NHS Health Checks + Social Marketing

Customer Orientation Behaviour

How do you get to know and really understand your target audience?

What is the “problem behaviour” and what is the “desired behaviour”?

Theory

What behavioural theories are most relevant to inform and guide the intervention?

Insight

What really moves and motivates the people you want to reach?

Competition Segmentation

What competes for peoples’ attention, time and energy?

How will you divide your target audience into manageable groups? (e.g. people with similar needs, attitudes or behaviours)

Exchange

What is the cost to the consumer in achieving the proposed benefit? The perceived and/or actual costs versus benefits?

Methods Mix

What range of methods will you use to support the changes in behaviour?

Customer orientation

Questions from the customer’s perspective...

• • • • • • • • • • • • • What is an NHS Health Check?

Why do I need one?

Where do I get it?

What will happen to me?

What will it involve?

Who will do it?

What happens after the Check?

What’s in it for me?

Why should I bother with it?

Is there a choice of Checks?

Do I get one Check, or more?

Do I have to go on my own?

Can’t I do it myself – I’m pretty capable?

NHS Health Checks are not just a programme for implementation

“Why do I need one?” “What is a Health Check?” “Who does it?” “What happens?”

it’s about real people

Matching

Reminders of why the check was important and why you went; feel OK about going again Knowing what the NHS Heath Check is for and looking forward to what it will do for you; receiving the invitation; getting ready to go Going for the check; the welcome you receive; rapport with the healthcare professional; what happens; the results; what happens next

Behaviour

Behavioural goals

There may be several behaviours we wish people to do in connection with NHS Health Checks...what is realistic and achievable?

This is a lot to ask people to do...

especially all at once!

Segmentation

Audiences

• Adults aged between 40-74 years • People most at risk of vascular disease • People living in the most disadvantaged communities Disadvantaged and marginalised communities: o o o o o o o White British low socio-economic groups Black, Asian and Minority Ethnic Groups Gypsy and Travelling Communities Migrant Workers People in the criminal justice system People with long term mental illness People with a disability

Audience responses to the NHS Health Checks...

Eligible population

* the “tippers” are good starting point for additional recruitment push

Some characteristics of a good segmentation

Segments need to be meaningful and manageable to all those who are expected to use them

– Of little use if cannot be identified efficiently by frontline services

Segments need to be cohesive and different

– Very similar within individual segment – Distinctive from other segments

Needs to be replicable and actionable

– Practical to recreate across the system – Staff need to understand, identify customers to segment & know how to vary delivery accordingly

The segments will need refreshing over time

– Due to demographic change, service design change, delivery improvements, etc

A segmentation model

The Healthy Foundations Lifestage Segmentation has real potential for application to NHS Health Checks...

Healthy Foundations Lifestage Segmentation

4

th

November 2009

© Healthy Foundations Lifestage Segmentation Research 1 4

Motivation segmentation – cluster map

Balanced Risk-takers (17%) High motivatio n Health Conscious Realists (21%)

Live for Today (25%)

Unconfident Fatalists (18%) Hedonistic Immortals (19%) Note: not to scale Low motivatio n

‘Live for Today’ – Health Motivation Profile

Size = 25% = 9.5 million adults Weighted base =1256 Unweighted base = 1396

Profile

• Covers all demographic groups • Tends to live in more deprived areas

Behaviours

• Fairly poor health behaviours • Most likely to smoke • More likely than average to be increasing/high risk drinkers • 10% do both • Less likely than average to eat 5 or more portions of fruit/veg a day • Less likely than average to take 5x30 mins exercise a week • 45% do neither

A ‘Live for Today’ from Lewisham

What are we like?

I’m an 18 year old guy from Lewisham, just getting along for now. I don’t have much money and normally my money runs out before I get my dole cheque. This makes me feel pretty down. I have the odd smoke and drink quite a bit to make me feel better.

I don’t plan anything in life. I don’t think about tomorrow or much about the future. Who wants to live forever anyway? Leading a healthy lifestyle doesn’t sound like much fun and I think it would be difficult. I don’t enjoy cooking healthy meals in the evening. I eat lots of takeaways and I know that’s bad.

I used to do sport at school. But nowadays I don’t feel motivated. What’s the point? But I don’t look half as bad as some people. When I’m running after a bus though, it’s not as easy as it used to be, think it’s the smokes. I think I would really like to travel and get out of here some time in my life, don’t know when. But life’s quite grim.

For more information on the Healthy Foundations Lifestage Segmentation model contact Ewen Macgregor or Vincent La Placa 020 7972 4447 Health Improvement and Protection Directorate

Ambitions for Health and Healthy Foundations link: http://www.dh.gov.uk/en/Publicationsandstatistics/Publi cations/PublicationsPolicyAndGuidance/DH_090348 © Healthy Foundations Lifestage Segmentation Research

Insight

Generating insight from…

• Frontline staff and other stakeholders • Surveys • Data mining of customer databases e.g. supermarket loyalty cards • Customer journey mapping • Customer immersion techniques • Usability testing and website analysis • Qualitative research with the target group: focus groups, in-depth interviews, paired depths, deliberative workshops etc • Ethnography (the scientific description of peoples and cultures) • Public consultations • Formal and informal contact with representative bodies • Agents or intermediaries • Written correspondence • Media coverage • Sales data • Media analysis of press and broadcast coverage to understand the social, political and cultural context • Process evaluations • Reviews of interventions’ effectiveness

From ‘data’ to ‘insight’

Data Understanding

What?

