Alcohol - count 14 campaign: evaluation report

Background

1. The Scottish Government's systematic approach to preventing alcohol-related harm is set out in the national strategy: Alcohol Framework 2018: Preventing Harm. The Framework places the World Health Organization's (WHO) three 'best buys' at its centre – to reduce the affordability, attractiveness and availability of alcohol. This focus is demonstrated in practice through activity such as the introduction of minimum unit pricing and our upcoming consultation on potential alcohol marketing restrictions.

2. The UK Chief Medical Officers' (CMOs') lower-risk guidelines on alcohol were revised in 2016, creating a need for awareness raising work. One of the twenty commitments set out in our Alcohol Framework states that:

We will initiate national marketing work, with partners, promoting the messages of the UK CMOs' lower-risk drinking guidelines during 2018, and we will launch this campaign nationwide in 2019.

3. To meet this commitment, the Scottish Government delivered the 'Count 14' national public information campaign. The Count 14 campaign aims to raise awareness of the 14 unit weekly lower-risk guidelines and break down what this means in terms of specific alcoholic drinks.

4. Although the campaign targeted the whole adult drinking population (18+), there was a specific focus throughout on men and all those aged 45-64, due to higher levels of alcohol consumption on average. Self-reported surveys, including the annual Scottish Health Survey,^[i] evidence this. This influenced choice of media, targeting decisions as well as some partnership and field marketing activity.

5. In Phase One, field marketing activity was closely linked to areas of higher deprivation due to alcohol-related harm being more prevalent,^[ii] as well as health literacy concerns. Following the Phase One survey results, which provided direct evidence of lower levels of knowledge and understanding of the guidelines within lower socio-economic groups, further focussed field and partnership activity was undertaken to seek to improve this.

Count 14 Campaign – Phase One

6. Two main phases of Count 14 were undertaken, in March 2019 for a period of three weeks and in January/February 2020 for a period of six weeks. The campaign included close work with partners including the Lower-risk Drinking Guidelines Expert Advisory Group, Public Health Scotland, Alcohol and Drug Partnerships, and national supermarkets.

6. Prior to campaign development, insight was gathered among the target audience through an Omnibus survey in October 2018. This identified two key insights: that few drinkers understood the lower-risk guidelines being 14 units per week for both men and women. And, in order for someone to consider their own consumption, 14 units would need to be presented in terms of drinks (pints, glasses, shots and bottles) in order to have relevance. Following creative testing research, the 'Count 14' creative route was selected.

7. The campaign itself ran for three weeks in March 2019 (11 March until 31 March). A TV ad was developed for live TV and video-on-demand services, plus digital advertising and social media.

8. A radio advert was produced for national and community stations as well as three print executions (shown below) for use as press adverts in national newspapers and as posters distributed to GP surgeries, stakeholders and other partner organisations.

9. A website (www.count14.scot) was created providing interactive tools, including a drinks generator and calculator, and situational examples of how to track drinking and cut down. This also links in to further health information at NHS Inform (www.NHSinform.scot).

10. The Public Relations strand of the campaign identified a range of 'voices' to create a relatable and credible narrative around the guidelines (why they exist, health harms and the benefits of following them). This included the Chief Medical Officer and regional NHS public health voices, as well as members of the public and relatable, well-known people in Scotland.

11. In supermarkets, field marketing was used to engage the public near point of purchase, via stands at Lidl and ASDA locations. This consisted of an interactive challenge, with members of the public, to boost learning and recall of the 14 unit message as well as distribution of resources including measuring cups, unit pourers and unit calculator wheels. This led to 4,000+ face to face engagements.

12. Partnership marketing was used to extend the reach of the campaign and increase credibility through trusted partner voices. Twenty partners were involved including charities, leisure organisations, retailers and large employers. Activity included partners displaying Count 14 banners within their premises, information being provided to employees/customers and resources being distributed.

13. We also worked closely with local Public Health leads and Alcohol and Drug Partnerships to provide campaign resources and encourage local amplification of Count 14.

Phase One – Evaluation

14. Quantitative pre and post campaign tracking was carried out by Progressive Partnership, an independent research agency. This involved face to face on-street interviews with men and women over 18 who drink alcohol in Scotland. The sample size was 840 for the pre-campaign tracker (February 2019) and 830 for the post-campaign tracker (April/May 2019). Quotas were set for gender and socio-economic group whilst data was weighted to be nationally representative. The volume of respondents within the 45-54 and 55-64 age groups were boosted due to the higher consumption levels associated with these age groups.

