Flu Season Vaccine Creative Testing

Final Report

Prepared for Health Canada

Prepared by Narrative Research
PSPC Contract Number: CW2241323
Contracted Value: $74,082.80
Contract Date: 2022-10-03
Delivery Date: 2022-11-21
POR number: 054-22

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

Ce rapport est aussi disponible en français

Flu Season Vaccine Creative Testing
Final Report

Prepared for Health Canada
Supplier Name: Narrative Research
November 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 fifteen online focus groups with members of the general public (5 sessions), parents of children less than five years old or pregnant people (5 sessions) and people living with chronic health conditions (5 sessions) in targeted communities located in each of five regions: British Columbia/Yukon, Prairies/Northwest Territories, Ontario/Nunavut, Quebec and Atlantic. Sessions included a mix of gender, ages, cultural backgrounds and Indigenous representation. The Quebec sessions were conducted in French while all other discussions were held in English. The research was conducted between October 17 and 20, 2022.

Cette publication est aussi disponible en français sous le titre :
Test créatif de la campagne sur la grippe saisonnière

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:
H14-426/2023E-PDF
International Standard Book Number (ISBN):
978-0-660-46452-7
Related publications (registration number: POR-54-22):
Catalogue Number H14-426/2023F-PDF (Final Report, French)
ISBN 978-0-660-46453-4

©His Majesty the King in Right of Canada, as represented by the Minister of Health, 2022

Table of Contents
Page

Appendices:

Executive Summary

Narrative Research Inc.
Contract Number: CW2241323
POR Registration Number: 054-22
Contract Award Date: 2022-10-03
Contracted Cost: $74,082.80

Background and Research Methodology

Influenza, also known as the flu, is one of the leading causes of death in Canada with peaks of activities in the fall and winter months. While preventative measures are desirable to minimize the spread of the virus, yearly vaccination remains one of the most impactful measures to prevent the flu, with fall being the ultimate time to receive the shot. In this context, Health Canada developed its 2022-2023 Seasonal Flu Vaccine Awareness Campaign scheduled to be launched in the fall of 2022. The goal of the campaign is to increase awareness that at-risk populations are more at risk for complications from the flu, that people in close contact with at-risk populations can also protect themselves and at-risk populations by getting an annual flu shot. Targeted audiences more at risk of serious complications resulting from flu infection include adults over 65 years old, people living with chronic health conditions, children under 5 years old, and people who are pregnant. Prior to finalizing the campaign's creative approach, Health Canada was interested in testing reactions to three concepts, with the goal of informing the development of the final creative.

The purpose of the research was to evaluate the three potential concepts to determine if the content is:

In addition, the research was designed to:

The results of this study will be used to help Health Canada make a decision concerning the final creative concept for their 2022 seasonal flu campaign. The three creative concepts yielded helpful feedback among participants which ultimately resulted in a clear choice for top concept.
To achieve these objectives, a qualitative research approach was undertaken. This included a total of 15 online focus groups conducted between October 17 – 20, 2022 in specific communities located across five regions: British Columbia/Yukon, Prairies/Northwest Territories, Ontario/Nunavut, Quebec, and Atlantic Canada. In each region, one focus group was conducted with members of the general public, one group was conducted with parents of children less than five years old or pregnant people, and one group was conducted with people living with chronic health conditions.

Each session lasted approximately 90 minutes. Twelve sessions were conducted in English and the three in Quebec were conducted in French. Participants in the general public groups were provided an incentive of $100 and those in the parents/pregnant groups or the chronic health conditions groups were provided an incentive of $125. Across all groups, a total of 120 individuals were recruited and 104 participated. One additional participant was unable to take part in the session due to technical difficulty, but was provided with an incentive, as is normal practice.

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: November 21, 2022

Key Findings

During the focus groups, participants were presented with three concepts that each included four (five in one case) animated website banners, each presented in draft format as a series of still images. Each concept was presented and discussed one at a time, with the presentation order rotated across groups to minimize any presentation bias. An individual poll collecting overall reactions on the concept's memorability, credibility, call to action, and its ability to capture attention was administered after the creative was shown, and before the group discussion. Following the discussion of all three concepts, participants were asked to choose which one is most likely to convince them to get the seasonal flu shot this year. The following summarizes the key findings from the Flu Season Vaccine Creative Testing research study.

Overall Reactions and Preferences
There is appreciation for an awareness campaign to remind the public about the flu vaccine and encourage at-risk populations to get the seasonal flu shot to help protect themselves from flu-related complications.

In terms of the creative approach, on average, Concept A performed better than either Concept B or C, notably in the general population and chronic health conditions groups. Concept A was generally preferred for its graphic appeal, the clarity of its message, and because the call to action is strongly suggestive while being not too forceful. That said, participants in the parents/pregnant people groups generally preferred Concept B for having a less forceful tone and for presenting the flu vaccine as one of the components to a healthy lifestyle.

Figure 1.
Figure 1. Text version below.
Description: Composite of the four options for Concept A. Each option shows a smiling person with a band-aid on an exposed upper arm with different coloured backgrounds. The people depicted are: a pregnant woman, a teenager, a senior, and a child.

Text reads:
"I'm at high risk for flu-related complications because I'm pregnant. Pregnancy has weakened my immune system. Pregnancy has weakened my immune system, so it's harder to fight off infections. Get the flu shot for you and me."
"I'm at high risk for flu-related complications because of my chronic health condition. My condition weakens my immune system. My condition weakens my immune system, so it's harder to fight off infections. Get the flu shot for you and me."
"I'm at high risk for flu-related complications because I'm 65. People 65 and older have a harder time fighting infection. Get the flu shot for you and me."
"My kids are at high risk for flu-related complications because they're under 5. My children's immune systems are still developing. Get the flu shot for you and me."

Reactions to Concept A

Regardless of preferences, overall reactions to Concept A were mostly positive, notably for the message of civic duty, the overall visual appeal, and the rationale for targeting some groups. Some liked how this version explained why these target audiences are more at risk and why the flu shot is important, which lends credibility to the message.

Both the visuals and the tagline ('get the flu shot for you and me') effectively conveyed the invitation to get vaccinated in a clear and concise manner. The graphic presentation was felt to clearly communicate the intended message, especially with its impactful infographic on the last frame. In addition, showing the image of an individual throughout the ad (i.e. on each frame) helps grab attention and contributes to the concept's overall appeal.

The tone was felt to be empathetic and encouraging, although too overly happy to align with the seriousness of the seasonal flu topic. Moreover, a handful of participants noted that there is fatigue with the "for you and for me" messaging that has been repeatedly heard in the context of the promotion of the COVID-19 public health measures. It should be noted that many participants in the parents/pregnant people sessions found the tone too forceful or directive, notably in the use of the verb "get" in the tagline.

Mention of "for you and me" in the tagline, combined with explaining the risk of flu complication experienced by at-risk groups, helped convey a broader appeal, with the target audience being seen as everyone. Ethnic diversity is well represented in this concept and contributes to the broader appeal. The first-person narrative was also well received as it felt more personal and relatable, even among those not in the at-risk groups.
Figure 2.
Figure 2. Text version below.
Description: Composite of the 5 options for Concept B, all with different coloured backgrounds. Option 1 shows a smiling toddler; option 2 shows a group of seniors in the outdoors; option 3 shows a pregnant woman holding her stomach; option 4 shows a woman in the kitchen; option 5 shows a physician speaking to a patient.

Text reads:
"Children develop a lot in their first 5 years, including their immune systems. Getting the flu show protects them from complications from the flu until their immune system can. Protect yourself and those at risk for flu-related complications. Get a flu shot."
"There are lots of ways to help live a healthy and full life after 65. Getting the flu show is one of them. Protect yourself and those at risk for flu-related complications. Get a flu shot."
"There are lots of things you can do for a health pregnancy. Getting the flu shot is one of them. Protect yourself and those at risk for flu-related complications. Get a flu shot."
"There are strategies for coping with a chronic health condition. Getting the flu shot is one of them. Protect yourself and those at risk for flu-related complication. Get a flu shot."
"There are strategies for coping with a chronic health condition. Getting the flu shot is one of them. Protect yourself and those at risk for flu-related complication. Get a flu shot."

