stigma associated with substance use and the concept that offers the best message, both "Let's Build Solutions" and "Even Tough Guys Need Support" were equally selected, and more highly rated than "Make Sure You Have the Right Tools." That said, the three concepts received only moderate appreciation scores.

In general, "Let's Build Solutions" performed well for its positive tone, specific call to action, focus on teamwork and a more encompassing message, while "Even Tough Guys Need Support" was chosen for its simple message that addresses the stigma of the tough guy not being able to seek help.

In terms of which concept is best at letting people know about the risks associated with substance use and how to reduce those risks, male participants were divided in their choice, while members from the general public believed that "Let's Build Solutions" and "Make Sure You Have the Right Tools" were most effective in doing so.

Opinions were mixed as to which concept performs best from a graphic presentation standpoint. "Let's Build Solutions" was liked for its serious design, use of photography and prominent feature of naloxone in the visuals. "Make Sure You Have the Right Tools" stood out for its bright colours, familiarity with safety messaging and the images being relatable. "Even Tough Guys Need Support" presented eye-catching colours and the use of illustration that was more relatable to some people.

Communication Channels

Best ways to communicate the message to the target audiences included at worksites, in public washrooms, in public transit, or on social media. To a lesser extent, television was considered an appropriate medium, or through trades associations or union representatives, or in public places where construction workers who are homeless may go (e.g., shelters, public libraries, malls).

Introduction

Context

In the last few years, the number of overdoses and deaths related to the use of opioids has increased exponentially to become a national public health crisis. Health Canada report that an estimated 22,828 people in Canada have died from what is likely an opioid-related overdose between January 2016 and March 2021. During that time, the negative effects of the COVID-19 pandemic are apparent, with an 88% increase in apparent opioid toxicity deaths occurring between April 2020 and March 2021 from the same time period prior to the pandemic.

Although the opioid crisis is a complex issue with broad reaching effects across the population, men in physically demanding jobs are at increased risk from opioid related harms, as young to middle-aged men account for three-quarters of apparent opioid overdose related deaths. A disproportionate number of these men are employed in physically demanding, male-dominated occupations, such as construction, trades, heavy machinery operation, and long-haul transportation.

In this context, Health Canada's Communications and Public Affairs Branch (CPAB) has been working on the development of a new creative concept and visual identity as part of the Department's multi-year marketing campaign to address the growing opioid overdose crisis. While the campaign aims at educating the public at large, the message is specifically targeted at men working in physically demanding industries. More specifically, the campaign aims to:

Objectives

In this context, Health Canada was interested in testing creative concepts developed as part of this marketing campaign. The test was designed to determine which concept resonates most with the targeted audiences, primarily men working in physically demanding industries, and secondarily, members from the general public. More specifically, the goal of the research is to:

Ultimately, results from this study will be used to assist Health Canada in making a final creative concept selection for production.

This report presents the findings of the research. It includes a high-level executive summary, the description of the detailed methodology used and the detailed findings of the online focus group discussions, including recommendations made. The working documents are appended to the report, including the recruitment screener (Appendix A), the moderator's guide (Appendix B), and the material reviewed (Appendix C).

Research Methodology

Target Audience

For the purpose of the study, there were two target audiences, namely:

Research Approach

The study included a total of 12 online focus groups conducted between February 2 and 7, 2022. The following provides a breakdown of groups based on location, language and audience:

Number of Online Focus Groups
Region Language Males in Physically Demanding Professions General Population Total Groups
BC (Vancouver, Thompson-Caribou, Fraser) English 1 1 2
Prairies (Medicine Hat, Edmonton, Calgary, Saskatchewan, Manitoba) English 1 1 2
Ontario (Thunder Bay, Sudbury, Toronto, Guelph, Ottawa) English 1 1 2
Quebec (Montreal, Québec City) French 1 1 2
Atlantic (Fredericton, Moncton, Halifax) English 1 1 2
Northern Territories and northern regions of provinces English 1 1 2
TOTAL   6 6 12

In total, 10 people were recruited for each session, to ensure at least eight participated. From 119 recruited individuals, 98 took part across all sessions. Each group discussion lasted approximately 90 minutes and participants received a cash incentive of $100 (general population) or $125 (males in physically demanding professions) in appreciation for their time. All group discussions were held in English with the exception of those in Quebec which were conducted in French.

Each general population group included a mix of gender, age, household type, employment status, occupation and education level. Male groups included individuals who were currently employed (or on-leave) from designated occupations. In each male focus group, eight participants were recruited from the trades and construction industry, while two participants were recruited from various other industries including transportation and warehousing; manufacturing; and transport and equipment operator (which included heavy and tractor-trailer truck drivers, material moving machine operators, cargo and freight agents, forklift operator / driver, machine operator, material handler, material mover, heavy equipment operator, backhoe operator, shovel operator, loader operator, bulldozer operator, and front end loader operator). Each male focus group also included three participants with supervisory roles. In addition, each group (male and general public groups) included a mix of cultural backgrounds, and aimed to include one or two Indigenous people.

All participants were recruited per the recruitment specifications for the Government of Canada. Recruitment was conducted through qualitative panels stored on Canadian servers, with follow up calls to confirm the details provided and to ensure quotas were met. Those with current or past employment in sensitive occupations were excluded from the research, in addition to those who have others in the household in this situation. These sectors included marketing, marketing research, advertising, media, public relations, graphic design, a political party, federal government, the field of drug treatment, law enforcement, and the medical and/or pharmaceutical sector. In addition, individuals who have been to at least five qualitative sessions in the past five years, those who have attended a session in the past six months, and those who have participated in group discussions related to evaluating forms, brochures or documentations were excluded from the research during the recruitment process.

Context of Qualitative Research

Qualitative discussions are intended as moderator-directed, informal, non-threatening discussions with participants whose characteristics, habits and attitudes are considered relevant to the topic of discussion. The primary benefits of individual or group qualitative discussions are that they allow for in-depth probing with qualifying participants on behavioural habits, usage patterns, perceptions and attitudes related to the subject matter. This type of discussion allows for flexibility in exploring other areas that may be pertinent to the investigation. Qualitative research allows for more complete understanding of the segment in that the thoughts or feelings are expressed in the participants' "own language" and at their "own levels of passion." Qualitative techniques are used in marketing research as a means of developing insight and direction, rather than collecting quantitatively precise data or absolute measures. As such, results are directional only and cannot be projected to the overall population under study.

Research Findings

Advertising Recall

Prior to sharing the creative concepts, participants were asked what, if any, public service announcements or advertisements from governments or public sector organizations they had seen or heard in the past couple of years concerning the use of substances such as drugs and alcohol. Across audiences and locations, there was moderate recall of such advertisements, with most recalling advertisements being on the topic of responsible alcohol and cannabis consumption. Television and social media were the most recalled sources for these messages, though radio, posters and billboards were also mentioned by some.

"Really vague recall – it's on the periphery. Some ads about weed and not driving, from the federal government. Saw it on CTV." – Male, Prairies

"Saw a couple [of ads] on a bus, about opioids, saying one in three opioid users die. My guess would be CAMH [sponsored it]." – Male, Ontario

"À propos du cannabis quand ils l'ont légalisé. Comme quoi ça ressemble à de l'alcool. Je les aie vu à la télé et aussi sur Facebook." (About cannabis when they legalized it. That it is like alcohol. I saw them on television and also on Facebook.) – Male, Quebec

"I can't remember it too well. Some years ago, some ad on cable TV for marijuana. But [my memory is] very faint." – Male, Atlantic

"I've seen some around town and in the paper, maybe Facebook as well, saying that Fentanyl can be dangerous." – General Population, Territories

"I have heard on the radio about drinking and driving – making sure you get a safe ride. A billboard as well, encouraging saying no to alcohol during pregnancy." – General Population, Prairies

Terminology

In a brief group discussion prior to seeing the concepts, participants were asked to define the term "substance use". In general, the term is understood as speaking of the consumption of substances such as alcohol, drugs, and medication for recreational purposes, in a way that affects someone's capacity or judgement. That said, it is sometimes associated with hard drugs such as heroin or cocaine, rather than cannabis, and with addictive medication, such as fentanyl, thus suggesting the concept of an unhealthy behaviour rather than a socially acceptable one. Indeed, the term generally has a slightly negative connotation rather than referring to the acceptable recreational uses of substances.

"I presume it means anything that changes your way of being – something that alters your physical and mental state." – General Population, Ontario

"Any foreign substance you put in your body, but it's not always abuse." – General Population, Territories

"Anything that alters your normal state. It's ok to have a drink, but if you have ten of them, use turns to abuse. Use is different than abuse. There can be benefits from use." – Male, Ontario

"Substance has a negative connotation to it." – Male, Ontario

"I'd say abuse instead of substance use – because then it's specific about excess." – Male, Territories

"Using alcohol or anything that affects your judgement, even medication" – Male, BC

When asked what would be the best way to refer to the use of different substances such as drugs and alcohol, socially, recreationally, and occasionally, many participants felt that the term "substance use" would still be appropriate, while only a few felt that the term "substance use" implied a more serious issue than the situation described (e.g., harsh drug use, or abuse of substances in general). No consistent suggestions were provided for a better descriptor, though many distinguished between the terms substance "use" and substance "abuse" or "misuse", feeling that "usage" implied more common uses of drugs and alcohol, and "abuse" denoted an issue or problem.

"[Substance use] is a pretty reasonable term. But addiction isn't spoken about enough. We really should talk about it." – General Population, Territories

The term "consommation de substances" elicited more negative connotations among French-speaking participants and was less commonly associated with the leisure consumption of a reasonable amount of alcohol or legal drugs. No other term was suggested as being more appropriate.

"Je pense que consommation de substances c'est vu de façon négative. Avant la légalisation, on pensait aux drogues illégales. L'alcool, étant donné que c'est légal, je ne pense pas à ça comme une substance." (I think substance use is viewed negatively. Before legalization, we thought about illegal drugs. Alcohol, since it's legal, I don't think of it as a substance.) – Male, Quebec

"Je n'aime pas le terme, c'est péjoratif. Comme si quelqu'un nous reprochait quelque chose. Aller prendre une bière, ce n'est pas de la consommation de substance." (I don't like the term, it's pejorative. As if someone was blaming us for something. Going for a beer is not substance use.) – Male, Quebec

"Je ne vois pas l'alcool comme une substance; c'est surtout un mot pour désigner des substances illégales." (I don't consider alcohol as a substance; it is a word to mostly describe illegal substances.) – General Population, Quebec

Concept Testing

Participants were presented with three advertising campaign concepts that each included one factsheet, one poster, one website banner and three social media posts. Each concept was presented and discussed one at a time, and the presentation order of concepts was randomized across groups to avoid any presentation bias.

