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West of Scotland Cancer
Awareness Project
Bowel Cancer Campaign
Contents
Campaign contacts and details for usage
Details of scoping activities
Insights into public bowel cancer awareness
Intervention strategy and development
Pictures of the leaflets and photos from the project
exhibition
Top line results and lessons learned
Insight and scoping including literature review
Pre-testing
Evaluation
Institute for Social Marketing
Douglas Eadie [email protected]
Tel: 01786 467390
Web: www.ism.stir.ac.uk
Creative Agencies The Bridge (Television and radio adverts)
Margaret Byrnes
Tel: 0141 552 8384
Web: www.thebridgeuk.com
Marque Design (Leaflets and posters)
Paul Noe
Tel: 0141 332 3335
Web: www.marquecreative.com
Two Bob Rocket (Photography)
Paul Hampton
Tel: 0141 427 9111
Web: www.twobobrocket.co.uk
Ownership of materials and usage rights Campaign owned by the West of Scotland Cancer Awareness
Project
Permission to use from Emilia Crighton (Public Health
Consultant – NHS Greater Glasgow and Clyde) email:
Photography licensed – fee will be chargeable
If using same actor and voice over for TV and radio commercial
fee will be chargeable
Key partners NHS Greater Glasgow and Clyde, NHS Forth Valley, NHS
Ayrshire and Arran, NHS Lanarkshire
Funding via Big Lottery Fund
Bowel Cancer UK
Contacts for Campaign
Scoping
Introduction The West of Scotland Cancer Awareness Project (WoSCAP) was a
partnership between the five west of Scotland NHS Boards (Argyll and Clyde, Ayrshire and Arran, Forth Valley, Greater Glasgow and Lanarkshire)
They were awarded £1.3 million over three years by the Big Lottery Fund in 2002.
£240,000 of the grant was used to develop a public awareness campaign on the early detection of bowel cancer
£94,000 of the grant was used for research and evaluation
The project won 9 awards in total for healthcare communications, social marketing, advertising and design (3 for the bowel campaign)
Aim of the bowel cancer project
To encourage those ‘at risk’ of bowel
cancer to present earlier to the NHS with
signs and symptoms of the disease
Target group
Men and women living in the most
deprived areas within the west of Scotland
aged 50+ with signs and symptoms of
colorectal cancer
Our Starting Point
At baseline, (922 interviews) 46% awareness of bowel cancer Almost 50% would put up with symptoms as long as possible Symptoms such us unusual bleeding or long term constipation often
rationalised as ‘just one of these things you put up with’ Late presentation often due to lack of awareness, embarrassment,
invasive tests but fear of a diagnosis of cancer is key Epidemiology of disease – 3500 new cases every year in Scotland.
If detected early, 80% chance of cure Impact on services – fear from professionals about services being
swamped by large numbers of ‘worried well’ Service providers initially against plans due to potential impact on
secondary care which could affect diagnosis and treatment times Value for money- had the opportunity to reach target group
effectively
Professional Views - bowel
“A campaign of this nature is ethically
unacceptable”
“This campaign will swamp services with
the „worried well‟
“Who are you and what evidence do you
have to support the chances of a
campaign of this nature being successful”?
The Challenge – health professionals
To overcome resistance and negative attitudes from health professionals
To develop communication strategy to reach 4500 internal stakeholders
To support services to deliver when campaign was ‘live’
To turn sceptics into active participants by involving them in the process and decision making
Insight from public research
Reasonable levels of awareness of disease, poor awareness of signs and symptoms
Low awareness of incidence levels Lack of awareness that disease can be
effectively treated if detected early Issues about embarrassment and stigma to
present but major issue is fear of diagnosis of cancer
Focus on ‘risk’ factors in communications may alienate target audience
What People said - Bowel
A man’s more likely to sit there for months and say to himself,
it’ll go away
My friend died of bowel cancer. She always thought she
just had piles
Apart from bleeding, you’d have to have
symptoms for quite a while. You’d find any
excuse for it – say it was the bevy last night, or you had a dodgy meal.
