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Use of new media to support passage of Vietnam's national tobacco control legislation
  1. Mego Lien1,
  2. Tom Carroll1,
  3. Stephen Hamill1,
  4. Phan Thi Hai2
  1. 1 Department of Policy, Advocacy and Communication, Vital Strategies, New York, New York, USA
  2. 2 Department of Viet Nam Tobacco Control Fund, Ministry of Health, Hanoi, Vietnam
  1. Correspondence to Mego Lien, Vital Strategies, 61 Broadway, Suite 2800, New York, NY 10006, USA; mego.lien{at}gmail.com

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Background

In November 2012, the National Assembly (NA) of Vietnam passed the country's first comprehensive tobacco control legislation.1 Following guidelines of the Framework Convention on Tobacco Control, the legislation was implemented from 1 May 2013 and included smoke-free public places, graphic pack warnings, increased taxes on cigarettes and establishment of a sustainable health promotion fund.1 This public health landmark resulted from a large-scale, long-term policy, advocacy and communication effort, which included the campaign described here. The effort was conducted by the Government of Vietnam and local and international non-governmental organisations, and coordinated by the Vietnam Standing Committee on Smoking and Health (VINACOSH).

In May to June 2012, directly leading up to the NA's vote on the tobacco control law, World Lung Foundation (now Vital Strategies) and VINACOSH developed and implemented a tobacco control mass media campaign to educate the public about the harms of tobacco and secondhand smoke and to garner support for the legislation. Compared with prior campaigns with budgets of up to US$200 000, this campaign had a significantly smaller budget of about US$50 000. The majority was spent on message dissemination and media buys (table 1). The campaign used mass media communication materials that built on two prior national TV campaigns in 2010 and 2011. In addition to traditional television broadcasting, which was supported by provincial-level television, radio, LCD screens and loudspeakers, the campaign targeted Vietnamese youth using online and mobile new media channels, which drove electronic signatures for a mobile and online ‘petition’. In Vietnam, smartphone usage (36%) is found to be lower than overall mobile phone usage (93%), but growing rapidly: 3G data subscriptions nearly doubled from 11.9% in 2012 to 21.4% in 2015.2 Estimates suggest that 44% or nearly 40 million Vietnamese people are online, and 57% of internet users actively use Facebook.2

Table 1

Multiplatform communication approach for national campaign

To avoid ‘slacktivism’—online advocacy that is not translated into real-world action3—a goal of 5000 petition signatures was established to generate media attention prior to the NA vote. This goal was determined with a local public relations agency, considering results from prior similar campaigns. A key aspect of the campaign was engagement with the Youth Union, a government-sanctioned social and political organisation that counts all Vietnamese youth aged 15–35 as members. This engagement provided access to its grassroots member organisations in each of Vietnam's 63 provinces.

This campaign represented one of Vietnam's first efforts to use new media to support tobacco control advocacy. Informed by earlier evidence,4 the campaign strategy leveraged multiple communication channels to form a comprehensive, multiplatform approach (table 1).

Results

The http://www.vn0khoithuoc.com website captured and recorded ‘signatures’ by SMS replies and website sign-ups. More than 6000 people ‘signed’ the petition over the campaign—3269 through the microsite and 2842 by SMS. On signing, all online petition signers were asked to provide basic demographic and contact information and to select all channels they had been exposed to about the petition. Two months after the legislation passed, an online evaluation survey was sent to 3250 petition signers' email addresses. This survey had an 11.8% response rate, after removing invalid addresses and refusals.

Press relations efforts related to the campaign and petition generated articles in 64 online news journals and 56 print news journals. Consistent with the government's relationship with the media in Vietnam, press coverage of the campaign was uniformly supportive and positive.

The majority of petition signatories (69.6%) fell into the target age demographic of the campaign, that is, youth aged between 15 and 35 years. Similarly, 84.8% of follow-up survey respondents reported being aged between 16 and 34 years, and were mostly female (64.7%), educated (90.7% with secondary school degrees or higher) and lifetime non-smokers (92.5%).