Reactions Across Concepts

The following provides overall reactions across all campaign concepts:

Importance of addressing opioid use: Regardless of the personal appreciation for any of the concepts, many participants appreciated that the topic of opioid use was being addressed and felt that it was an important area of focus. Many who participated shared stories of experience in their networks with substance use, notably opioids, and reiterated the importance of the topic being addressed.

Need to recognize the presence of women in the construction industry: Despite men in physically-demanding trades being the primary target audience, participants across groups felt that the message should recognize the presence of women on worksites. Many participants were confused as to why the concepts did not provide the context to explain why men are targeted in the campaign. The approach was puzzling to many, as they recognize the presence of women in physically-demanding jobs, and the risks associated with substance use across gender. Further, given that some messaging spoke of supporting colleagues and creating a space to talk about substance use, many felt that women should be included in these actions.

"I didn't like that it is only geared to men. There are so many women working in these fields as well." [Let's Build Solutions concept] – General Population, Prairies

The tone in the visuals should reflect the tone of the message: The topic of addressing the opioids crisis is considered serious in tone, in contrast to some of the images of smiling people found in any of the three concepts, which evoked more of a relaxed and confident, even jovial environment. This was felt to be incoherent, while affecting the message impact and credibility. In addition, some of the concepts were understood as an implicit approval of use of drugs while at work and this was felt to be inappropriate and irresponsible.

"I feel the images are very happy and it is something I could use for a party invitation. It does not grab my attention because nothing stands out." [Let's Build Solutions concept] – General Population, BC

"Je ne comprends pas pourquoi on parle de drogue et d'overdose sur les affiches quand tout le monde a des sourires." (I don't understand why they speak of drugs and overdoses on the posters when everyone is shown smiling.) – Male, Quebec

While somewhat addressing the risks of substance use, the concepts do not efficiently address the stigma: Although the concepts somewhat communicate the importance of addressing the risks associated with substance use, none were seen as effectively addressing the stigma associated with it in an evident manner. In general, the three concepts were seen as communicating the need to provide support to address the consequences of substance use (through safety measures or carrying naloxone) and that the issue needs to be addressed and talked about. In some instances, the campaigns were seen as addressing the risks associated with substance use and how to address those risks. That said, none of the concepts are effective at addressing the stigma associated with substance use itself in a way that is recognizable to participants. However, the stigma of talking about substance use is somewhat addressed by all three concepts.

"In this world, the trades and construction can be very macho and lots of guys have a tendency to not show weakness and it is important to try to destigmatize that." – Male, Atlantic

There is a risk of further stigmatization by focusing on the construction industry: Implying that substance use is affecting specific industries may result in further stigmatization of those workers, notably within the construction industry. By implying that substance use is more prevalent in the construction industry, it further reinforces preconceptions that construction work means substance use. The concepts did not effectively explain why this industry was targeted, and the addition of information or statistics was felt to be needed to provide context.

"It is very focused on people working in construction or heavy machinery. I guess to me it seems that they are trying to raise awareness there is a higher rate of population in those industries that use drugs." – General Population, Atlantic

"I think it is good but I am wondering if there is statistics that back up about where it says, 'substance use and addiction are more likely to impact those in physically demanding industries'." – General Population, Atlantic

Featuring individual people from visible minority groups also poses the risk of stigmatization: Although showing racial diversity was appreciated, by showcasing people of colour in some instances, the concepts were seen as implying that drug use is more common in those groups. This perception was mostly heightened by singling out BIPOC individuals, rather than showing diversity in a group of people together. As such, it was felt that group images would minimize the stigma associated with any specific racial group.

"I feel we should make it more inclusive because just the thing of having a black person on the poster makes it very specific. It says that black people are more susceptible for drug use. It should target more communities on the same poster." [Make Sure You Have the Right Tools concept] – General Public, BC

Showing consequences of substance use would have greater memorable impact: There is a sense that to have a greater lasting impact, the campaign concept should more clearly identify the possible consequences of a substance use issue that is unresolved, such as losing your job or family, dying, having an accident, or causing an accident in the workplace. Seeing naloxone was appreciated in many of the tested concepts, but juxtaposed with happy workers, this was seen as a mis-match and that if naloxone is shown, it should be shown in a photo showcasing a situation where it should be carried or used.

"Le problème c'est que t'essai d'empêcher une overdose. Il faudrait montre le problème, les conséquences; ce serait mieux. On dirait que la consommation est banalisée. On ne montre pas le problème comme si c'était grave." (The problem is that you are trying to prevent an overdose. We should show the problem, the consequences; that would be better. It seems that consumption is trivialized. We do not show the problem as if it were serious.) – Male, Quebec

"Je ne comprends pas la stratégie de dire de consommer plutôt que de parler de conséquences." (I don't understand the approach to speak of substance use rather than talking about the consequences of it.) – General Population, Quebec

"They need to be real. I have seen UK ads that are very dark, ads like that where they stick in your head. Show the consequences. You do heroin you will be on the street." – Male, BC

The invitation to step in and support coworkers is considered unrealistic in the context of some workplaces: Although deemed a good idea in theory, the invitation for coworkers to reach out to someone who is struggling with addiction is not widely considered realistic given the risk of serious professional consequences. In fact, many mentioned that it is unlikely that someone dealing with addiction will reach out for help, for fear of being fired and not being able to find work elsewhere. As such, it was believed that a workplace protection program is needed in support of this public education campaign, along with an education campaign specific to employers and supervisors. A confidential 1-800 phone number was also suggested to seek assistance.

"Si quelqu'un a besoin d'aide, il faut l'aider. Mais où sont les ressources?" (If someone needs help, we have to help them. But where are the resources?) [Let's Build Solutions concept] – Male, Quebec

"As far as the message it is telling us it is ok to reach out for help. This is the government telling us that. A company or people we work for if we were to come clean [to] the company, the boss might not be very sensitive. It becomes a fear of losing your job." [Even Tough Guys Need Support concept] – Male, Atlantic

"With all three of these [concepts], the first feeling I get when I look at these is I get frustrated and I think of all of the reasons that systemically people cannot do what these posters are asking people to do [open up about substance use]. Talking openly in the workplace? They will report you to the police." – Male, Atlantic

"More than likely if you were to bring up drug abuse to your boss or coworker you would not see the next day at work. Period." – Male, BC

Overall, campaigns A (Let's Build Solutions) and C (Even Tough Guys Need Support) received more positive reactions from participants compared with campaign B (Make Sure You Have the Right Tools): Males were somewhat more likely to favour campaign B compared with members of the general population. Overall, Males were most likely to think campaign A was strongest. Males in Quebec had the most affinity for campaign A.

The following provides an overview of the reactions specific to each of the three campaign concepts:

Concept A: Let's Build Solutions

The following provides an overview of reactions specific to the "Let's Build Solutions" concept.

Overall reactions to this concept were modestly positive, notably for the message's positivity and wide-reaching appeal. Although the message conveyed appears to be the most appreciated across concepts for its serious and positive tone, many of the statements' play on words combined with the generic images of people in workplaces made participants note that the approach looked light, generic and as would be expected of government. Some had impressions that the overall look was "corporate" or overly official. Yet still, it was appreciated that the tone remains hopeful and somewhat engaging in how it speaks of solutions and collaboration. Some participants found the campaign to be overly busy and even overwhelming.

Overall, the material was less likely to grab the attention of those in Quebec and Ontario compared to those from Atlantic, BC, Prairies or the Territories. Indeed overall, those in Quebec and Ontario rated this campaign lower than those located elsewhere in the country.

"I find it overwhelming – just a lot. There is so much to look at. I pay less attention because there are so many pictures. I like the third social media though because it's simpler." – General Population, Prairies

"It looks too complex, like corporate; like something in an office." – Male, Ontario

"Ils disent de regarder ce qui se passe à côté de nous pour voir si tu peux aider quelqu'un. Que quelqu'un qui consomme c'est l'affaire de tous. Mais je ne me sens pas concerné parce que je ne connais personne dans mon entourage qui sont dans cette situation." (They are saying look at what is happening around you to see if you can help someone. That someone who uses substances is everyone's business. But I don't feel concerned because I don't know anyone around me who is in this situation.) – General Population, Quebec

The concept conveyed the message that solutions are available to address substance use among workers, with solutions that entailed a collaborative approach. The campaign clearly communicated that addressing substance use, whether it be alcohol, drugs, or medication, is achievable when engaging a community of people. Terms like "solutions," "build," "support," "talk," and "help" clearly conveyed a positive, inspiring tone with a caring approach.

"The messages are action oriented, which is good, asking you to do something – be supportive, be ready to take care of someone if there is an overdose. Be ready to use naloxone." – Male, Territories

"I like that they are trying to open up a safe space to talk. There are stigmas to be tough. This message to foster a safe space is great." – General Population, Ontario

"[The intent is to] educate people and make them more mindful of what is going around them." – Male, BC

"J'aime l'accent sur l'entraide parce que les personnes en détresse ont de la misère de demander de l'aide." (I like the emphasis on helping each other because people in distress have a hard time asking for help.) – Male, Quebec

"Let's build solutions, let's get involved. It prompts me to get involved. There are solutions." – General Population, BC

While there was a general appreciation for the topic of substance use to be raised, it was believed by a few that addressing the causes of substance use is required to affect change.

"It is not drugs that is the problem. There is no awareness for people dealing with substances and mental health issues." – Male, BC

A few also felt that asking people to have naloxone available was unrealistic and difficult to implement, especially for those who are not familiar with opioid use or addictions.

"C'est ridicule de parler de naloxone; ça ne se trouve pas sur les chantiers de construction. Avec un message comme ça, personne ne va savoir quoi faire." (It is ridiculous to talk about naloxone; you can't find that on construction sites. With a message like that, no one will know what to do.) – Male, Quebec

The specific messages communicated by each of the concept components are clear with the exception of the last social media post. The play on words that use construction terms to reference collaboration (Let's build solutions) in some components is effective at conveying the intended message appropriately, with the exception of the last social media post which could be interpreted as having a double meaning. The header, "if you are going to use drugs, don't use alone" implies an invitation to use substances as a group, rather than seek assistance or warn someone else of personal consumption as a safety measure. It was suggested to reword the statement to something like: "if you are going to use drugs, let someone else know to keep safe." Further, many underscored the importance of not promoting or implying that it is ok to use drugs while at work.

