Factors Influencing Trust in Agencies That Disseminate Tobacco Prevention Information

Abstract

Several health-related agencies administer national and targeted public education campaigns to provide health information and change health-related behaviors. The trust the public has in these agencies as the source of the message impacts the effectiveness of their communication campaigns. In this study, we explore the perceived trust of agencies that communicate health messages in the tobacco control field. As part of a larger tobacco regulatory science study, we conducted six 90-min focus groups comprising 41 participants. Five main themes emerged pertinent to the agency: (1) its integrity, (2) its competence, (3) its motives, (4) how it is portrayed in the media, and (5) skepticism and mistrust about it. Given the significant resources spent on health messaging to the public and potential benefits offered by this communication, an understanding of public trust in the agencies as the source of health messages is important. Findings suggest health information may be ignored or discounted when there is mistrust in the agency sending those messages.

Appendix

Study Aim 1: Focus Group Guide

Greeting: Welcome and Thank you for being here today. We really appreciate you taking the time to participate in this discussion.

Role: My name is__________. I will be the moderator for the discussion. My role today will be to ask some specific questions and to keep the conversation going. We have a lot to cover, so I may need to change the subject or move ahead with the discussion. But, please stop me if you want to add anything or if you have any questions. Our discussion today will last about 90 min.

We are fortunate to have some help today. I’d like to introduce you to our co-moderator, __________. S/he may ask some clarifying questions as they come up.

The note taker for today is ________________. His/her job will be to take notes during the discussion. We want to be sure to get all of the important things you say.

Purpose: Before we get started, I wanted to talk a little bit about the purpose for the group and about confidentiality. I think everybody here knows why we’re here, but let me go over it just in case. We are part of a research team at the University of North Carolina at Chapel Hill. Today’s focus group is interested in discussing how you get information about health issues, what organizations you believe provide trustworthy information about health issues, and your thought about any recent health advertisements and campaigns you have seen or heard. We will also show you some logos of health organization and ask your thoughts about what these organizations do.

We’re going to be having a group discussion. It’s not an interview where I ask a question and each person answers the questions and we move on to the next one. It’s a discussion. We’ll be putting topics on the table and the idea is for everyone to participate in the discussion. What’s particularly helpful is if somebody says something and you’re sitting here thinking, “Yeah, that’s sort of like what I think” we want to hear that. But we also want to hear from you if you are thinking, “NO, that’s not how I think about it.” We want to hear similarities and differences among the group. There is no right or wrong answer to these questions. Your participation in today’s focus group will help create messages about tobacco products that are easily understood and trustworthy.

Before we begin, I would like to state that the conversation is being audio-taped to help us remember what is said during this discussion. You may ask me to turn off the recorder at any time or simply say you do not want to answer a question. I would like to stress that everything said here today will be confidential. What you say will be used only to help us with our research. Nothing you say will be connected with your name. We would also like everyone to keep things confidential, so whatever you say and whatever you hear someone say, we would hope that it wouldn’t go out of this room. I hope you will feel free to speak openly but be aware of our limits in protecting your confidentiality. Lastly, if possible I would like to ask that you turn off the volume of your cell phones and pagers to minimize possible distractions.

Section I: Health Concerns and Channels (30 min)

Let’s start today’s discussion with having everyone tell us….

• 1. What they believe are the most important health issues for people their age?

Probe [If nothing is mentioned by participant—(say) So this can be anything from a cold, acne, to a spot on your skin. This can be something in the past or something you are just interested in knowing.]

• 2. When you are interested in finding information about these types of health issues, where do you go?

Probe [find a book, contact your physician, read a magazine, search for it on a computer, ask a friend, ask a parent]

Moderator Instructions: (1) Reiterate and prioritize the responses discussed by participants, (2) Discuss only 1 to 3 of the channels reported by participants, (3) Ask questions 3–5 for each channel, and (4) Start with the most frequent response

• 3. What made you choose to use [insert channel] as a source of information?

*Note: for internet* How do you choose the place to search for your information?

Why do you choose this particular website?

Probe [Is it because it is the first one on the list, provides easy and understandable information?]

• 4. How do you know this source is providing you accurate health information?

• 5. How do you determine if this source of information is trustworthy?

Moderator instruction: Question 6 is asked after going through 1–3 of the channels

• 6. When was the last time you saw health information, even when you were not looking for it?

Probe [while using the computer (ads), TV ads, while waiting in the physician’s office, posters at work or school; Facebook, Instagram, twitter, etc.]

Note taker: List all channels mentioned by participants

Now let’s talk about health information about cigarette smoking and other tobacco products.

• 7. As you think about the health information you know and don’t know about smoking cigarettes and using other tobacco products, what kind of health information would you like to know more about?

Probe [may start conversation about e-cigarettes or other tobacco products, Ask whether they want to know benefits of quitting versus health risk]

Probe [warnings, ingredients, tips on quitting?]

• 8. If you want to find information about [list health issues mentioned by participants], where would you look?

Note taker: List any channels that are different from first set of responses.

Moderator Instructions: Discuss whether the new channels are trustworthy or not (use questions below as a guide).