Project Structure and Links
Steering Group
Project Team
Oral Sub-GroupResearch &
Evaluation Sub-Group
Colorectal Sub-Group
LocalImplementation
Teams
LocalImplementation
Teams
RCAG
Other NOFProjects
MCN’s
NHS Cancer SG’s
Project Structure & Links
ExecutiveGroup
Local Implementation Teams (LITs)
L.I.T.
OPERATIONALFacilitated by Project Team
SERVICE PLANNINGFacilitated by NHS Board
Remit
Communication strategy (internal –
NHS personnel; external – media,
interested bodies; physical –
distribution of resources)
Training (mapping, developing,
facilitating, evaluation)
Development and implementation of
local initiatives
Remit
Consider how services will cope
with the potential impact of the
campaign:
Structures
Referral systems
Training
Communication
Representation
Senior Campaign Manager
(WoSCAP)
LHCC Rep (PHP, GP, Nurse)
Health Promotion
Social inclusion member
Pharmacist
Primary Care (remit for training)
Community Health Project(s)
Representation
Public Health
Service Planning
Clinician
Nurse Specialist
Service Redesign
Primary Care
Pharmacy
LHCC Manager
WoSCAP
Sub-group
Research and
Evaluation
DevelopmentDevelopment
The strategy
Targeting a ‘hard to reach’ audience who can easily be ‘turned off’ by health prevention messages
Focus on ‘early detection’ not prevention
Promote early presentation of bowel cancer which will lead to improved outcomes and quality of life
Campaign messages had to focus on informing target group of ‘new’ information about their health in a relevant, non threatening and non patronising approach
Television was the perfect medium to reach the audience as traditionally they watch 4-5 hours television most days.
The strategy
Needed key baseline evidence from which to develop objectives
Baseline study was commissioned to understand target group’s knowledge, attitudes and perceptions of bowel cancer – also had a control area
From baseline studies, developed clear objectives for advertising, research and evaluation and impact on services
Conducted needs assessment with primary and secondary care teams to assess training needs
The strategy
Engagement with key professional stakeholders via comprehensive communication strategy and involving champions in decision making and local implementation teams
Finding common ground and a ‘win win’ situation with health professionals. What could we do to facilitate delivery of the service?
Development and delivery of a training programme for health professionals
Recruiting the right team with appropriate skills mix and confidence to deal with senior clinicians, primary care teams and cancer leads
The Strategy
Developed high profile media campaign
Communication messages and approach based on results from research
High profile initiatives including ministerial launch
Regular proactive stories in the media
Local initiatives including working with charities, voluntary organisations, events, photographic exhibition
Pre-testing – Bowel Campaign
5 concepts pre-tested in 6 focus groups
‘niggling worries’ addressed real barriers to action – inertia and fear
Proved compelling and intriguing due to dialogue with man confronting his fears
It had a direct call to action – ‘go to your doctor if your bowel habits change or you have blood in your motions’
It was felt to be an empathetic way of tackling the fear that surrounds the subject area
Pre-testing – Bowel Campaign
Women in the west of Scotland not ready to be seen posing on the toilet!