"I find the crew up post funny – 'let's see if you can get your buddy hooked on this too' – It sounds like you are encouraging substance use." – Male, Territories

"I look at the social media and I see this 'crew up' thing, which tells people to use drugs together. I don't like that wording at all." – General Population, Ontario

"The crew up one would be a joke – the part about 'if you are going to use drugs don't use alone' – I like that it is not shaming it, but it may not be taken seriously either." – General Population, Territories

"Support your group could be to go out for a beer after work. It has a double meaning." – Male, BC

"On the last social media, it may be interpreted to do drugs together. They should say, 'tell somebody if you are going to use drugs.'" – General Population, Atlantic

The message was felt to have more widespread appeal, while still primarily targeting those working in physically demanding jobs, including both workers and supervisors. The visuals identified workers in physically demanding work environments, though not specifically targeting construction workers or tradespeople to the same extent as the other concepts. As such, this concept held more widespread appeal across industries, as well as for those who are in networks around people affected by substance use. The message is also directed at both workers and supervisors in playing a role to address substance use. Terms like, "create a safe space", "support your crew", and "building solutions" pointed to supervisors, while terms like "if you or a team member", and "crewmates" suggested that coworkers need to get involved. That said, these messages also had a negative impact on some participants, who felt that management or supervisors would not be open to having these discussions, or having these discussions take place at work, and as such, the messaging was unrealistic. In some cases, however, supervisors indicated that the ads would prompt them to start thinking about their own crewmates, and felt that the message was an important one to communicate.

"It reminds me way too much of 'Bell Let's Talk,' but it's B.S. It talks about a safe space, but it is not going to happen at a work site. Management doesn't want to hear about it and no one is really going to talk about their problems. This ad makes me angry." – General Population, Ontario

"It's a nice way of beginning a conversation around substance use and abuse. I appreciate that it draws attention to lessening the stigma. People would maybe feel inspired to reach out to coworkers and discuss safe ways to use substances. It's good that it doesn't try to stop people from using substances, but just starting a conversation instead of being judgemental." – General Population, Territories

"I'm not sure I believe people would own up to it for fear of losing their jobs." – General Population, Ontario

"I'd actually start thinking about the guys I work with – wondering if someone is struggling. It's pretty important." – Male, Territories

"I do think this one is a little different in that it is not so much targeted towards those using but more to those around those who might be using – create a safe space; support those around you." – General Population, Atlantic

That said, some participants felt that the message was mostly directed at individual workers and supervisors, rather than engaging employers to be part of the solution. Indeed, the fear of workplace consequences (e.g., losing a job) is an important barrier to reaching out for assistance from coworkers. It was believed that an outreach initiative to employers would be required to support the campaign message.

"It is putting the responsibility on the individuals where it should be putting the responsibility on the employer." – Male, Atlantic
"I think it is targeting labour jobs. Demanding jobs but also employers and companies where it talks about building solutions. Not always can workers work on solutions but the employers can." – Male, BC

The concept was felt to suggest that men are more likely to be vulnerable to substance abuse, and that substance use should be normalized. Participants felt that illustrating men implied that they are most vulnerable to substance use, and that the concept was communicating that substance use is 'normal' and should be talked about. Many commented that the message was not judgemental about substance use, but rather that it was clearly trying to encourage discussion and support among individuals who may be struggling. While this was seen as a positive step in the right direction, it was believed that to be effective, the message should encourage those using substances to reach out for assistance, or at least to accept assistance when it is offered.

"I feel that if you were to walk up to a coworker that has an issue and hand him a pamphlet or a link to the website, they would think it is insulting and that it's none of your business. When someone needs help, they have to want it first." – Male, Atlantic

The graphic presentation was felt to be more serious and what is expected of government, though less eye-catching. The use of a white background combined with a collection of images featuring real people resulted in a design that is expected of government. While some felt that this lends credibility and supports the serious nature of the message, others felt that it lacks the visual appeal required to elicit interest. Nonetheless, the use of real people and bright colours is liked, while the use of too many images (notably on the poster, factsheet and website banner) caused many to find it cluttered and busy. Some felt the graphic elements (coloured boxes) were unnecessary "clutter" and created a dated, corporate look.

The use of models who were smiling was felt to take away from the serious message and tone of the wording. Indeed, some felt there was a clear disconnect between the smiling, happy faces, and the serious message to address substance use and prevent overdoses. That said, the situations shown were felt to be positive and supportive, namely the scenes of two individuals talking, coupled with the message of building solutions.

"The blocks of colour don't make sense – it doesn't look like construction." – Male, Territories

"The images look distracting with the white borders and boxes. It's distracting… it needs to be simplified." – General Population, BC

"It looks like a beer ad because everyone is so happy. It almost looks like it is promoting drinking on the job, going from the visuals." – Male, Ontario

"This whole thing is way too happy and too cheery. The construction worker looks fake; no one looks sad or dirty. Maybe you should have someone that looks like beat up in some way." – Male, Atlantic

The language used contributed to grabbing attention and conveyed a positive and supportive tone, despite some issues. The short, catchy, and positive headers were felt to be attention-grabbing and, in some instances, motivating to continue reading or take action. The use of directive verbs – support, build, need, help, know – grabbed attention and engaged some readers. Although the message was found to be supportive, it also lacked credibility for many, who felt that the call to action to speak up was not possible, given the fear of losing one's job. As such, there were recommendations from participants to offer confidential contacts or other suggestions, such as speaking to a union representative or member of an HR team to talk.

"I like that it says 'let's build solutions' – it gives hope, like there is a way out." – Male, Prairies

"I like the idea of supporting your crew. That creates a team environment. You should have each others' backs. If your coworker isn't performing at standard, then everyone's safety is at risk. But I really disagree with the crew up one. I don't like the message of not doing it alone. It gives permission to encourage friends to do it as well." – General Population, Prairies

"It's aggressive, but in a good way – take the bull by the horns kind of way. 'These are the issues, let's find some solutions.' I find that uplifting; that there is hope. The wording keeps it serious as well, just get rid of all the smiles." – Male, Ontario

"The message is to talk about it on the job site, but that's not believable. No one will have a conversation about drug use without fear of losing their jobs. They should have someone they can speak to – speak to your rep, or your HR, so that it is clear who you can speak to confidentially." – General Population, Territories

The images used were felt to be relatable, but at odds with the seriousness of the messaging. Participants noted that the images of discussions were relatable to those working in construction trades, but were not realistic in that the models used looked too happy and upbeat to be discussing such a serious topic. Further, although the inclusion of alcohol in the context of substance use was felt to be appropriate by some, others felt that the beer bottles shown communicated a notion of 'partying' or 'celebrating', which was at odds with the general theme of support and opening up dialogue about substance use.

Some participants felt that it would be important to show images more closely related to the topic. For example, in the materials discussing overdoses, some felt that showing an overdose, or a serious situation would be better than showing images of men working.

"It's relatable, it looks like my workplace, and it acknowledges something that is the right thing to say – that addiction is more likely to impact people in these fields." – Male, Prairies

"They look too happy to be having a substance abuse problem." – General Population, Ontario

"Showing naloxone is effective, but it should be more specific. Good to include, but show more information like when you should use it or where to get a kit." – General Population, Territories

Some participants found the lack of female models and choice of race of models to be problematic. Throughout evaluations of this concept, many pointed out that the exclusive focus on men in images felt exclusionary. More inclusive wording such as "…those who work in…" rather than specifically naming men was felt to be inclusive of all genders, though not properly represented in the images. Further, some felt that the placement of certain individuals of colour could be construed as racial stereotyping vis-a-vis propensity to use substances.

"It is very male focused. I work on a remote site. There are women on these crews who struggle with these issues as well, so it is really lacking inclusivity." – Male, Territories

"When I see, 'substance use and addiction are more likely to impact those who work' or 'industries like yours;' when I hear that language, I think of both genders but in the pictures, I see only men." – General Population, Atlantic

"The fact sheet and the poster have images that seem quite racially targeted to me." – General Population, Territories

The concept's call to action was moderate. After seeing the concept, some participants indicated that they may reach out to others in their teams to check in, while others felt that they may seek out and carry naloxone as a result of seeing the ads. That said, many others felt that the concept would not result in any action on their part.

"I might actually get naloxone and carry it." – General Population, Territories

"It might make me more aware. Now I know what a naloxone kit looks like. It's a good idea to have one." – Male, Ontario

"I would read about it in the lunchroom. But not sure I would carry naloxone because I wouldn't want to be responsible for administering it." – Male, Ontario

Final participant advice included suggestions to include a wider audience, make the intended actions clearer, ensure the tone and expressions of the models match the seriousness of the subject, and include specific advice about where to go for a confidential conversation about substance use. Participants offered several key suggestions to clarify and improve the concept, including the following:

Concept B: Make Sure You Have the Right Tools

The following provides reactions specific to the "Make Sure You Have the Right Tools" concept.

This concept elicited mixed reactions, with an attractive design but a less strong message. In general, the simplicity of the design and key words grabbed attention – particularly "Naloxone is essential safety equipment." For some, the information about naloxone was a positive, clear message, while for others, featuring this drug caused some issues. In particular, some participants felt that highlighting the use of naloxone may present a burden or create an expectation on non-trained individuals to administer the drug, which was not viewed as a comfortable situation for all. In Quebec, a few male participants working in trades either did not know about naloxone, or had never seen it available on work sites, thus lessening the message's clarity and credibility.

"It makes me angry – that they're saying 'Gear up to help' – like they are promoting naloxone, but the safety officers are the ones that should be doing it, not everybody." – General Population, Prairies

"It looks like a workplace safety campaign and I'm torn on that. I've heard that men in trades are a high-risk group for opioid overdoses and maybe that's a way to target the group, but again it looks so much like a safety campaign that the point may be lost." – Male, Territories

"La naloxone est un équipement de sécurité essentielle, ben voyons, personne n'a ça sur un chantier." (Naloxone is important safety equipment. Seriously? Nobody has that available on work sites.) – Male, Quebec

The message was felt to lack clarity for general population participants particularly, and implies that substance use is prevalent only in the construction industry. By contrast, males in the trades felt that the concept targeted them and was effective at speaking of safety. This concept was seen as primarily focusing on the use of opioids, rather than the use of various substances.

"I do not like that it is only geared towards opioids although substance abuse is inclusive of alcohol and other drugs." – General Population, Atlantic

At a glance, the headers and images do not convey the message of addressing addiction, but rather speak of workplace safety in general for many. As such, statements like "gear up to help," "make sure you have the right tools," "be safe on and off the job," and "talking, listening, supporting" did not identify the topic in a way to elicit interest in reading more. That said, once reviewing the components in more detail during the testing, participants were left with the impression that substance use (and to some extent, abuse) is prevalent in the construction or trades industry, with the issue in need of being addressed. Some particularly appreciated the acknowledgement of the situation on the job site as a safety issue, and appreciated that there was a strong message to try to lower the stigma associated with substance use.

