“I don’t trust it, so I don’t read it”: How do older Australians navigate and search for information about their health and driving?

Abstract

Objectives

Driving is pivotal to successful aging, yet older people may need to adapt their driving to changes associated with aging or transition to driving retirement at some stage. However, most older people are reluctant to discuss or plan for changes to their future mobility. This study describes formative research to inform a social marketing campaign to promote the “DRIVING AND STAYING INDEPENDENT” resource assisting older drivers to make informed decisions about timely changes to their driving.

Methods

Semi-structured interviews were conducted with 16 drivers aged between 67 and 84 years living in the state of NSW, Australia. A discussion guide based on social marketing principles was used to explore the perspectives and experiences of older drivers seeking health and driving information. Thematic analysis was conducted on the interview data.

Results

Succinct, clear messages with a clear call to action were identified as essential features of social marketing campaigns targeting older drivers. Realistic portrayals of older people in marketing material are important in engaging the audience. Older drivers preferred positive messages that emphasize the relevance of the product to them. Trusted and reputable sources were of utmost importance when seeking health and driving information. Traditional channels such as TV and radio remain the dominant media consumed by the older participants, however, digital resources are being used increasingly.

Conclusions

This study provides important insights for an evidence-based social marketing campaign promoting the “DRIVING AND STAYING INDEPENDENT” resource to older drivers. The findings add to the limited literature on campaigns targeting older adults and may prove valuable for promoting other issues relevant to older adults. Campaigns targeting older drivers should consider selecting clear messages, demonstrating relevance to the audience, using trustworthy sources and selecting channels used by older adults.

Keywords:

• Social marketing
• seniors
• older adults
• driving
• health promotion
• decision making

Introduction

In most developed countries, unacceptable alternative modes of transport have led to older people being reliant on the car as their dominant form of mobility (Buys et al. 2012; Cui et al. 2016). Driving fosters a sense of independence and social connectedness and is pivotal to successful aging (Musselwhite and Haddad 2010; Pristavec 2018; Veerhuis et al. 2022). While driving remains crucial to the well-being of older people, physical and cognitive changes can impact their ability to drive safely (Pomidor 2019). Furthermore, older people are at a higher risk of mortality or injury than younger drivers if involved in a car accident (Pitta et al. 2021). To address these concerns, education resources to support older people with decisions about driving have been proposed. This includes implementing strategies to continue driving safely such as avoiding high risk situations and planning for driving retirement (Baldock et al. 2016). The “Driving and staying independent: A decision aid for older drivers” decision aid has been developed to assist Australian older drivers living in the state of NSW with decisions about their driving and future mobility (see www.adhere.org.au/olderdrivers/).

Discussions about changes in driving behavior and future mobility options are necessary (Pomidor 2019) as older drivers typically live 6–10 years beyond their driving life (Foley et al. 2002; Babulal et al. 2019). However, discussions about driving between older people, health professionals and their families rarely occur (Betz et al. 2019). Older people avoid conversations or rarely consider changes to their driving behavior because of the associated expectations of loss or mortality with driving retirement (Veerhuis et al. 2022). Various situations may trigger an older person to consider changes to their driving behavior including a car collision, age-based licensing requirements and declines in health or driving confidence (Veerhuis et al. 2022). There is some evidence that self-assessment can increase awareness of changes that can impact driving safety and facilitate discussions with family, friends and medical professionals (Eby et al. 2003)

One strategy used by our research team to address these challenges in NSW, Australia was to co-design a driving decision aid with older people. The “DRIVING AND STAYING INDEPENDENT” decision aid provides a structured approach to support older people make decisions about their driving. To encourage the use of the decision aid, we need to understand how to effectively engage older people to consider their future driving behavior, including the nuanced ways in which older people perceive advertisements about health and driving. Developing an understanding in this area will enable an evidence-based targeted social marketing campaign to be created that encourages older people to use the decision aid to consider their driving behavior.

