The Follow Who Know Road Campaign in Nigeria: Development, Impact, and Lessons Learned from a COVID-19 Mass Media Campaign

"Breakthrough ACTION wanted to create a campaign that took into consideration how adaptive the disease is, and how to tailor the promotion of testing, prevention and vaccination at different stages."

This programme brief, published by Breakthrough ACTION, describes the process of implementing the Follow Who Know Road campaign, a mass media campaign in Nigeria that sought to reduce COVID-19 vaccine hesitancy, increase testing among people who are symptomatic or exposed, and increase adoption of COVID-19 prevention behaviours among suspected and confirmed cases. The brief looks at how the campaign was developed and implemented, from developing the creative concept to broadcasting the campaign. It also offers lessons learned that social and behaviour change (SBC) practitioners can apply to their work, particularly during a public health emergency.

As explained in the brief, as of August 2022, nearly 2 in 3 Nigerians over the age of 18 were still unvaccinated. "Community members believed COVID-19 was 'a plan created by the government' or that it did not exist and that prevention strategies, such as vaccines, were untrustworthy." To dispel these myths and encourage vaccine uptake, the Government of Nigeria partnered with Breakthrough ACTION-Nigeria to develop a mass media campaign that became known as the Follow Who Know Road Campaign.  

The brief explains how the campaign was grounded in theory, data, and an understanding of the audience. The campaign development process began with a review of theory and evidence to ensure that COVID-19 information could be understood and recalled and would drive Nigerians to receive the COVID-19 vaccine. For example, in developing the campaign, the Breakthrough ACTION-Nigeria team shaped its work around a World Health Organization vaccine hesitancy model that involved the 3 Cs: confidence (in the safety and efficacy of vaccination), complacency (convincing people to take action), and convenience (making it easy to access the vaccine). This model helped to plot individuals along a vaccine hesitancy continuum. To understand the audience, the project used Johnson & Johnson Global Public Health's existing audience segment definitions: Confident Enthusiasts, Enthusiastic Pragmatists, Vaccine Ambivalents, Vaccine Skeptics, and COVID Cynics. A survey on COVID-19 perception and vaccine acceptance allowed the production team to develop a strategy that was based on the above models. This strategy outlined which audiences to focus on, what messages they should receive, and what channels would be used. For example, the campaign developers decided to focus the mass media campaign on audiences who were already open to getting vaccinated, as they made up 80% of the population. This approach would maximise the chances of being able to change behaviour and therefore the impact of the campaign.

From the audience survey insights, Breakthrough ACTION-Nigeria and its partners then developed the creative concept and the big idea. The brief explains how the creative brief was developed, which included identifying the communication objectives that would help increase the uptake of vaccinations, the positioning statements, the call to action, the creative consideration, the communication channels, the messaging, and the development process and timelines.

This step was followed by concept testing, where four story concepts were tested among four cohorts across Nigeria's six geopolitical zones. As explained in the brief, during this stage, audience members directly engaged with the content and provided input to analyse the effectiveness of possible campaign pieces, identifying how well ideas resonate with the intended audience and ways they can be improved.

The brief explains how the testing helped shape the development of the final story, which focused on Madam Naija, an influential leader who rejects COVID-19 vaccination, falls sick, recovers, and becomes an advocate for vaccination and testing to protect family, friends, and the entire community. Based on research that showed a high regard for advice from healthcare workers, the project added Aproko Doctor, a healthcare worker and trusted social media influencer in Nigeria. The title, Follow Who Know Road, was also developed through a creative content development process involving partners and audience members.

As with all previous processes, the project also applied a systematic process to the campaign production stage. The brief explains that a lead producer, involved from the very beginning, led the production process. This person kept the process on track, provided production advice, and played a key role in ensuring the spots were responsive to the latest COVID-19 guidance. Based on the creative concept, the next step for the production team involved the writing of scripts, which also underwent testing and adjustments along the way. The final product was a story that unfolded over nine short spots, with a new spot airing every month. Spot 1 and 2 focused on the need for vaccination, spots 3 and 4 focused on testing before treatment, spots 5 and 6 focused on vaccination as a means of prevention, and spots 7, 8, and 9 focused on receiving all necessary doses of the COVID-19 vaccine, including people with co-morbidities. The episodes were produced in 19 languages. The project also produced and aired accompanying unbranded public service announcements (PSAs) that were designed to dispel misinformation and address COVID-19 vaccination barriers in a comprehensive way.

As a final step, the brief explores how the campaign was broadcast and disseminated using mass media channels: television, radio, and social media. These channels were chosen as they are the most commonly used forms of communication in Nigeria. The brief also outlines the development of the media plan and the media buying strategy. Overall, the spots were aired across 77 local radio stations and one national radio station, reaching an estimated 46 million people. The TV spots were aired on eleven TV stations, reaching an estimated 73 million people.  

The impact of Follow Who Know Road on communities is outlined in the final section of the brief. According to the brief, the campaign had a significant reach in Nigeria, especially on a national level. From August 2022 to February 2023, the COVID-19 vaccination rate increased more than 1.5 times in Nigeria. A study executed by Kantar, a market research agency, between December and February 2023 showed that more than 2 in 3 unvaccinated people exposed to the campaign showed a positive change in their vaccine intentions and behaviour post-campaign, and 88% of respondents reported being exposed to the campaign. From a second wave of the Kantar study done in July of 2023, 4 in 5 respondents indicated that the campaign has resulted in a positive behaviour and/or intention change towards the COVID-19 vaccine.

Based on Breakthrough ACTION-Nigeria's experience in developing and implementing the campaign and the positive impact it had on transforming vaccine hesitancy, the brief offers a number of lessons learned, which, in short, include the following:

• Use data throughout the process as a tool for adaptation and ensuring effective reach.
• Involve all team members from the beginning and throughout the process.
• Stay up to date with new data and guidelines and be ready to apply changes as they come.
• Establish a strong and interesting story first that will make adding information easier.
• Do not let a public health emergency change the rigour used for developing SBC mass media campaigns.
• During a public health emergency, develop PSAs to air concurrent with a campaign.