Keynote Presentation: Introduction2013.wsmconference.co.uk/2011/downloads/11S4 Dr Graham... ·...

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11-12 April 2011 Citywest Hotel, Dublin, Ireland


Keynote Presentation:Introduction

Chair: John Cahill

CEO, McCann Healthcare Worldwide

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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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Smoking Behaviour Change Evaluation 0804.xlsx

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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

http://thensmc.com/resources/vfm

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Questions

Please wait for the microphone and state your name and

organisation before asking your question


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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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to the right target


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


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



Taker

Prejudice

Non-taker

barrier

0.Landscape

Analysis

1. WHO

2. WHAT3. HOW



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


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


Segment C (15%)


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


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


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


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0.Landscape

Analysis

1. WHO

2. WHAT3. HOW


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


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


Don’t worry too much about breast cancer &

screening.


Contemp. (17%)

Severity:No.1 cause of cancer deathfor Japanese

female in 40’s

0.Landscape

Analysis

1. WHO

2. WHAT3. HOW


Brest cancer is everyone’s issue of life or death.


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.


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City + CancerScan

Residents

send leaflets

0.Landscape

Analysis

1. WHO

2. WHAT3. HOW

HOW: execution

Prep/ Action

Contemp.

Pre-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


Intervention

w/ customized message

N = 1,394


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


to the right target


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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

[email protected]

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thank you


Questions



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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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Questions




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Refreshments and Exhibition(Exhibition Hall)


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