With pregnancy smoking rates showing a slight increase in 2014/2015 Hertfordshire County Council’s Public Health Service wanted to encourage pregnant smokers to quit for good. Senior Campaigns and Communications Officer Jo Necchi explains what they did.
Although the number of women in Hertfordshire smoking throughout pregnancy is comparatively low, they were declining only slowly and slightly increased in 2014/2015.
Smoking in pregnancy has serious lifelong health implications for both mothers and babies. The financial implications are also compelling, with costs to the NHS reaching almost £90 million annually.
It was therefore a local priority for us to find a way of encouraging women to quit for good.
The plan
My colleague and I had received social marketing training prior to developing this campaign, so we really wanted maximise the impact of the campaign by using a behaviour change approach throughout.
This meant we had to understand our audience, what factors made them continue to smoke whilst pregnant, and what might motivate them to break the addiction.
Firstly we defined our objectives. We wanted to reduce the prevalence of smoking in pregnancy by five per cent compared with the previous year. We also wanted to increase referrals to our specialist stop smoking service and the number of women and their partners accepting behavioural support to quit. Our final objective was to help strengthen professional engagement and confidence in referring people to the service.
Most importantly, we recognised that to achieve these objectives our campaign must be rooted in evidence and insight. Smoking in pregnancy is a complex issue and we needed to fully understand women’s perceptions, beliefs and behaviours to develop an effective campaign.
We carried out secondary research to find out what insight was already available from other organisations, including the Behavioural Insights Team at Public Health England.
We also carried out primary research, speaking directly to a range of practitioners for their insights, and held a focus group with women in our target audience to understand some of the social and lifestyle factors that influence their behaviour.
This research provided us with a rich picture of why people might continue to smoke during pregnancy. It also helped us understand the type of information that women felt would most likely promote and sustain a change in their behaviour. The focus group also helped us co-create key messages and campaign creatives that really resonated with them.
There is a lot of stigma associated with women who smoke during pregnancy, but our research revealed that whilst women feel judged and under pressure to quit, making them feel guilty does not change their behaviour. This led us to develop a supportive, non-judgemental campaign.
Our research also revealed that families played an important role in influencing and supporting women to improve their health, so we also developed materials that appealed to partners and grandparents.
We used the insights gained to develop four campaign concepts that we shared with our focus group. Interestingly, the softer concept that we originally planned was not provocative enough for the focus group. They preferred more intense harder hitting imagery, so we developed the creatives and messages in response to their feedback.
Some stakeholders disliked the final concepts. However, they understood that the most important thing is to develop materials that have the greatest impact on your target audience and incite a reaction. Investing time into the research stage gave us the evidence to back-up our decisions.
The execution
With our visuals agreed, we had to decide on our implementation plan. We researched with our target audience which communication channels would be preferred and most effective for conveying our messages.
Our focus group told us that Facebook was where messages would most likely be seen, so we incorporated a month of paid Facebook advertising and also used our own free social media channels and website.
We developed a range of visual collateral too, including banners and posters for display in maternity units and children’s centres; and postcards, leaflets and beer mats that carried our key messages.
The final part of executing this campaign was the support for professionals.
We created a toolkit for midwives, which included a lanyard of ‘myth busters’ and conversation starters to help with difficult conversations and a streamlined referral process to encourage professionals to refer women to our specialist stop smoking service. We also ran a series of masterclasses and training sessions to give all stakeholders the knowledge and skills they needed to be confident talking about the issue.
The impact
Our results showed that in 2015/16 smoking in pregnancy rates fell from 7.8 per cent to seven per cent; more than a 10 per cent reduction - doubling our original target. There was a 128 per cent increase in referrals to our stop smoking service (which has further increased in 2016/17) and anecdotal feedback from midwives showed they felt more comfortable referring patients to the service using our campaign materials.
Why it worked
The time and money we invested in research were essential to this campaign’s success and the social marketing approach really helped us understand and target information appropriately to our audience.
We had strong clear messages which resonated with families and professionals, and streamlined referral pathways, including introducing a self-referral facility.
We made nicotine replacement therapy free to partners (as it was for pregnant women) and provided professionals with equipment to perform carbon monoxide breath tests.
The campaign combined effective messages and channels with practical changes which made stopping smoking easier for the people we needed to reach.
However, one of the biggest factors in its success was how integrated the campaign was with partners across the county.
Lessons learned
We would have liked to have run a benchmarking survey with our professional colleagues before the campaign so that we had evidence of their improved confidence levels by the end of campaign to augment our anecdotal reports.
Want to know more?
For more information please contact Jo Necchi.