3. mmr social marketing strategy - barking and dagenham - sw project

★☆REVOLUTIONMARKETING.

A strategic social marketing plan to improve uptake of the MMR vaccination in five deprived wards in Barking and Dagenham

Sam Woodhouse – M00218005

MKT4025 – Social Marketing in Practice, 5 May 2010

Assignment 3

MA Health and Social Marketing Middlesex University

For presentation to:


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Table of Contents Introduction..………………………………………………………………………………………………………4 Executive Summary ...................................................................................................................5

1.0 Background, Purpose And Focus..........................................................................................7 1.1 MMR – The Issue ..................................................................................................................7 1.2 MMR and Barking And Dagenham........................................................................................9 1.3 About NHS Barking And Dagenham and the Borough........................................................10 1.4 NHS Barking and Dagenham’s Approach ...........................................................................12 1.5 Reporting and Governance Structures ................................................................................14

2.0 Situation Analysis .................................................................................................................16 2.1 Distinct Competencies.........................................................................................................16 2.2 Swot Analysis: Strengths; Weaknesses; Opportunities; Threats.........................................17 2.2 Past or Similar Efforts: Activities, Results, And Lessons Learnt; Insight .............................18

3.0 Target Market Profile.............................................................................................................21 3.1 Target Market Need Assessment ........................................................................................21 3.2 Identifying the Target Market...............................................................................................23

3.2.1 Size...............................................................................................................................23 3.2.2 Demographics, Geographics, Related Behaviours, Psychographics ...........................23 3.2.3 Ward Level Target Group: ............................................................................................24 3.2.4 Final Target Market ......................................................................................................24

3.3 Stage Of Change.................................................................................................................25

4.0 Marketing Objectives And Goals .........................................................................................26 4.1 Social Marketing Objectives ................................................................................................26 4.2 Goals ...................................................................................................................................26

5.0 Positioning .............................................................................................................................27 5.1 Target Market Barriers, Benefits, And The Competition......................................................27

5.1.1 Perceived Barriers To Desired Behaviour ....................................................................27 5.1.2 Potential Benefits To Desired Behaviour......................................................................27 5.1.3 Competing Behaviour ...................................................................................................28 5.1.4 Stakeholder Analysis ....................................................................................................28

5.2 Positioning Segments..........................................................................................................29

6.0 Marketing Mix Strategies (The P’s) ......................................................................................31 6.1 Product ................................................................................................................................31 6.2 Price ....................................................................................................................................31 6.3 Place....................................................................................................................................32 6.4 Promotion ............................................................................................................................33

6.4.1 Communication Strategies ...........................................................................................34 6.4.2 Messages .....................................................................................................................38

6.5 Physical ...............................................................................................................................40 6.6 Processes............................................................................................................................40 6.7 People .................................................................................................................................40

7.0 Budget ....................................................................................................................................41 7.1 Costs For Implementing Marketing Plan, including Evaluation ...........................................41 7.2 Any Anticipated Incremental Revenues or Cost Savings ....................................................41

8.0 Implementation ......................................................................................................................42 8.1 Action Plan ..........................................................................................................................43

9.0 Evaluation Plan......................................................................................................................46


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9.1 Purpose And Audience for Evaluation.................................................................................46 9.2 Evaluation Of The Marketing Mix To Inform The Overall Outcomes And Process..............47 8.3 What Will Be Measured: Output/Process, Outcome, and Impact Measures .......................47 9.0 Appendices..........................................................................................................................48

Appendix A - Targeted Advertising Opportunities in Selected Wards ...................................48 Appendix B – Children Centres in Target Wards...................................................................53 Appendix C - Project Management Plan ...............................................................................54

10.0 References ...........................................................................................................................55


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Introduction This strategy is written from the perspective of a social marketing agency “**Revolution Marketing" to provide an objective and professional presentation. The approach is built upon the Total Process Planning Model is the guiding framework for social marketing activity. This model provides a robust and systematic framework for approaching a social marketing project. Phase one will cover full scoping, in which secondary research will be reviewed and quantitative and qualitative research carried out. Phase two will include planning and development, in which a promotional plan to support interventions will be created, whilst phase three will be the implementation, the beginning of the long term promotional campaign. Evaluation will follow the campaign delivery. It is important to fully support and endorse the investment of time and effort in the front end scoping and development stages of the model, which are critical to ensuring that strong foundations are laid on which to develop and build the intervention proposition for NHS Barking and Dagenham and the target citizens. The strategy is presented using an adaptation of Kotler and Lee’s Social marketing Planning Primer (2008, p. 36).