Theoretical framework

Social marketing is the “adaptation of commercial marketing technologies to programs designed to influence the voluntary behaviour of target audiences to improve their welfare and that of the society of which they are a part” (Andreasen 1994, 109). Andreasen’s (2002) approach emphasizes the importance of formative research to gain an understanding of the target audience and factors influencing their behavior from their own perspective (Akbar et al. 2021). Andreasen’s (2002) framework was successfully used to develop campaigns promoting falls prevention, asthma awareness and physical activity programs for older people (Evers et al. 2013a; DiGuiseppi et al. 2014; Currie et al. 2020; Goethals et al. 2020). Systematic reviews of campaigns targeting older people found that campaigns using a greater number of Andreasen’s (2002) social marketing benchmark criteria were more effective in promoting positive behavior change (Carins and Rundle-Thiele 2014; Fujihira et al. 2015; Goethals et al. 2020).

Previous research found that older people prefer messages which promote positive attributes such as independence, freedom and agency (Clark et al. 2013; Jung et al. 2013; Rosenthal et al. 2020). Older people are also more receptive to positively framed messages and when asked demonstrated increased recall from these messages compared to negatively framed messages (Shamaskin et al. 2010; Jayanti 2014). Positively framed messages also foster self-efficacy among people (Eagle et al. 2013, 235). Conversely, negatively framed messages are counterproductive because they result in decision avoidance and a reluctance to accept adverse assessment outcomes (Shamaskin et al. 2010; Andrew et al. 2015). Simple and direct messages are more suitable for advertising targeting older people, as the use of syntactically complex messages can reduce message recall in older people (Evers et al. 2013b; Kim et al. 2016).

This paper presents the findings of formative research to develop a social marketing campaign promoting a decision aid for older drivers living in New South Wales (NSW), Australia. This study aimed to explore the perspective and experiences of older drivers about seeking health and driving information. The findings will inform crucial aspects of a social marketing campaign to promote “Driving and Staying Independent: a decision aid for older drivers” which is freely available online at www.adhere.org,au/olderdrivers.

Methods

Study design

Semi-structured interviews were chosen to generate in-depth insights into the perspective and experiences of older drivers seeking health and driving information (Liamputtong 2020). Semi-structured interviews enabled a flexible approach to reveal new insights about the topic about which there is little known (Liamputtong 2020). Open-ended questions and probing enabled the researchers to gain insight into the views of the target audience which was necessary to develop an effective social marketing campaign (Prestin and Pearce 2010). Interviews took place via phone or video conferencing using the Zoom software application.

Interview questions and advertisements

A discussion guide (Appendix A) was developed based on social marketing principles to inform a marketing strategy targeting older drivers (Andreasen 2002).

Participants were shown examples of health and driving-related advertisements that were freely accessible online (see Figure 1). Health advertisements were used in conjunction with driving as health declines are perceived triggers to discuss or consider their driving behavior (Veerhuis et al. 2022). The advertisements illustrated social marketing approaches and included: positive vs negative framing, rational vs emotional appeals, individual vs community motivation and various representations of older people in advertising (Figure 1).

Figure 1. Example advertisements presented to participants. Reproduced with the permission of Transport for NSW.

Participants and recruitment

Older people were invited to participate in the study via emails sent through relevant community organizations with high numbers of members being older people. Eligible participants were English-speaking, living in NSW, 60 years and older and current drivers. Interested individuals who contacted the research team were emailed a participant information sheet and a consent form. Signed consent forms were returned via email. Participants were contacted via telephone to arrange a suitable time for an interview. No incentives were offered to participants. Ethical approval was provided by the joint University of Wollongong and Illawarra Shoalhaven Local Health District Health and Medical Human Research Ethics Committee (ETHO 3735).

Data collection

Data collection took place between September 2021 and October 2021 with 16 drivers. Demographic details were collected from the participants (Table 1). The participants were living in NSW, Australia and aged between 67 and 84 years.

Table 1. Demographic characteristics of study participants.

