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The data provided was very useful in identifying our target audience and will also be of great importance in the case of future campaigns.

Karen Chaplin Senior Commissioning Manager

Creative solutions

The high incidence of COPD within the area of Barnsley Primary Care Trust (PCT) can be traced to both its coal mining past and its relatively high levels of smoking.

The prevalence of smoking is strongly linked with levels of deprivation, contributing to lifestyles of continually poor health. With the most deprived groups in the population typically living for fewer years than the least deprived groups, the cost of smoking is extreme.

As well as its toll in lives lost, smoking also causes diseases such as COPD that cost the health service extraordinary amounts of money. Barnsley’s high rate of COPD contributed to the £2 million cost of related admissions billed to the local health service between April 2006 and March 2007.

Solution

The trust wanted to raise awareness of COPD to help those with a high risk of developing the disease to identify their symptoms, seek appropriate advice from their GP and better manage their care, thereby avoiding more unnecessary hospital admissions.

Robust data played an integral part in the redevelopment of services. The PCT worked with Dr Foster Intelligence on compiling market research that identified the most appropriate audiences, provided understanding of their attitudes and behaviours, and helped in the design of a social marketing campaign.

"We knew that COPD services needed significant enhancements, particularly given the high prevalence of the disease," said Karen Chaplin, the PCT’s senior commissioning manager. "Community services were lacking – there wasn’t a great deal for patients in between the GP service and hospital admission.

"The awareness and education campaign was only one part of a much larger programme of COPD service redesign. The programme included health promotion, ill -health prevention, and development of specialist nursing, community matron and pulmonary rehabilitation services.

"Within the last 18 months there has been a big focus on COPD services," Chaplin continued. "This campaign was one of the integral parts of that development. The data provided was very useful in identifying our target audience and will also be of great importance in the case of future campaigns."

Four focus groups were used to:

Assess the level of public understanding of COPD
Understand the motivations and attitudes of those at risk of the disease
Encourage group participants to take preventative action
Identify the most effective ways to raise awareness of the disease.

Many COPD sufferers do not realise they have the disease and so live with it for years. Signs of the disease can be relatively minor, such as flu-like symptoms or being out of breath after physical exertion, and many people attribute the symptoms to being unfit or a heavy smoker.

Common features shared by Barnsley’s target audience included being middle-aged or older, from relatively deprived social groups and having unhealthy lifestyles. The research also found that substantially more women than men used the smoking cessation services.

Outcome

In developing the services to reflect the target population’s needs better, Chaplin found: "The research helped us highlight specific areas of deprivation and identify and understand far more about our target audience in terms of areas, age groups, gender and lifestyle than we have ever had previously.

"Before, we categorised the groups as ‘people from deprived communities’, which was a rather bland term, whereas now it is much more meaningful. We have more insight and detail now than we ever did before.

"As commissioners, we will be asking providers to identify their clients in a more specific way, as they now have access to far more detailed target audience information."

The trust’s target audience included families living in large housing estates with school age children, older people in low-rise social housing and manual workers close to retirement age living in ex-manufacturing towns.

By clearly identifying the audience, the project team decided that a telemarketing campaign would be the most effective method of communication. In order to raise awareness of the campaign, posters were displayed throughout the targeted areas. Ten thousand homes were called, and residents were offered more support in the form of posted information packs that gave details on the stop smoking service, affordable warmth for the home, healthy walks, COPD and the opportunity to learn more from a home visit by a smoking cessation advisor.

"We have had some really good results from the campaign so far," Chaplin said. "The success rate of people being referred to the smoking cessation service has been impressive. We are just awaiting the final data results."

"I believe that this type of data and research benefits everyone. By encouraging people to look after themselves and manage their own health and wellbeing, we are hopefully keeping people out of hospital. Commissioning value for money in terms of increased efficiency and better outcomes also means spending the taxpayer’s money more wisely.

"I think there is a lot of potential to use data analysis in the way that we have done – from the broadest level of changing people’s behaviours as part of reducing the health inequalities agenda by encouraging and assisting them in taking responsibility for their own health, to health promotion and ill -health prevention," Chaplin continued.

"We will be able to use the data to drive long-term sustainable public health campaigns about smoking, breathing difficulties and where to go for help. We will not stop now – we will feed the learning into our future work."

As far as future projects are concerned, Chaplin said: "We already have plans to develop social marketing in the area of coronary heart disease and sexual health. Those are both areas where we have significant amounts of work to do in terms of reducing inequalities.

"Because of what we have learned through the COPD campaign, we feel that social marketing could be a huge contributor to overall development in both areas.

"The 'non-traditional' approach [of the COPD campaign] was viewed with scepticism by some, but most are now converts and accept that creative approaches can bring positive outcomes."

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