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Executive summary Revolution Marketing is pleased to submit this strategy for the Barking and Dagenham Partnership to address MMR uptake in the borough through a combination of prevention, promotion and control work streams. The Barking and Dagenham Partnership is a strategic alliance of local provider agencies local provider agencies – (NHS Barking and Dagenham; London Borough of Barking and Dagenham; The Metropolitan Police; Council for Voluntary Services; and Barking, Havering and Redbridge University Hospitals Trust). The Partnership would like to commission an agency to develop and deliver a social marketing campaign aimed at increasing the uptake of the MMR vaccination in the borough. The campaign will form part of their comprehensive Health and Well-being (including immunisation) Strategy. The MMR vaccination has historically low uptake across the UK, and Barking and Dagenham is no exception, with current uptake rates of 81%, well below the 95% target that ensures herd immunity’. Previous insight identifies low socio-economic groups as particularly at risk of not obtaining MMR protection for their children, and these populations can be located in five more deprived wards within Barking and Dagenham. This target audience will be encouraged to access the MMR vaccination where they previously may not have one, by developing a high level social marketing campaign. Within these communities, white working class parents aged 20-34 years are identified as the primary target audience. Barking and Dagenham Partnership has access to deep-level population data using Mosaic and other insight activity that will inform the development and implementation of the campaign. Recommendations based on existing insight and analysis of the current situation, include providing mobile vaccination services, build sales promotions to incentivise the vaccination, and utilize very targeted media channels to convey a message. It is advised that all development of concepts, and messages, be pre-tested with members of the local target audience to support the implementation. Staff and practitioner education will form a key part of this campaign to support delivery and follow-up of the services and messages. This programme will be developed and delivered from September 2010 to July 2011 including a full external evaluation, and has a suggested budget of approximately £60,000.


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List of Acronyms BHRUT Barking, Havering, and Redbridge University Hospitals Trust BME Black and Minority Ethnic CSL Commissioning Support for London CVS Council for Voluntary Services HWB Health and Wellbeing (strategy) JSNA Joint Strategic Needs Assessment LSMU London Social Marketing Unit MMR Measles, Mumps and Rubella NHSBD National Health Service in Barking and Dagenham PHIAC Public Health Interventions Advisory Committee PCT Primary Care TrustSalad99 SE Socio-economic (groups) UCL University College London WHO World Health Organisation


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1.0 Background, purpose and focus “Immunisation plays a vital role in children’s health by providing protection against common infections. These infections can have devastating effects and even cause death. NICE guidance, for those who have a role in immunisation, makes recommendations which aim to increase the uptake in groups and settings where immunisation levels are currently low.”

Prof. Catherine Law, Chair of the PHIAC at NICE (2009). The client, NHSBD, has presented an interesting challenge to Revolution Marketing to turn around their historically poor uptake of the MMR vaccination. The aims of the project are to:

- Identify target populations to focus social marketing campaign through secondary research; - Develop a social marketing campaign to drive behaviour change to increase uptake of the

MMR vaccination within defined target groups; - Contribute to an improved parental perception of the MMR vaccination.

Revolution will strategically plan the development, delivery and evaluation of a social marketing campaign. Revolution has reviewed existing secondary evidence and identified gaps in the primary research.

