What raises yours?
This project was the third part of a social marketing campaign commissioned by The Modernisation Initiative, a three-year programme funded by Guy's and St Thomas' Charity to improve healthcare in Lambeth and Southwark. The project aimed to encourage blood pressure checks among white men aged 35 to 65.
Focus group research revealed that this audience responded well to a humorous approach and a campaign called ‘What raises yours?’ was developed, fronted by sports commentator and darts player Bobby George. Outreach events were held in community settings, such as supermarket car parks and the Lambeth Country Fair.
Results from all three stages of the social marketing campaign:
- 17 per cent of respondents reported they had seen or heard of one of the campaigns
- Of these, 52 per cent said they had learnt something new about blood pressure, 13 per cent had a blood pressure check, and 41 per cent were likely to have a blood pressure check as a result of seeing the campaign
- The number of respondents who did nothing to reduce their risk of high blood pressure fell by up to 25 per cent between 2005 and 2007
High blood pressure (HBP), or hypertension, is a major risk factor for stroke, coronary heart disease and other illnesses such as kidney disease and aortic aneurysm.
Around 1 in 3 adults in the UK (approximately 16 million) has HBP, and it is estimated that 18 per cent of adult men and 13 per cent of adult women have HBP but are not getting treatment for it.
The risk of developing HBP increases with age, with half of those aged over 75 having hypertension. In addition, people of African-Caribbean origin are more likely to develop HBP than other ethnic groups.
The Modernisation Initiative was a three-year programme to improve healthcare in the London Boroughs of Lambeth and Southwark funded by the Guy's and St Thomas' Charity. The overall aims of the programme were to:
- Establish a baseline of HBP awareness in Lambeth and Southwark
- Identify the most at-risk target groups
- To motivate healthy behaviour change amongst residents
An initial survey by research agency Ipsos MORI established a baseline of HBP awareness in Lambeth and Southwark and identified the most at-risk target groups. The survey also explored the effectiveness of various awareness-raising strategies and examined ways of promoting healthy lifestyles in the local community.
The research identified the following:
- Less likely to be concerned about developing HBP in the future
- Less likely to be registered with a GP
- 12 per cent of men have never had a blood pressure check
Age: 35 to 65
- The incidence of reported HBP peaked at age 65
- Most likely to have done nothing to reduce risk of developing HBP
Ethnicity: Caribbean, West African, white
- Make up 80 per cent of Lambeth and Southwark population
- A key variant regarding level of concern and other important measures
The Modernisation Initiative targeted men aged 35 to 65 from each ethnic group in three phases, with the wider community forming a secondary audience. The first two phases targeted West African and Caribbean men and was undertaken by PR agency Where It's At. The third and final campaign was developed by communications agency Forster and was targeted at white men. These three tailored campaigns formed part of the local blood pressure awareness programme, which ran from September 2006 to September 2007. This case study focuses on the third campaign that targeted white men, which took place between April and September 2007.
The campaign aimed to:
- Increase awareness of the risks and consequences of HBP among white males aged 35 to 65
- Increase the number of blood pressure checks by white males aged 35 to 65
The Modernisation Initiative carried out a literature review to identify evidence of effective social marketing programmes and health promotion interventions for men.
Following the initial baseline survey conducted by Ipsos MORI, which also identified the three most at-risk groups for targeting, Ipsos MORI conducted focus groups with these three primary audiences. The aims of this primary research were to:
- Explore knowledge, perceptions and beliefs of the target audiences
- Investigate the current behavioural choices of the target groups, particularly the barriers to healthy lifestyle choices and ways of motivating them to change
- Identify key messages to increase awareness of blood pressure checking as a preventative measure
- Identify effective, culturally appropriate health promotion interventions
Research consultancy The Dream Mill was subsequently commissioned by The Modernisation Initiative to conduct two focus groups with white men from the target area, based on the findings from the Ipsos MORI research. The aim was to find out more about how the audience felt about their health in general, blood pressure in particular, and what communications methods and channels were likely to be most effective.
The focus groups revealed the following insights, which were used to develop the marketing mix:
Low knowledge and misconceptions
Lack of knowledge and misperceptions about HBP meant the target audience felt little reason to get their blood pressure checked. For example, some said they would have a check if they felt symptoms, despite the fact there are no obvious symptoms of HBP.
Wary of traditional GP settings
The target audience felt that most face-to-face interactions with GPs involved being told to give up things they enjoyed or being given bad news about their health. For example, one comment was 'I don't like going to the doctor because he's always telling me I'm doing something wrong or have to change how I live.' Despite this, the target audience still viewed GPs as the most authoritative sources of medical knowledge.
The target audience felt that making an appointment with the GP was not an easy way of getting a health check, particularly due to work commitments during the day. They felt they had to wait a long time for an appointment and preferred services to come to them at convenient times and locations. They much preferred walk-in centres where no appointment was required or used mobile health clinics at sporting, community events or school fairs.
The research also identified ways the target audience could be encouraged to get a blood pressure check:
Normalising the procedure
Many men said they would be more likely to have their blood pressure checked if the process was normalised through simple procedures, no-nonsense communication and knowing their peers were doing it too.