Reactions to Concept B

By contrast, Concept B elicited mixed reactions, although it was well received by those in the parents/pregnant people groups and some of those in the chronic health conditions groups who appreciated the presentation of the flu vaccine as one way of many to remain healthy, rather than the only way. Using the flu vaccine as a tool to protect people in at-risk groups and inviting people to "help those people-children-pregnant" to live a healthy life resonated with many, although many others felt that the call to action was too weak.

The tone of Concept B was considered to be happy and relaxing, in addition to being seen as empowering by some by using positive and calm lifestyle images, and a less forceful approach to presenting the flu vaccine. The target for the concept was considered to be primarily those in the at-risk groups, and to a lesser extent, those around them. The manner in which the concept presents the flu vaccine as one of the many strategies, or ways, someone in the at-risk group can use to ensure a healthy lifestyle implied that they were the campaign's target audiences. However, the concept does not effectively encourage getting the flu vaccine for a wider audience.

Figure 3.
Figure 1. Text version below.
Description: Composite of the four options for Concept C, each with different coloured backgrounds. Each option shows a smiling person with a band-aid on an exposed upper arm, along with a second picture showing a medical mask. The people depicted are: a man, a child, an older woman, and pregnant woman.

Text reads:
 "Chronic health conditions can affect immune systems, making it harder to fight off infection. With fewer people wearing these, people with chronic conditions and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot."
"Kids under 5 are still building immunity to fight infection. With fewer people wearing these, parents with kids under 5 and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot."
"For people 65+, it's harder to fight off infection. With fewer people wearing these, people 65+ and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot."
"When pregnant, it's harder to fight off infection. With fewer people wearing these, pregnant people and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot."

Reactions to Concept C

Concept C was polarizing, with many participants reacting strongly and negatively to the mask imagery used. This concept elicited mixed and strong reactions, and it presents serious risks in terms of message confusion and dismissal. Concerns were expressed with presenting the flu vaccine as more important this year because of the pandemic, which also led many to question the message's credibility.

At the same time, some participants indicated that due to hearing similar messages during the pandemic, they may dismiss or ignore the campaign. Some participants recognized that masks are very controversial and have never been associated with the seasonal flu in the past. All together, the concept was memorable for many, but for primarily negative reasons.

The tone of Concept C was felt to be forceful and one that elicits shame. Terms such as "bossy", "demanding" and "guilting" were used to describe the tone and some felt like it was intended to shame (or blame those no longer wearing masks). Due to the last few years of the COVID-19 pandemic, a few participants mistrust government messages concerning public health and are tired of hearing about masking.

From a graphic standpoint, the images of people used in Concept C were felt to be appropriate and related to the subject, but as noted the mask brought out polarization among participants. There was, however, a consensus that the frames were text heavy which may deter many from reading the ads. On a positive note, there is good colour and text contrast throughout the banners, making the ads attractive and easy to read. That said, the call to action in Concept C was found to lack credibility. While the concept is viewed as a clear invitation to get the flu shot, the call to action is weakened by the message's lack of credibility or dismissed due to negative reactions mentions of masking.

Introduction

Context

Influenza, also known as the flu, is one of the leading causes of death in Canada every year. Although it averages about 12,200 hospitalizations and 3,500 deaths per year, there are preventative measure that can be taken to protect oneself and others from becoming infected. Hand washing and covering coughs are great ways to limit the spread of influenza, but the most effective way to prevent getting the flu is by getting a yearly/seasonal flu shot. Influenza activity is usually low in the spring and summer but begins to rise during the fall and winter. The fall is the prime time to get a flu shot to help protect yourself and to reduce the likelihood of spreading the flu to others.

In an effort to educate and generate awareness amongst-at-risk audiences, and those in close contact with at-risk audiences of the importance of getting an annual flu shot, Health Canada plans to launch the 2022/2023 Seasonal Flu Vaccine Awareness Campaign in the Fall of 2022. The goal of the campaign is to target audiences that are most at risk of serious complications from flu infections, namely, adults 65 years of age or older, people living with chronic health conditions, pregnant people, and parents of children under five years of age, and those in close contact with these at-risk groups. Validating the campaign creative was considered an important step in the current context, especially given the enhanced risk of vaccine advertisement fatigue due to the COVID-19 pandemic and possible message confusion regarding the type of vaccine.

Objectives

In this context, Health Canada was interested in testing creative concepts developed as part of this awareness campaign. More specifically, the study was designed to evaluate three concepts to:

Research Methodology

Target Audience

The target audience for the study included residents from the general public (Canadians 18 years and older) and various segments who are considered at higher risk of flu-related complications. These included:

Research Approach

The study included a total of fifteen online focus groups conducted between October 17 – 20, 2022. More specifically, three groups were conducted in targeted communities within each of five regions:

In total, eight people were recruited for each session with the expectation that at least five would participate. From 120 recruited individuals, 104 took part across all sessions. Each group discussion lasted approximately 90 minutes and participants received a cash incentive of $100 for participants in the general population sessions or $125 for those in all other groups, in appreciation for their time. The three Quebec groups were conducted in French and all others in English.

In each region, there was one group with each of the following audiences: parents (of children 4 years old or younger) and pregnant individuals (either pregnant or planning to be within one year); people living with select chronic health conditions; and members from the general public. The chronic health conditions considered as part of the research included: cancer or other immune compromising conditions (e.g., organ transplant, etc.), diabetes. cardiac disorders (e.g., heat disease, etc.), pulmonary disorders (e.g., lung disease, cystic fibrosis, asthma, etc.), anemia, obesity, renal disease (kidney disease), and neurological or neurodevelopment conditions.

There was an equal proportion of those who regularly get the flu shot and those who do not in each group. There was a mix of group ages, genders, education level, household income (general population groups only), household type and cultural background.

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 these types of work. These sectors included marketing, marketing research, public relations, advertising, media (TV, radio, newspaper), graphic design; provincial or federal government departments or agency related to healthcare, and medical, healthcare or pharmaceutical industries. 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 advertising and communication materials 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 qualified 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

Participants were presented with three seasonal flu vaccine concepts for advertisements that each included four (or five in one case) website banners intended to be animated when finalized but presented in draft format as a series of still stock images for testing purposes. Each concept was presented and discussed one at a time, with the presentation order rotated across groups to minimize any presentation order bias. An individual poll collecting overall reactions on each concept's memorability, credibility, call to action, and its ability to capture attention was administered after the presentation of each concept, and prior to the group discussion.

Overall Feedback

The overall campaign, regardless of the concepts presented, is mainly viewed as a reminder to get a seasonal flu shot rather than being aimed at changing perceptions.

Although feedback was sought primarily related to each individual concept, some of the opinions were shared across concepts. The following provides overall reactions across all concepts:

Most participants understood that the campaign was not necessarily trying to change an individual's mind about getting the flu vaccine but was rather endeavouring to promote the idea of getting a flu shot this year among those who normally do so. In a few instances, the campaign (regardless of concept) was felt to be a reminder to have a conversation about the vaccine, particularly concerning vulnerable populations, with some participants indicating that the campaign would serve as a reminder to talk to others.

"Does it encourage? – to me this would remind me – I don't know if this would change my mind." General Population, Atlantic

Some participants were curious as to what information would be available if they were to click on the ad. Being able to book a flu shot appointment was generally expected by some, but others were also looking for more information such as, the effects of the vaccine, who qualifies, how vaccines work, and statistics on risk factors.

Another element that was mentioned regardless of concept is a desire for a simple design with good colour contrast which was believed to be most effective at grabbing attention.

After reviewing all three concepts, participants were asked which of two approaches they found most compelling in how the message was conveyed in the ads, whether using the first-person or third person. By far, the first-person approach was most liked for grabbing attention and presenting a situation that is more personal, and likely more realistic.

"La première personne ça me donne plus l'impression d'être en tête-à-tête avec quelqu'un. Qu'il y a quelqu'un qui me parle. Quelqu'un qui me donne sa réalité donc je me sens plus concerné." (The first person gives me more the impression of being one-on-one with someone. That there is someone talking to me. Someone who gives me their reality so I feel more concerned.) General Population, Quebec

Concept A

The following provides an overview of reactions specific to Concept A.