1.1 MMR – the Issue In 1988, the combined version of the Measles, Mumps and Rubella (MMR) vaccination was introduced as part of the national immunisation programme. MMR is given at 12-15 months and a booster at 4 years old. The World Health Organisation (www.who.int) recommends the MMR combination where it is available. The introduction of MMR vaccine in 1988 effectively halted the three yearly cycles of mumps epidemics in young children. The programme initially reported a positive return with rates peaking at 92% uptake, just short of the 95% target that ensures herd immunity (HPA, 2010). Following millions of vaccinations, an article published by Wakefield et al. in The Lancet (1998, p.637), made reference to a clinical link between the MMR jab and autism. Tabloids reported the association and in 2002 1,257 articles in the UK media covered the MMR-Autism link (Goldacre, 2008). A number of studies have found no link between MMR and autism (e.g. DeWilde et al. 2001, Peltola et al. 1998, Taylor et al. 2002). Donald and Muthu's (2002) review of such research suggests that all the credible evidence refutes any such link and that there is still, to date, no empirical data linking the vaccine to autism (Boyce, 2005, p.17). However, the subsequent uptake of vaccinations dropped to 79% (Elliman and Bedford, 2007, p.1055). Although public confidence has since grown and the programme has seen a slow gradual incline to around 85% national uptake (www.HPA.org.uk), this presence in the public eye has had a damaging effect on public behaviour decisions. Meanwhile, confirmed cases of measles in England and Wales rose from 56 in 1998 to 971 in 2007 (as shown in figure 1). Scientists have analysed media coverage of the MMR vaccine (Leask and Chapman 2002, Gangarosa et al. 1998, Mason and Donnelly 2000, Poland and Jacobsen 2001, cited in Boyce, 2005, p.8). Friederichs, Cameron and Robertson (2004, p.465) reported that “sustained adverse publicity” resulted in the drop in uptake rates.


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The media are often blamed for the decline in vaccination take-up rates, Poland and Jacobsen argue there is: “...an inadequate scientific knowledge base within the media, and an irresponsible tendency toward the sensational contributes and plays into public fears and concerns as the media and the anti-vaccine groups engage one another without regard to scientific knowledge, facts or credentials.” (2001, p.2442). The World Health Organization (WHO) states that “based on the extensive review presented…no evidence exists of a causal association between MMR vaccine and autism or autistic disorders.” (WHO, 2003, www.who.int). Cameron and Littler (2005, p.287) confirm that MMR uptake has decreased following prominent adverse publicity since 1998. Kassioanos (2001, cited in Cullen, 2005, p. 31) advocates that the vaccines available in the UK are among the safest available, provided that their contraindications are observed. Indeed, Cullen considers that to deny a child immunisation, may ultimately be to deny him or her good health in life (2005, p.31. Andrews and Boyle advocate that around 25% of all children’s deaths in the developed world could potentially be prevented by immunisations (2002, p.178).

Figure 1. MMR coverage at 24 months in the UK and confirmed cases of measles of all ages (England and Wales), 1995 - 2007. Taken from HPA, 2008. Brown (1990) describes the media as a behaviour modifying ‘set of tools’, while Wallack summarises it as an ‘opportunity of the greatest magnitude’ for influencing behaviour (1990, cited


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in Grilli et al, 2002). Judging by the case studies, we can assume that the media may represent a positive influence towards social change, but may also damage reputations, reduce ‘consumer’ confidence and alter health beliefs. Nonetheless, vaccination programmes are considered as effective preventative programmes to reduce risk of disease and reduce potential burden on health services. The government White Paper “Choosing Health” positions immunisation as “important in protecting individuals and population against disease which can kill or cause serious long-term ill health” (2004, p.45). In February 2010, the Lancet had retracted Wakefield’s earlier report from their publication. Goldacre proposes in the Guardian (30th Aug 2008) that it is not only Wakefield who is to blame, but also the media for irresponsibly reporting a socially sensitive subject. Despite the evidence and subsequent retraction, uptake rates are still low as evidenced by the London average with 79% first dose uptake.

1.2 MMR and Barking and Dagenham Despite the evidence and autism report retraction, uptake rates remain lower than the London average of 79% first dose uptake. In Barking and Dagenham, in 2006-07, uptake was only reported at 71% uptake, which compares poorly to other boroughs, and other immunisation programmes across London and the UK. As a key performance indicator, there is significant pressure to improve the rates of protection within the infant population. NHS Barking and Dagenham’s new Health and Wellbeing Strategy, along with the Marketing, Engagement and Communications Strategy, and Commissioning Strategy identified Immunisation as a key target for improvement over the next two years. It is also a significant contributor to World Class Commissioning, a number of competencies that NHSBD is required to work towards by the NHS in order to deliver high-level practices and service commissioning. To achieve significant improvement on the current MMR uptake, these strategies must maximise the marketing of the vaccination, the service, and the need to complement other commissioning and provider service work. The Health and Wellbeing Strategy priorities indicate that a key desired outcome for the borough will be for the infant immunisation uptake rate to reach the national target of 90% by 2010/11. Key agreed actions to support this aim include:

-‐ Ensure awareness of the benefits of immunisation; -‐ Establish a locality-based approach to immunisation; -‐ Improve information accuracy and flow.