Influence of partners
Men would be more likely to get checked if their wives or girlfriends ‘nagged’ them into it.
Working alongside selected members from The Modernisation Initiative, a public health doctor, and a member of the Lambeth Primary Care Trust (PCT) communications team, Forster created four different creative routes based on the research findings. These were tested in focus groups, which found that:
- The audience responded well to a humorous, not too serious approach to the subject
- They did not want any messages to feel patronising and would not believe a ‘case study’ from a peer (they believed these to be made up), but preferred expert knowledge and facts
- It would be important to integrate messages into their everyday lives, using channels they trusted and already interacted with, such as football clubs and pubs
The target audience favoured the creative route entitled ‘What raises yours?’, which reflected the humour of the target audience and captured a certain cheekiness that was not patronising or sermonising. This creative was refined based on the insights from the focus groups.
The What raises yours? campaign was designed to encourage the target audience to have regular blood pressure checks, by emphasising the ease and demystifying and normalising the process.
Based on the outcomes of the focus groups with target audience members, the campaign brand name and designs warned men that undetected HBP could cause impotence, stroke, kidney and heart disease. The risqué images and slogan were engaging, but also focused on providing the facts and emphasised the ease of having a blood pressure check. They also alerted the audience to the fact that they need not see their GP for a blood pressure check – a key barrier highlighted by the research – but could instead make appointments with their practice nurse.
Creative marketing collateral that continued this humorous theme were disseminated in the form of:
- Brochures, which included expert opinion from a local GP and a public health consultant – although the target audience were wary of visits to GP surgeries, they still valued GPs' opinions and were motivated by hard facts
- Instant win scratch cards with ‘myth busting' questions about blood pressure, which could be used to start conversations with the target audience, and winners would be rewarded with a healthy snack
Research showed that the target audience were likely to avoid traditional health settings, like GP surgeries, and their free time was spent on leisure activities, such as going to the pub, betting shop or football, or attending community events with their families.
To combat this ‘competition’, relevant communications settings and partnerships were identified to distribute campaign materials, based on locations where the target audience often frequented. This ensured that resources could be targeted cost-effectively and the best coverage secured. Collateral was distributed to over 200 locations across the two boroughs:
- 18 William Hill betting shops
- 37 pubs
- 11 Costcutter stores
- 162 pharmacies
- 16 local independent newsagents and shops
- Two working men’s social clubs
- Five snooker clubs
- Millwall FC (posters in three home stands at two pre-season games versus Aldershot and Southampton in July)
- At Men’s Health week events
Forster wanted to recruit a celebrity with whom the target audience could relate to endorse and support the campaign. The following celebrities were identified as suitable campaign ambassadors:
- Bobby George (darts player and BBC sports commentator)
- Danny Baker (radio DJ and Millwall Football Club fan)
- Neil ‘Razor’ Ruddock (ex-Millwall Football Club player and TV personality)
- Tony Cascarino (ex-Millwall Football Club player and football pundit)
The team were delighted when Bobby George agreed to come on board with the campaign. He had recently appeared on the relevant TV programme ‘Celebrity Fit Club' and was known and respected by the target audience. He is of a similar age and demographic to the audience and his profile helped ensure media interest. Personal appearances at campaign events meant he could interact directly with the target audience, providing a strong interest in the campaign.
“Bobby George is a darts player, his lifestyle was seen to be quite similar to the target audience, but he had also recently changed his behaviour when he hit 60. He had gone on Celebrity Fit Club. He’d become much more aware of health and fitness and so was a positive role model, because the audience could easily associate with him, and because he had been able to turn his fitness awareness and health around.” (Ella Sunyer, Forster)
Stands and blood pressure checks in community settings
Based on the research finding that opportunistic blood pressure tests would be the best route to reach men, local events were used to promote blood pressure checks. Settings were chosen on the basis of where men and their families in the borough were likely to be frequenting. This was on the basis of research which showed that alongside opportunistic tests, harnessing female pester power would be a good way to encourage more men to get their blood pressure checked. A What raises yours? stand was set up at local community events , where people could have their blood pressure checked by a nurse and book appointments.
Through earlier stakeholder mapping conducted by The Modernisation Initiative, Forster was able to identify and engage with key GP surgeries, outreach nurses and pharmacies to support the campaign and community events. Support for the campaign was also generated through a newsletter distributed by The Modernisation Initiative to a wide range of stakeholders across the two boroughs.
The campaign was launched to coincide with the London Marathon with an event at Southwark Park on 22 April 2007. Free blood pressure checks were offered by community nurses and healthcare assistants. Participants could play darts with Bobby George to try and ‘score’ their blood pressure number and win a hamper. This encouraged people to take part by making the process fun, sociable and not intimidating.
