Prevention campaigns are often seen as the answer to addressing substance use in the community. They are visible, wide-reaching, and often meet the requirement to “do something about the substance use problem!” But just as often, campaigns can fail to produce the outcomes that are needed. Among those studied over the past 20 years,[i] the most effective have involved smoking prevention in the U.S.[ii], while the most extensive antidrug campaign in the U.S., the National Youth Anti-Drug Media Campaign, which focused on marijuana, not only failed to produce positive outcomes, but showed negative indications of increasing marijuana initiation rather than preventing it.[iii]
Building on the learnings from this research and capturing some of the principles of behavioral and communication theories, Dr. William Crano and his colleagues[iv] at Claremont Graduate University have been working with a model called EQUIP to help prevention and communications practitioners develop the most effective and persuasive messages. Strong messaging is even more important today as those of us working in prevention need to understand and use a wide array of media—e.g., the mass, print, and social media--to ensure that we can reach vulnerable populations. Print media have become even less important in this virtual world of today. So communication efforts need to be based on strong messages that can be adapted to the appropriate channels for reaching the audience. Operationally, to be most effective, a campaign needs to not only attract the targeted audience members, but also, challenge their pro-substance use beliefs, and disarm their opposition to the campaign message.
Who is the target audience for the campaigns?
While most prevention campaigns target a universal youth population who are nonusers and are intended to keep them that way, there has been little attention to identifying differences in risk of use in this non-using population. But, in 2008, Dr. Crano and colleagues[v] re-analyzed data from the evaluation of the National Youth Anti-Drug Media Campaign referenced above and found that there were differences in the characteristics of non-users at baseline, which represented different levels of risk of use in this population. The Crano team identified a group known as resolute non-users who expressed attitudes and intentions not to use marijuana. Another group, called vulnerable non-users, expressed uncertainty in their attitudes and intentions in regard to using marijuana at some point in the future. When measured at the end of 4 years, 66% of the vulnerable nonusers had used marijuana compared to 26% of the resolute nonusers. Recognizing and targeting these differences in the audience for a campaign could make a big difference in terms of its ability to succeed.
How does the EQUIP model help us build a persuasive message?
Like all evidence-based prevention programming, EQUIP is theoretically-based. It builds on three theories that help us understand different aspects of persuasion messaging developed by Lasswell, Hovland, and McGuire. Lasswell (1948) framed a single question that requires that we understand “Who says what to whom, and with what effect?” His question is useful because it prompts campaign developers to be mindful of specific features involved in the persuasion process: the communication source (the who), message content and delivery medium (the what), and message target audience (to whom) when assessing a communication’s persuasive outcome (with what effect?). These are key elements of any persuasive message, and they must be considered when developing effective appeals.
Hovland’s message learning theory (1953) suggests that a persuasive message must raise a question in the receiver’s mind; then it must answer the question and provide an incentive to accepting the answer. For example, you may have learned from focus groups that some nonusers believe that most kids in their school are using marijuana even though that is not true—so your message could be, “You might think that lots of teens your age are using marijuana, but the 2020 survey in your school shows that 4 out of 5 students are not.”
The third theory is a model by McGuire (1985) which explains how various elements in the communications process interact to effect outcomes like attention, understanding, and attitude change. Similar to Lasswell’s, McGuire’s variables include source (“who”) message (“what”: content and medium), target (to “whom”), and focus of the communication(e.g., marijuana, heroin, amphetamines, gambling, overeating).
The EQUIP model incorporates these concepts and serves as a guide to developers. It reminds developers that the communication must Engage receivers, have them Question their established belief, Undermine or destabilize the belief, Inform the receiver of a superior alternative, and Persuade the receiver to accept this alternative. Each of these interacting requirements should be met if the communication is to have maximal effect.
EQUIP Model Elements
The Engage feature of EQUIP is a critical element in all communications programming. Attracting the audience to the message with content—surprising facts, unexpected approaches—or executional elements—bright colors, music, movement etc. are all designed to attract and hold the audience’s attention long enough to get the message across.
As described, the Question phase is to reduce a receivers’ certainty in the validity of their attitudinal position. For example, they may think that vaping tobacco protects against getting addicted to nicotine; so challenging that position with straight and authoritative statements on the addictive qualities of nicotine, whether smoked or vaped, in addition to suggesting that the sooner they quit, the better for their health. The message gives the right information and an incentive to quit.