• 9. What made you choose to use [insert channel] as a source of information?

• 10. How do you know this source is providing you accurate health information?

• 11. How do you determine if this source of information is trustworthy?

Let’s move the topic of discussion towards pro health advertisements you may recall seeing or hearing in the past about stopping smoking or avoiding tobacco products.

• 12. What stop smoking or tobacco prevention advertisements do you recall?

Probe [Advertisements with real smokers, true stories about family members who smoke, Place to call to help quit smoking]

• 13. Are you aware of which types of organizations sponsor these campaigns? What are they?

• 14. How do you know [insert name of organizations participants provide] is providing you accurate health information?

• 15. How do you determine if this source of information is trustworthy?

Section II: Logos (25 min)

I would like to give you a brief questionnaire. Please complete it on your own and hand it back to me when you are done. (handout the Logo questionnaire)

Now we are going to go through each of the logos on your brief questionnaire and talk about each one. Please look at the screen. (EPA, CDC, Surgeon General, FDA, American Legacy Foundation, NIH, NCI)

Moderator Instructions: (1) Focus group participants view one logo at a time and receive questions 16–20 for each logo, (2) Moderator point to the logo and say the agency full name.

• 16. Have you ever heard of the [insert agency full name]?

Probe [Where have you seen the logo before?]

• 17. What do you know about this agency?

Probe [What do you think this agency is supposed to do?]

• 18. Do you recall seeing this logo on anything related to smoking or tobacco use?

• 19. Do you trust this agency to give you accurate health information?

• 20. Please describe any positive or negative feelings you have about this agency?

Probe [Do they do a good job? Are they reflected positively in the media? Are they experts in their field?]

Moderator Instructions: click to slide with all logos

The next slide has all the logos. I have just one question regarding all the logos.

• 21. Which one of these agencies do you trust the most for providing accurate health information?

Probe [If the group seems to trust all government organizations, ask why they trust the government to provide accurate health information]

Section III: Knowledge/Attitude of FDA (15 min)

Now I would like to discuss one particular agency in more detail. The US Food and Drug Administration, or FDA.

Moderator Instruction: Go to next slide of the FDA logo slide

Moderator tells group: The Family Smoking Prevention and Tobacco Control Act signed into law on June 2009 established the US Food and Drug Administration (FDA) as the “primary Federal regulatory authority with respect to the manufacture, marketing, and distribution of tobacco products”. This means that one thing the FDA will do is to better inform youth, young adults and adults who use any tobacco products about the health risks of those products. Specifically, FDA will require tobacco manufacturers to list ingredients, report levels of harmful constituents in smoking products, and require health warnings on labels.

• 22. Were you aware of this new role for FDA?

Probe [if no one knows about this role, ask if they have any questions about what you just described. You can also describe some of the new FDA responsibilities such as inspecting retail stores to make sure tobacco advertisements are not giving free samples, no single cigarette sales are occurring, and FDA is in charge of disclosing the ingredients of cigarettes to the public.]

• 23. Given that the FDA is now the primary federal regulatory agency for tobacco products, what do you think about the new role for this agency?

Probe [What are your concerns? What will make you less concerned? Is FDA the right agency for this job?]

• 24. What do you think FDA should do to help consumers of tobacco products better understand the health risks?

Probe [How should they communicate information to the consumers of cigarettes and other tobacco products?]

Moderator Instruction: clicks to the slide with the Surgeon General’s Warning on a cigarette packet.

Please take a look at the next slide.

• 25. What do you think about the current Surgeon General’s warning labels on cigarette packs?

Probe [Do you think it helps people stop smoking? Should they be changed? If so, how?]

• 26. Describe the level of trust you have for information you receive from the Surgeon General?

Probe [Evaluate their response to this question based on whether the Surgeon General was considered the most trusted agency from the logo list….why they trust it or don’t trust it?]

Moderator Instruction: clicks to the slide with the Surgeon General’s Warning but FDA Logo.

Please take a look at the final slide (cigarette packet with FDA logo).

• 27. What do you think would be the impact of adding an FDA logo to warning labels about the harms of smoking and using tobacco?

Probes [Will this make people think tobacco use is safer, will it help people to recognize the harms of smoking? Will it help smokers quit?]

• 28. Since the FDA is associated with protecting consumers, would putting an FDA logo on cigarette packs cause people to think cigarettes are safer?

• 29. Is there any other agency/organization that you believe would be better than the FDA to list on cigarette warning labels?

Moderator Instruction: If there is an additional 5–10 min ask the following two questions.

Since we are not at the end of our time, I would like to ask a few additional questions. Up to this point, we have discussed the trustworthiness or credibility of health organizations and agencies. I would like to end the group asking questions about the credibility of other industries.

• 30. How trustworthy do you believe information is from the pharmaceutical industry?

• 31. What do you think about information from the tobacco industry? How trustworthy is the information on the pack and in product advertisements?

This concludes our focus group questions.

• 32. Is there anything else we have not yet discussed that you would like to mention related to what we’ve been talking about?

Thank you very much for taking part in this discussion today.