Figure 1 plots sign-ups to the online petition (mobile and web) against campaign activity, delineated by channels. An initial peak in petition sign-ups occurred at the time 1 campaign launch, which involved a combination of activities across SMS, Facebook, television and public relations. The lower but sustained sign-up activity at time 2 corresponds to paid Facebook advertising, with some support from public relations and an email alert. The largest peak in sign-ups took place through mobile at time 3, when the TV ads featuring the SMS short code and website URL began airing nationally. The final peak, at time 4, occurred through online sign-ups while the TV ads with short code aired, supported by public relations and urgent emails alerting people to the legislation deadline.

Figure 1

Number of online petition sign-ups by media activity.

Of the 3269 online petition signers, 2659 reported the channels from which they learnt about the campaign. Nearly half of the respondents (47.3%) said that they were informed about the petition through Facebook ads, followed by SMS (21.0%) and friend/family/word-of-mouth (18.8%; table 2).

Table 2

Reported channel exposures (How did you hear about the campaign to support the tobacco control law? Check all that apply)

The largest percentage of respondents in the follow-up survey reported hearing about the petition through the Facebook ads (56.1%; table 2). Facebook was also selected most commonly as the most effective channel in influencing them to sign the petition (32.0%; table 3).

Table 3

Most effective channel reported to influence petition signing (Of the media channels you selected, which one was most effective in influencing you to sign the petition?)

Two ad placement models were used in buying ads on Facebook—cost-per-click (CPC) and cost-per-thousand-impressions (CPM). CPC placements generated much lower CPC than CPM placements. Within both models, ads using an emotive image of a boy from the television ad outperformed a more informational style of ad using a no-smoking roundel (figure 2). Between two CPC placement-based ads with the same image, the ad with text about protecting youth fared better than the ad using ‘social proof’-style text about joining more than 3500 others in signing the petition (table 4).

Table 4

Facebook metrics by ad/message type

The vast majority of follow-up survey respondents who recalled receiving the SMS or seeing the Facebook or TV ads reported taking action afterwards. These actions included talking to somebody about the ad contents (83.5% of respondents who received the SMS, 73.1% of those who saw the Facebook ads and 73.1% of those who saw the TV ads), forwarding the ads to someone else (78.5% SMS, 76.2% Facebook), or encouraging somebody else to sign the petition (88.7% SMS, 78.5% Facebook, 76.7% TV). Nearly 95% of respondents reported high interest in participating in future tobacco control advocacy campaigns.

Discussion

This campaign used a mix of traditional mass media and new media channels—targeting the public and policymakers—to increase knowledge of tobacco harms, support for national legislation and engagement in tobacco control advocacy. Proximal indicators of the campaign's success include the 6111 petition signatures and 120 press stories generated in response to the campaign, in the lead-up to the legislation's passage. The vast majority of survey respondents also reported taking further action after seeing the campaign, much of which included higher engagement behaviours, such as speaking to others about the campaign and encouraging others to sign the petition.

The campaign primarily captured a subpopulation of young, educated, female non-smokers to sign the petition. This outcome identifies these young women as a key target audience for tobacco control advocacy campaigns. It also strengthens the rationale for partnering with organisations in Vietnam like the Women's Union, which, like the Youth Union, is a government-sanctioned political organisation, open to all women in Vietnam and with grassroots member organisations in all provinces. In the years following the campaign, this demographic has continued to be mobilised for tobacco control advocacy in Vietnam, through the Facebook page that was created for the campaign and through events such as World No Tobacco Day.

Evaluation survey results showed strong interest among respondents in participating in future tobacco control advocacy efforts, in spite of rare engagement reported in tobacco control and online advocacy. These findings suggest that the campaign effectively identified and engaged an audience that was primed to take interest in tobacco control but previously did not have an organised platform to act. By organising this subpopulation of non-smokers around a call to action and capturing participants' contact information, the campaign provided a mechanism to mobilise this group around tobacco control.

The success of the campaign in generating petition signatures and press stories, which ultimately supported the legislation's passage, suggests that opportunities exist through new media and the press to advocate for social and policy issues in Vietnam. The topic of smoke-free may have gained traction in this case because it was framed as an issue that related to the well-being of Vietnamese people, particularly children, and because the campaign positively encouraged the government to pass the legislation, instead of taking a critical approach.