The Undermine element requires that the persuasive message not only raises doubt about a belief’s validity, but provides a credible alternative to the destabilized attitude, a reason to abandon the attitude and adopt a new position. The Question and Undermine phases work together.
The Inform, as the term implies, provides information that is topic-relevant and evidence-based; and usually identifying appropriate sources that add to its credibility. The EQUIP model helps to construct such messages. Emphasizing social impact rather than physical harms may also produce better responses among youth who are more concerned about their social life rather than their health. At the same time, it is important to avoid overstating physical harms or extreme effects of the use of substances that can readily be disproved or dismissed. As in the ‘scare tactics’ of old, such statements can lead to message rejection.
The final EQUIP element, Persuade, includes the need to motivate acceptance, and to mitigate resistance. This then allows for a reasonably open-minded consideration of the substance use persuasive prevention communication.
Message developers should maintain as much control as possible over message creation, delivery, and interpretation. In so doing, some of the following can help strengthen your ability to do this successfully.
On the Source (Any person, character, or entity that is the sender of the message; if present in the communication, called an explicit source; or if not specifically identified or explained, called an implicit source).
Since we know that the credibility and characteristics of the source are important to message receivers, using an explicit source—i.e., one that appears in the communication—has advantages over implicit sources where the audience is left to guess about its characteristics and motives.
Credible message sources of high expertise and trustworthiness are more likely to create greater message elaboration and less resistance.
Matching, which is making a connection between the source and the intended audience, is a major element in effective messaging. Features commonly used in matching include age, gender, race or ethnicity, and social status. The aim is for the receivers to recognize that the source is similar to them.
Because receivers who may be at different stages of substance use respond differently to persuasive messages, it is important to conduct focus groups and other methods to understand the target group’s attitudes, beliefs, and knowledge about the substances and related issues so effective messages can be developed.
On the Message (What and How is it said?)
To be maximally effective, the content of a message should contain information the receiver wants or needs and should be based on strong evidence. Such messaging is more likely to persuade than appeals based on unsupported opinion.
Tailoring persuasive messages to the specific vulnerabilities of the individual or targeting a communication to groups of individuals with similar traits is the most productive prevention approach.
How the message is delivered by different sources can be important. For example, while peers can use extreme or moderate language in delivering the message to their peers, adult sources get more effective results when they moderate their language.
On the Audience (To Whom is it said?)
Understanding the audience through formative research such as focus groups as suggested above and tailoring the communications so they will appeal individually to each audience member will increase the relevance and impact of your campaign.
Testing the messages through focus groups or other qualitative methods is important…how credible to this audience is the source? Do they ‘get’ the message?
On the Outcome (with What Effect?)
As always in prevention, we need to measure the impact of our programming. As we said, formative research—e.g., focus groups, key informants, etc.—is important to ensure your message is understandable to the target and relevant in terms of your goals. Impact evaluation at various stages will help to determine if your short-term objectives are being met; and you are on the way towards your long-term goals.
General campaign goals can be:
to reinforce and strengthen nonuse attitudes and intentions
to increase perceptions of risks to one’s health
to change attitudes toward the behavior or substance,
to prevent initiation,
to reduce use, or
to encourage cessation.
[i] United Nations Office on Drugs and Crime. (2015). International standards on drug use prevention. Retrieved July 8, 2016, from www.unodc.org/unodc/en/prevention/prevention-standards.htm [ii] Farrelly, M.C., Niederdeppe, J., and Yarsevich, J. Youth tobacco prevention mass media campaigns: past, present, and future directions. Tobacco Control (2003). 12 (Suppl 1): 35-47. [iii] Hornik, R., Jacobsohn, L., Orwin, R., Piesse, A.,m and Kalton, G. (2008), Effects of the National Youth Anti-Drug Media Campaign on Youths. American Journal of Public Health, 98:2229—2236. [iv] Crano, W.D., Alvaro, E.M., and Siegel, J.T. Creating persuasive substance-use prevention communications: The EQUIP Model. In: Prevention of Substance Use. Sloboda, Z., Petras, H., Robertson, E., Hingson, R., Editors. Springer, 2019. [v] Crano, W. D., Siegel, J. T., Alvaro, E. M., Lac, A., and Hemovich, V. (2008), “The At-Risk Adolescent Marijuana Nonuser: Expanding the Standard Distinction,” Prevention Science, 9, 129-137.