Implementation
Integrated Approach
Research Research
Communication Communication
Training Training
Service Provision Service Provision
Local Intiative Local Initia
tive
Advertising
Campaign Activities for the
public Ministerial launch which was covered by national television, radio and all
regional press
Television and radio advertising – 2 phases between November 2004 –February 2005
Direct mailshot to 250,000 homes
Sponsored competition attracting over 900 entries
Clyde Action (sponsored radio promotional week of activities)
website
Bowel Cancer UK supported a work place initiative with Glasgow City Council (100,000 employees)
Mobile photographic exhibition which was supplied for community events
Community events
Programme of proactive media activities
Activities with health professionals
Fully accredited training programme developed with NHS Education for Scotland
Programme delivered by secondary care clinicians and primary care representatives
Focus on referral pathways and protocols, risk factors, epidemiology, investigations for diagnosis, treatment, staging and the campaign. DVD was used to create scenarios and case studies in GP surgery, pharmacy highlighting how to approach patients and what action to take
17 Symposia on bowel cancer took place attended by 573 staff
£100,000 budget allocated to support delivery of out-patient clinics when the campaign was ‘live’
Regular newsletters both by email and hard copy
Updates and blogs on website
Poster
Poster
Leaflet – front and back page
Leaflet - contents
Leaflet - contents
Leaflet - contents
Competition Leaflet
Competition Leaflet
Photographic Exhibition
Photographic Exhibition
Photographic Exhibition
Budget
Research and evaluation £ 94,000
Production costs £ 86,350
Media costs £ 92,000
Agency fees £ 30,000
Primary/secondary care training £ 13,000
Support materials £ 50,000
Launch event £ 3,759
Supporting acute services £100,000
TOTAL £ 469,109
EvaluationEvaluation
Topline Results
583 semi-structured interviews with target group in campaign area, 351 in control area
71% awareness of television campaign
10% awareness of materials
9% awareness of radio campaign
14% increase in awareness of blood in stools as symptom from baseline
62% reported advertising encouraged them to see their GP sooner
Topline Results
417 questionnaires completed by patients attending outpatient
appointments across 12 sites in the west of Scotland
65% were aware of the bowel campaign
60% presented because they were concerned about symptoms
62% said the campaign had encouraged them to go and see
their GP sooner
46% presented because of bleeding from bottom
42% presented because of a change in bowel habit
28% presented because of blood in their stools
Topline Results
Referral rates in Ayrshire increased by
10%
“ I was impressed by the uptake of people
who in the past would not have consulted”
GP – NHS Ayrshire and Arran
Topline Results
Hairmyres Fast Track Clinic
(November2004 – March 2005)
6 tumours
18 polyps
12 cases of Diverticular disease
All patients attended as a direct result of
seeing the campaign
Views after campaign - bowel
“Fortunately, WoSCAP was a lot more than increasing public awareness. In preparation for the campaign, many meetings were organised to increase knowledge, awareness and readiness of clinical services in the region. As well as being educational, these meetings strengthened local team working and communication. The project also provided financial support for local initiatives to streamline diagnostic services and reduce waiting times.
This may be the lasting legacy of the campaign and I now think my initial concerns were unfounded and WoSCAP has made a positive contribution to bowel cancer services in the West of Scotland”.
Bob Diament – Lead clinician for colorectal services in the West of Scotland and chair of the MCN.
Lessons learned
Need time to plan – clear vision
Need support of professionals and involve them at an early stage
Ensure interventions are research driven, not expert led
If you want to raise a high profile, use television as the key medium
Documents to access
Literature review to guide the development of the West of Scotland Cancer
Awareness Project (Centre for Social Marketing – now ISM)
Exploratory research to guide the development of the West of Scotland
Cancer Awareness Project (Centre for Social Marketing – now ISM)
West of Scotland Cancer Awareness Project – Baseline report (Centre for
Social Marketing – now ISM)
West of Scotland Cancer Awareness Project – Bowel cancer mass media
campaign – findings from the first follow up (Institute for Social Marketing)
An evaluation of the impact of the WoSCAP bowel campaign on secondary
care services
How internal communications saved lives – The story of the West of
Scotland Cancer Awareness Project bowel cancer campaign
Follow upFollow up
Follow up
The bowel project won 3 national awards
Association of Healthcare Communications Awards - 2005: Best
campaign for improving health
Scottish Marketing Society Awards – 2007: Internal Communications
Scottish Design Awards – 2005: Best Corporate Literature –
WoSCAP Final Report
National bowel screening resources in Scotland are based on
content of WoSCAP materials
The WoSCAP project is quoted locally, nationally and internationally
as one of the best examples of social marketing in the UK in recent
years
