Evaluation of ‘Shisha No Thanks’ – a co-design social marketing campaign on the harms of waterpipe smoking | BMC Public Health
The Shisha No Thanks project
The aims of the Shisha No Thanks project were to highlight and raise awareness about the health risks of waterpipe smoking among young people (18-35 years old) from an Arabic speaking background and to encourage discussion around quitting or reducing waterpipe smoking. The project ran from October 2019 to June 2020, predominately in the South East, South West, and Western areas of Sydney, Australia, where there is a higher proportion of people who identify as being of Arabic speaking background. The project was run by a government local health district (South Eastern Sydney Local Health District), in partnership with a community organisation (Lebanese Muslim Association) and was funded by the Cancer Institute NSW (a state government cancer control agency).
Shisha No Thanks was a co-design project that involved the project team working closely with the community partner organisation, members of the community, community champions and health professionals to identify the key messages and strategies for the awareness raising campaign. The project team was mindful throughout the entire process to ensure that the campaign was run respectfully towards the community and was culturally appropriate.
Campaign resources were developed from the community co-design workshops and evidence-based research, and included a feature campaign video,  a large collection of social media content (such as short videos clips, memes and graphics), and a suite of factsheets for young people, pregnant women and families, community workers and health professionals, which were available in English and Arabic  (See Fig. 1 and Appendix 1 for examples).
Selected ‘Shisha No Thanks’ project resources
These campaign resources were disseminated to the community through the campaign’s website  and social media accounts (Facebook,  Instagram  and YouTube ). The project also engaged the community through local media coverage (English and Arabic speaking media; TV, radio and online), by attending community events (e.g. expos and information days) and conducting community worker information sessions.
Study design, participants and data collection
The impact evaluation used a cohort design to measure awareness before and after the project among the target audience. A community panel was recruited through the Lebanese Muslim Association’s communication channels (email newsletter, social media accounts), community champions, and flyers at events (see Appendix 2 for examples of recruitment material). Participants were required to be 18-35 years old and either smoke waterpipe or know someone who does. Potential participants were directed to complete an online recruitment survey to confirm eligibility in the study, provide demographic details (including their waterpipe smoking activity) and their mobile phone number (See Appendix 3 for Recruitment Survey).
Participants were then sent a weekly SMS text message with a survey question about their knowledge and attitudes about waterpipe smoking. As most young people use their mobile phones frequently each day, an SMS survey was an effective way of easily reaching the target audience. Participants were sent a set of 8 questions before the project started, with 1 question being sent per week for 8 weeks from Aug-Oct 2019. Then the same 8 questions were sent towards the end of the project, again with 1 question being sent per week for 8 weeks from Jan-Mar 2020. In the interim period, participants were sent other questions related to waterpipe smoking to maintain communication between participants and the project. (See Appendix 4 for Survey Questions). This approach of sending 1 question per week was chosen to reduce the perceived burden of responding to the survey questions. Main participant recruitment documents and all data collection surveys were produced in English and Arabic, and participants were given the option to choose to receive the SMS text messages in either English or Arabic.
The SMS survey questions were adapted from the Cancer Institute NSW Tobacco Tracking Survey  and the Syrian Center for Tobacco Studies Narghile-Waterpipe Users Survey . The questions were related to participants’ awareness of messages about the harms of waterpipe smoking, attitudes towards the health impacts of waterpipe smoking, intention to reduce waterpipe smoking, community conversations about waterpipe smoking, and awareness of services to support cessation of waterpipe smoking. Questions were designed to be short and succinct to fit with the SMS format, and were either multiple choice response, or short free-text response.
Participants were reimbursed for their involvement in the study with three $50AUD e-vouchers. The survey used the Qualtrics platform which has the capacity to send SMS messages to the study participants’ mobile phone number.
Data extracted from Qualtrics was entered into an Excel spreadsheet file. Data was then analysed using IBM SPSS Statistics v26. For the 8 questions that were asked before and after the project, only paired data (i.e. data where the participant had responded to the same question at both baseline and post-campaign) were used for analysis and reported. Given the matched nature of the data, binary categorical responses were analysed using McNemar’s test, [25, 26] and non-parametric scaled data was analysed using Wilcoxon Signed Rank test . Subgroup analysis was also conducted based on age group, gender and waterpipe use. For the 6 questions that were asked only once (in the interim period), descriptive analysis was conducted.
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