Overall Reaction

Overall reactions to this concept were mostly positive, notably for the message of civic duty, the overall visual appeal, and the rationale for targeting some groups.

In general, this concept was liked for being simple, concise, informative, and effective at communicating the message to get the flu shot. It should be noted that group participants rated this concept most favourably across concepts with regards to memory, attention, motivation, and credibility.

Some participants liked how this version explained why the target audiences are more at risk and why the flu shot is important, which lends credibility to the message, as well as contributing to providing a rationale for the call to action. In addition, several participants made comments about how this concept was able to share stories in a short period of time and have those stories be relatable. This was achieved by focusing on one individual in each ad and explaining their story.

"J'aime cette formule-là qui est plus vivante et plus attirante visuellement. Ça situe d'avantage la grippe au début et ça explique le pourquoi le vaccin est nécessaire. C'est parce que la maladie affaiblie mon système immunitaire donc c'est pour ça qu'on doit prendre le vaccin." (I like this concept which is more lively and more visually attractive. It speaks of the flu more at the beginning and explains why you need the vaccine. It's because the disease weakens my immune system so that's why we have to get the vaccine.) Chronic Conditions, Quebec

"This one is clear and attractive. The wording is clear and tells me why you need to get the flu shot – it explains it." Parents/Pregnant People, Prairies/Northwest Territories

The simplicity of the design was appreciated as it drew attention to the empathetic, yet motivating tone and the call to action in the circle on the final frame was well received for its clarity. Further, the concept's focus on the faces of individuals made the message feel relatable for many.

"Showing people's faces makes me think of my mom, my kids. It makes you interested in seeing what's behind the message." Parents/Pregnant People, BC/Yukon

Message Relevance

The message was considered clear, concise, and somewhat relevant to the target audiences. The tone was felt to be empathetic and encouraging, although too overly happy to align with the seriousness of the seasonal flu topic.

Both the visuals and the tagline effectively conveyed the invitation to get a flu shot. It was felt by a few that showing the Government of Canada wordmark on each frame rather than solely on the final frame would enhance the message's credibility.

The tone elicited empathy and helped the call to action, although a handful of participants explained they were tired of the "for you and for me" messaging they have repeatedly heard over the past few years in the context of the promotion of the COVID-19 public health measures. At the same time, while featuring a positive tone is appealing, the individuals shown are considered to be too happy to reflect the serious nature of the message and the potential consequences of the seasonal flu. It should be noted that many participants in the parents/pregnant people sessions found the tone too forceful, notably in the use of the verb "get" in the tagline which was felt to be too directive.

"When is says 'for you and me' it reminds me of COVID." Parents/Pregnant People, Ontario/Nunavut

"The problem is that the chronic pain person just looks too happy. Otherwise, I can relate to it." Parents/Pregnant People, Prairies/Northwest Territories

"I understand that getting the flu shot is important for anyone with a weakened immune system, so we all should get it. But when it says, 'get the flu shot', it sounds too demanding." Parents/Pregnant People, BC/Yukon

"It certainly wants to make you take action – nobody wants to hurt anybody. It makes me pay attention." General Population, Atlantic

"J'aime qu'ils disent 'faites-vous vacciner contre la grippe pour vous et pour moi', ça va chercher l'empathie." (I like that they say 'get the flu shot for you and for me'; it elicits empathy.) General Population, Quebec

Target Audience

The target audience was described as everyone, not just the at-risk groups.

Mention of "for you and me" in the tagline, combined with explaining the risk of flu complications that could be experienced by at-risk groups helped convey a broader appeal for this concept. A wide range of ethnic diversity is well represented in this campaign and was also felt to contribute to the broader appeal of the concept.

"I have kids and have an elder grandparent – so those were the two that spoke to me." General Population, Ontario/Nunavut

"These ads are quite different – a narrator that is relating their story to you. It is invoking your civic responsibility to protect people around you – you've engaged a lot more people." General Population, BC/Yukon

"I personally see more diversity in people as far as colour goes." Chronic Conditions, BC/Yukon

The first-person narrative was also well received as it felt more personal and relatable, even among those not in the at-risk groups. That said, among some, this approach caused some confusion in the child web banner, notably in the use of "my" or "I" in the text and "for you and me" in the tagline, leading some to question whether the "me" in the tagline referred to the child or the parent. Parents and pregnant people in English-speaking groups did not make note of this, however.

"The fact that it is in the first person is persuasive." Parents/Pregnant People, BC/Yukon

Delivery of Message

The graphic presentation was felt to clearly communicate the intended message, especially with its clear and impactful infographic on the last frame.

The last frame was often cited for being memorable, for presenting the information in a simple and visually contrasting way, as well as placing the focus on the words "flu shot", which clearly conveyed the campaign's intent. In addition, showing the image of an individual throughout the ad (i.e., on each frame) helps grab attention and contributes to the concept's overall appeal.

"The logo at the end is clear and memorable." Parents/Pregnant People, Ontario/Nunavut

"Avec le cercle qui dit de se faire vacciner contre la grippe, on sait où on s'en va avec cette publicité; l'accent est là." (With the circle that says to get the flu shot you know where you are going with this ad; the focus is on that.) Chronic Conditions, Quebec

The circle with that logo pops more than just the straight messaging." Chronic Conditions, BC/Yukon

Improving the contrast between the text and background on some of the banners was felt to be required to improve readability, while improved contrast between the background and the visual colours would also draw more attention to the person featured.

"I find it kind of boring – the colours don't work; it is not very pleasing [especially the younger male with the chronic health condition]. I find them plain and boring." Chronic Conditions, Ontario/Nunavut

Call to Action

The message is perceived to be encouraging people to get the flu vaccine, to protect themselves and more vulnerable people.

The clear focus on the flu vaccine, the at-risk groups and the tagline ("get the flu shot for you and me") are viewed as a strong recommendation to get the flu vaccine. That said, the ad was perceived to act as a reminder for those who already receive the vaccine, while it did not appear to influence the choice of those who do not normally get the shot. For those who may have felt skeptical about getting a flu shot, some participants felt as though it was the person in the frame asking for a favour. This resonated well with many. Some, however, still felt as though it was too forceful and pushy mainly because of the word "get".

"The last frame is powerful. It really drives the message home about getting the flu shot." Parents/Pregnant People, Prairies/Northwest Territories

"It's an easy message – that you're doing it for everyone else. It's relatable – you're part of a collective." Parents/Pregnant People, Atlantic

"It's too much of a command – it implies that you're not a good citizen if you don't get it. Here's the government telling me to get another shot." Parents/Pregnant People, Ontario/Nunavut

Final participant advice related to the concept included a variety of suggestions. Some indicated that the legibility of the ad would be improved with greater contrast of the colours. Others suggested that the expressions of those shown should be made to be more serious and in line with the topic of the seasonal flu. Others felt that the wording on the final slide should be less 'commanding' and more suggestive to get a flu shot. Additionally, some participants suggested that it would be helpful to clearly demonstrate that the flu vaccine works (e.g., as a percentage), either on the ad itself or on the website.

Concept B

The following provides an overview of reactions specific to Concept B.

Overall Reaction

This concept elicited mixed reactions, although it was well received by those in the parents/pregnant people groups and some of those in the chronic conditions groups, who appreciated the presentation of the flu vaccine as one of many ways to remain healthy rather than the only way.

Mixed reactions were received regarding Concept B. While some, especially parents and pregnant people, liked how the flu vaccine is presented as part of a holistic approach to be healthy in a less forceful manner than with the other concepts, others felt that it broadened the focus too much and made the call to action too weak.

"I really like the subtle message. It doesn't bring guilt into it. Says that there are different ways to protect yourself." Parents/Pregnant People, Atlantic

"I kind of like it is just a vague fact of protect yourself and others – just a nudge to go do so." General Population, Ontario/Nunavut

"We can't ignore how polarized things have become and people don't want to be guilted into doing something or feeling lectured – so this is perfect." General Population, BC/Yukon

"Life after 65 – it sounds to me if you don't get the flu shot you are going to die – to me it is threatening. It is trying to incorporate COVID – using the same wording that was used for the COVID vaccine – it just doesn't say anything new to me." Chronic Conditions, Atlantic

Some participants from the chronic health conditions groups liked that the concept showcased people living their lives actively and successfully, despite the fact that they themselves feel as though they are constantly needing to be looking after their own health.