"This campaign is socially unacceptable. To me this is an ad saying it is ok to work on a construction site when you're high because someone will be there to save your life. The general theme of saying 'it's ok to build while high' is not ok with me." – General Population, Ontario

"It's good – saying get the right tools, and lowers the stigma of asking for help. That's really important." – Male, Prairies

One message received was around the importance of having naloxone on work sites as a key piece of safety equipment. The messages and imagery around the importance of having naloxone was appreciated by many, though there were some concerns around the implications of wide use of naloxone, what the responsibility was for someone carrying it, and whether this should be widely used. In addition, participants were looking for more information about where naloxone can be purchased or acquired, and in what circumstances it should be used. There appeared to be differences of awareness and knowledge regarding the availability of naloxone, with Atlantic Canadian participants more likely to be aware that it is available to the public at pharmacies.

"Naloxone needs to be explained." – Male, Ontario

"It's great that they say to bring naloxone or Narcan as part of a standard first aid or response kit." – General Population, Ontario

"I'm confused – why is naloxone a tool? Does everyone need to have it?" – General Population, Prairies

"I've never seen a [naloxone] 'doser' before. It's good that they show it. I didn't know what it was at first. I'd like to see how it's used, and when you're supposed to use it." – Male, Territories

"You're putting people in the position of healthcare, to take responsibility with naloxone." – General Population, Ontario

"They should show how it's used – show an emergency response personnel, a worker on the ground and a coworker administering naloxone." – Male, Territories

"Yeah, like now I have to buy that thing and keep it in my tool box?" – Male, Territories

"It is more informative about how to save someone from an overdose, with the naloxone kit because a lot of people are not aware of that. Gear up to help, make sure you have the right safety equipment." – Male, BC

The imagery was somewhat problematic but did grab the attention of many participants. The look of the concept was found to be visually arresting for many participants and attention grabbing. The similarity between the creative approach for this concept and general safety messaging on some work sites was both appealing (for being familiar) and something that was felt to be ineffective (that it wouldn't stand out).

"Ça a l'air d'une campagne de la CSST et je ne vois pas le but à première vue." (At a glance, it looks like a workplace safety (Quebec workers compensation board - CNESST) campaign and I don't see the point of it.) – General Population, Quebec

Participants were quick to point out that the subject was serious, and as such, the models should not be happy or jovial, but should instead look as though they are realistically having a conversation about substance use.

"I'm puzzled by it. They are talking about opioids and people are smiling. It doesn't look like it's being taken seriously." – Male, Ontario

"The main guy is too happy. If someone is struggling, they aren't happy like we're going to a party – it would be more effective if a more realistic emotion was shown." – General Population, Ontario

"The design is decent; the yellow stands out. But the smiling is weird." – Male, Ontario

Many expressed concerns over the choice of only having male models shown, as well as the presentation of certain ethnicities, though the concept was also seen to be communicating that anyone could be vulnerable to substance use. Unaided, many participants expressed concern at the lack of female models in the concept, while others indicated that showcasing a single individual who was a person of colour may stigmatize substance use further, communicating that people of colour are more likely to be substance users.

"I am having trouble getting past the fact that they are saying that people of colour are the ones having the drug issues." – Male, BC

"I just don't know why it's all male-presenting." – General Population, Territories

"It's a bit too much saying that construction workers have a problem with substance use. That's the message. And sometimes people in trades do have problems, but it should be wider, and show some women too. Anyone gets some income and sometimes they turn to drugs." – Male, Territories

The concept using 'everyday' individuals gave the impression to some that substance use cannot always be seen, and that anyone could be having issues with addiction, thus the need to support and talk about the topic.

"It says don't look down on anyone. It can be anyone – everyday people could have substance abuse issues." – Male, Prairies

Males in the Atlantic Canadian groups felt that the imagery and wording were not realistically representing construction workers in how they dress, relate to each other and speak, and as such, the message lacked some credibility.

"You should try to figure out how construction workers communicate with each other and view each other and talk to each other. This whole campaign looks so perfect from a government point of view. Everything is nice, neat and tidy in the pictures and the statements. But in the real world with drugs and with construction, things are messy, things are out of place, things are scattered." – Male, Atlantic

The bright colours received mixed reactions, with some appreciating how the bright and bold colours would grab their attention and be reminiscent of safety on work sites, while others felt they are too jarring and take away from the messaging. In some instances, the colours being reminiscent of safety campaigns may not attract attention.

"It's bright and grabs your attention. High viz! I think of my workplace immediately – I work in the mines and this looks like it's in the mines." – Male, Territories

"Using safety colours gathers attention. I like how they are bringing it to the construction industry, and the positive image, talking about positive solutions." – Male, Prairies

The language used was felt to be straightforward and clear, though the use of some phrases was criticized. In particular, many males working in the trades critiqued the use of the term "safe space," feeling that it did not resonate with them – being a term that could be overused.

By contrast, the term "gear up to help" was lauded for being action-oriented and clear to the reader. In Atlantic Canada, however, this expression was somewhat associated with the idea of obtaining drugs, thus presenting an issue in the context of the concept message.

"I like the 'right tools' language. It should put opioids right at the beginning though so it's less confusing. Change it to a question like 'do you have all your tools today?' – then I'd pay more attention." – Male, Ontario

"The thing about 'gear up to help' – there's something there that grabs me. PPE, makes me question what we have." – Male, Territories

"The term 'safe space' is grating. When I hear it, I immediately lose interest – it's so overused. Anyone who has any kind of problem now needs a safe space." – Male, Territories

In the Atlantic Canadian male focus group, however, the term "gear up" was associated to drug lingo by some, thus causing confusion.

"Are you guys trying to use drug lingo in order to get a reaction or read more? When someone grabs gear, they are talking about drugs. This is confusing because you are trying to get a connection with the users but not in a proper way." – Male, Atlantic

Despite the headers speaking of broad workplace situations, the first and last social media posts were most appreciated. The header of the last social media post ("Talking. Listening. Supporting.") elicited interest and was felt to be compelling, along with the message that "Naloxone is safety equipment," which was felt to be a clear acknowledgement of the need for this equipment on site. Those working in construction trades felt that the concept, and these posts particularly, were targeted towards them, something they felt was important and needed.

"It's really attention-grabbing, but only for those in construction. It says they are the ones who use substances." – General Population, Ontario

"[Saying that] 'Naloxone is essential safety equipment' is right on. The message grabs you and it's clear." – Male, Ontario

"It really speaks to guys in the trades, a group that is especially hard hit with opioids." – Male, Territories

"I was looking at the social graphics – talking, listening and reporting – people are not alone in this." – General Population, BC

The target audience is considered to be men in the construction or trades industry. The construction-related words or expressions ("gear up", "safety equipment", "tools") combined with the visuals and colours clearly point to men in the construction industry or tradespeople as being the target audience. While some appreciated this as a way to talk about an issue that is not typically openly discussed, others felt that it overly targets this industry, and could imply that construction workers are more prone to drug use. Though appreciated, the use of people of colour, especially when shown as individuals rather than in a group, implied to many that these individuals are more susceptible to drug use, which was felt by some to be racist.

"It's the construction industry. It's me. It's about safety." – Male, Prairies

"It is for employers. General people aren't going to carry naloxone. It's really geared towards employers in construction." – General Population, Ontario

"It's not for me, it's about naloxone. It's someone else. I don't know anything about it. I'd just call 911. Maybe they would get it on construction crews." – General Population, Ontario

"I like the diversity, but I'm curious why people of colour are included in an issue about substance abuse, like they're being singled out with drugs." – General Population, Prairies

"The fact sheet and poster have images that seem quite racially targeted to me." – General Population, Territories

The intended action is understood to be a directive to carry naloxone, as well as asking people around those with substance use issues to offer to talk. Many participants working in the trades indicated that they would ask about naloxone as a consequence of seeing this concept, as well as offering to help or talk to others in their workplace. By contrast, general population participants felt that the concept wouldn't have an effect on them.

"I'd be more available to talk to people, offering help, tell people to go to the site." – Male, Prairies

"I'd grab a naloxone kit." – Male, Ontario

"I would try to talk to someone, but I'm not sure anyone would." – Male, Territories

"I wouldn't do anything. I'm not involved in this trade. But if I was, I hope I would get in there and learn how to use naloxone." – General Population, Prairies

Final participant advice included to widen the audience, ensure a consistent, serious tone, and include more specific instructions. Participants offered several key suggestions to clarify and improve the concept, including:

Concept C: Even Tough Guys Need Support

The following provides reactions specific to the concept labelled, "Even Tough Guys Need Support."

Overall, the "Even Tough Guys Need Support" concept received both positive and negative reactions, with participants finding the concept to be attention-grabbing and straightforward in its messaging, but issues with some of the wording and imagery. Participants found the bright colours of the concept to draw their attention, along with a bold, but polarizing style of showing images. While some found the drawings to be relatable, others found them to be childish or laughable.

"It's a really important message, but the cartoony images take away from that. It takes strength to reach out – that's true. Men in trades think they are indestructible and they're not." – Male, Territories

"At first I thought 'this is so cheesy!' but the message is on point. It's actually effective because it's so cheesy." – General Population, Territories

The message caused some confusion and lacked credibility for some, while others felt it was understandable and important as a message. The concept was viewed as suggesting that if men who display strong and confident behaviours are sometimes in need of assistance, they should reach out to get support. This approach was felt to be unrealistic, as there is a belief that those men are unlikely to feel compelled by this invitation to reach out. The concept does not effectively convey the need for those around to step in, something that may be more effective in helping to address the situation. Further, it was articulated that substance use affects people regardless of their appearance of strength, such that the message to reach out for help should be somehow broadened. That said, the message was also felt to be understandable and important to communicate. Finally, the underlying message of needing to reach out for help if experiencing substance use issues was appreciated, but some of the wording was problematic.