Why?

Insight

SO WHAT!

Information, facts and observations related to understanding the people involved An understanding of what’s going on A deeper truth that strikes a chord with people

Key insights

All these are key themes :

• Prevention is widely accepted as being better than cure • Peace of mind is a common motivator in attending an NHS Health Check in either lowering the risk or preventing the onset of disease OR getting a ‘second chance’ to put things right • A short term goal is improving health and wellbeing in the short term, getting the most out of life today, increased vitality • Optimism: being around in later life to reap rewards of hard work and seeing children and grandchildren grow up happy and well – especially in communities where people die early from heart disease and stroke

Barriers

• Getting a letter inviting you for a check from an NHS organisation you are not familiar with/do not recognise • Your Health Check is conditional to a long, complicated and boring appointment system which is convenient to everyone but you • Not knowing why you need a Health Check • Being unaware of your risk of disease • Having to wait a long time to get a Health Check • Complicated telephone appointment systems • A poor, or non-existent relationship with your GP and/or surgery • Anticipating bad news and being told you have to change your lifestyle (when you like what you do)

Barriers ..cont

• Lack of knowledge of the risks of cardiovascular disease • Fear of getting bad results • ‘Health’ check is vague and could mean anything • For some women: fear that the check involves a physical examination • Making lifestyle changes and ‘healthy living’ perceived as making yourself dull and lonely • Healthy living is not the ‘norm’ for your community • Thinking you have to change lots of things all at once – this is unrealistic

Insight – Migrant Workers

• People are in the UK to work and this takes priority • Not necessarily a correlation between length of stay in the UK and knowledge and understanding of health services • May be registered with a GP but this doesn’t mean people understand what services are available (for free) • Are seeking security and stability; health and wellbeing status most vulnerable in the first year of stay • Often arrive speaking no English and language confidence and skill develops over time • Opportunities to access healthcare depends greatly on whether the community has ‘organised’ itself e.g. information sharing • Opportunities to access health care also depend greatly on advocacy and outreach • Migrant workers most likely to be connecting with health services and are therefore generally younger than the 40-75 years age range

Competition & Exchange

‘Exchange’ concept

Example: Healthy eating

Now!

•Can’t enjoy a Friday-night

takeaway

•Limited pleasure & comfort

from food

•Won’t it be more expensive? •Self-image boring goody-

two-shoes

Costs In future!

•Longer life expectancy •Fewer illnesses in future

Benefits

Competition for NHS Health Checks – some themes

• I’m too busy and I can’t fit it in • Prefer not to know if I am ill • I can’t be ill – how will this affect me, my family, my job

etc?

• No-one else I know is having this done, why me? • I don’t feel unwell – so why bother with this? • I’ll have to take time off work • I don’t want to take tablets for the rest of my life • I don’t want to have any kind of physical examination • I can do this myself at the gym or chemist – how is this

different or better?

Exchange – some themes

• The check will tell me how I’m doing • I’d get peace of mind at least, from getting checked out • I would agree prevention is better than cure • Other people I know had a check and it sounded OK so

why not?

• At least if there’s something wrong with me my doctor

will tell me what can be done about it

• It was easy to get the check • At least I’ve got a second chance to put some of this

stuff right now, before it gets worse

• At the check I found out there’s a lot I can do myself if I

want to

• This means I’ll be healthier for longer and enjoy myself

with my grandchildren

To increase uptake of NHS Health Checks...

Increase the benefits Reduce the barriers

Intervention & marketing mix

Four primary ways to influence behaviour

Summary

Key Findings

• The single most powerful influence upon whether someone has a Health Check or not, is their GP – followed by family and friends, other healthcare professionals • In terms of cost effectiveness, a personal communication via a letter of invitation from their own GP, door drops, word of mouth recommendation, direct marketing, outdoor advertising and finally posters are most to least cost effective in this order • There is widespread recognition that ‘prevention is better than cure’ • Although people don’t look forward to it they do expect the healthcare professional to question their lifestyle • The benefits of Health Checks are perceived to be making the most of today; peace of mind in getting checked out; a second chance at putting something right if it’s going wrong; adding years to life to enjoy retirement and the rewards of lifelong hard work; enjoying seeing children and grandchildren grow up

Key Findings (cont)

• We shouldn’t assume everyone has the same basic knowledge and understanding of human anatomy and physiology – this is key if we want people to know why the NHS Health Check is important and how their lifestyle behaviours affect their bodies • Stressing the difference between ‘prevention’, ‘treatment’ and ‘cure’ is important to avoid confusion and raising expectations • Communicating risk needs to avoid references to ‘%risk’ and instead focus on low, medium or high risk of developing specific

diseases

• Translation is a good start for people for whom English is not their first language but there needs to be a recognition that the information itself may need to change – not just the language • Again, although not relished, people recognise the Health Check may mean they have to change what they do – they are prepared for this but it has to be manageable – ‘one thing at a

time

John Bromley and Luke Van der Beeke National Social Marketing Centre Artillery House Artillery Row London SW1P 1RT [email protected]