Message Relevance

The message was well-understood to be that the flu vaccine is part of a healthy lifestyle. The tone was considered to be happy and relaxed, and soft, although being seen as empowering by a few.

This concept was felt to present the flu vaccine as one of the many ways to remain healthy (in the same way as healthy eating and exercising). While this was a welcome message for some, for others it did not strongly convey the necessity of getting the flu shot, nor did it necessarily indicate to that the flu shot is required to reduce flu-related complications for certain populations.

"I like that it's a bit more subtle, but it may not be as clear. It's trying to get you to see that there is a tool in your toolkit." Parents/Pregnant People, Prairies/Northwest Territories

"[Le message est qu'il] faut se protéger et en même temps ça protège les autres. C'est un outil [la vaccination] qui nous aide à nous protéger et qu'il faut utiliser." (The message is that we have to protect ourselves and at the same time it protects others. Vaccination is a tool that helps us be protected and that we need to use.) Chronic Conditions, Quebec

"Telling me it is important to get a flu shot. I agree it doesn't give enough background on why we should be getting the flu shot." Chronic Conditions, Ontario/Nunavut

"If you get the flu shot you can do the things that the people in the pictures are doing." General Population, Prairies/Northwest Territories

The concept was felt to present a healthy lifestyle as being holistic and encompassing of many ways of promoting good health, with the flu vaccine being one of them. This approach was particularly appreciated by those in the parents/pregnant people groups for being a reminder rather than a command. That said, many other participants felt that the lack of clear focus on the flu vaccine in both the initial frame and the imagery may lead to message confusion if someone is quickly looking at it.

"On ne s'imagine pas que c'est quelque chose pour le vaccin tout de suite. Le message de se faire vacciner contre la grippe devrait être en plus gros caractère ou ressortir. Il faut lire tout le reste pour comprendre." (We don't see right away that this is something for the vaccine. The message to get the flu shot should be in larger print or stand out. You have to read everything else to understand.) Chronic Conditions, Quebec

Indeed, without reading the content, the overall generic "look and feel" and the imagery was seen as applicable to many other topics, including financial services and insurance. The messaging was felt, by some, to be lacking some support for the statements and gave no real background information about the flu vaccine. That said, a handful of participants suggested that this concept felt believable and credible, primarily because it was felt to clearly be on behalf of the government.

"L'objectif c'est d'aider la personne à avoir une belle grossesse, et un des moyens c'est la vaccination. La chose importante c'est la santé et la vaccination c'est un des moyens [pour être en santé]. La publicité donne une façon plus douce d'amener les gens à se faire vacciner. On admet que ce n'est pas la seule chose importante et ce n'est pas [la vaccination] qui va sauver la personne à risque." (The goal is to help the person have a beautiful pregnancy, and one of the ways is vaccination. The important thing is health and vaccination is one of the ways to be healthy. The ad provides a softer way to get people vaccinated. We admit that this is not the only important thing and it is not vaccination that will save the person at risk.) General Population, Quebec

"This looks like it could be banking or insurance. The photos don't really speak to the flu." Parents/Pregnant People, Ontario/Nunavut

Both the positive and calm lifestyle images, and a less forceful approach to presenting the idea of getting the flu vaccine evoked a positive feeling for some, and one that presents the decision to get the flu vaccine as one to be taken by each individual. This tone was seen as soft and less aggressive and someone could read it and understand it, regardless of where their personal opinions towards vaccinations may lie.

"The tone is polite, it's not fearmongering. It's appropriate." Parents/Pregnant People, Ontario/Nunavut

"Le ton est doux, il n'y a pas de gros punch. De se faire vacciner pour la grippe pourrait être mis plus en évidence." (The tone is soft, there is no big punch. Getting vaccinated for the flu could be more prominent.) Chronic Conditions, Quebec

"C'est la santé mais ça a l'air de la santé heureuse. Dans la façon des textes, le fait qu'ils disent de se faire vacciner pour la grippe en fait partie, c'est une ouverture, un choix, c'est plus doux." (It's health but it looks like happy health. In the way the texts are written, the fact that they say to get vaccinated for the flu is part of it, it is an opening, a choice, it is softer.) Parents/Pregnant People, Quebec

Target Audience

The target audience was considered to be primarily those in the at-risk groups, and to a lesser extent, those around them.

The manner in which the concept presents the flu vaccine as one of the many strategies, or ways, someone in the at-risk groups can use to ensure a healthy lifestyle implied that they were the campaign's target audiences. However, some believed that the target audience explanations (e.g., pregnant women's immune systems are weaker, etc.) were untrue and did not help motivate any action.

"It's a short, clear message that everyone can benefit from the flu shot – not just those affected but those around them as well." Parents/Pregnant People, Ontario/Nunavut

"Je me suis senti interpellé par le 'après 65 ans', mais je me demande pourquoi à 65 ans mais pas avant?" (I felt compelled by the 'after 65 years old', but I wonder why is the age set at 65 and not before?) Chronic Conditions, Quebec

"I don't fit in any of the categories they are targeting so it doesn't make me feel like I should rush out and get it." General Population, BC/Yukon

Delivery of Message

From a design standpoint, the lifestyle images and the contrasting background colours against the white frame and text were appreciated, however, many thought the secondary frames were too wordy.

There were varying opinions concerning the images in this concept. The inclusion of lifestyle images was felt by many to be engaging and the people's expressions seemed more genuine, especially the one of the pregnant woman ad. That said, the images were not effective at conveying the message to get the flu vaccine. There were mentions of having the sections/frames broken up made it more unclear.

"I really like the initial pictures, but I wouldn't follow and read all the text. The pictures are great, especially the baby." Parents/Pregnant People, Prairies/Northwest Territories

"They should use fewer words to get the point across. Say 'Talk to a doctor about the flu shot' or something like that and bold the word of the person you're talking to, like 'pregnancy'." Parents/Pregnant People, Prairies/Northwest Territories

"Je le préfère visuellement, c'est plus beau, plus recherché, plus doux." (I prefer it visually, it's more beautiful, more refined, softer.) General Population, Quebec

Among those living with chronic illness, some felt as thought the images were not representative of what it actually looks like to live with a chronic illness.

"The model they have for the chronic health condition doesn't represent chronic health people and what they do with their lives (woman cooking)." Chronic Conditions, Ontario/Nunavut

"Why do they have someone cooking? It's irrelevant for the message. They should show something more relevant to a chronic health condition." Parents/Pregnant People, Prairies/Northwest Territories

After the first four focus groups, the image used in the older adult example was changed for the remainder of the sessions, to show a group of individuals, rather than a single woman playing the violin. The replacement, showing the group of older individuals was felt to work well, with participants being more likely to see themselves in the image, rather than the idea that the seasonal flu vaccine is more targeted towards women. Similarly, an alternative for the image showing a woman cooking representing someone living with a chronic condition featuring a physician and a patient was added. This alternative image was well received as it was felt to be more relevant to the target audience and preferred by many.

In the Quebec groups, it was mentioned that positioning the flu vaccine as a 'strategy' to achieve a healthy life felt very corporate and rigid, and did not take into account the emotional components that are often part of a decision to get vaccinated.

Call to Action

The concept does not effectively encourage getting the flu vaccine for a wide audience.

The concept's focus on adopting a healthy lifestyle more broadly presented the flu vaccine as optional rather than an essential component in preventing flu-related complications. To some, it felt less forceful, and was appreciated. However, others felt that this approach made the flu vaccine an option, and one that is only necessary for certain audiences.

