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11-12 April 2011 Citywest Hotel, Dublin, Ireland
11-12 April 2011 Citywest Hotel, Dublin, Ireland
Keynote Presentation:Introduction
Chair: John Cahill
CEO, McCann Healthcare Worldwide
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11-12 April 2011 Citywest Hotel, Dublin, Ireland
11-12 April 2011 Citywest Hotel, Dublin, Ireland
Keynote Presentation: The Value for Money of Behaviour ChangeDr Graham Lister
Visiting Professor, Health and Social Care London South
Bank University (UK)
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Graham Lister NSMC
Behaviour change is not an optional extra◦ A public relations gloss or just an NHS money saver
We cannot afford the NHS without it ◦ And we can’t ignore costs to families, employers or LAs
Behaviour change is good value for society!◦ We have to demonstrate this to a wider public
◦ In a clear and consistent way
◦ Now!
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Expensive and inconsistent: no consensus on◦ Measures of costs, change or impacts
◦ How Value for Money should be measured
◦ What behaviour change achieves for health
Most evaluations are inconsistent because◦ Each reinvents its approach and measures
But this only applies to large programmes◦ Most local programmes are evaluated qualitatively
◦ An important basis for VfM but inconclusive
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National Advisory Board◦ Fiona Adshead, Julian Le Grand, Mike Kelly, Richard
Little, Ian Basnett, Sunjai Gupta, Robert Anderson.
Working team◦ Rowena Merritt, Graham Lister, Stephen Bell, Aiden
Truss (NSMC) - Lesley Owen, Simon Ellis (NICE)
To develop behaviour change VfM tools for◦ Smoking, Alcohol harm reduction, Obesity at
schools, Breast Feeding and Cancer Screening
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Review Guidelines ◦ What can we build on?
Build consensus approach 50 experts and users◦ What works for you?
NICE review of benchmark studies◦ Measures of behaviour change and their impacts?
Estimate health and social impacts◦ Using WHO Burden of Disease and Benchmark studies
Develop 5 Ready Reckoner tools
Pilot and adjust tools for 10 users + 30 experts
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Lots of Guidelines◦ NSMC, NICE, COI, CO, LGID, ACE...... 10 and rising
Very similar guidance◦ Engage stakeholders and clarify objectives◦ Map the intended process and unintended outcomes◦ Establish baseline comparator ◦ Estimate cost and impacts for all stakeholders◦ Examine extent and duration of changes in outcomes◦ Estimate the value of outcomes◦ Discount costs and outcomes
But little practical help on the difficult steps
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Practitioners don’t need guides they need help◦ To defend programmes to PCTs, LAs and GPFH
◦ To show what behaviour change is worth
◦ And they want a VfM approach to VfM
Experts had expert views (all different)◦ Most wanted cost/QALY before/after NHS and LA costs
◦ But wanted options for client/ employer/social costs
◦ Some wanted Social Return on Investment
◦ To weight for disadvantage or not was debatable
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Few agreed indicators of behaviour change◦ We need common measures
Costing of interventions is generally poor◦ Guidelines were provided
There are measures of costs to the NHS◦ Could be based on NHS Programme Budgets
But few measures of the health impacts◦ From benchmark studies or WHO Burden of Disease
No consistent framework for social impacts◦ A pragmatic layered framework is needed
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Using WHO data and/or benchmark studies
For each behaviour we found estimates of:◦ Total impact on health (burden of disease)
◦ Costs to NHS
◦ Other costs such as care services and criminal justice
◦ Plus impacts on Government, employers and clients
We divided by the people at risk over 40 years◦ We used measures of behaviour for 1990
Gives theoretical impacts per person ◦ Modified by the extent and duration of change
The value of achieving behaviour change indicator
Ready reckoners just do the maths◦ If you know the value of a behaviour change and ◦ No of people achieving indicator (by age/ disadvantage)◦ At what cost to all stakeholders, you can◦ Project lifetime impacts (for a range of estimates)◦ And discount to current values
This provides the basis for◦ Cost per QALY before and after NHS and LA savings◦ Deaths averted, Years of Life Saved, Odds Ratio, NNT◦ Lifetime savings to clients, employers, government◦ Weighting for disadvantage if you choose◦ Social Return on Investment
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Join the VfM movement:◦ At http://thensmc.com/resources/vfm; you need to
register and log-in to be able to use the tool
◦ Watch out for 4 more tools by June
Public Health England to provide direction◦ With NICE, PH Observatories, NHS Evidence, QIPP, DPHs
NSMC to support behaviour change ◦ Develop training, networking and support
◦ Build and improve tools as knowledge develops
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11-12 April 2011 Citywest Hotel, Dublin, Ireland
Questions
Please wait for the microphone and state your name and
organisation before asking your question
11-12 April 2011 Citywest Hotel, Dublin, Ireland
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11-12 April 2011 Citywest Hotel, Dublin, Ireland
Keynote Presentation: Japanese social marketingsuccess: Improving both cancer screening and ROIAkio Yonekura
Marketing Director, Cancer Scan Co Ltd
Japanese Social Marketing Success:
Improving both cancer screening & ROI
Akio Yonekura
Marketing Director, Cancer Scan Co., Ltd.