15. The results demonstrate that 55% of those shown examples of the Count 14 advertising remembered previously seeing this, known as prompted recall. Most of those recalling the campaign had seen the TV advert (37%) with some hearing/seeing the radio advert (22%), the digital advertising/social media (22%) and the press advert/poster (20%).

16. There were good levels of cut-through, meaning that our Count 14 advertising stood out amongst other alcohol advertising. Of those who reported that they had seen or heard advertising on alcohol consumption, 57% were likely to have been exposed to the Count 14 campaign advertising.The key message getting through was the existence of recommended weekly guidelines, mentioned by 26% of those who had seen/heard advertising on alcohol consumption. Encouragingly, although Count 14 is not a behaviour change campaign, 4/10 of those recognising the campaign had taken/planned action after seeing/hearing the campaign.

17. The proportion of those aware of the existence of drinking guidelines remained consistently high, 83% pre-campaign and 80% post campaign.

18. Crucially, the surveys found an increase in the proportion of those aware of alcohol guidelines who knew the recommended limit was 14 units, from 21% pre-campaign to 34% post-campaign. Across the whole sample (not just those aware of guidelines existing), awareness significantly increased from 17% to 27%.

19. In terms of breaking the guidelines down into drinks, researchers carried out the pre-campaign tracker survey on the basis of asking if people understood the correct number of units in one drink, of their preferred choice e.g. the number of units in one pint of beer. It later became clear during creative development, and further research, that the more effective way to communicate this message was through the number of preferred drinks in 14 units e.g. 6 pints of beer generally equates to 14 units. This objective was therefore adjusted for Phase Two of the campaign.

20. Women and those in higher socio-economic groups were most likely to be knowledgeable around the guidelines, whilst men and those in lower socio-economic groups were not. This suggested a need to up-weight communications targeted at those groups in future activity.

Count 14 Campaign – Phase Two

21. The second phase of the campaign ran for a period of six weeks in January/February 2020. Due to the positive Phase One results, the creative approach and media mix were largely retained, albeit over a longer period of time. Specific actions were taken to attempt to improve the reach and understanding amongst men and those in lower socio-economic groups.

22. The same TV advert was used in Phase Two, specific advertising slots were chosen to target men and lower socio-economic groups e.g. during sports programmes. New radio adverts were created in order to specifically focus on the number of pints of beer and measures of spirits adding up to 14 units, drinks more regularly consumed by men and lower socio-economic groups.

23. Partnership activity was increased and 24 partnerships were secured with organisations including DC Thomson, AG Barr and Buchanan's. The partnership activity again included partners displaying Count 14 banners within their premises, information being provided to employees/customers and resources being distributed.

24. We developed a new partnership with C&C Group (owners of brands including Tennent's and Magners) and Celtic F.C., who displayed Count 14 advertising on pitch side LEDs, match programmes and big/hospitality screens, across 5 home matches. Count 14 adverts were also displayed on the Celtic website during the campaign period. This provided an opportunity to reach a high volume of men within a new setting.

25. Field marketing was up-weighted, and included a 12-day roadshow in ASDA and Lidl stores across Scotland. We continued to utilise trusted voices as well as influencers within the Partnerships and Public Relations approach.

Phase Two – Evaluation

26. As in Phase One, quantitative pre and post campaign tracking was carried out by Progressive Partnership. The Phase One post-campaign tracker (April/May 2019) was used as the Phase Two pre-campaign tracker. This was supplemented by an online omnibus survey, carried out in November 2019 with a sample size of 1,002 people. The online omnibus survey allowed us to switch the focus to asking people about the number of servings of their preferred drink adding up to 14 units, rather than the number of units in one drink. The Phase Two post-campaign tracker survey was carried out in March 2020 and had a sample size of 822 people.

27. The results demonstrate that 57% of those shown examples of the Count 14 advertising remembered previously seeing this (prompted recall), this is a slight increase from Phase One (+2%). Most of those recalling the campaign had seen the TV advert (43%) with some hearing/seeing the radio advert (28%), the digital advertising/social media (25%) and the press advert/poster (25%).