"Ça ne me convainc pas. Je fais partie des [gens avec des] maladies chroniques mais je ne me suis jamais fait vacciner pour la grippe. C'est des choses qu'on sait déjà. [Les publicités] ciblent les personnes qui se font déjà vacciner. C'est trop doux, trop ciblé. Dire qu'est ce qui peut arriver si on n'a pas le vaccin aurait plus d'impact." (It doesn't convince me. I'm one of the [people with] chronic illnesses but I've never been vaccinated for the flu. These are things we already know. The ads targets people who are already getting vaccinated. It's too soft, too focused. Saying what can happen if you don't have the vaccine would have more impact.) Chronic Conditions, Quebec

"There is an aspect of society that doesn't like to be told what to do and this is definitely telling you what to do – by our government no less." Chronic Conditions, BC/Yukon

"Dans chaque publicité ils disent qu'il y a plusieurs choses que tu peux faire. C'est un choix qu'ils te donnent sans être une obligation. Ce n'est pas imposé." (In each ad they say that there are several things you can do. It's a choice they give you without being an obligation. It is not imposed.) Parents/Pregnant People, Quebec

Participants who regularly got their flu vaccine did not feel strongly compelled by the message, while a few of those who did not get their flu vaccine every year believed that the tone and approach were too soft and lacked sufficient information for the message to be compelling.

Final participant advice related to Concept B included suggestions to strengthen the urgency of the call to action, and to use the replacement images for the 65+ (i.e. the group of people) and the image of the physician for the chronic illness frames. Although the action-oriented "lifestyle" images were appreciated, participants also suggested that they should be relevant to the wider target audience.

Concept C

The following provides an overview of reactions specific to Concept C.

Overall Reaction

While this concept elicited mixed reactions, it presents serious risks in terms of message confusion and of possibly being dismissed by audiences due to the use of the mask imagery. It was also felt to lack a personal connection to the viewer.

The biggest issue with this concept was its reference to the pandemic's possible impact on the flu season, without properly explaining it. Concerns were expressed with presenting the seasonal flu vaccine as more important this year than in other years because of fewer people now wearing masks, which also led many to question the message's credibility. At the same time, some participants indicated that due to hearing similar messages about protecting others by wearing masks during the pandemic, that they may dismiss or ignore the message in this campaign. Some participants recognized that masks are very controversial and have never been associated with the seasonal flu in the past. Altogether, the concept was memorable for many, but for negative reasons. The message resonated only for a few participants, who found the link to mask-wearing to be credible and timely.

"I hate the mask. The mask is COVID, not the flu." Parents/Pregnant People, Prairies/Northwest Territories

"I love this. It's a clear explanation of why it's important, about the immune system, and it is also emotional – you see them rolling up their sleeve" Parents/Pregnant People, Ontario/Nunavut

"It is a very Canadian message – I am going to do this for someone next door who might be compromised. But I have had people say what do I care about your immunity, I am sick of wearing masks." Chronic Conditions, Atlantic

"Especially after COVID, people have a seven-second attention span so would only read it in a place where I am already bored." Chronic Conditions, Prairies/Northwest Territories.

" Pour moi ce n'est pas positif. On est écœuré des histoires de masques et de vaccin. C'est moralisateur. J'ai l'impression qu'on devrait se sentir coupable de ne plus porter le masque alors c'est très problématique. " (For me this is not positive. We are fed up by the masks and vaccines. It is moralistic. I feel like we should feel guilty about not wearing the mask anymore so it's very problematic.) General Population, Quebec

Message Relevance

The message caused some confusion and issues with credibility in how the flu vaccine is presented as being more important this year because fewer people are now wearing masks. The tone of the campaign was felt to be forceful and one that elicits emotion, including shame.

The message implied that flu complications are more acute this year due to more people no longer wearing masks, although the ads were not felt to provide sufficient information to support this claim. Many questioned why the pandemic would increase the risks associated with flu complications and the need to get a flu shot, which affected the message's credibility. A few even felt that this may be a dishonest tactic used to shame people into getting the flu vaccine. Despite these perceptions, there is an appreciation for explaining why the flu vaccine is needed for key groups (e.g., "chronic health conditions can affect immune systems…" or "when pregnant it's harder to fight off infection"…).

"The mask is over exaggerated already – trying to get awareness about a flu shot." General Population, Prairies/Northwest Territories.

"Aussitôt que j'ai vu l'image du masque j'ai pensé que ça ne passerait pas. Ce concept dit qu'il n'y avait pas de complication pour la grippe avant la pandémie [tandis qu'il y en a maintenant] et il y a un ton accusateur : ceux qui ne porte pas de masque, c'est votre faute s'il y a des complications." (As soon as I saw the image of the mask, I thought it would not go well. This concept says there were no complications from the flu before the pandemic [whereas there are now] and there is an accusatory tone: those who do not wear a mask, it is your fault if there are complications.) Chronic Conditions, Quebec

"I get it. We're not out of the woods, and we should think of others who are vulnerable by getting the flu shot. I don't like it, but I get it." Parents/Pregnant People, Atlantic

Terms such as "bossy", "demanding" and "guilting" were used to describe the tone and some felt like it was intended to shame people into getting the flu shot (or blame those no longer wearing masks). Due to the last few years of the COVID-19 pandemic, a few participants mistrust government messages concerning public health and are tired of hearing about masking.

"This was a little harsh and off-putting for me." General Population, Ontario/Nunavut

"It has the tone that there has been a change in society – I don't know if that is the case." General Population, Ontario/Nunavut

"Le message avec le masque apporte un sentiment de culpabilité et ça t'amène à te poser la question si tu devrais porter [le masque]. C'est aussi un jugement; est-ce que je dois me sentir coupable si je ne le porte pas?" (The message with the mask brings a feeling of guilt and it makes you wonder if you should wear it. It is also a judgment; Do I have to feel guilty if I don't wear a mask?) General Population, Quebec

Target Audience

The target audience is seen as being those in the at-risk group and their close contacts.

Participants noted that the text specifically identifies the target audience that need a flu shot as including people in specific target groups and those around them (e.g., 'pregnant people and those around them need a flu shot'; 'people 65+ and those around them need a flu shot').

"I would talk to my mother and friends. I'd have a discussion with this one. It's about protection for everybody, not just yourself." Parents/Pregnant People, Ontario/Nunavut

"Two represent my household situation directly – the chronic health one and the 65-year-old, those hit home right away." Chronic Conditions, Atlantic

Delivery of Message

From a graphic standpoint, the images of people were felt to be appropriate and related to the subject, but the mask brought out polarization among participants and some confusion that the campaign might be for COVID-19 instead of the flu.

Participants appreciated the graphic elements in this concept, indicating that the imagery of people and bold lettering was strong and helped to convey a clear message. There was, however, a consensus that the frames were text heavy which may deter many from reading the ads. The images on their own were not felt to effectively convey the topic of the seasonal flu vaccine, but rather, the inclusion of the image of a mask confused many and was felt to make a stronger reference to the COVID-19 vaccine instead, or perhaps even worse, just a message about mask wearing. There were several mentions of the smiling faces being off-putting, and too happy to match with the serious tone of the subject. On a positive note, there was felt to be good colour and text contrast throughout the banners, making the ads attractive and easy to read.

"The mask made me cringe. It's irrelevant. Before COVID, masks weren't used to protect against the flu." Parents/Pregnant People, BC/Yukon

"If I look at those slides, I think it is about COVID and not the flu shot – it looks like the focus is on the mask." General Population, Atlantic

Some felt the mask provided a strong justification for why certain groups of people need more protection, while others felt the imagery was confusing, triggering, and conveying the underlying message that 'if you don't get the flu shot, you will have to wear a mask again.' Several participants also expressed that they thought the images looked too staged or fake to be credible.

A small number of participants in the chronic conditions sessions agreed that the rationale presented in the campaign was correct (needing the flu shot because fewer are wearing masks), but they also recognized how controversial masks have become.

Call to Action

The call to action lacks credibility.

While the concept is viewed as a clear invitation to get the seasonal flu shot, the call to action is weakened by the message's lack of credibility or dismissed due to negative reactions related to masking. Many participants claimed that this concept seemed to imply that flu complications are more acute this year due to more people no longer wearing masks and masks were not a part of the seasonal flu before the COVID-19 pandemic, so there was a lack of understanding of the messaging. Again, this aspect of the concept weakened its credibility and caused a mistrust of the source.

"It's fearmongering. Saying you have to continue wearing the mask, implying that if you don't get the shot, they are going to bring masks back." Parents/Pregnant People, Ontario/Nunavut

"I feel like using the word "need" […] they are saying you can't make a choice here […] that makes me not want to listen to it. It goes from being elective to kind of pushy." Chronic Conditions, Ontario/Nunavut

"Masks make some people think about COVID and some people will not pay attention." General Population, BC/Yukon

Overall, results indicate that this concept could present major risks of confusion and lack of credibility, and should not be considered for future development.