Variable	N (%)
Age
Mean, years	74.9
Range, years	67–84
Gender
Female	10 (63%)
Male	6 (37%)
Location*
Major city	9 (56%)
Inner regional	6 (38%)
Outer regional	1 (6%)
Living arrangement
With spouse/partner in own home	13 (81%)
Alone in own home	3 (19%)
Highest qualification
Certificate	1 (6%)
Diploma	3 (19%)
Undergraduate degree	4 (25%)
Master postgraduate degree	6 (38%)
PhD	2 (12%)
Employment status
Retired	15 (94%)
Employed casually	1 (6%)

*ARIA + categorization

Interviews lasted between 45 and 60 min and were audio-recorded only. Concurrent data collection and data analysis were undertaken, and recruitment ceased once the depth of data and quality of dialogue reached was sufficient to achieve the aim of the study (Malterud et al. 2016; Braun and Clarke 2021). Audio recordings were transcribed by a third-party transcription service.

Data analysis

Qualitative data generated from interviews were analyzed using thematic analysis (Braun and Clarke 2006). Thematic analysis was chosen as it allows a rich and detailed account of the data (Braun and Clarke 2006). Notes were taken during interviews and a full reading was undertaken before analysis. Following the first reading, an initial set of codes were generated by the researcher and applied to the data (Braun and Clarke 2006). Next, the codes were collated into potential sub-themes and after that themes based on any similarities and differences (Braun and Clarke 2006). Themes and sub-themes were defined and named in line with the aim of the study and reviewed to ensure the themes accurately reflected the coded extracts of data.

Results

Five themes were generated from this study (Table 2). The themes identified key tenets for effective marketing messages for older people; succinct, clear and appealing messages, relevant and positive messaging, trustworthy and reputable sources, traditional marketing channels and digital resources embraced by older drivers.

Table 2. Key tenets for guiding effective marketing messages for older drivers.

Theme	Sub-theme
Succinct, clear and appealing message	Purpose clear Use of simple, plain, non-technical language Large font with limited text Contrasting text and background Call to action
Relevant and positive messaging	Images realistic and relatable to older people Real people, not models The right age Promotion of personal relevance Positively message framing
Trustworthy and reputable sources	Health professionals, government, universities
Traditional marketing channels	Mass media Email General Practitioners
Digital resources embraced by older drivers	Internet searches Cautious about social media Digital literacy “Hard” resources still have place

Succinct, clear and appealing message

The importance of a succinct and clear marketing message was articulated repeatedly during the interviews. Messages were considered succinct and clear if the purpose of the advertisement was immediately understood, the presentation of the advertisement was appealing, and simple, non-technical language was used.

Participants preferred slogans that described the key message of the advertisement in plain language as described by a female participant about a delirium care poster:

I like ‘B’ [advertisement about delirium care] in that it’s just delirium care, what you need to know, so it’s really simple and to the point and just very explicit.…. I like it in that as much as it’s straight to the point and you know exactly, in that sense. (P09, Female, 80 years)

Another element that reflected the importance of a message being succinct and clear was the advertisement having an appealing presentation. Large font and contrasting colors between text and background were specific examples appealing to older people:

The writing is small, the writing is very, very small. The blue against the blue background I don’t think that’s eye-catching and is it gold writing on that? That’s very hard to read and I got my glasses, so I can see well with glasses and there’s a lot of writing down at the bottom. (P14 Female 68 years)

Participants also highlighted preferences for “uncluttered” designs and were less likely to read’ “busy” designs which included too many words:

Well, the one on the right, that’s far too busy. It’s got too many words, and I don’t even know whether I’d even look at that. I doubt I would even read those words if it was trying to get my attention. (P01, Male, 71 years)

Another crucial component of a successful marketing message was the inclusion of a “call to action”, with the advertisement providing details about how the consumer can seek further information:

I think it’s a very clear message, “Is your driving changing?” and it’s offering to help you do something about it, it’s offering you information and I like that. It immediately catches your attention, immediately you know what that is. (P14, Female, 68 years)

Messages which did not provide a clear course of action with no signpost to further information were viewed unfavorably.

Relevant and positive messages

Positively framed and relevant messages were also identified by older people as a key tenet of effective marketing. Marketing materials were considered acceptable if they included images of older people the participant identified with Participants considered material relevant based on the physical appearance, lifestyle and behavior depicted.

However, the types of images considered acceptable differed between participants. Some highlighted the importance of using images of people the target audience could identify with. Others cautioned against using images of older people as not all older people identify themselves as falling within this age group.