(NHSBD HWB Strategy, 2010)

All social marketing work will complement national and local targets as well as supplement the strategic aims of the organisation. Data from the latest detailed statistical immunisation review from 2005-06 (NHS Information Centre) ascertained that the London borough of Barking and Dagenham has approximately 2,700 children aged two years old, 74% of whom had been immunized against Measles, Mumps and Rubella. With reference to children aged up to 5 years, 82% had been immunized against MMR, although only 62% of the same group had received the additional booster injection to provide full immunity. Table 1 shows the figures to date over the past twelve months in the borough, the figures show that there is a drop in uptake rather than suggesting any marked increase in uptake of the MMR immunisation programme.


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Table 1: MMR uptake data in Barking and Dagenham 2009/2010 COVER DATA - 2009/2010

Immunisation Year to Date

(run on 12/04/2010) Target 2009/10

2 Year Cohort (RiO) 3462 tbc Number vaccinated 2757 tbc MMR (1 dose) % 79.64% 83.00% 5 Year Cohort (RiO) 3045 tbc no. vaccinated 1805 tbc MMR (2 dose) % 59.28% 82.00% The statistics confirm that there are a significant number of parents not having their children immunised. It is considered beneficial that NHS Barking and Dagenham and London Borough of Barking and Dagenham (referred to as the strategic Partnership), identify the immunisation of children amongst their immediate priorities. This will support stakeholder engagement and any process recommendations that come from this venture.

1.3 About NHS Barking and Dagenham and the borough NHSBD is the first “commissioning only” Primary Care Trust in the country. It is responsible for one of the more deprived areas of London, tackling severe health inequalities and issues. Barking and Dagenham has a population of 170,000 living in just over 69,000 households. The borough is one of the fastest growing in the country, with the population predicted to increase to 208,000 by 2020/21. The borough has a higher proportion of older people and children than the London average. Almost one quarter of the population is aged 0 -15 years compared to the London average of 19%. In Barking and Dagenham, national data shows that residents are not as healthy as they should be. Compared to other parts of the country they don’t live as long, with many dying earlier from cancer or heart disease. Almost half the residents of Barking and Dagenham live in areas classified as being amongst the fifth most deprived areas in England. For both sexes, life expectancy in these poorly deprived areas of the borough is over three years less than for people living in the more affluent wards. General health and well-being is not as good either. There are high levels of teenage pregnancy that can adversely affect the development of parents and children; lower levels of immunisations for childhood diseases result in days off school for the child and days away from work for the parent. Lower numbers of residents often ignore opportunities for screening or access to health services leaving them exposed to long term health conditions. Much of a person’s state of health and well-being is determined by the way in which they live. Nearly one in three of the local adult population smokes. Over four out of every ten of local children in Year 6 are overweight or obese. A third of young people in the borough do not engage in regular exercise. Alcohol abuse is a key factor in over 3,700 cases of domestic violence every year. A significant number of children are not immunised to the levels that are safe for the community. In many ways Barking and Dagenham is unlike most other London boroughs. Its industrial past and socio-economic composition make it more akin to many northern areas located on the outskirts of industrial cities. Historically, the level of health investment, until recently, was


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regularly at around 10% below weighted capitation. This manifested itself in low levels of investment particularly in primary care, with low standard premises, high proportions of small and single-handed, traditional general practices, high use of the secondary sector for essentially primary care conditions, and poor ratings from the public when asked about the quality and accessibility of their primary care services. It is a small outer London borough with housing, 29% green space and a significant amount of brown field land from previous industrial use. Key issues at a glance:

• Industrial past • Lack of investment in health • Increasing diversity • Health challenges: mortality (early death), morbidity (illness and disability), lifestyle, sexual

health and mental health Key facts: population

• Approximately 25% of population aged 0-15 years • Approximately 12% of population 65 years or over • Projected figures from now to 2020 show:

• A continued population growth across most age groups but more especially in those under 15 (22% rise), those aged 50 to 60 (35% increase) and those aged over 90 (50% rise).