Final participant advice related to this concept included suggestions to use less aggressive language to encourage people to get the flu shot and removing of the mask imagery and messaging.

Concept Preferences

On average across groups, Concept A performed better than either Concept B and C, most notably in the general population and chronic condition groups.

Following the discussion of each of the three concepts, participants were asked to choose which one is most likely to convince them to get the seasonal flu shot this year.

Concept A was most selected by participants in the general population and chronic conditions groups, while those in the parents/pregnant people groups generally preferred Concept B. Concept A was generally preferred for its graphic appeal, the clarity of its message, and because the call to action is strongly suggestive while being not too forceful. If Concept B was preferred it was noted for having a less forceful tone and for presenting the flu vaccine as one of many components to living a healthy lifestyle, rather than the only solution. Concept C was largely dismissed because of the confusion with COVID-19 and the polarizing image of the mask, across groups, though a few chose it for providing clear background information.

"I choose A because it's about you and me – protecting the community." Parents/Pregnant People, Atlantic

"C is the best – it gives scientific evidence." Parents/Pregnant People, BC/Yukon

"I choose B because it has action pictures. It's a positive message, but a serious tone." Parents/Pregnant People, Ontario/Nunavut

"B because it is about a healthy lifestyle, accountability and making sure you are respecting other people, and it has no shame factor – which a lot of people got from COVID ads. It is like eating vegetables; you probably should do this." Chronic Conditions, Prairies/Northwest Territories.

"C makes such a perfect point that we saw so much less flu when people were wearing masks, but this will alienate people." Chronic Conditions, Prairies/Northwest Territories.

"Concept A – it is that personal appeal. Can you do it [get the shot] too to help me? I want to have a beer with this guy and I like the button at the end." Chronic Conditions, Atlantic

"I really think in the end it comes down to that final slide [A with the circle image call to action] – it is all inclusive and it is informative." General Population, Atlantic

"J'aimais le Concept B mais je n'y porterai pas attention parce que ça ressemble à une pub d'assurance, donc j'ai choisi le Concept A." (I liked Concept B but I would not pay attention to it because it looks like an insurance ad, so I chose Concept A.) General Population, Quebec

"Le côté visuel [du Concept A] m'attire plus. Le côté où on fait appel à l'empathie et de prendre soin de l'autre. [Ça m'attire] plus que la culpabilité du Concept C et vu que le message n'était pas trop clair au niveau du Concept B." (The visual side [of Concept A] attracts me more. The part where we appeal to empathy and taking care of others. [It appeals] to me more than the guilt of Concept C and since the message was not too clear in Concept B.") Chronic Conditions, Quebec

Regardless of the concept selected based on the strength of the call to action, elements of all three concepts held graphic appeal that should be considered as the campaign is further developed:

Information Channels

A variety of websites were considered appropriate to inform the public about the flu vaccine, in addition to having posters in high traffic locations.

Participants were asked what the best way would be to let them know about the flu vaccine. For the most part, general sites such as Gmail, Google, Outlook, as well as social media, including Facebook, TikTok, and Instagram, were considered the best place to see an online ad about the flu vaccine. Websites specializing in healthcare, such as Health Canada or 'Clic Santé' were also identified. In Quebec, La Presse Plus was also mentioned.

A few also felt that the use of more mainstream media to convey information about the flu vaccine, including outdoor billboards and bus boards, would likely have broader reach. Finally, posting signs at medical clinic or at pharmacies were seen as a good way to advertise the flu vaccine, as well as through public libraries and grocery stores.

"Des bannières sur des arrêts d'autobus, ou dans des salles d'attentes. Dans des endroits où les gens ont le temps de regarder et lire les publicités." (Banners on bus stops, or in waiting rooms. In places where people have time to look at them and read advertisements.) Parents/Pregnant People, Quebec

Conclusions

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

Direction

As it moves to finalize the development of its seasonal flu vaccine campaign, Health Canada should consider the following:

  1. Further develop Concept A, with minor changes.

    The final campaign should continue using the first-person point of view as it was felt to be more relatable. The concept's simplicity and focus of messaging, and call to action worked well as is. The graphic design also generally works well, notably in terms of the choice of colours. Some consideration should be paid to ensuring that the expressions on the faces of models used are more serious in tone rather than overly happy. Indeed, the smiles should be toned down to show that this is a serious subject. Many participants thought that the joyful expressions made the person look too happy, considering the importance of the matter at hand. Concept A's use of photography on all slides helped to grab attention throughout the concept's frames. The circle with the call to action was well liked and should be kept as the campaign is further developed.

  2. Borrowed from Concept B, it should be suggested that the flu vaccine is one of many the ways to protect those at risk, rather than the only way.

    The more inclusive approach of Concept B may be more impactful for many than an approach that feels more forceful and directive, particularly for those who don't typically get the seasonal flu vaccine. This idea should be incorporated without changing the overall message of Concept A and its focus on the flu vaccine.

  3. Words should be bolded, as in Concept C, to make the text more legible.

    Bold lettering, as used in Concept C was felt to be the clearest and most legible. The colour contrast should also be improved to better feature the individual on each frame of whichever concept is developed. Additionally, consideration should be paid to ensuring good contrast of the person versus the background. There were some comments about the colour of shirts blending into the background in some of the concepts, and how better contrast would improve the overall quality of the image.

  4. To enhance the message's credibility, consider showing the Government of Canada wordmark on all frames.

    Some participants felt as though the ad would be more convincing and reliable if it was clear that it was sponsored by the Government of Canada right from the start of the ad. Despite a number of participants being distrustful of government messaging, it is important that the ad be advocated by a credible source.

Appendix A:
Recruitment Screener

Health Canada: Seasonal Flu Marketing Campaign 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
Monday Oct. 17 1 5:00PM 4:00PM 3:00PM/2:00PM Prairies/NWT – Parents/Pregnant EN MC
2 6:00PM 5:00PM 6:30PM/6:00PM Atlantic – General Population EN CW
3 7:00PM 6:00PM 7:30PM/7:00PM Atlantic – Parents/Pregnant EN MC
4 8:30PM 7:30PM 6:30PM/5:30PM Prairies/NWT – General Population EN CW
Tuesday Oct 18 5 6:00PM 5:00PM 2:00PM BC/Yukon – Parents/Pregnant EN MC
6 6:30PM 5:30PM 5:30PM Quebec – Chronic Health Conditions FR CP
7 7:00PM 6:00PM 6:00PM Ontario/Nunavut – General Population EN CW
8 8:00PM 7:00PM 7:00PM Ontario/Nunavut – Parents/Pregnant EN MC
9 8:30PM 7:30PM 7:30PM Quebec – General Population FR CP
10 9:30PM 8:30PM 5:30PM BC/Yukon – General Population EN CW
Wednesday Oct 19 11 7:00PM 6:00PM 6:00PM Ontario/Nunavut – Chronic Health Conditions EN CW
12 8:30PM 7:30PM 7:30PM Quebec – Parents/Pregnant FR CP
13 9:30PM 8:30PM 5:30PM BC/Yukon – Chronic Health Conditions EN CW
Thursday Oct 20 14 6:00PM 5:00PM 6:30PM/6:00PM Atlantic – Chronic Health Conditions EN CW
15 8:30PM 7:30PM 6:30PM/5:30PM Prairies/NWT – Chronic Health Conditions EN CW

Audience Group Number
PARENTS/PREGNANT 1, 3, 5, 8, 12
CHRONIC CONDITIONS 6, 11, 13, 14, 15
GENERAL POPULATION 2, 4, 7, 9, 10

Language Group Number
English 1-5, 7-8, 10-11, 13-15
French 6, 9, 12

Specification Summary

Total of 15 sessions
Audience Atlantic
(English)		 Ontario/ Nunavut (English) Prairies/ NWT (English) BC/Yukon (English) Quebec (French) Total Groups Total
Recruits
General Population 18+ 1 1 1 1 1 5 40
People with Select Chronic Health Conditions 1 1 1 1 1 5 40
Parent of Children 4 Years Old or Younger / Pregnant People 1 1 1 1 1 5 40
TOTAL 3 3 3 3 3 15 120

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:
Government of Canada: 1-800-926-9105; questions@tpsgc-pwgsc.gc.ca
Narrative Research: 888-272-6777; focusgroups@narrativeresearch.ca

SECTION G: General Introduction

Hello, my name is _______________ and I am calling on behalf of Narrative Research, a national market research company. Would you prefer that I 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: "J'appelle aujourd'hui concernant les groupes de discussion qui se tiendront en anglais. Désirez-vous qu'un collègue vous rappelle afin de vous inviter à participer à un groupe de discussion qui aura lieu en français?" IF YES, ARRANGE CALL BACK

Let me assure you that we are not trying to sell you anything. We are conducting a public opinion research project for the Government of Canada and we are looking for people to take part in a 90-minute online focus group discussion that will be scheduled from October 17 to October 20. Participants will receive a financial incentive if they qualify to take part. Is this something you might be interested in?
Yes............................................. 1
No.............................................. 2 THANK & TERMINATE

The purpose of this group discussion is to hear people's opinions on advertisement and communications materials being developed by the Government of Canada. Your participation is voluntary, anonymous and confidential. No attempt will be made to sell you anything or change your point of view.