Participants reported feeling that many advertisements had unrealistic or idealized representations of aging. Advertising portraying older people as being too “fit” or engaged in activities not deemed age-appropriate was unrelatable. One advertisement resulted in one female participant mocking the portrayal of one person who was simultaneously dancing and playing tennis.

Participants preferred “realistic” portrayals of older people in the advertising material that represented them or reflected a broader population:

A lot of the stuff seems to have really fit, well-healthy trim people, and that’s why I quite like the other one because they’re just not so glammed up, I suppose. (P09 Female, 80 years)

Several participants also expressed an aversion to advertising portraying behaviour that was not considered age appropriate.

Participants expressed difficulty identifying with advertisements featuring people they perceived to be in an age group different from their own. Several participants discussed not identifying as “older”:

If I saw something for older drivers I think, well I’m not older yet. Seniors is a more defining timeframe. Whereas older could be in the future for me, I’m definitely not older. (P05 Female, 82 years)

Some participants also identified that images of models who they perceived as being younger or older than the target audience did not facilitate engagement with the marketing material:

If you’re trying to attract people over 60 to be looking at these ads to have a really old person male or female as the central figure may not get to your message across where having a younger looking couple could. It’s quite possible but then on the reverse, if you had an older couple, much older than this, people like these two that are in this ad would think, “Well, this is not for me.” So, it could almost be that you’d need two parallel ads. (P11, Female, 73 years)

The majority of participants indicated that marketing messages emphasizing personal benefits are more effective than those emphasizing benefits to the broader community;

Well, I think it’s gonna [going to] be an individual thing. I wanna [want to] keep my independence for as long as I can, and I think that one is gonna [going to] be far stronger than that general appeal. That sounds really selfish and whatever. But I think initially the individual one would grab you. (P09 Female, 80 years)

When presented with a series of public health advertisements most participants expressed a preference for positive advertisements, found them more effective and wanted to engage with the positive material more than those advertisements portraying negative messages. Messages were perceived as being positive when the marketing material provided information/content, images and language that promoted positive goals such as independence.

For driving, participants overwhelmingly preferred to view marketing material that included positive messaging. Messaging was appealing when language was used that conveyed help and support as opposed to loss or fear:

I think if it’s the word helping of seniors – probably is a better way, “We’re trying to help you rather than take things away from you.” Try those other words, being more positive than negative, I guess – because the real problem, I guess, we are trying to address here is the people are starting to lose the freedom that they’ve had all their life, and it needs to be broken to them gently and sensitively and maybe what alternatives are available for them. (P01, Male, 71 years)

For messages about driving, one participant reported feeling connected with the title of the material because the title’s concept of staying independent was a personally appealing goal:

I really like the ‘staying independent, safe, connected and supported’, that’s a really important part to me and maybe I’d like that a bit more than what the resource would help me consider, do you know what I mean? And the main message is the one that I think would appeal, trying to stay independent, that’s what people want, isn’t it? Well, I know I would like it. (P09 Female, 80 years)

Trustworthy and reputable sources

The importance of trusted and reputable sources was of utmost importance to the participants when they searched for information about their health or driving. The participants trusted sources such as general practitioners or specialist medical doctors, medical, university and government websites. One participant described his general practitioner as a more trusted source to obtain information about personal health matters than internet searches:

Anything particularly personal to me, I would go to my doctor and I really would rely on the doctor to give me the advice, maybe occasionally have a little bit of a look at Dr. Google, but I don’t have a lot of faith in that. There’s so much that they can’t tell you anyway that suits me – I believe it doesn’t suit you in any case, so I’d rather trust the professional than a website. (P01, Male, 71 years)

Other participants identified searching for academic literature as a more credible source of information about health or driving than celebrity podcasters:

Sometimes there’s somebody that’s made a paper or something they know about. Some university or some medical centre or something like that written something, a thesis or something about a particular subject. I tend to go to those sorts of stuff…I tend not to go to the Joe Rogans of the world. (P15, Male, 76 years)

Participants explained how obtaining credible information from a trusted source assisted them in making informed decisions on matters related to their health and driving.

