1. Changing Behaviours for Safe Listening (to music on personal devices) Elena Altieri, World Health Organization, June 6, 2015

2. Introduce health communications concepts Provide an overview of the behavioral change communications (BCC) strategy for the safe listening initiative Discuss the relevance of the strategy to development of a safe listening standard Objectives of the session

3. THE SAFE LISTENING INITIATIVE

4. Safe Listening: The vision People of all ages enjoy music in the full protection of their hearing Fewer cases of hearing damage and loss

5. Safe Listening: Objectives Awareness about hearing damage and loss Policies and legislation Software and hardware to help users adopt the right behaviour Other

6. Awareness and Behaviour AWARENESS AND ENVIRONMENTall AWARENESS AND ENVIRONMENT = responsibility of all FINAL BEHAVIOURSindividual FINAL BEHAVIOURS = responsibility of each individual Hearing damage is a function of level and time of exposure. It is each single individual who decides how much music they listen to; for how long at what volume.

7. Challenge enablers Standards, hardware, software are essential enablers that can contribute to reducing hearing damage and loss BUT … users and their behaviors only can make a difference.

8. How can we persuade individuals to take better care of their hearing?

9. HEALTH COMMUNICATIONS

10. Health communications: a definition The study and use of communications strategies to inform and influence individual and community decisions that enhance health. ( USA Dept. of Health and Human Services) e.g.: tobacco control, physical activity, healthy diet, road safety, hand washing, HIV-aids prevention, etc.

11. Key BCC Concepts Exchange Price Barriers

12. Some Theory*: How people behave * Michael L. Rothschild Journal of Marketing Most individuals: Act out of self-interest Act out of self-interest Think in terms of exchange Think in terms of exchange Make a decision between the alternative suggested and its competitionn Make a decision between the alternative suggested and its competitionn

13. HEALTH COMMUNICATIONS FOR SAFE LISTENING

14. Health communication for Safe Listening A safe listening standard can be effective in bringing about a change in listening behaviours only if the users :  Become aware  Understand and appreciate  Believe  Do/Act

15. Safe listening: comms objectives Provide information Provide information about risk, consequences, correct behavior in a persuasive and adequate way to the target audience to influence their behaviors Influence users' decisions Influence users' decisions with respect to what hardware and software they chose to play (enjoy) music

16. Positioning (marketing statement) Safe listening will become the new norm. Being able to control volume and duration of exposure will become a priority feature for users Users will be looking for help from the industry to monitor decibel levels and time of exposure. User will be willing to lower the volume in exchange for peace of mind for their future.

17. Safe Listening: comms outcomes Users prefer ( choose, pay more, look for, request, conduct research on, share, etc) hardware and software products that help them control their listening behaviours Users follow instructions provided by warning signs embedded in hardware and software.

18. HOW? Understand users Research: we need to understand what they know, what they think, what matters to them, why the care, why they don't Offer clear and attractive benefits that can outweigh the cost or price perceived for the desired behaviour

19. Preliminary research What we know* about users and safe listening: Knowledge 90% understand that listening safety is a function of sound level and duration of exposure. 83% know where to purchase technology to reduce risk 66% are familiar with “Output Limiting”, 13% use them (+9% sometimes) 89% are familiar with “Noise Canceling” or “Insert Earphones” Attitude 85% feel confident that they know when to turn their music down Behaviour 48% use technology to reduce risk (+15% sometimes) 33% have received a warning on the device ( 34% ignored it, 6% disabled it, 8% turned it to a higher volume setting) * WHO/University of Colorado/University of Singapore, 2015

20. What we know* about users and safe listening: Knowledge 90% understand that listening safety is a function of sound level and duration of exposure. 83% know where to purchase technology to reduce risk 66% are familiar with “Output Limiting”, 13% use them (+9% sometimes) 89% are familiar with “Noise Canceling” or “Insert Earphones” Attitude 85% feel confident that they know when to turn their music down WHY? Behaviour 48% use technology to reduce risk (+15% sometimes) 33% have received a warning on the device ( 34% ignored it, 6% disabled it, 8% turned it to a higher volume setting) WHY? * WHO/University of Colorado/University of Singapore, 2015 Preliminary research

21. * WHO/University of Colorado/University of Singapore, 2015

22. Target audience with specific needs * WHO/University of Colorado, 2015 Target audience with specific needs

23. 60% think there should be more information on the device packaging and user manual 79% of respondents would turn the music to lower volume if they knew they were listening at an unsafe level. 16% enjoy listening to loud music, even if unsafe for their hearing “risk takers”. Cues for action: * WHO/University of Colorado/University of Singapore, 2015

24. 60% think there should be more information on the device packaging and user manual 79% of respondents would turn the music to lower volume if they knew they were listening at an unsafe level. 16% enjoy listening to loud music, even if unsafe for their hearing “risk takers”. Cues for action: Target audience * WHO/University of Colorado/University of Singapore, 2015

25. What do you think about having a way to place a limit on the maximum volume of the sound coming from your device? AnswerPercentage (%) All devices should have optional controls that the listener can use to make the device unable to reach potentially damaging sound levels. 39% All devices should be regulated and not allowed to reach potentially damaging sound levels 7% All devices should provide a way for me to monitor my sound level exposure using both volume setting and duration (time) of listening so I know when I am in danger of harming my hearing. 38% No changes need to be made to the way devices operate now 12% Other solution4% Total100% * WHO/University of Colorado/University of Singapore, 2015

26. Who has responsibility for ensuring listening to music is safe in order to prevent hearing loss? AnswerPercentage (%) Listeners using music players94% Parents51% Public health educators43% Medical professionals (audiologists, physicians) 38% Manufacturers producing headphones/earphones 38% Teachers (primary, secondary)31% Manufacturers producing music players30% Music Industry (persons making and producing music) 16% Other5% * WHO/University of Colorado/University of Singapore, 2015

27. The communication strategy Research: Complement on-line market research to fill some gaps information ( TBC) Strategy: Reach out to audiences while the behavior happens: through hardware and software Messages: Related to susceptibility (can this happen to you?); act now to prevent hearing damage or to be able to enjoy music your whole life (lower the volume, switch off, etc) Testing: Develop messages concepts based on research and test of possible messages through Focus Group Discussions with different segments Develop of provisional messages for testing on APP with a selected sample on ALPHA Version Develop of final messages Monitoring of users response during deployment of WHO APP ( 1 year) End: Identify a set of tested specific messages ( content and format) that could become part of the standard.

28. questions for discussion Communications & the standard: questions for discussion

29. Dissemination Blogs, websites, forum, …? Which ones? On the packaging: Does the standard include recommendations on what goes on the packaging? On the manual of instruction: can a standard recommend language and content for the manual of instructions? Additional communications: Can a standard recommend additional communications to be included in the package (e.g. flier or note) Can a standard recommend the use of a "compliance stamp" visually recognizable on all products? Can a standard include recommendations related to the training to sales representative and personnel in shops? For software, is the best option to invite users to install and look for tools to protect their hearing or should the industry embed these tools automatically? ( the more steps/actions separate the user from the behavior the harder is the change) Others How do end users become aware that a standard is a available and that it is an added value of a product on the market?

30. Related to the warning messages: How specific should / can the standard be in relation to what messages are delivered and how? Should the alert be audio, visual, vibration, a combination? Should the alert be personalizable? Some informal research indicates that it is HOW the warning is delivered that bothers the users not the WHAT. Can ( should) a standard address this? Should the standard include information related to extra features that allow the device to take full control of the behavior ( the device is instructed to lower volume automatically or switch off the music after some time)

31. Thank you