[IF ONLINE, PROVIDE A LINK TO NARRATIVE RESEARCH'S PRIVACY POLICY AT THE BOTTOM OF EACH PAGE: https://narrativeresearch.ca/privacy-policy/#politique-de-confidentialit%C3%A9]

[IF BY PHONE: Narrative Research's privacy policy is available upon request. IF ASKED, PROVIDE PRIVACY POLICY LINK BY PHONE OR RECORD EMAIL WHERE IT WILL BE SENT]

This research is registered with the Canadian Research Insights Council Research Verification Service. [IF NEEDED, SPECIFY: to verify the research, you can visit canadianresearchinsightscouncil.ca/rvs/home/?lang=en. The survey registration number is 20221012-NA615]

The format of the focus group is an informal small online group discussion led by a professional moderator. May I ask you a few quick questions to see if you are the type of participant we are looking for? This should take about 5 or 6 minutes.
Yes............................................. 1
No.............................................. 2 THANK & TERMINATE

SECTION P: Profiling Questions

INSTRUCTIONS: If yes to any of the above, thank & terminate
INSTRUCTIONS: Recruit mix of provinces/territories and communities in each group
INSTRUCTIONS: Thank & Terminate if less than 2 years
INSTRUCTIONS: If less than 18 (code 1) Thank & Terminate. Recruit mix of ages in each group
INSTRUCTIONS: Recruit an equal mix of male/female for all groups except for the PARENT/PREGNANT group where 3 should be male and others either female or gender diverse.
INSTRUCTIONS: If "Yes" (code 1) consider for PARENTS/PREGNANT groups. Otherwise, consider for one of the other groups.
INSTRUCTIONS: If "Yes" (code 1) consider for PARENTS/PREGNANT groups. Recruit min 3 per PARENTS/PREGNANT group. If "No" (Code 2) ask QP8
INSTRUCTIONS: If "yes" (code 1) consider for PARENTS/PREGNANT groups. Recruit max 2 per group. Otherwise, consider for one of the other groups.
INSTRUCTIONS: Recruit mix in each group
INSTRUCTIONS: If any chosen (code 1-8), consider for CHRONIC CONDITIONS groups. Recruit mix in each CHRONIC CONDITIONS group
INSTRUCTIONS: Recruit equal mix (50-50) in each group
INSTRUCTIONS: Recruit min 1 Indigenous per group. If other ethnic backgrounds, recruit mix in each group to represent the general composition of each market.
INSTRUCTIONS: Recruit mix in each group
INSTRUCTIONS: Max 3 per group who are unemployed, retired, student, or other (code 4-7). Thank & terminate if "unsure/prefer not to answer"
INSTRUCTIONS: Thank & Terminate if similar occupations as in QP1
INSTRUCTIONS: Thank & Terminate if similar occupations as in QP1
INSTRUCTIONS: Recruit mix in the GENERAL POPULATION groups

SECTION N: Netfocus Questions

The focus groups for this project will be conducted online and will require the use of a laptop or desktop computer connected to high-speed Internet and equipped with a webcam, a microphone and speakers. Note that because of the complexity of the material we are showing on the screen during the focus group, you cannot use a computer tablet or a smartphone to access the online session. The screen of those electronics is simply too small for the purpose of this research project.

  1. Do you have access to a laptop or desktop computer with high-speed Internet to take part in this focus group? [MULTIPLE RESPONSES KEEPING CODE 3 EXCLUSIVE]

    Yes, laptop or desktop computer....................... 1
    No................................................................... 2

    INSTRUCTIONS: If no, thank & terminate
  2. Is the computer you will use for the focus group equipped with a webcam, a microphone and speakers you will be able to use? Note that you will be required to keep your webcam on for the duration of the focus group.

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

    INSTRUCTIONS: If no, thank & terminate
  3. You will need to be in a place that is quiet and free of distractions for the duration of the session. This includes being on your own, without pets, children or other people nearby, and in a quiet room. An outdoor area, a vehicle, or a public place are NOT acceptable locations. Are you able to secure a quiet environment without distractions or noises for the duration of the focus group session?

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

    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 or logistic requirements. We thank you for your interest in this research.

SECTION R: Previous Focus Group Experience Questions

I just have a few more questions…

  1. Have you ever attended a group discussion or interview for which you received a sum of money?

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

    INSTRUCTIONS: Max 4 recruits per group who answered "yes". If "yes" continue. If "no", go to SECTION I: Invitation
  2. When was the last time you attended a group discussion or interview? _____________
  3. How many groups or interviews have you attended in the past 5 years? ____________ MAX 4
  4. 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.
- ever attended a group discussion on advertising and communications materials

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 online at <INSERT TIME> on <INSERT DATE>. The session will bring together 6 to 8 people and it will last 90 minutes to two hours. We will send you a link to join the online focus group via Zoom and during the session, you will provide feedback on advertisements and communication materials currently being developed by the Government of Canada. In appreciation for your time to attend the focus group, you will receive [GENERAL POPULATION groups: $100 / PARENTS/PREGNANT and CHRONIC CONDITIONS groups: $125] after the session.

  1. Are you available and interested in taking part in this focus group?

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

    INSTRUCTIONS: If no, thank & terminate
  2. The discussion in which you will be participating will be video 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 video recorded?

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

    INSTRUCTIONS: If no, thank & terminate
  3. There may be employees from the Government of Canada and the marketing agency 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 THANK AND TERMINATE

    INSTRUCTIONS: If no, thank & terminate
  4. Which of the two official languages, English or French, do you speak most often on a regular basis? [SINGLE RESPONSE]

    English........................................ 1
    French........................................ 2
    Both equally................................ 3

    INSTRUCTIONS: Must answer French (code 2) for Quebec groups
  5. The group discussion will be held [GROUPS X,X,X: in French] [ALL OTHER GROUPS: in English]. Participants will be asked to read text, write responses and/or review images prior to and during the session. Are you able to take part in these activities [GROUPS X,X,X: in French] [ALL OTHER GROUPS: in English] on your own, without assistance?

    Yes............................................. 1
    No.............................................. 2
    Unsure....................................... 8

    INSTRUCTIONS: If "no" or Unsure, thank & terminate
  6. There will be someone available to assist you with the login process to join the online session. There will be a professional facilitator conducting the focus groups, and they will provide time during the session for participants to share their opinions. Are there any accommodations you may require to ensure you are able to participate in this focus group?

RECORD VERBATIM COMMENT: _______

Could we please confirm the email address where we can send you the instructions to log in to the focus group session?

Record email address (and verify): ________________________________________________.
We will send you by email the log-in instructions at least 1 day in advance of the group. The group discussion will begin promptly at <TIME> and will last about 90 minutes. Up to two hours of your time will be required including the login and introduction process. Please log in on time to ensure that the session is not delayed. If you arrive late, we will not be able to include you in the discussion, and will not provide you with the incentive.