Participants consistently reported that their general practitioner was their primary source of health information. Trust, strong relationships and the accessibility of general practitioners were cited as reasons for the preference.

Traditional marketing channels

Media consumption among the participants was dominated by traditional channels such as TV and radio, however, email and social media use were also common. Participants discussed a preference for newspapers, TV, and radio as daily sources of news and general information. Both print and online sources were accessed. Notably, seniors’ publications were identified by only a small number of participants as a source of news and information. The national TV and radio broadcaster ABC and to a lesser extent multicultural and multilingual broadcaster SBS were the preferred channels.

Digital resources embraced by older drivers

Digital literacy levels were high among the participants. They accessed a range of digital devices to access information such as smartphones, tablets and personal computers. Some participants acknowledged that challenges arose when navigating large volumes of information online.

Many participants described using internet searches to locate health and driving information. Consulting “Dr. Google” was a common phrase used by participants:

You can usually find something about what you’re Googling. I sort of had a finger that’s purple, so you’ll just type in ‘purple finger’ and of course hundreds of things come up and a lot of them are to do with American universities and things like that but I think on the whole, it’s okay. (P10, Female, 79 years)

Social media was used by many of the participants but primarily used for keeping in touch with friends and family rather than an information source on health or driving. Social media use varied from daily to infrequently, with some never using it. Several participants expressed distrust and caution of information found on the internet and social media:

I would rely on the doctor. I would not trust a lot of the information, that appears on Google, and certainly not on Facebook. (P13 Female 84 years)

However, for some participants, advice would ultimately be sought from their general practitioners. This experience was highlighted by one male participant:

But in spite of what all that say [information from the internet], I’d go and talk to the doctor about it. I think that’s more important about what it says about your health. (P15, Male, 76 years)

Participants had differing views on the preference for digital or hard copy information. Participants often discussed accessing the digital resource first and printing a copy only if necessary. The preference for printed material depended on the length, complexity, readability and cost. They routinely made online purchases so this was not a barrier to accessing information for the participants. Participants also indicated they were competent in using digital technology but several understood that some of their peers were not computer-literate.

Participants discussed frequently engaging with material received via email from personal correspondences, organizations and news outlets:

So, if you really wanna [want to] hit everybody – and maybe you can get ads to cover the cost of the document in NRMA, AAMI [car insurance companies] and all that sort of stuff, would buy ads in the document so that it’s minimal cost to send it out to everybody at a particular age. I think you should consider that. (P15, Male, 76 years)

When asked how best they could be made aware of the decision aid, many participants suggested a targeted direct post mailing to the home would engage older drivers, particularly those without access to technology

Now, I recently got some information about cervical cancer and that was sent directly by post to me and that’s something you take notice of a personal letter. So that could get sent out to all people over the age of 65, just telling you how to get the information you want them to have about driving safely, either the ad or how to get a hard copy of the information. There are large swathes of people who are not computer-literate and don’t have access to a computer even. So, for them, technology is not useful at all. (P06 Female 74 years old)

Discussion

This study reports the findings of formative research to develop a social marketing campaign targeting older drivers living in NSW, Australia. We mapped the findings to Andreasen’s social marketing criteria providing insight into how best to design future social marketing campaigns for older Australian drivers (Figure 2).

Figure 2. Model to guide effective marketing messages for older drivers based on Andreasen’s social marketing framework.

The findings of this study suggest that concise, direct marketing messages are preferred by older people. Our findings support research by Evers et al. (2013b) indicating older people respond positively to direct and simple taglines (Evers et al. 2013b) rather than complex messages which can reduce message recall in older people (Kim et al. 2016). Presentation of the marketing material is also a critical component to ensure that older people will engage with marketing material. Marketing material should include large font, contrasting text to background and inclusion of a call to action or signposting to further information. These mirror a previous study that found large, contrasting, bold text and a prominent call to action in advertising were important elements of advertising targeting older people more generally (Evers et al. 2013b).

Overall, our study finds that positively framed messages appealed to older people more than negatively framed messages. Messages which were viewed as providing supportive, helpful advice or emphasized ways to achieve their goals were well received. Similarly, United States-based research found positive health communication messages engaged older people to consider the topic area more so than negatively framed messages (Shamaskin et al. 2010; Jayanti 2014). Participants preferred advertising material that emphasized the benefits of the product to the individual rather than the benefits to the community.