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+
=
cancer screening rate
= =
$ per cancer screening taker
3 times 1/2 time
ROI 2 times
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Deliver the right message
to the right target
with the right media
2011/ 3/ 11 14:46
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death: 12,000+
missing: 14,000+
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9,000+ people
from 15+ countries
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$100M+ donation
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and prayers from all over the world
thank you
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issue
issue: cancer
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no.1 cause of death in Japan since 1981
Source: Vital Statistics in Japan -The latest trends-Vital and Health Statistics Division,
Statistics and Information Department, Minister‟s Secretariat, Ministry of Health , Labour and Welfare
Source: Estimation of national medical care expenditure in Japan, Statistics and Information Dept. Minister‟s Secretariat, Ministry of Health, Labour and Welfare
million $
0
5000
10000
15000
20000
25000
1980 1985 1990 1995 2000 2003 2004 2005 2006 2007 2008
Cancer Diabetes Hypertensitive diseases
medical expenditure 5 times since 1980
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solution
1
3
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1
3
of all cancer deaths can be
prevented by cancer screening
solution: cancer screening
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Goal: 50% by 2012
1981 Cancer became the leading cause of death
1984 Comprehensive 10-year Strategy for Cancer Control
2007 Cancer Control Act
Basic Plan to Promote Cancer Control Program
-> officially set screening goal: 50% by 2012
City
Set goal
& Support
Ministry
of HealthState
Set goal
& Support
Resident
promote
cancer screening
financial
support
Screening
Provider
$
screening
143.8
160.9
212
236 237
100
120
140
160
180
200
220
240
260
50
55
60
65
70
75
80
2005 2006 2007 2008 2009
year
million $
MH aggressively increased budget
Source: MHLW Budget Report ‟09, Statistics and Information Department, Minister‟s Secretariat, Ministry of Health, Labour and Welfare
Japan MHLW budget on cancer control
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Pink Ribbon Campaign
Pink Ribbon Campaign got active
$, when/ where to take it,Screening method
How to make an appointment(send a postcard.
Call to ask questions.)
cities followed
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143.8
160.9
212
236 237
55.3
64.9
69.6
73.874.2
100
120
140
160
180
200
220
240
260
50
55
60
65
70
75
80
2005 2006 2007 2008 2009
year
Million $%
Awareness: benefit of cancer screening by mammography
Source: NTT Resonant Co., Ltd, “awareness survey for 20,000 women about breast cancer „05, „06, ‟07, „08, „09”
awareness followed
Japan MHLW budget on cancer control
17.6
12.914.2 14.7
16.3
55.3
64.9
69.6
73.8 74.2
2005 2006 2007 2008 2009
0
10
20
30
40
50
60
70
80
90
100
year
%
action didn‟t follow
Source: National Livelihood Survey, Statistics and Information Department, Minister‟s Secretariat, Ministry of Health, Labour and Welfare
Breast cancer screening rate
Awareness: benefit of cancer screening by mammography
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?how can we improve
cancer screening
with cost-efficiency?
Cancer Scan‟s way
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Deliver the right message
to the right target
with the right media
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
P&G marketing + scientific evidence
- Select target w/ equity in mind
- Develop hypothesis on target‟s
motivations/ barriers, utilizing
behavior science (TTM, TPB, IBM,
etc.)
- Conduct qualitative/
quantitative research to
understand target‟s “insight”- Develop executions and
deliver them to the target
- Select media/ com.
channel based on target‟s
insight and evidence (e.g.