"It's an understandable message – it takes strength to reach out." – Male, Ontario

"Even if you change tough to strong, it still has too many red flags for me. The terminology and concept of tough guys is not a broad enough audience. It pushes people into a box." – Male, Prairies

"I kind of giggled when I saw it. It looks too cute, but it's a less wordy message, and it is clearer what they are getting across." – General Population, Ontario

"The word 'addiction' stands out – talking to someone who has a problem." – Male, Ontario

"Tout ce que je vois c'est des hommes en construction et ils disent que c'est pas parce qu'on on est fort qu'on peut pas passer a travers. Et on dit que c'est les gens les plus forts qui sont plus susceptible de souffrir." (All I see is men in the construction sector and they say that it's not because we are strong that we cannot get through. And it's said that it's the strongest people who are more likely to suffer.) – Male, Quebec

The use of an overdone stereotype of construction workers being labelled "tough guys" in the English concept was felt to be problematic. In fact, the term "tough guys" in the English concept is construed pejoratively by many when associated with a construction worker, as it supports preconceived ideas of the type of person in these trades. Further, the term is often used sarcastically, so was not deemed to be effective in its messaging. That said, the concept of someone needing to be strong to seek help, and that help is available and should be sought, even when there is reluctance, was felt to be a positive and necessary message. As with other concepts, there were many participants who questioned why the concept was focused only on males, and calls for the materials to be more inclusive.

"It's not just tough guys, it's everyone. It focused too much on the tough people. But everyone needs help. I find it a turnoff because other people have addiction issues." – Male, Ontario

"There is overuse of 'tough guy' – it's patronizing – like how I would talk to a child." – Male, Territories

"Everybody has struggles – even pro sports players – they need to talk to someone too. Having the strength to ask for help is hard to do. This would definitely encourage me to get help or any of my friends." – Male, Territories

"I like the 'different kind of strength' message; that works – opening up and talking about the fact that there is an issue. But the tough guys' language should go. It should definitely be more diverse. Women work in these industries and struggle too." – General Population, Territories

"It is singling out tough guys but what is a tough guy?" – Male, Atlantic

English terms such as "strong men" or "strong people" were felt to be more appropriate for some to evoke the concept of strength. To remove some of the negative association with the term "tough guys," participants suggested that the use of the terms "strong men" or "strong people" or "tough crew" could be more appropriate, along with other suggestions such as "hard worker" or "dedicated employees," or even "sometimes we just need help." Nonetheless, it was believed that all men or people are at risk of having an issue with substance use, not only those who appear to be strong.

"I'm not a big fan of the tough guy message – it misses the mark for me, it's derogatory. If I were trying to insult my friend I would call them a tough guy, so it doesn't open the conversation. It talks down to someone. You could offend someone with it – like 'hey tough guy.' Change it to strong people or something like that." – Male, Prairies

"The tough guys thing – that's kind of condescending. It's too much of a stereotype. We're beyond that. Say that even dedicated employees need support, or hard workers, or strong people – that's better but even that – we all need help, everyone. Just say that." – General Population, Ontario

French-speaking participants felt that the language used in the concept was not close enough to spoken language that might be used on work sites, which in turn affected the concept's personal relevance and credibility. More specifically, French terms like "dur à cuire," "hommes forts," "hommes robustes," "crée un espace sûr," and "personnes confrontées" were felt to be too formal to be compelling to the target audience. No alternative wording suggestions were provided.

"Les durs à cuire et demander de l'aide, les tournures de phrase ne viennent pas me chercher." (Tough guys and asking for help; the type of language isn't compelling to me.) – Male, Quebec

The clear message of the concept for those who are struggling to reach out for help was appreciated by many males who indicated that help with substance addiction must start with the affected individual. Further, the message to 'speak up' was felt to be a good reminder, and an important topic to have out in the open.

"What caught me was the tough guy – got me to look twice at the ad, made me think about how many guys are actually using around me in my workplace." – Male, Ontario

"The message is more focused on the substance user to have the strength to reach out for help, whereas the other campaigns were more focused on encouraging others to reach out and help those who are struggling. But it does have to start with that person who is struggling, so it works." – Male, Territories

"It's compassionate – makes you understand how serious it is, that it takes a different kind of strength to reach out. Makes you understand." – General Population, Prairies

"I don't like the tough guy phrasing, but I understand there are issues that are more predominant for men. And if there are particular struggles with males, they should be targeted, but just don't show this where women could see it." – General Population, Territories

"The message is good. It is trying to empower the person who may have an addiction to reach out and making them feel that it is not a bad thing to need some help." – Male, BC

"C'est un encouragement à demander de l'aide. Ce n'est pas les faibles qui demandent de l'aide; il faut être fort." (It is an encouragement to ask for help. It is not the weak who ask for help; you have to be strong.) – General Population, Quebec

"This one is for the person struggling with something, asking them to reach out for help. The other ones were asking the friend to help them." – Male, Territories

The target audience was considered to be exclusively men in the construction industry, particularly those affected by substance use. The yellow, black and orange colours, the images of men wearing safety vests, and the use of words such as "spotter" implied that men in the construction or trades industry were targeted by the message. Despite it being clear, the decision to focus on men in a specific sector was questioned by most, as discussed earlier in this document.

"This is for men in construction. A stereotype. Leaves out women on the site." – Male, Ontario

"This is construction, or a blue collar focus, a little more generic, but talking about males in the workplace." – General Population, Territories

"It's stereotypical. It's all me – implies that women and non-binary people are not susceptible to substance abuse." – General Population, Ontario

"I have no issue with it being all male because there are 99% men in my workplace, and males don't want to talk. It's a male problem. It hits the mark." – Male, Prairies

"It's for guys in construction or maybe heavy machinery; just men but I think this should apply to everyone – more industry." – General Population, Atlantic

From a graphic standpoint, colours are eye-catching, but the use of drawings rather than images elicits mixed feelings. The bright, bold, and contrasting colours grab attention, and the contrast between the background colour and the text makes the headings stand out. That said, the use of drawings rather than photography lacked credibility for some, and the portrayal of men only wearing beards was questioned, sending a message to some that tough guys all have a beard.

"The cartoon made me chuckle. It's a silly stance to take for something so serious. It takes away from the credibility." – General Population, Ontario

"The drawings are too comical, too happy, but they do grab your attention, even though they are cheesy." – General Population, Territories

"Le graphisme, les dessins je ne les aiment pas. C'est quasiment regarder une bande dessinée de Lucky Luke. Et on est tanné de l'image de l'homme dur du gros cabochon, c'est une insulte." (The graphics, the drawings I don't like them. It's almost like watching a Lucky Luke comic. And we are tired of the image of the tough guy; of the 'dumb;' it is an insult.) – Male, Quebec

In addition, portraying men on construction sites offering comfort or support by touching each other was felt to be unrealistic for some, although the supportive gesture was felt to be important to other participants. On the other hand, some felt that using drawings rather than photography grabbed their attention and made the images more memorable, as well as relatable to a wider audience, as they were less specific. The images themselves were appreciated by some for being more generic and less specific to one particular industry.

"The hand on the shoulder is better than just having guys chatting. It does a better job of suggesting the guys are having a conversation about a serious topic and that one guy is supporting the other." – Male, Territories

Some of the components lacked clarity, notably the last social media post. With some people not knowing about naloxone, the message conveyed by the last social media post is unclear to many, suggesting that a realistic image of naloxone should be used (rather than a drawing and/or package). In addition, a few participants were under the impression that the naloxone package was black, thus being confused by seeing one that is white.

"I didn't know what naloxone is – is that what it really looks like? They should show a real picture of it." – Male, Ontario

Final advice included to update the wording, expand the target audience, and include more specific information about where to seek help. Participants offered several key suggestions to clarify and improve the concept, including:

Preferred Concepts

Following the discussion of each of the three concepts, participants were asked to choose which one was most effective at achieving different things. The following provides an overview of those choices:

Channels

In some of the focus groups, where time permitted, participants were asked to briefly describe how the information from the concepts reviewed could be best conveyed to them. Participants' suggestions included:

In addition to advertising directly to workers and supervisors through these means, it was suggested to direct specific information about creating safe workplaces to employers/construction companies.

Conclusions

The following provides broad conclusions from the summary of research findings.

The term "substance use" in English is most commonly seen as speaking of the consumption of substances such as alcohol, drugs and medication for recreational purposes, but in a way that affects someone's capacity or judgement.

While the term "substance use" in English was considered to speak of the consumption of various substances that affect someone's health or judgment, it was somewhat associated with the idea of abusive or unhealthy consumption, and to a few participants, it implied stronger drugs (e.g., fentanyl, cocaine, heroin) or illegal substances. Nonetheless, the term "substance use" is still considered the most appropriate term to speak about the use of substances such as drugs and alcohol, socially, recreationally, and occasionally. By contrast, the term "consommation de substances" in French elicited more negative connotations.

While reactions to the three concepts tested varied, a number of areas elicited similar comments, notably in terms of the topic addressed, the target audience, the tone, message and imagery.

Beyond comments specific to each of the three concepts tested, a number of items were consistently mentioned across feedback, and should be considered when developing the final campaign concept.

Overall reactions to the "Let's Build Solutions" were modestly positive, notably for the message's positivity and wide-reaching appeal.

This concept was most appreciated for its approach to suggesting that addressing substance use involves everyone, using photography of real people, showing various substances for which consumption could be problematic (not only opioids), and in how the message focuses on solutions and collaboration. The use of positive language and directive verbs contributed to conveying a supportive tone that rendered the concept engaging. That being said, the bland, generic, and "corporate" look with limited colours did not grab attention and was expected of a government advertisement. The ads appear visually cluttered for the inclusion of multiple images and blocks of colours.

The concept conveyed the message that solutions are available to address substance use among workers, with solutions that entailed a collaborative approach. While presenting naloxone as one of the tools to address the situation is appreciated, there lacks information on where to get it and how or when to use it. Across the concept components, the message from the last social media post ("If you are going to use drugs, don't use alone") was felt to be misleading and implying that it is acceptable to do drugs at work. Consideration should be given to reword the statement to "If you are going to use drugs, let someone else know to keep safe."

While the primary target audience was felt to be men working in physically demanding jobs, this concept was also seen as targeting coworkers and supervisors on work sites. The concept was also felt to suggest that men are more likely to be vulnerable to substance abuse, and that substance use should be normalized. Overall, the concept's call to action was moderate.

Reactions to the "Make Sure You Have the Right Tools" concept were mixed, with an attractive design but a weaker message.

Most appreciated that this concept was simple in its design, focused on naloxone as safety equipment, and clearly communicated the need to address the issue. That said, the concept placed responsibility on workers to carry and use naloxone, without providing information on what it is and where to obtain it, as well as how and when to use it. The fact that the concept features men in the construction industry and people from visible racial minority groups in individual images may send the message that substance use is more prevalent among those groups.

The more specific focus on addressing opioids overdoses, combined with the choice of images and select words or expressions, limited the concept's relevance to the construction industry. While the overall message is specific to opioids, the headlines are more generically speaking of safety, and when combined with the visuals and colours, is reminiscent of a workplace safety campaign. Further, referring to a "safe space" at work was felt to be overused or not aligned with workplace lingo. By contrast, the action-oriented term "gear up to help" held appeal, though associated by some as referring to obtaining drugs. The headers, "Talking. Listening. Supporting." and "Naloxone is safety equipment" were felt to be compelling reminders of the concept's main message.