All participants in this study had given thought to their driving behavior. Many had experiences with friends or family that had stopped driving. As Evers et al. (2013b) highlighted, health messages that older people see as irrelevant are ignored. Future marketing campaigns developed for older drivers need to take multiple approaches to ensure it is relevant to drivers at various stages of their driving life: those wanting to continue driving, those self-regulating their driving behavior and those who might need to retire from driving.

The older people interviewed expressed the importance of depictions of older people they could identify with. There was an aversion to “models” and unrealistic portrayals of older people which was also found in research from Australia, Brazil and France (Evers et al. 2013b; Chevalier and Moal-Ulvoas 2018; Rosenthal et al. 2020). The present study highlighted that “older people” are not a single market segment but a heterogenous and dynamic group consisting of a wide age range of different genders, cultures, interests, and backgrounds (Meiners and Seeberger 2010). To adequately reach the different groups, demographic segmentation will allow tailored marketing material to engage all segments of the target market. This study reinforces the importance of using design elements suitable for older audiences.

This study also highlighted that older people are discerning in who and where they seek information about health and driving. Government departments, universities and health professionals such as general practitioners were found to be trusted. This supports previous research showing that health professionals and trusted sources play an important role in decisions about driving (Andrew et al. 2015; Betz et al. 2016; Ang et al. 2019). Engaging general practitioners to promote the decision aid could be an effective strategy to reach older drivers (Andrew et al. 2015).

Media consumption was centered around traditional channels such as TV, radio and newspapers. TV and radio were dominated by the public broadcaster ABC and SBS with few indicating substantial consumption of commercial networks. This poses a challenge for social marketers, as ABC is a noncommercial platform. Exposure can only be gained through reporting of public health messages in news and interest segments through noncommercial platforms. Social media was not a preferred method of engaging older people with important health messages. Limited use and skepticism of information on social media may reduce the effectiveness of social media campaigns for older people. Internet searches and email was routinely used by older drivers in this study and therefore using email lists or email newsletters sent by reputable government departments would be an effective way to reach older people digitally. The discussion of physical places to engage with older people was limited, possibly due to undertaking research during a period with COVID restrictions due to COVID-19.

This study highlighted the importance of ensuring that health resources are accessible to older people. A review of internet usage by older people suggests that level of education, income, health status and cognitive function influence internet use (Hunsaker and Hargittai 2018). Although most participants in this study readily accessed information online using a variety of devices, many preferred printed materials depending on the length and complexity of the material being read. Recent research into the needs of older people also highlighted the importance of developing digital resources specifically for the needs of older people (Perhonen et al. 2020).

Although the findings of this study should be interpreted with caution, there are useful implications for social marketing campaigns targeting older drivers. Using succinct clear messages with a clear call to action is more attractive to older drivers. Careful consideration should be given to using large font, ensuring text is in contrast to the background and limiting information overload. Marketers should use “real” people rather than models and ensure that older people are portrayed realistically. The age of people used in campaigns sends important messages about the target audience. Using people who are too young or too older limits the appeal of advertising, suggesting that segmentation by age is necessary. When communicating health and driving messages, trusted sources are of the utmost importance to older drivers. Traditional channels such as TV and radio remain important channels for reaching older audiences, however, digital resources are increasingly being used. Digital resources can play an important part in disseminating information, however, caution needs to be exercised in social media campaigns where trust is an important element.

Limitations

The findings need to be interpreted in the context of the following limitations. The findings are not generalizable to the Australian population. A more representative sample, including the perspectives from a range of culturally and linguistically diverse communities and rural or remote regions, would have widened the understanding of the topic. These groups are likely to experience different challenges when accessing information and resources about health and driving and could provide differing views and understandings on this topic. Most of the participants in this study were university educated who regularly engaged with online searches for information, therefore the findings do not represent those with lower literacy levels. Future studies that include a larger sample of older people from a diverse range of cultural, geographical and socioeconomic groups are required to confirm our findings.

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

This research was supported by Transport for NSW.