CDC comm. guide)
- Develop com. strategy
(concept) based on target‟s
“insight”
- Utilize message framing
theory when necessary
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Trial Intervention in Tokyo
- breast cancer -
Trial Intervention Outline
• Goal: Achieve 50% breast cancer screening rate
• Project duration: Jul ‟09 ~ Mar ‟10
(after the city sent out 1st
invitation)
• Team consisting of:
Tokyo state govern. officials, City officials,
Japan National Cancer Center Prof. and Cancer Scan
• City population: approx. 174,500
(women over 40: approx. 47,500)
• Breast cancer screening rate: approx. 30 ~ 40%
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0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
WHO: target understanding
? who is the target?
what is her insight?
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
WHO: target understanding
1. Quantitative Research (n=8,000, age 51-59)
- screening history, screening intention,
cancer history (including family‟s)
- perception against cancer/cancer screening
(susceptibility/severity/barrier/benefit/cue to
action/ self-efficacy (Health Belief Model), and etc.
City + Cancer ScanResidentsent out questionnairesapprox. 40% replied
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0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
WHO: target understanding
1. Quantitative Research (n=8,000, age 51-59)
Taker
Prejudice
Non-taker
barrier
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
WHO: target understanding
1. Quantitative Research (n=8,000, age 51-59)
Non-taker Taker
Reality
1.Pre-
contemplation
Stage
2.Contemplation
Stage
3.Preparation/
Action Stage
Maintenance
Stage
barrier barrier barrier15% 17% 26% 42%
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Prep/ Action (26%)
Inconvenient
(barrier)
Embarrassing
(barrier)
Not necessary
(benefit)
Friends
recommend me
Worried
about cancer
(severity)
Confident about
my health
(self-efficacy)
Pre-contemp. (15%)
Inconvenient
(barrier)
Embarrassing
(barrier)
Not necessary
(benefit)Friends
recommend me
Worried
about cancer
(severity)
Confident about
my health
(self-efficacy)
Contemp. (17%)
Inconvenient
(barrier)
Embarrassing
(barrier)
Not necessary
(benefit)Friends
recommend me
Worried
about cancer
(severity)
Confident about
my health
(self-efficacy)
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
WHO: target understanding
2. Qualitative Research (n=20, age 51-59)
“Not so sure where to start”
「I know the severity of
breast cancer and
importance of screening, and
know I need to go now. But I
am not so sure where to
start. Sorry, I‟m lazy.」
Prep/ Action (26%)
“I am so scared...”
Contemp. (17%)
「I‟ve heard of the
importance of screening and
probably I‟d better go, right?
But what if cancer is
detected? What am I gonna
do? I am so scared.」
“I am just fine. Don‟t worry.”
Segment C (15%)
「I know breast cancer is a
big thing these days. But it‟s
not my issue. I am very
healthy. I haven‟t been
hospitalized or anything. I‟ll
consider screening when I
become unhealthy.」
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0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
WHAT: message development
? what is the right message
based on her insight?
WHAT: message development
A-to-Z of how to takescreening in your city
Don’t worry too much about breast cancer &
screening.
Brest cancer is everyone’s issue of life or death.
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
“I am just fine. Don‟t worry.”
Segment C (15%)
“I am so scared...”
Contemp. (17%)
“Not so sure where to start.”
Prep/ Action (26%)
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0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
? what is the right execution
and media to deliver it?
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
brutal information environment
1016
words
0
5000
10000
15000
20000
25000
平成8 9 10 11 12 13 14 15 16 17 18
Amount of Information generated
Amount of Information received
Internet and cell phone penetration
accelerated in Japan
„96 „97 „98 „99 „00 „01 „02 „03 „04 „05 „06
1019
words
Source:Ministry of Internal Affairs and Communications. (2006). Census of information distribution.
99.2% of
information is
not received
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0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
Intervention Methods Breast Cancer Scr.(MM)
Call System by provider 1)
Small Media 2)
Incentive(alone) -
Mass Media Campaign(alone) -
Mass Education -
1-on-1 Education
Monetary Burden Reduction
CDC Community Guide 2008:
Evidence on effectiveness of intervention methods
1)call system to remind of cancer screening dates, etc.
2)broacher to explain cancer/ screening (importance, how to take it, etc.)
94.6%
81.7%
70.5%66.8%66.5%
56.7%
49.3%
43.6%
36.1%
23.2%
.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Healthcare
professional
(Doctor, Nurse
etc)
Newsletter,
public relations
magazine by
public services
Friends,
colluegues
TV programsNewspapersRadio programsMagazinesWebsitesTV advertisingWEB advertising
2nd
most trustable info source
Source: Ministry of Health, Labour and Welfare, Nationwide survey for target segmentation of Japanese Healthy People 21. 2009:
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
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0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
City + Cancer Scan
Residents
Prep/ Action
Contemp.