As mentioned, we will be pleased to provide everyone who participates with [GENERAL POPULATION groups: $100 / PARENTS/PREGNANT and CHRONIC CONDITIONS groups: $125], provided by e-Transfer or cheque, as you'd prefer. It takes approximately 5 business days to receive an incentive by e-Transfer or approximately 2-3 weeks following your participation to receive an incentive by cheque.

  1. Would you prefer to receive your incentive by e-Transfer or cheque?

    e-Transfer................................... 1
    Cheque....................................... 2

  2. [IF PREFER TO RECEIVE INCENTIVE BY E-TRANSFER – CODE 1 IN QI6] Could you please confirm the e-mail address where you would like the e-transfer sent after the focus groups?

    Email address:________________________________________________________________
    And please confirm the spelling of your name: _______________________________________

    The e-transfer password will be provided to you via email following the group.

  3. [IF PREFER TO RECEIVE INCENTIVE BY CHEQUE – CODE 2 IN QI6] Could I have the mailing address where you would like the cheque mailed after the focus groups?

    Mailing address:_______________________________________________________________
    City: ________________________________________________________________________
    Province: ____________________________________Postal Code: _____________________
    And please confirm the spelling of your name: _______________________________________

  4. 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 ________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? [CONFIRM INFORMATION ALREADY COLLECTED AND CHANGE/COMPLETE AS NECESSARY]
    First Name: ____________________________________________
    Last Name: ____________________________________________
    Email: ________________________________________________
    Cell Phone: ____________________________________________
    Home Phone: __________________________________________
    Work Phone: ___________________________________________

INSTRUCTIONS: 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

  1. Recruit 8 respondents per group
  2. CHECK QUOTAS
  3. Ensure participant has a good speaking (overall responses) ability-If in doubt, DO NOT INVITE
  4. Do not put names on profile sheet unless you have a firm commitment.
  5. 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:

Seasonal Flu Marketing Campaign Focus Testing (HC POR 22-19)

Moderator's Guide – Final

Study Goals (Confidential – Not read to participants)

Introduction 10 minutes

Creative Testing 65 minutes

As I mentioned earlier, I'd like to show you a number of ideas that could be used by the Government of Canada for a Seasonal Flu advertising campaign. We will look at three concepts, each including four examples of web banners.

The ads are still in development, and they have not yet been produced. As I am showing you the concepts, you will have to envision what the final ads would look like. You will be able to click directly on the ads to get to a web site with more information.
We will look and discuss each concept 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 CONCEPT ONE AT A TIME – ROTATE ORDER OF CONCEPTS ACROSS GROUPS

Concept A: For you and for me
Concept B: Lots of things
Concept C: Masks off

Campaign Presentation Order
Audience BC/Yukon Prairies/NWT Ontario/Nunavut Atlantic Quebec
Parents/Pregnant G5: A-B-C G1: B-A-C G8: C-B-A G3: A-B-C G12: C-B-A
Chronic Conditions G13: C-B-A G15: A-B-C G11: B-A-C G14: C-B-A G6: B-A-C
General Population G10: B-A-C G4: C-B-A G7: A-B-C G2: B-A-C G9: A-B-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.

[POLL A-C – OPINIONS CONCEPT A-C]
Indicate on a 1-10 scale the extent to which the statement aligns with what you think the combination of ads from this concept (where 1 means "no, not at all" and 10 means "yes, absolutely"):

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

Now let's have a look at the next concept. REPEAT POLL/DISCUSSION FOR THE OTHER CONCEPTS

Final Choice & Best Channels 15 minutes

Now that we've seen all three concepts, I'd like to know which one you think is the strongest. Take a moment to complete a poll:

[POLL D – PREFERRENCE]

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

Thanks & Closure:

That's all my questions; thank you for taking part in our discussion. We will follow up with you by email 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:
Materials Tested

Figure 4.
Figure 4. Text version below.
Description: White background with the words “Concept A” written in white font within small blue box.

Figure 5.
Figure 5. Text version below.
Figure 5 - Description: A smiling teenager wearing a tie-dyed t-shirt with the sleeve rolled up and a visible neon band-aid. The background is orange.

Text reads: I’m at high risk for flu-related complications because of my chronic health condition. My condition weakens my immune system. My condition weakens my immune system, so it’s harder to fight off infections. Get the flu shot for you and me.


Figure 6.
Figure 6. Text version below.
Figure 6 - Description: A smiling pregnant woman holding her pregnant stomach. The background is beige.

Text reads: I’m at high risk for flu-related complications because I’m pregnant. Pregnancy has weakened my immune system. Pregnancy has weakened my immune system, so it’s harder to fight off infections. Get the flu shot for you and me.


Figure 7.
Figure 7. Text version below.
Figure 7 - Description: A smiling 5-year old child holds her arm with a band-aid. The background is blue.

Text reads: “My kids are at high risk for flu-related complications because they’re under 5. My children’s immune systems are still developing. Get the flu shot for you and me.”


Figure 8.
Figure 8. Text version below.
Figure 8 - Description: Smiling older man holds his arm with a visible band-aid. The background is red.

Text reads: I’m at high risk for flu-related complications because I’m 65. People 65 and older have a harder time fighting infection. Get the flu shot for you and me.


Figure 9.
Figure 9. Text version below.
Figure 9 - Description: White background with the words “Concept B” written in white font within small blue box.

Figure 10.
Figure 10. Text version below.
Figure 10 - Description: Two options with the same text but different imagery. The first option shows a smiling woman in the kitchen cooking a meal. The second option shows a smiling doctor speaking with a patient.

Text reads: “There are strategies for coping with a chronic health condition. Getting the flu shot is one of them. Protect yourself and those at risk for flu-related complication. Get a flu shot.”


Figure 11.
Figure 11. Text version below.
Figure 11 - Description: Side profile image of pregnant woman holding her stomach.

Text reads: There are lots of things you can do for a health pregnancy. Getting the flu shot is one of them. Protect yourself and those at risk for flu-related complications. Get a flu shot.


Figure 12.
Figure 12. Text version below.
Figure 12 - Description: Image of smiling toddler.

Text reads:  “Children develop a lot in their first 5 years, including their immune systems. Getting the flu show protects them from complications from the flu until their immune system can. Protect yourself and those at risk for flu-related complications. Get a flu shot.”


Figure 13.
Figure 13. Text version below.
Figure 13 - Description: Image of four active older adults standing side by side in the outdoors.

Text reads: There are lots of ways to help live a healthy and full life after 65. Getting the flu show is one of them. Protect yourself and those at risk for flu-related complications. Get a flu shot.


Figure 14.
Figure 14. Text version below.
Figure 14 - Description: White background with the words “Concept C” written in white font within small blue box.

Figure 15.
Figure 15. Text version below.
Figure 15 - Description: Image of smiling man with rolled up t-shirt showing band-aid on upper arm. Next frame has a white medical mask. Third frame shows sleeve rolled up and beige band-aid.

Text reads: “Chronic health conditions can affect immune systems, making it harder to fight off infection. With fewer people wearing these, people with chronic conditions and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot.”


Figure 16.
Figure 16. Text version below.
Figure 16 - Description: Side profile image of pregnant woman sitting on chair, holding her stomach. Next frame shows a white medical mask. Third frame shows upper arm with sleeve rolled up and beige band-aid.

Text reads: “When pregnant, it’s harder to fight off infection. With fewer people wearing these, pregnant people and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot.”


Figure 17.
Figure 17. Text version below.
Figure 17 - Description: Smiling child has large blue band-aid on upper arm. Next frame shows a white medical mask. Third frame shows close up of upper arm with prominent band-aid.

Text reads:  Kids under 5 are still building immunity to fight infection. With fewer people wearing these, parents with kids under 5 and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot.


Figure 18.
Figure 18. Text version below.
Figure 18 - Description: Smiling older woman with band-aid on upper arm. Next frame shows a white medical mask. Third frame shows upper arm with sleeve rolled up and beige band-aid.

Text reads: For people 65+, it’s harder to fight off infection. With fewer people wearing these, people 65+ and those around them need a flu shot. Protect yourself and those at risk for flu-related complications. Get a flu shot.


Figure 19.
Figure 19. Text version below.
Figure 19 - Description: White background with the word “Preference” written in white font within small blue box.

Figure 20.
Figure 20. Text version below.
Figure 20 - Description: Composite image of Concepts A, B, and C.