From a design standpoint, some liked the vibrancy of the colours that would grab their attention, spoke to the construction sites, and was reminiscent of safety messages, while others found the colours to be too jarring and making the material unattractive.

Reactions to the concept "Even Tough Guys Need Support" were more polarized, with some finding the concept to be attention-grabbing and the message to be clear, direct and concise, while others found that the imagery and the wording lacked credibility or personal relevance.

The message was understood to convey that men who display strong and confident behaviours are sometimes in need of assistance and should reach out for support. While some appreciated the myth busting, others felt that the message is oversimplified and over generalized thus affecting its credibility. The stereotypes were further reinforced by the use of the term "tough guys" in English with terms such as "strong men" or "strong people" felt to be more appropriate. Some of the terminology in the French version such as "dur à cuire," "hommes forts," "hommes robustes," "crée un espace sûr," and "personnes confrontées" were felt to be too formal to be compelling, although no alternative suggestions were made. In some instances, the concept was felt to lack credibility, as the expressions were not reflective of spoken language heard on job sites.

Despite issues with the wording, the concept was effective for some in articulating the need for those who may not appear to be struggling to reach out for help. That said, the concept's imagery, colours and expressions clearly identified men in the construction industry as being the concept's target audience, notably those affected by substance use.

From a graphic standpoint, the colours are eye-catching, but the use of drawings rather than images elicits mixed feelings. The use of illustration was felt to be more relatable by some, while it lacked seriousness for others. Illustrating only men wearing beards was puzzling to many. While some felt that showing a construction male worker touching another man's shoulder illustrated caring, others felt that it lacked credibility based on their own worksite experience. Across components, the last social media post lacked clarity, especially for those who are not familiar with naloxone.

None of the concepts outperformed the others on all aspects evaluated.

When discussing concept preferences and strengths, none of the three concepts examined clearly outperformed the others on the aspects evaluated. Both "Let's Build Solutions" and "Even Tough Guys Need Support" were preferred overall and more highly rated than "Make Sure You Have the Right Tools," although the three concepts received only moderate appreciation scores across audiences. The concepts "Let's Build Solutions" and "Even Tough Guys Need Support" were also seen as communicating the best message overall. "Let's Build Solutions" performs well for its positive tone, specific call to action, focus on teamwork and more encompassing message, while "Even Tough Guys Need Support" was chosen for its simple message that addresses the stigma of the tough guy not being able to seek help.

Both of these concepts were also seen as best at addressing the stigma associated with substance use, despite not doing so very effectively. In terms of which concept is best at letting people know about the risks associated with substance use and how to reduce those risks, male participants were divided in their choice, while members of the general public believed that "Let's Build Solutions" and "Make Sure You Have the Right Tools" were most effective in doing so.

Opinions were mixed as to which concept performs best from a graphic presentation standpoint. "Let's Build Solutions" was liked for its serious design, use of photography and prominent feature of naloxone in the visuals. "Make Sure You Have the Right Tools" stood out for its bright colours, familiarity with safety messaging and the images being relatable. "Even Tough Guys Need Support" presented eye-catching colours and the use of illustration that was more relatable to some people.

The best ways to communicate the message to the target audiences included at worksites, in public washrooms, in public transit, or on social media.

The most effective means of reaching the target audience was felt to be where construction workers and those working in physically demanding jobs were often found, such as on worksites or in public transit. Public washrooms were also felt to be an appropriate location for posters, as it provides a private location for someone to consider the message and take note of the URL. This is also the case for social media which would provide easy access to the website. To a lesser extent, television was considered an appropriate medium, or through trades associations or union representatives, or in public places where construction workers who are homeless may go (e.g., shelters, public libraries, malls).

Direction

As it moves to finalize the development of the final concept for its campaign, Health Canada should consider the following:

1. Either "Let's Build Solutions" or "Even Tough Guys Need Support" should be further developed, with modifications.

While there is no clear concept that outperformed the others, both the "Let's Build Solutions" and "Tough Guys Need Support" elicited positive reactions for the clarity of the message, the positive tone, and the way it presents the topic of addressing substance use as an important consideration. While "Let's Build Solutions" offered a more positive tone and inclusive message, its design lacked appeal and its call to action was only moderate. "Even Tough Guys Need Support" presented a more visually striking design and direct message for men in the construction industry, although opinions were mixed with respect to the use of illustration and the context of some of the images.

2. Regardless of the final choice of concept design, the overall message of the concept "Let's Build Solutions" should be included in the final campaign concept, with proper supports in place.

Having the campaign in place addresses an issue many participants felt has not been sufficiently talked about, and the supportive message of building solutions is appreciated. However, if asking people to talk about issues affecting the workplace, there needs to be appropriate supports and protections in place to ensure that having a conversation does not put a worker at risk of losing their job or being stigmatized at work. Some part of the message about it 'being ok to ask for help' or that 'we all need help sometimes' should also be an important component of messaging as this strongly resonated with participants. Consideration should also be given to engage employers in providing the required support for employees to seek assistance, without fear of retribution.

3. The direction for the graphic and visual presentation is less clear, however showing a diversity of real people combined with colourful backgrounds should be considered.

In choosing the colours in combination with the headlines, attention should be paid to ensure that the concept chosen is not mistakenly understood as having a more generic workplace safety message. In addition, it is important to ensure that the tone and emotions shown in the visuals match the perceived seriousness of the topic.

4. The final concept should include a mix of genders and a diversity of people in visuals.

Although men might be the primary target audience, the visuals should include both men and women to imply that the latter play a role in addressing the issue of substance use in the workplace, particularly in supporting or assisting coworkers. Likewise, consider including people from a variety of different ethnic backgrounds in each of the campaign components, so as not to imply that substance use is more prevalent with any one specific group. In doing so, showing groups of people would provide a more positive image than showing single individuals.

5. Consider providing supporting evidence for targeting a gender and specific types of workplaces.

To improve the message credibility and avoid the possibility of stigmatizing specific groups, consider including statistics or facts supporting the need to address substance abuse among men in physically-demanding jobs. Doing so will provide a rationale and ensure there is understanding as to why the message is focusing on a specific audience.

6. Consider putting in place tactical suggestions for how to get support (e.g., confidential phone number), how to access and use naloxone, and what to say to get the conversation going or to support coworkers.

Proper worker protection and confidential support resources should be considered in support of the campaign, to facilitate the process of workers opening up about a substance use issue at work. In addition, there may be a need to work with employers to establish a safe place at work for employees to seek help without fear or retribution.

Appendix A:
Recruitment Screener

Health Canada: Opioids Overdose Crisis Brand and Message Focus Testing Recruitment Screener – FINAL

Name:
Home phone:
Work phone:
Cell:
Email:
Community:
Province:

SECTION 1: Schedule & Specifications

NETFOCUS GROUP SCHEDULE
Date (2022) Group AST EST Participant Time Audience Language Moderator
Wed. Feb 2 1 3:00PM 2:00PM 12:00PM/1:00PM AB/Prairies: General Public EN MC
2 7:00PM 6:00PM 7:00PM Atlantic (NB/NS): Males EN CP
3 8:30PM 7:30PM 5:30PM/6:30PM AB/Prairies: Males EN MC
4 9:30PM 8:30PM 5:30PM BC: Males EN CP
Thur. Feb. 3 5 6:30PM 5:30PM 5:30PM Quebec: General Public FR CP
6 6:30PM 5:30PM 5:30PM Ontario: General Public EN MC
7 8:30PM 7:30PM 7:30PM Quebec: Males FR CP
8 8:30PM 7:30PM 7:30PM/6:30PM/5:30PM Territories (Yukon; NWT, NU): General Public EN MC
Mon. Feb. 7 9 12:00PM 11:00AM 12:00PM Atlantic (NB/NS): General Public EN CP
10 4:00PM 3:00PM 12:00PM BC: General Public EN CP
11 6:30PM 5:30PM 5:30PM Ontario: Males EN MC
12 8:30PM 7:30PM 7:30PM/6:30PM/5:30PM Territories (Yukon; NWT, NU): Males EN MC

Specification Summary

Number of Online Focus Groups
Region Language Time Zone Males in Physically Demanding Professions General Population Total Groups Total Recruits
BC (Vancouver, Thompson-Caribou, Fraser) EN PST 1 1 2 20
Alberta/ Prairies (Medicine Hat, Edmonton, Calgary, Saskatchewan, Manitoba) EN MST/ CST 1 1 2 20
Ontario (Thunder Bay, Sudbury, Toronto, Guelph, Ottawa) EN EST 1 1 2 20
Quebec (Montreal, Québec City) FR EST 1 1 2 20
Atlantic (Fredericton, Moncton, Halifax) EN AST 1 1 2 20
Northern Territories (NWT & Yukon) EN MST 1 1 2 20
TOTAL     6 6 12 120

RECRUITER NOTE - WHEN TERMINATING AN INTERVIEW, SAY: "Thank you very much for your cooperation. We are unable to invite you to participate because we have enough participants who have a similar profile to yours."

RECRUITER NOTE: If a respondent wishes to verify the validity of the study, please contact:
Narrative Research: 888-414-1336; focusgroups@narrativeresearch.ca

NOTE THAT THROUGHOUT THE SCREENER, INSTRUCTIONS APPEAR BELOW EACH QUESTION

SECTION G: General Introduction

Hello, my name is _______________ and I am calling on behalf of Narrative Research, a national market research company. Let me assure you that we are not trying to sell you anything. As part of a research project that we are conducting on behalf of the Government of Canada, we are looking for people aged 18+ to take part in a small online group discussion the week of <INSERT DATE>. Those who qualify and take part in the focus group will receive a [$100 for gen pop groups/$125 for Male groups] financial incentive. Is this something you might be interested in?
Yes.................................................... 1
No.................................................... 2 THANK & TERMINATE

Do you prefer to continue in English or French? / Préférez-vous continuer en français ou anglais?