• Overall, only a small increase in the number of people aged over 65 years. • An expanding population with a predicted large expansion of young people and

children resulting from the Thames Gateway Development. • Changing demographics:

• Predictions for a static older population proportion, but other will groups increase. • Changing ethnicity bringing different health needs, e.g. sickle cell, diabetes, obesity.

Sources: GLA Population Estimates & ONS Experimental Ethnic Estimates (2006 release)

According to estimates produced in mid-2007, the Borough had 167,000 residents, of whom:

• 24.2% were aged under 16 years, • 20% were aged 16-29 • 23.3% were aged 30-44


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• 18.1% were aged 45–64 • 14.4% were over the age of 60 (women) and 65 (men)

The ethnic composition of the borough was:

• Asian / Asian British 7.7% • Black/Black British 11.2% • Chinese or other ethnic group 1.9% • Mixed race 2.5% • White 76.7%

Economic Deprivation:

• In 2007, 22nd most deprived district in England (of 354) and 7th most deprived in London. • In 2004, it was 42nd nationally and 11th most deprived in London (of 33). • Fourteen of Barking and Dagenham’s 17 wards were among the fifth most deprived in

England. • People living in Barking and Dagenham had the lowest average income in London. • 6,100 (8%) of the potentially economically active people in the borough were unemployed.

This is higher than both the London and national averages. • 32% of children live in households that are classed as income-deprived. • 66.5% of children are living in poverty (2007).

Key Facts: Health:

• Spearhead area, with low adult life expectancy and increasing deprivation • Growing young people population, thereby increasing fertility rates • High prevalence of childhood obesity • High rates of smoking amongst adults • Low levels of “5-a-day” uptake and dietary awareness • Low parental/household income • High levels of teenage conceptions • High numbers of young people and adults not in education, employment or training

Key Facts: Adult Education:

• 54.6% of 19-64yr males and 19-59yr females are qualified to level 2 or higher • 39.5% of the population aged 16 to 74 are without qualifications.

Key Facts: Employment:

• 64% employed • 18.7% working age claiming out of work benefits • Median earning of employees in the area £517.00 • 38% of children in the borough live in workless households and 21% are living in

households that are claiming the highest rate of working tax credit. More detailed population information will be accessed through Mosaic data to determine access and attributes of the target audience. An important change has recently been seen in the rapid rise of the borough’s population of black and minority ethnic residents. Proportionally, in 1991, only 7% of the borough’s population was non-white. This had risen to nearly 15% in 2001, and is now estimated to be at approximately 23%. The borough is 22nd of 354 authorities in the Index of Multiple Deprivation, 14 of the 17 wards are in the bottom 20%, none in the top 50%. Barking and Dagenham has the lowest levels of household incomes in London.