The television ads featuring the SMS code were most effective in generating petition signatures over the campaign period. The next highest peaks of activity occurred when a mix of mass media, new media and interpersonal communication channels was used concurrently. However, mapping sign-ups against media activity showed that the Facebook ads produced a period of low though sustained activity, and in fact created the greatest impact on petition signatures when they aired at the same time as consistent messages on other media channels. Of the communication channels used, Facebook ads were most commonly reported as the source of awareness of the petition and the channel that drove respondents to sign the petition.

Facebook ad performance was consistent with literature on the effectiveness of different tobacco control advertisements.5 Ads that adopted an emotional-appeal approach generated more clicks to the petition than ads adopting a more informational approach.

These findings offer important lessons for future campaigns undertaken in resource-limited settings. The decision of where to plan and buy media requires a balance of multiple considerations, namely cost, reach and potential impact. Television remains the medium that can achieve the highest reach and impact,5 but at the highest total cost. The results suggest that lower-cost channels (eg, Facebook, SMS, public relations) and even no-cost, low-reach channels (eg, emails and interpersonal communication) can create high impact when combined and coordinated. Furthermore, incorporating new media channels into campaigns allows an integrated campaign to create actionable moments for users, such as responding to texts or signing petitions. When combined, these various channels may serve to balance out the limitations of one another, balancing reach, persuasive value and cost-per-impression. Across all channels, careful consideration of messaging can generate greater response rates. Even within 120 characters of SMS, messaging matters.

A further public relations effort was conducted after the collection of petition signatures, targeting policymakers and the wider public, to extend campaign messaging and demonstrate to the government the public's strong support for the legislation. The press effort also reflected the campaign's success back to the petition signatories themselves, validating broad interest and engagement in tobacco control and helping to create a social normative influence. Importantly, achievement of the campaign's initial objective—demonstrating online youth advocacy through petition signatures—provided a stimulus to support the broader legislative objective, targeting policymakers.

The specific social and political context in Vietnam should be accounted for when considering the generalisability of the campaign results. First, the campaign was designed to create an impact by working within Vietnam's socialist political system. In this context, public mobilisation had more potential to occur when campaign messaging was sponsored by a government entity (ie, VINACOSH) and channelled through the Youth Union from its central government headquarters. In Vietnam, the participation of the central government and Youth Union most likely increased respondents' willingness to engage in the policymaking process. Respondents also reported rarely using online channels for advocacy in Vietnam. Different political and media contexts would have different impacts on the public's response to the campaign.

By balancing the strengths and limitations of various media channels, the new media campaign in Vietnam effectively maximised reach within tight budget constraints, drove signatures to the online petition and promoted awareness of support for the tobacco control legislation. The findings suggest that resource-limited campaigns that use a mix of communication channels can effectively identify and mobilise large groups to advocate for tobacco control.

Acknowledgments

The authors gratefully acknowledge the Ministry of Health of Vietnam, the Youth Union of Vietnam and the World Health Organisation for their support in developing and implementing the campaign and evaluation activities. They are also grateful for the support of the following organisations which supported their efforts: Vietnam Public Health Association, Hanoi School of Public Health, Hanoi Medical University and Community Development Services. The authors also thank the media agencies Danson Media, Hamnghi Media and Digisun Production for their work in developing and implementing various aspects of the campaign; Do Thi Phi for her invaluable support throughout; and Christina Curell for her work in finalising this paper.

References

Footnotes

  • Contributors ML was involved in campaign design and implementation; survey and questionnaire design; data analysis and interpretation; literature review; writing and editing of this paper. TC was involved in campaign design and implementation; overall study design and guidance; data analysis and interpretation; writing and editing of this paper. SH was involved in social media campaign implementation; survey and questionnaire design; data analysis and interpretation; review and contribution to writing and editing of this paper. PTH oversaw management of campaign as part of overall advocacy effort to draft and pass legislation; review of this paper.

  • Funding The campaign and surveys were supported by grants from Bloomberg Philanthropies.

  • Competing interests None declared.

  • Ethics approval Retrospective ethics approval was obtained by the Institutional Ethical Review Board of the Hanoi School of Public Health in Vietnam.

  • Provenance and peer review Not commissioned; externally peer reviewed.