How plain speaking can get you blocked by Facebook
The Facebook advertising was created from an existing television commercial which had already aired on regional TV stations around WA.
This article was published by VicHealth in March 2019.
With its ability to reach very large or very specific populations at low cost, Facebook has proven to be an ideal platform for some health messages, but the social media giant’s rules around advertising content have stopped some Australian health campaigns in their tracks.
Why? You need to read the fine print…
A health promotion campaign making waves in the mainstream media is usually a cause for celebration. But in 2018 one cancer-related campaign took the media by storm, generating numerous articles online and even becoming the star of its own ABC-TV Media Watch segment, all very much thanks to Facebook and its content review processes.
Created by the Cancer Council Western Australia (CCWA), the Find Cancer Early campaign focused on the five most common cancers in WA: bowel, breast, lung, prostate and skin cancer.
The aim was to target people over the age of 40 in regional WA, with a particular focus on hard to reach sub-populations, such as Aboriginal and Torres Strait Islander people.
The CCWA strategy combined community health intervention with digital and mass media elements. ‘From April to July 2018 we had aimed to have a whole load of media happenings,’ explains Hannah Cauchi, Regional Education Co-ordinator for CCWA.
‘This included TV, radio, press and digital campaigning across Facebook, Gmail, YouTube and Google AdWords.’
We made five static ads and one video ad from what was repurposed content, and Facebook blocked them all.
The Facebook advertising was created from an existing television commercial which had already aired on regional TV stations around WA. The ads featured five regionally-based doctors in the bathroom talking about cancer symptoms and encouraging people to see a doctor.
‘We made five static ads and one video ad from what was repurposed content,’ says Cauchi. ‘And Facebook blocked them all.’
CCWA had not experienced issues with the campaign on any other platform. It had been approved by 14 newspapers, all other digital channels, five regional TV stations and 34 regional radio stations (an additional radio station agreed to air the ads, but only outside of school drop-off and pick-up times).
So, what went wrong when it came to Facebook and Find Cancer Early?
Poo versus You
One of the key components of the campaign was its use of simple language, the ordinary words that people use with the family doctor, rather than medical terminology.
For the elements of the campaign that dealt with bowel cancer and prostate cancer this meant delving into the common vernacular.
‘We did a lot of research into the kind of language that people understand, and that they feel comfortable using,’ says Cauchi. ‘What came up were the basic words that you’d teach a child when you were toilet training: poo and pee rather than terminology like faeces, stool or urine.’
Specifically, the campaign had the regional doctors telling people to ‘look for blood in your poo’ and ‘check for blood in your pee’.
At first, Cauchi believed the use of ‘poo’ and ‘pee’ was behind Facebook’s blocking of the campaign but, surprisingly, those words were not the problem. ‘On review, Facebook saw the terminology ‘you’ and ’your’, referring to people’s personal attributes, as the cause of the block,’ she says.
Facebook has been at the centre of numerous controversies regarding the content the platform hosts, many of which came to a head during and in the wake of the 2016 US Presidential elections.
The end result of its various political entanglements has been a big drop in perceptions around the trustworthiness of Facebook. The company has been hard at work to change that with a great deal of promotion being given to its new techniques for addressing fake news.
Improving transparency around some of Facebook’s internal practices has been an element of that. In April 2018 the company finally made its 27-page Community Standards document available to the public, explaining why it chooses to take down some posts, while leaving up others.
Ads must not contain content that asserts or implies personal attributes.
On the advertising side, Facebook has extensive guidelines in the form of its Advertising Policies including details of what it regards as Prohibited Content. The Find Cancer Early campaign ran into trouble with regard to the rules around ‘Personal Attributes’.
The policy says that ‘Ads must not contain content that asserts or implies personal attributes’.
In the list of what constitutes a personal attribute, including race, religion, age, sexual orientation, criminal record and membership of a trade union, the words ‘medical condition (including physical or mental health)’ stand out.
Facebook specifically notes in its examples the question ‘do you have diabetes?’ as running contrary to its ad policies.
