The Translation of Evidence-Based Anti-Smoking Television Advertisements in the Context of a Middle-Income Country: Which Types of Messaging Strategies Work Best?

Theoretical Background and research questions/hypothesis: Research in high income countries suggest anti-smoking television advertisements (ads) that use graphic negative messages or personal testimonials to depict serious consequences of smoking are most effective in prompting quitting thought and behaviors, while there was mixed evidence for other messaging strategies. The effective translation of these strategies to low- and middle-income countries (LMICs) began to emerge but some specific messaging strategies remains understudied and needs carefully examined within the socio-cultural context of LMICs.

Methods: The study used focus groups to evaluate the relative performance of eight antismoking television ads with differing messaging strategies from 54 male smokers aged 18 to 34 years in Taiwan. Participants evaluated eight ads on a standard rating questionnaire individually, engaged in a semi-structured group discussion, and were followed up by telephone to assess their recall one week after the focus group session. Ads were selected based on their ad characteristics that contrast with each other (i.e., testimonials, visceral imagery, or industry manipulation; graphic vs. less graphic portrayal of harms; or high vs. low emotional arousal). Three ads were produced in Taiwan while five ads were adapted from evidence-based ads produced by other countries. T-test was conducted to compare ad ratings for individual items and a perceived effectiveness scale.

Results: The foreign testimonial ad featuring highly graphic and emotional portrayal of human suffering and serious consequences of smoking was the most effective ad among the eight ads. The ad produced the highest negative emotional response and provided a direct linkage between disease outcomes and smoking, confirmed by qualitative discussions. The other foreign testimonial featuring an old woman with a hole in her throat and two visceral graphic ads did not perform as well as the most effective testimonial ad but were rated significantly higher than other ads. The old woman testimonial received variable responses duo to its lack of explicit linkage between her tracheotomy stoma and smoking. The two visceral graphic ads received similar ratings since smokers weighted upon the susceptibility and severity of diseases depicted in ads. Smokers thought two domestic testimonial ads less emotionally provocative and effective despite ads featuring people who share similar sociodemographics to them. Anti-tobacco industry ad was considered ineffective because smokers found little personal relevance to anti-tobacco industry agenda. The least effective ad was the humorous ad due to little discomfort and implicit warnings about consequences of smoking. Qualitative results indicate that the arousal characteristics of ads are more important than demographic characteristics of the people featured in ads.

Conclusions: The study findings suggest that personal testimonials that graphically and emotionally portray victims’ smoking-attributed diseases may have the greatest potential to motivate smokers to think about quitting smoking because of their highly negative emotional arousal and personal relevance.

Implications for research and/or practice: Antismoking ads that graphically and emotionally communicate the serious consequences of smoking can work in diverse cultural contexts. But some specific types of messaging strategies need to be carefully examined and adapted to sociocultural contexts in order to be effective.