28. There were again good levels of cut-through, of those who reported that they had seen or heard advertising on alcohol consumption, 59% were likely to have been exposed to the Count 14 campaign advertising. Key messages getting through included the existence of recommended weekly guidelines (26%) and the 14 unit guideline (16%).

29. The proportion of those aware of alcohol guidelines remained consistent, 82% pre-Phase Two and 83% post-Phase Two. As in Phase One, the proportion of those aware of the guidelines who could identify the correct weekly 14 unit limit remained broadly consistent, with a slight increase from 34% before Phase Two to 39% after. Across the whole sample (not just those aware of guidelines existing), awareness significantly increased from 27% pre-Phase Two to 32% after. Results were higher amongst those recognising the campaign, 46% amongst those aware of guidelines and 40% for the whole sample.

30. There were positive results around increased understanding of how many servings of beer, wine or spirits make up 14 units, although understanding was low overall. The proportion of the whole sample identifying the correct number of servings making up 14 units remained broadly consistent; from 12% to 16% for beer/larger/cider, from 10% to 14% for wine but decreased from 22% to 17% for spirits.

31. Results were consistent when taking into account which one of these drinks categories individuals preferred; beer drinkers (from 15% to 16%) and wine drinkers (from 15% to 20%) but a slight decrease in spirit drinkers (from 24% to 20%). Generally campaign recognisers had higher scores, 22% of campaign recognisers identifying the correct number of servings of their preferred drink in 14 units as opposed to 12% of non-recognisers.

32. A new secondary objective was measured around awareness of the recommendation to spread drinking over 3 or more days. The results demonstrate consistency in the proportion of respondents aware of this, from 58% to 59%, with the scores being higher among recognisers than non-recognisers.

33. Across the results, women and those in higher socio-economic groups remained most likely to be knowledgeable around the guidelines, whilst men and those in lower socio-economic groups were not so knowledgeable. Despite the actions taken to address this, there were no material changes in results.

Overall evaluation results

34. Taking both phases into account, the results are summarised below:

Metric	Baseline	Achieved Phase 1	Achieved Phase 2	Campaign recognisers (Phase 2)
Prompted awareness of the Count 14 campaign.	n/a	55%	57% (+2%)	n/a
Proportion of those aware of the existence of weekly consumption guidelines.	83%	80% (-3%)	82% (+2%)	87%
Proportion of those, aware of guidelines, who can identify this correctly as 14 units a week.	21%	34% (+13%)	39% (+5%)	46%
Proportion of those who can identify the 14 unit weekly guidelines correctly.	17%	27% (+10%)	32% (+5%)	40%
Proportion of those who can accurately describe how many drinks of their choice make up 14 units – for beer, wine and spirits (Phase 2 only).	n/a	n/a	Beer: 16% (+1%) Wine: 20% (+4%) Spirits: 20% (+4%)	Beer: 18% Wine: 23% Spirits: 27%
Proportion of those who are aware of the recommendation to spread drinking over three days or more (Phase 2 only).	n/a	58%	59% (+1%)	66%

Analysis and conclusion

35. Across the two phases of activity over 2019 and 2020, scores around campaign recognition and awareness of the existence of weekly consumption guidelines were high. The vast majority of those surveyed were aware of the existence of drinking guidelines (82% after Phase Two).

36. Taking both phases into account, the proportion of those aware of guidelines who could identify 14 units as the correct weekly limit, has substantially increased from 21% pre-Count 14 to 39% after both phases, an 18% increase. The substantial increase in awareness after phase one (+13%) was sustained and there was a slight increase in phase two (+5%). Among all of those surveyed, not just those who were aware of guidelines, awareness of the 14 unit limit increased from 17% pre-Count 14 activity to 32% after both phases.

37. Some progress has been made on increasing understanding of how the 14 unit guidelines equate to individual drinks, although these scores remain low overall. This may be due to this being a difficult message to communicate as it is heavily dependent on arithmetic and alcohol strength, which varies greatly across products.

38. Generally, increases in all metrics are higher among campaign recognisers and higher again amongst those who recognise 2 or 3 media channels. This demonstrates that the campaign has made a positive impact on increasing awareness and understanding of the UK CMOs' low-risk drinking guidelines in Scotland.

39. It is clear that further work is required to increase awareness levels further, particularly amongst men and those in lower socio-economic groups. We will consider future national marketing and health messaging on alcohol consumption in light of these findings.