Find Cancer Early isn’t the first health promotion campaign to experience difficulties with Facebook. It’s not even the first health promotion from WA to run into problems.
In July 2017 Facebook blocked the WA anti-obesity campaign LiveLighter and its #grabbablegutpromotion. The campaign used images of people gripping handfuls of abdominal fat and asked people if they wanted to ‘bust your #grabbablegut’. Facebook blocked the campaign stating that it didn’t ‘allow adverts that reference body images in a way that may make some viewers upset’.
LiveLighter went on to use the Facebook ban as part of its campaign messaging on other social media platforms, such as Twitter.Facebook has also banned US-based campaigns for sex education (which also experienced problems on Twitter) and even, as the company struggles with how it handles political news and messaging, an ad for a fundraiser bike ride for disabled veterans in Florida.
Facebook’s vital role
On the opposing side of these frustrations is the knowledge that Facebook can be a vital platform for health promotion.
‘Social media has become a powerful platform to directly engage a community,’ says Stefan Grun, Executive Manager of Marketing and Communications for VicHealth. ‘Beyond its strength as a campaign tool when working with a limited budget, a social media platform like Facebook offers some capacities that traditional mass market media just doesn’t have.’
We know that people aged over 40 respond very well to information delivered via Facebook.
‘Facebook certainly does offer an important audience for us, and like other digital platforms, it allows us to geo-target our ads to reach the most remote parts of WA,’ says Cauchi. ‘We also know that people aged over 40 respond very well to information delivered via Facebook.’
For the most part, the over-40 demographic ‘do as they’re told on Facebook’, says Cauchi candidly. They’ll share the information they’ve seen with friends, and even see their doctor if they’re told to. ‘They actually take that information on board and change their behaviour.
Grun adds that social media allows for a campaign to be updated ‘on-the-fly’ based on feedback from the target audience.
‘It allows for a collaborative relationship, whether that’s with the general public or a targeted group – you can be part of a real-time conversation with your audience.’
The capacity of Facebook and, to a degree, other social platforms to deliver a targeted message to the right people has been demonstrably effective in many areas including education around HPV and cervical cancer in the US and youth sexual health.
Some international researchers have highlighted its potential to reach a large number of users with a sexual health message, at a low cost. In Australia, Facebook has also been noted to be an effective tool for helping health promotion messages reach Indigenous populations, a group the Find Cancer Early campaign was targeting, along with other clearly defined target audiences throughout regional WA.
‘People in regional areas of WA are up to 30 per cent more likely to die within five years of a cancer diagnosis than people in the city,’ says Cauchi.
‘We needed to make sure we excluded the metro area entirely, and geo-targeted all regional WA, including the most remote parts. That was a significant part of our strategy; how to get to those people who we needed to get to.’
One size does not fit all
In rejecting WA’s Find Cancer Early campaign Facebook said, ‘The language of the ad should be focused on the product and not users.’ There is of course no product as such, putting health promotional messages at a disadvantage in the platform’s formulaic content reviews.
‘It seems the intent of this particular ad featuring the five GPs was entirely lost on Facebook,’ Cauchi says.
Ultimately, CCWA was able to change the wording of the campaign to fit Facebook’s policies, removing the individual focus of the message but without compromising the vernacular of the campaign.
‘Instead of being able to say, “If you have noticed blood in your poo at least once, go and see your doctor”, that message was changed to “People who have noticed blood in their poo at least once should see their doctor”,’ says Cauchi.
CCWA says there were concerns that losing the word ‘you’ would lessen the impact of Find Cancer Early.
‘That’s why initially we didn’t go ahead with any advertising for a period of a few weeks, while we had a lot of back-and-forth with our media company and Facebook.’
While strategic adjustments to the campaign’s wording (plus the impact of a large amount of national media coverage) were eventually able to get Find Cancer Early up on Facebook, Cauchi says there were limits to how much compromise could be made without reducing the impact of the campaign.
‘It was still effective because we stuck to our symptom terminology. That was the terminology that had been tested with real regional cancer patients and we weren’t going to move away from that. So as a compromise, we made some small adjustments, to continue to provide our message and our advice, but with the right terminology.’