How to Engage Rural Communities with Strategic Communications

By Rakeem Robinson, research fellow, Center for Public Interest Communications, College of Journalism and Communications, University of Florida

Building support for smoke-free policies and interventions requires strategic communications that can capture the attention of rural communities.

Rural populations are disproportionately affected by tobacco use and secondhand smoke exposure and are more likely to suffer from disease or death from tobacco use than people living in urban communities. Potential contributing factors include low socioeconomic status (SES), lack of cessation services, lower levels of education, inadequate insurance coverage, distance to health care facilities and local and state policies that do not support communities in reducing smoking rates.

Unique historical, cultural, familial and social factors that may affect tobacco use exist in rural communities. Some communities have social traditions involving tobacco use that make quitting even more difficult. Tobacco use is often considered acceptable, and sometimes supported by family and community members in communities where residents have strong family ties and close-knit social networks. This is particularly true in tobacco growing communities. Residents are often exposed to tobacco industry marketing campaigns, including through sponsorships of rural sporting events or targeting through marketing designed for blue-collar and rural men with “rugged, manly images”.

To create effective change, advocates must know the specific challenges communities are facing. These challenges include not just the rates of smoking, but also the social and psychological drivers behind smoking. Advocates can use this understanding to develop communications strategies that resonate with, rather than challenge, how people in these community sees themselves, their cultural norms and what they value. Building messages from this understanding is critical, not only for inspiring people to never pick up a cigarette or to quit smoking, but also in building support with local and state leaders and policy makers.

To understand which anti-tobacco messages resonate with people living in rural communities, Carol Riker, MSN and RN, and her colleagues at the University of Kentucky conducted a study comprised of 39 rural individuals. Of the participants, 59% were female, 61.5% were between 55 and 74 years of age, 65.8% were Caucasian, 74.4% had greater than a high school education, 7.7% were current smokers, and 16.2% either grew tobacco or owned property where tobacco was grown.

Two focus groups and 22 interviews to evaluate the effectiveness of smoke-free messages in rural communities were conducted to identify the most effective message content and media delivery for the participants. The researchers asked questions related to secondhand smoke and the participants exposure to, and attitudes toward, smoke-free policy. Additional questions were asked to elicit responses regarding culturally sensitive ways of delivering information on secondhand smoke and smoke-free policy.

The researchers identified four elements for crafting an effective message strategy that can resonate with rural communities:

1. Advocates should work with people from the community to identify norms, values and interests to tailor messages and stories to the community.

For example, the participants identified four themes that would motivate them to engage with anti-smoking ads: medical dangers of smoking and secondhand smoke, the impacts on workers’ health in businesses that allow smoking, analogies that help them understand why tobacco-free policies need to be passed, messages that assure that businesses will not suffer from smoke-free ordinances and messages that are careful not to threaten a community’s nostalgia for smoking. For example, if a person’s parents and grandparents smoked or worked in tobacco, and they have fond memories of that, messages must be careful not to challenge that nostalgia. With rural communities it is important to resonate with individuals’ worldviews and values of individualism and limited government oversight. As one participant said, “The issue of freedom has to be addressed in some fashion to clearly demonstrate that smoke is harming other people,” and “The smoke might be out of sight, but the particles are still there . . . and somebody is still inhaling particles.”Participants said messages should not feel like a personal attack on smokers. Some participants responded well to the message “It’s about the smoke, not the smoker.” Addressing concerns with individual freedoms and rights will be important for these sorts of communities.

2. Messages should be short and to the point, and in words that people who are not familiar with the topic can understand.

For example, participants suggested ads use an “everyday speaking” voice, avoid big words and use visual images. Participants said messages should be delivered in ways that will catch the audience’s eye and not take a lot of time to read. They suggested placing ads on television, radio, social media and billboards, but emphasized that messages should stay fresh. Additionally, participants suggested including powerful and emotional graphic images. While images should capture attention, they should not be so graphic or harsh that it leads people to turn away or miss the point of the ad.

3. Messages should be delivered through stories.

Storytelling is one of the most powerful tools we have for conveying complex information and helping people connect with and resonate with data. Advocates can use stories to exemplify local data to help build understanding of the community, and couple that story with a chart or graph that the story illustrates. For example, one participant said, “If more people heard a story like [a parent dying], they might jump in [to support smoke-free policies].”

4. Advocates should work with local authority figures and community leaders to disseminate messages.

For example, one participant said, “Instead of the surgeon general, use a local medical person.” Another participant said, “If I [saw] somebody in there I know, I’d read the whole page.” People are much more open to information when it comes from trusted messengers.

To create effective communications, advocates need to develop messages and tactics that connect to what a community cares about and share these messages in places where they know their audience is looking. Advocates must be deliberate in the way they tell stories, being cognizant of context and narratives, if they intend to inspire long-lasting individual behavior change or larger scale policy change.

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References

Hutcheson TD, Greiner KA, Ellerbeck EF, et al. Understanding smoking cessation in rural communities. The Journal of Rural Health, 2008;24(2):116–124. doi:10.1111/j.1748-0361.2008.00147.

Riker, C. A., Butler, K. M., Ricks, J. M., Record, R. A., Begley, K., Anderson, D. G., & Hahn, E. J. Creating effective media messaging for rural smoke-free policy. Public Health Nursing, 2015;32(6):613–624. doi:10.1111/phn.12188.