RECRUITER NOTE - FOR ENGLISH GROUPS, IF PARTICIPANT WOULD PREFER TO CONTINUE IN FRENCH, PLEASE RESPOND WITH: «  Malheureusement, nous recherchons des gens qui parlent anglais pour participer à ces groupes de discussion. »
«  Nous vous remercions de votre intérêt.  » OR «  Désirez-vous que l'on communique avec vous à nouveau afin de vous inviter à participer à un groupe de discussion en français?  »

The purpose of this group discussion is to hear people's views on communications materials currently being developed. Participation in this research is voluntary and completely anonymous and confidential. No attempt will be made to sell you anything or change your point of view. The format of the focus group is an informal online small group discussion led by a professional moderator. May I ask you a few quick questions to see if you have the profile we are looking? This should take about 6 or 7 minutes.
Yes.................................................... 1
No.................................................... 2

IF NO, THANK & TERMINATE

SECTION P: Profiling Questions

To begin…
In which province or territory do you currently live?
Record name of province/territory: ______________________

P1 INSTRUCTIONS: Aim for mix within each region where applicable

In which city, town or village do you currently live?
Record name of city/town/village: ______________________

P2 INSTRUCTIONS: Check against community quotas. Recruit equal mix of designated locations within each region

How long have you lived in <INSERT RESPONSE FROM P2>? [RECORD # of Years: _________]
Less than 2 years............................. 1
At least 2 years or more................. 2

P3 INSTRUCTIONS: Thank & Terminate if less than 2 years

Do you or any member of your household currently work in or has retired from working in…? [READ LIST – ROTATE ORDER]
Marketing/Market Research......................................................................... 1
Public relations, advertising, media (TV, Radio, Newspaper), graphic design............................................................................. 2
A political party............................................................................... 3
Federal government................................................................... 4
The field of drug treatment....................................................................... 5
Law enforcement.................................................................. 6
The medical and/or pharmaceutical sector............................................................................. 7
None of these............................................................................... 8

P4 INSTRUCTIONS: If yes to any of code 1-7, thank & terminate. Continue if none of the above (code 8).

What is your current employment status?
Working full-time (at least 30 hours per week)............................................................................................................................................... 1
Working part-time (less than 30 hours per week)............................................................................................................................................... 2
Self-employed......................................................................................................................................... 3
Unemployed................................................................... 4
On work leave (including seasonal workers)......................................................................... 5
Not in the workforce, and not looking for work (e.g., full-time homemaker).................................................................. 6
Retired............................................................................................................................................. 7
Student attending school full-time.................................................................................................................................................. 8
Other (Specify: _____).............................................................................................................................................. 9
Prefer not to say.................................................................................................................................................... 10

P5 INSTRUCTIONS: If WORKING OR SELF-EMPLOYED (codes 1-3), continue to P6. If UNEMPLOYED or ON LEAVE (codes 4-5), go to P7. If RETIRED (code 7), go to P9.
GP GROUPS: Recruit mix; Max 4 per group who are not working (codes 4-10)
MALE GROUPS: Recruit min 6 who are WORKING OR SELF-EMPLOYED (codes 1-3) and max 4 who are UNEMPLOYED or on WORK LEAVE (codes 4-5)

IF EMPLOYED IN P5 (codes 1-3), ASK: In what sector do you work and what is your current occupation?
Sector: ____________________________________
Occupation: ________________________________

P6 INSTRUCTIONS: Exclude sensitive occupations/industries identified at P4; Recruit only physically-demanding occupations in the designated sectors (e.g., no office workers or administrative staff and executives)
GP GROUPS: Recruit mix of occupations
MALE GROUPS: Recruit mix of occupations among the following physically demanding professions/sector:

IF UNEMPLOYED OR ON WORK LEAVE AT P5 (codes 4-5), ASK: In the last year, were you actively employed in any of the following occupations?
Construction trades (see list at P6)....................... 1
Long-haul trucking.................................................. 2
Heavy machinery operators................................... 3
None of the above.................................................. 4

P7 INSTRUCTIONS: If code 1-3, consider for MALE GROUPS; if NONE (code 4) consider for GEN POP GROUPS

[ASK FOR MALE GROUPS ONLY AND IF CODE 1-3 AT P5 OR CODE 1-3 AT P7] [IF CODES 1-3 AT P5: Do] [IF CODES 1-3 AT P7: Did] you supervise others in your [IF CODES 1-3 AT P5: current] [IF CODES 1-3 AT P7: most recent] work position?
Yes.................................................... 1
No.................................................... 2

P8 INSTRUCTIONS: For MALES GROUPS, recruit 3 who answer yes and 7 who answer no in each group

IF RETIRED IN P5 (code 7), ASK: In what sector were you last employed before retirement and what was your occupation?
Sector: ____________________________________
Occupation: ________________________________

P9 INSTRUCTIONS: Thank & Terminate if similar occupations as in P4

Are you…?
Male................................................. 1
Female............................................. 2
Gender diverse................................ 3
Prefer not to say............................. 8

P10 INSTRUCTIONS:
GP GROUPS: Recruit equal mix of code 1 & 2 in each group; accept codes 3 & 8
MALE GROUPS: Consider if code 1 (male) and if physically demanding professions in P6/P7

Into which age group are you? [READ RESPONSES IN ORDER]
Less than 18.................................... 1
18-19............................................... 2
20-29............................................... 3
30-39............................................... 4
40-49............................................... 5
50-59............................................... 6
60-69............................................... 7
70 or older....................................... 8

P11 INSTRUCTIONS: If less than 18, thank & terminate
GP GROUPS: Recruit good mix of ages
MALE GROUPS: Recruit min 7 between 20 & 49 years old (codes 3-5). Recruit good mix of ages within that range in each group.

What is the highest level of education that you have completed?
Some high school or less.................................................................................................................................. 1
Completed high school.............................................................................................................................. 2
Some vocational studies............................................................................ 3
Completed vocational studies (without high school diploma)......................................................................... 4
Completed vocational studies (with high school diploma)......................................................................... 5
Some CEGEP/college/university.............................................................................................. 6
Completed CEGEP/college/university.............................................. 7
Postgraduate studies above bachelor's level................................................................................................................................. 8
Prefer not to say................................................................................................................................... 9

P12 INSTRUCTIONS: Recruit mix in GP GROUPS; aim for a mix in MALES groups

What was your household's total income last year? That is, the total income of all persons in your household combined, before taxes?
Under $20,000................................ 1
$20,000 to under $40,000............. 2
$40,000 to under $60,000............. 3
$60,000 to under $80,000............. 4
$80,000 to under $100,000........... 5
$100,000 to under $150,000......... 6
$150,000 or more........................... 7
Prefer not to say............................. 8

P13 INSTRUCTIONS: Recruit mix in GP GROUPS; aim for a mix in MALES groups

To make sure that we speak to a diversity of people, could you tell me what is your ethnic background?
White/European (for example, German, Irish, English, Italian, French, Polish, etc.)................................................................................ 1
Hispanic, Latino, Spanish (for example, Mexican, Cuban, Salvadoran, Columbian, etc.)................................................................................ 2
Black or African Canadian (for example, African Canadian, Jamaican, Haitian, Nigerian,
Ethiopian, etc.)........................................................................................ 3
East Asian (for example, Chinese, Filipino, Vietnamese, Korean, etc.)................................................................................ 4
South Asian (for example, East Indian, Pakistani, etc.)........................................................................................ 5
Middle Eastern or North African (for example, Lebanese, Iranian, Syrian, Moroccan, Algerian, etc.)................................................................................ 6
Indigenous (e.g. First Nations, Métis, Inuit)............................................................................... 7
Other (Specify: ___)................................................................................ 8
Unsure/Prefer not to say........................................................................................ 9

P14 INSTRUCTIONS: Multiple responses allowed. Recruit mix in each group, including 1-2 Indigenous

SECTION N: Netfocus Questions

The discussion groups for this project will be conducted over the phone and online simultaneously and will require the use of a laptop, desktop computer or computer tablet to login to a website and a telephone line (either landline or cell phone) to join a conference call for the duration of the focus group session. Note that you can use a smart phone to join the telephone conference call but not to login on the web meeting, as the screen size is too small to see the material that will be shared with participants.

NF1. Do you have access to a laptop, desktop computer or a large computer tablet with high-speed Internet to take part in this focus group?

Yes............................................................................ 1
No............................................................................ 2

NF1 INSTRUCTIONS: If no, thank & terminate

NF2. Once you are online for the session you will also be required to join a separate telephone conference call to be connected to the discussion with the rest of the group. You will need to use a telephone line and NOT your computer audio. Will you have access to a dedicated telephone (either landline or cellular) located near your computer to join the conference call? Note that you will not incur long-distance charges.

Yes................................................... 1
No.................................................... 2

NF2 INSTRUCTIONS: If no, thank & terminate

NF3. You will need to be in a place that is quiet and free of distractions for the duration of the session. This includes ensuring you can be on your own, without pets or other people nearby and in a quiet room. You will not be able to take part in the focus group from an outdoor area, a vehicle, or a public place, as these locations are too noisy. Are you able to secure a quiet and private environment without distractions or noises for the duration of the focus group session?

Yes................................................... 1
No.................................................... 2

NF3 INSTRUCTIONS: If no, thank & terminate

INSTRUCTIONS FOR NF1-NF3 THANK & TERMINATE: Based on your responses, we are unable to invite you to take part in this online focus group, as you do not meet the technical requirements. We thank you for your interest in this research.

SECTION R: Previous Focus Group Experience Questions

I just have a few more questions about your past participation in market research…

Have you ever attended a group discussion or interview for which you received a sum of money?
Yes.................................................... 1
No................................................... 2

Max 5 per group who answer YES, then continue; If NO, go to SECTION I: INVITATION

When was the last time you attended a group discussion or interview? _____________
[ASK IF WITHIN PAST 5 YEARS IN R2] How many groups or interviews have you attended in the past 5 years? ____________
What was the subject(s) of the focus group(s) or interview? __________________________

THANK AND TERMINATE IF THEY HAVE…
- been to 5 or more groups in the past 5 years (max 4 groups/interviews attended)
- attended a focus group in the past six months

SECTION I: Invitation

Based on your responses so far, we would like to invite you to participate in a small group discussion that will be conducted simultaneously over the telephone and online at <INSERT TIME> on <INSERT DATE>. The session will bring together 7 to 10 people and it will last between 90 minutes and 2 hours. The discussion will be about communications materials, including advertisements, currently being considered by the Government of Canada and you will receive [$100 for gen pop groups/$125 for Male groups] in appreciation for your time. To take part, you would simply log on to a secure website from your computer and at the same time join in a group discussion on the phone via conference call.
Are you available and interested in taking part in this focus group?
Yes.................................................... 1
No................................................... 2

I1 INSTRUCTIONS: If NO, thank & terminate

The discussion in which you will be participating will be recorded for research purposes only. Be assured that your comments and responses are strictly confidential and that your name will not be included in the research report. Are you comfortable with the discussion being recorded?
Yes.................................................... 1
No................................................... 2

I2 INSTRUCTIONS: If NO, thank & terminate

There may also be employees from the Government of Canada and a marketing company they are working with, who will be listening in on the discussion. They will not be given the last names of participants. Are you comfortable with having observers?
Yes.................................................... 1
No................................................... 2

I3 INSTRUCTIONS: If NO, thank & terminate

The group discussion will be held [GROUPS 1-9 & 11: in English] [GROUPS 10 & 12: in French]. Participants may also be asked to read text, write responses and/or review images during the session. Are you able to take part in these activities [GROUPS 1-9 & 11: in English] [GROUPS 10 & 12: in French] on your own, without assistance?
Yes.................................................... 1
No.................................................... 2
I am unsure...................................... 8

I4 INSTRUCTIONS: If NO or UNSURE, thank & terminate

Could we please confirm the email address where we can send you the detailed instructions for logging in to the group?
Record email address (and verify): ________________________________________________.