Pre-contemp.
send customized leaflets (invitation)
Prep/ Action Contemp.
How to make an appointment
1. Susceptibility
2. Severity
3. Benefit
Removingmonetary barrier
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
A-to-Z of how to takescreening in your city
“Not so sure where to start”
Prep/ Action (26%)
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Benefit:You can cure
breast cancer!Let’s go to MM!
Removing a barrier:
This is howscreening goes
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
Don’t worry too much about breast cancer &
screening.
“I am so scared...”
Contemp. (17%)
Severity:No.1 cause of cancer deathfor Japanese
female in 40’s
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution development
Brest cancer is everyone’s issue of life or death.
“I am just fine. Don‟t worry.”
Segment C (15%)
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$, when/ where to take it,Screening method
How to make an appointment(send a postcard.
Call to ask questions.)
City + Cancer Scan
Residents
questionnaire
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution
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City + CancerScan
Residents
reply
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution
City + CancerScan
Residents
develop database
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution
Prep/ Action
Contemp.
Pre-contemp.
Prep/ Action Contemp.
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City + CancerScan
Residents
send leaflets
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
HOW: execution
Prep/ Action
Contemp.
Pre-contemp.
Prep/ Action Contemp.
Control group
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
Result: amazing
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0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
Result: screening rate tripled
P2Y Non-taker(Female, 51-59)
N=1,859
Controlw/ city’s message
N = 465
Screening rate: 5.8%A: N=206 (7.3%) B: N=129 (4.7%)C: N=130 (4.6%)
Interventionw/ customized message
N = 1,394
Screening rate: 19.9%
Contemp. (B)N = 37617.3%
Prep/ Action (A)N = 62825.5%
Pre-contemp. (C)N = 39013.3%
OR = 2.3, P < .001
OR = 3.8, P < .001
OR = 5.7, P < .001
3 times
0.Landscape
Analysis
1. WHO
2. WHAT3. HOW
Result: $/screen-taker halved
1/2 times
P2Y Non-taker(Female, 51-59)
N=1,859
Control
w/ city‟s message
N = 465
Screening rate: 5.8%
Intervention
w/ customized message
N = 1,394
Screening rate: 19.9%
cost to bring 1 person
to breast cancer screening
$193/ person $355/ person
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Effectiveness Cost/ bahavior
# of cancer screening taker
= =
$ per cancer screening taker
3 times 1/2 time
Deliver the right message
to the right target
with the right media
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Kanazawa,IshikawaIntervened:5,178
screening taker:450
Fukui city,Fukui Pref.Intervened:5,100
screening taker:184
Tachikawa,TokyoIntervened:1,394
screening taker:277
Suginami,TokyoIntervened:3,000
screening taker:239
Adachi,TokyoIntervened:15,258
screening taker:1,595
Higashimurayama,Tokyo
Intervened:5,781screening taker:1,350
Toshima,TokyoIntervened:4,577
screening taker:457
Kobe,HyogoIntervened:3,000
screening taker:239
Onomichi,HiroshimaIntervened:3,000
screening taker:239
Matsusaka,MieIntervened:3,000
screening taker:239Nerima,Tokyo
Intervened:7,758
screening taker:1,173
Total(in 3 years)
Intervened:57,508screening taker:4,731
$149.64/behavior
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thank you
11-12 April 2011 Citywest Hotel, Dublin, Ireland
Questions
Please wait for the microphone and state your name and
organisation before asking your question
46
11-12 April 2011 Citywest Hotel, Dublin, Ireland
11-12 April 2011 Citywest Hotel, Dublin, Ireland
Keynote Presentation: M is for Marketing; M is for Movement
Prof Gerard Hastings OBE
Founder/Director "Institute for Social Marketing and Centre
for Tobacco Control Research at Stirling and Open University
(UK)
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11-12 April 2011 Citywest Hotel, Dublin, Ireland
Questions
Please wait for the microphone and state your name and
organisation before asking your question
11-12 April 2011 Citywest Hotel, Dublin, Ireland
48
11-12 April 2011 Citywest Hotel, Dublin, Ireland
Refreshments and Exhibition(Exhibition Hall)
11-12 April 2011 Citywest Hotel, Dublin, Ireland
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11-12 April 2011 Citywest Hotel, Dublin, Ireland