Blood pressure check events then took place at:
- Sainsbury’s in Vauxhall on 22 June
- Southwark Irish Festival in Peckham Rye on 1 July
- Lambeth Country Show in Brockwell Park on 21 and 22 July
The numbers of blood pressure checks taken on the two days at the Lambeth Country Show varied. Numbers remained low on Saturday 21 July for several reasons. The weather was very wet and thunderstorms kept people away from the event. In addition, several nurses pulled out of the event at the last moment due to unforeseen circumstances, such as sickness and house flooding. Not having enough nurses on hand to administer blood pressure checks meant the queues were difficult to manage and people did not wish to wait. On Sunday 22 July however, there was a rise in the number of blood pressure checks taken. This was probably due to better weather conditions and more nurses being available to take blood pressures, as well as Bobby George’s presence on this day, which attracted a significant number of people to the stand.
“Getting instant health advice at the community outreach events was the most effective. We were able to get their blood pressure tested there and then, and the target audience could see how easy and painless it was, and they could ask the nurse questions, so they were able to have direct engagement with health professionals which they weren’t otherwise getting. That ended up being a really good supplement to the visual nature to the campaign and the darts element, which initially got them interested.” (Ella Sunyer, Forster)
During the campaign the team decided to also conduct some direct, one-to-one engagement through using scratch cards to further promote the campaign. 245 people were approached on 22 and 23 July in prime locations across Vauxhall, Camberwell, Peckham, Bermondsey, Brixton and Old Kent Road. The scratch cards were particularly effective for starting conversations with the target audience in venues where they were often standing around, such as pubs and betting shops. Those who correctly answered the ‘myth busting’ questions about blood pressure won an instant prize of a cereal bar.
At this point during implementation, Forster took the opportunity to re-contact key locations, such as pharmacies, but this time face-to-face rather than through regional offices, to encourage them to put up posters, give out leaflets and start conversations with customers about their blood pressure.
“We found that when we were working with pharmacies that the initial contact was great, but then to really to get them to support the campaign we had to follow up with a face-to-face meeting with them to then talk to all their staff onsite. This allowed us to talk through what the messages of the campaign were, what their origins were, who the target audience were and to explain that it had been well tested.” (Ella Sunyer, Forster)
Though the remit of this campaign was to target white men, it was felt that there was further scope in future to target particular segments within this group, for example the homeless community who are less likely to be having regular blood pressure checks.
“Under this campaign, we adopted a broad approach, targeting all white men living in the boroughs. This meant that the campaign had wide reach and was able to target high numbers of men who were not accessing health services regularly. Key recommendations for future campaigns would be to conduct outreach work in the borough, for example with homeless communities and other such groups who are less likely to be accessing regular blood pressure checks.” (Ella Sunyer, Forster)
The Modernisation Initiative commissioned Ipsos MORI to evaluate the effectiveness of the campaign. This comprised of 10-minute quantitative face-to-face surveys with 750 residents, as well as 24 face-to-face in-depth interviews with the target group.
In addition, people requesting a blood pressure check at local events completed assessment forms to establish whether the campaign reached the target audience.
- 17 per cent of all respondents reported that they had seen or heard of at least 1 of the 3 campaigns
- Of these, 52 per cent said they had learnt something new about HBP, 13 per cent had a blood pressure check and 41 per cent were likely to have a blood pressure check as a result of seeing the campaign
- Those who saw the campaign were more likely to adopt a healthy lifestyle
- The number of respondents who did nothing to reduce their risk of HBP fell by up to 25 per cent between 2005 and 2007
- Social marketing techniques contributed to the success of the campaign
Blood pressure checks at local events
- Over 600 people had their blood pressure checked
- 297 (49 per cent) of those who had their blood pressure checked were 35- to 65-year-old men
- 83 people entered the darts competition at 2 events
Collateral distribution and media coverage
- 36,000 leaflets
- 800 posters
- 110 event posters
- 600 event leaflets
- 245 scratch cards
- Two banners appeared at each of the four events
- Media coverage was secured in PR Week, the South London Press and Southwark News
Upon completion of the campaign, Forster presented all the findings and lessons learnt to The Modernisation Initiative and stakeholders from the Southwark Health and Social Care and Lambeth PCT.
Forster has used the learning from this campaign to inform other campaigns it has conducted in regards to ensuring that target users are involved in all aspects of message and material designs. This ensures that chosen designs are used because they resonate with the target audience, rather than because the project team assumes they would be the right approach to take.
What raises yours? was shortlisted for the Best Social Marketing Project for the 2008 Health Service Journal Awards.
There were initial concerns about the provocative nature of the visual identity of the creative route that was developed in the campaign, in particular that the female form was over-sexualised. It was feared that this route might alienate some people. However, feedback from the target audience was that they were most likely to pay attention to this route so a decision was taken for this route to be developed.
“Go in with an open mind in terms of the design and creation of the messages, i.e. what you think might work might well may be blown out of the water by suggestions from the key target audience themselves. What you think might be distasteful or not very suitable, actually that might not be felt by the target audience.” (Ella Sunyer, Forster)
Having an appropriate and relevant celebrity endorsement, combined with engaging and interactive events worked well. This was supported by the large numbers of blood pressure checks taken at the Lambeth Country Show on the day when Bobby George was in attendance alongside the darts competition.
The campaign had strong outputs including recognition of the campaign among the target audience and numbers of men that had their blood pressure checked. In order for this success to be maintained and for deep-rooted behaviour change, recommendations are for intensive interventions, for example outreach work within specific communities.