We will send you the instructions by email at least 1 day in advance of the group. The group discussion will begin promptly at <TIME> and will last between 90 minutes and 2 hours. Please log in 15 minutes in advance to ensure that the session is not delayed. If you arrive late, we will not be able to include you in the discussion and you will not receive the financial incentive.

As mentioned, we will be pleased to provide everyone who participates with [$100 for gen pop groups/$125 for Male groups], provided by e-Transfer or cheque, as you'd prefer. It takes approximately 3 business days to receive an incentive by e-Transfer or approximately 2-3 weeks following your participation to receive an incentive by cheque.
Would you prefer to receive your incentive by e-Transfer or cheque?
e-Transfer........................................ 1
Cheque............................................. 2

I5 INSTRUCTIONS: If E-TRANSFER, continue to I6; If CHEQUE, skip to I7

Could you please confirm the e-mail address where you would like the e-transfer sent after the focus groups, as well as the proper spelling of your name? Note that the e-transfer password will be provided to you via email following the focus group.
RECORD EMAIL ADDRESS: ________________________
RECORD FIRST NAME: ___________________________
RECORD LAST NAME: ____________________________

Could I have the mailing address where you would like the cheque mailed after the focus groups, as well as the proper spelling of your name?
Mailing address:______________________________________________________________
City: _______________________________________________________________________
Province: ____________________________________Postal Code: _____________________
First name: ___________________ Last name: _____________________________________

As these are very small groups and with even one person missing, the overall success of the group may be affected, I would ask that once you have decided to attend that you make every effort to do so. If you are unable to take part in the study, please call_____ (collect) at ________, or email __________ as soon as possible so a replacement may be found. Please do not arrange for your own replacement.

So that we can call you to remind you about the focus group or contact you should there be any last-minute changes, can you please confirm your name and contact information for me?
First Name: ____________________________________________
Last Name: ____________________________________________
Email: ________________________________________________
Cell Phone: ____________________________________________
Home Phone: __________________________________________
Work Phone: ___________________________________________

I8 INSTRUCTIONS: Insert information already collected, for confirmation. If the respondent refuses to give his/her first or last name or phone number please assure them that this information will be kept strictly confidential in accordance with the privacy law and that it is used strictly to contact them to confirm their attendance and to inform them of any changes to the focus group. If they still refuse THANK & TERMINATE.

Thank you for your interest in our study. We look forward to hearing your thoughts and opinions!

Attention Recruiters
Recruit 10 participants per group
CHECK QUOTAS
Ensure participant has a good speaking (overall responses) ability-If in doubt, DO NOT INVITE
Do not put names on profile sheet unless you have a firm commitment.
Repeat the date, time and verify email before hanging up.

Confirming – DAY BEFORE GROUP

  1. Confirm in person with the participant the day prior to the group– do not leave a message unless necessary
  2. Confirm all key qualifying questions
  3. Confirm date and time
  4. Confirm they have received the login instructions

Appendix B:
Moderator's Guide

Health Canada: Opioids Overdose Crisis Brand and Message Focus Testing
Moderator's Guide – Final

Study Goals (Confidential – Not read to participants)

Introduction 10 minutes

General Discussion 10 minutes

[SLIDE 5] Before we look at the ideas for a public education campaign…

Creative Testing 60 minutes (20 minutes per concept)

[SLIDE 6-7] As I mentioned earlier, I'd like to show you a number of ideas for communication materials that could be used by the Government of Canada for a public education campaign being considered. We will look at three ideas or campaigns, each including a number of advertisements around the same theme. Each campaign will include one web banner, one poster advertisement that could be used in outdoor public places, such as billboards or bus shelters, and social media posts. For each campaign, I will also show design elements – including fonts, imagery and colours.

The ads are still in development, so they have not yet been produced. So, as I am showing you those concepts, you will have to envision what the final ads would look like. For example, I will show you ads that use stock images, but once those are finalized and produced, they would use professional photography or images.

[SLIDES 8-19] We will look and discuss each campaign one at a time. Hold your thoughts as I show you the ads. Once I am done, I will ask for your individual opinion before we discuss the concept as a group. Please pay attention to both the message and how it is communicated, as we will be discussing and focusing on those aspects. MODERATOR PRESENTS EACH CAMPAIGN ONE AT A TIME – ROTATE ORDER OF CAMPAIGNS ACROSS GROUPS

Campaign A: Let's Build Solutions
Campaign B: Make Sure You Have the Right Tools
Campaign C: Even Tough Guys Need Support

Campaign Presentation Order

Campaign Presentation Order

Audience BC AB/Prairies Ontario Atlantic North Quebec
Males G4: A-B-C G3: B-A-C G11: C-B-A G2: A-B-C G12: B-A-C G7: C-B-A
General Population G10: C-B-A G1: A-B-C G6: B-A-C G9: C-B-A G8: A-B-C G5: B-A-C

AFTER THE PRESENTATION OF THE CONCEPT: Before we talk about this idea, take a moment to answer, each on your own, the questions you see on the screen. Keep in mind, I can see your responses, but other participants will not.

Indicate on a 1-10 scale the extent to which the statement aligns with what you think (where 1 means "not at all" and 10 means "absolutely"):

AFTER THE EXERCISE: Now let's talk about your reactions together…

Overall Reactions:

Intent/Message/Credibility:

Clarity/Appropriateness:

Relevance/Appeal:

Design

Intended Call-to-Action/Memorability:

Now let's have a look at the next campaign. REPEAT REVIEW/DISCUSSIONFOR THE OTHER CAMPAIGNS

Final Choice & Best Channels 15 minutes

[SLIDES 20-21] Now that we've seen all three ideas, I'd like to know which one you think would be strongest at achieving two things: 1) encouraging you to address stigma, associated with substance use in order to make it easier for people to seek help and; 2) knowing the risks and ways to reduce them. Take a few minutes to individually answer those two questions:

[POLL 4] Which campaign is best at addressing stigma associated with substance use?

[POLL 5] Which campaign is best at letting people know about the risks associated with substance use and how to reduce those risks?

If time permits:

If time permits: How else would you like to receive information on the topics of stigma, substance use and risks associated with them from the Government of Canada?

Thanks & Closure:

[SLIDE 22] That's all my questions; thank you for taking part in our discussion. We will follow up with you regarding the incentive. Note that once finalized, the study report for this project will be available to the public through a government agency called Library and Archives Canada.

Appendix C:
Material's Tested

C1:

Fact Sheet
"Different aspects of substance use in the context of men in trades with an emphasis on building solutions. A naloxone nasal spray is presented"
The text reads:
Let's build solutions. Substance use and addiction are more likely to impact those who work in physically demanding industries like yours. If you or a team member are struggling with addictions, know that you are not alone. Help is available. Canada.ca/opioids

Poster
"Different aspects of substance use in the context of Men in Trades with an emphasis on a naloxone kit."
The text reads:
Support your crew. Create a safe space to talk about substance use. Substance use and addiction has a big impact on men working tough jobs. Your crewmates may be dealing with it alone. You can make it easier for them to reach out and get the support they may need. Canada.ca/opioids

Social Media
"Different aspects of substance use in the context of men in trades with an emphasis on discussing with their team mates."
The text reads:
"Crews need to talk. Create safe spaces to talk about substance use."
"Know what to do if you witness an overdose. Naloxone could save your crewmate."
"Crew up. If you are going to use drugs, don't use alone"

Website banner
The text reads:
"Let's build solutions to help crewmates struggling with substance use"

C2:

Fact Sheet
"A man in trades smiling wearing a hard hat"
The text reads:
"Make sure you have the right tools. Crews shouldn't work without the right safety equipment. It's the same for responding to an overdose. Gear up with available solutions. Know the signs of overdose and carry naloxone. Canada.ca/opioids"

Poster
"A man working in trades with protective equipment implying that naloxone should also be included in the industry's protective gear."
The text reads:
"Gear up to help. Being prepared is important. Build safe spaces to talk about addiction. Learn the signs of an overdose. Know how to use Naloxone. Be ready with the right tools – on and off the job. Canada.ca/opioids"

Social media
"An image of a naloxone nasal spray stating that it is essential safety equipment."
"A man working in trades with a message about using drugs is safer if it is done around other people in case there of an overdose"
The text reads:
"Be safe – on and off the job. If you are going to use drugs, don't use alone."
"Men working in trades discussing with a message saying that talking, listening and supporting helps those struggling with addiction by creating a safe space"
"Talking. Listening. Supporting. Build a safe space to support those struggling with addiction"

Website banner
"Men in trades discussing builiding safe spaces to help those affected by substance use and addiction"

C3:

Fact Sheet
"Cartoon of two men in construction standing next to each other."
The text reads:
"Even tough guy need support. Substance use and addiction are more likely to impact those in physically demanding industries like yours. Know and reduce the risks of opioids and substance use, talk to your teammates, and be ready to help those dealing with addiction. Canada.ca/opioids"

Poster
"Cartoon of a man working in trade extanding a compassionate hand toward a coworker. Help is available if you or a team member are affected by addiction"
The text reads:
"It takes strength to reach out for help. If you or a team member are affected by addiction, know that you are not alone. Help is available. Canada.ca/opioids"

Social Media
"Men in traders with imagery of substance use. A message about creating a safe space to talk about addiction"
The text reads:
It takes a different kind of strength to reach out.
"A man in trade with a pill containing an unknown substance. You can't tell if street drugs are toxic" "You can't tell if street drugs are toxic. Being though won't be enough. Be aware of the risks and be careful." "A naloxone kit over an image of two men in trades acknowledging the need for supervision and readiness" Long version: "Even tough guys need a spotter"

Website banner
Cartoon of a man working in trade extanding a compassionate hand toward a coworker.
The text reads:
"let's make it easier for tough guys to get help"