1.4 NHS Barking and Dagenham’s approach


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NHS Barking and Dagenham’s vision as identified in the Marketing Communications Strategy as: “NHSBD want Barking and Dagenham to be a place where people are healthier and happier. They are passionate about supporting people to improve their health and will work with partners to make sure they have world-class health services in local communities.” NHSBD will deliver their vision through: Leading locally – leading the NHS in Barking and Dagenham; being recognised by local people, staff and partners as responsible for getting health services right. Improving health – leading the delivery of world-class services which achieve real health improvement for local people. Delivering quality – leading the commissioning of services that are of the best quality and accessible to all. Offering choice – ensuring that local people have the widest access to a choice of the best quality health services. Working together – leading partnership working to offer local people the best possible services. Listening to others – engaging with local people, staff and partners, and ensuring their views and opinions are used continuously to improve services. Ensuring equality – appreciating the diversity of the population, ensuring local people have access to the services they need, regardless of age; gender; disability; ethnic origin; sexual orientation; religion or belief; and class or income. Valuing staff – recognising that NHS staff are the most important asset in the delivery of quality services and health improvement. On the basis of policy and experience, NHSBD has agreed a number of key principles that will inform the way in which they tackle ten priorities. They are as follows: 1. Putting the emphasis on prevention. Time and resources, such as the ‘Think Family’ programme, must go towards helping individuals, families, communities and organisations understand what they can do to promote positive health and well being. By working closely with the other partnership boards, the impact of early prevention across the borough will be strengthened so avoiding having to deal with more intense difficulties at a later date. 2. Making health and well being a personal agenda. NHSBD’s starting belief is that change is most effective when initiated and controlled by individual residents and their family. This means that members of the community need to be actively empowered by information on health, wellbeing and appropriate services. Messages and solutions need to be more personal. This can be achieved through a more effective use of those occasions where members of the public engage with local professionals to assess and plan for improvement; for example, personal health assessments, heart MOTs, child development visits. The main emphasis must be to enable individuals and families to take action through timely information, advice, education and subsequent reference to supportive services and groups. 3. Making health and well being a local agenda. Local neighbourhoods working with local professionals can also take control of the agenda, design then implement local solutions. But they need to be empowered by effective, local public health and well being information on issues and incorporate feedback on progress. 4. Borough based programmes and interventions are important strategies for achieving


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general impact on issues. The “Free Swimming” initiative is a positive example of the impact that can be made through such large-scale programmes. It demonstrates the benefit of how a coordinated and time-framed initiative can draw together resources to educate, inform, promote and ensure access to specific health and well being services. Carefully crafted communication based on real understanding of the needs of different segments of the community is a key component. 5. Joining up services to ensure timely and effective solutions to individual problems. Joining up could mean the effective transfer of information from one service provider to another or joint location and joint presentation of services. Wherever practical, services should be accessible locally within the community or at home. The development of the new health poly-systems offers opportunities for greatly improved integration of services to ensure an effective linkage of health and social care solutions informing broader solutions of education, housing, leisure and employment. 6. Developing greater local community capacity to achieve change. There already exists a track record of NHSBD working with local voluntary and community groups but it is clear that much more can be done to develop local resources. This has the dual benefit of developing very local and more accessible support on a number of key issues as well as providing the opportunity for local skill development. 7. Strengthening partnerships for change and improvement. NHSBD need to build on all existing partnership processes to ensure tighter joint performance expectations from investments and to motivate/encourage leaders across the organisations to champion these changes. Joint commissioning of services play a key role by ensuring the most effective investments of public money. Through pooling NHSBD resources, people and funding work together to develop new and creative solutions that more quickly tackle difficult issues within the borough. The Joint Strategic Needs Assessment (2008) provides useful population data. It stresses the World Health Organisation’s recommendations that 95% of children receive a mumps-containing vaccine (such as MMR) at age 12-18 months. During Q4 2007/08, in London, the percentage of 2-year-old children who received the MMR vaccine was 71%, ranging from 44% in Waltham Forest to 84% in Kensington & Chelsea. In Barking & Dagenham, MMR coverage has fluctuated over recent years. During Q4 2007/08, 77% of 2-year-olds received this vaccine. This is a decrease of 7% on 2006/07 figures. The NHSBD target is to improve this rate to 95 per cent of all children aged two by 2011. Although take up of childhood immunisations is higher in Barking and Dagenham than the London average, rates remain well below the national average of 90 per cent. The Health and Wellbeing Strategy (2009) identifies screening and immunisation as a key priority and as such, NHSBD aim to: “respond locally to improve the access, quality and uptake of the national immunisation and screening programmes. This means attention to the promotion of benefits and opportunities and the delivery of services at convenient times and places.”

1.5 Reporting and governance structures There are several key partnership boards that will be key to this process. The Health and Wellbeing board, chaired by NHS Barking and Dagenham, reports to the Public Service board. Below these, sit Departmental Management Teams and Marketing, Engagement and Communications team that will run with the day-to-day recommendations leaving the aforementioned boards with responsibility for final sign off of plan, strategy, recommendations and delivery. The Barking, Havering, and Redbridge University Hospitals Trust, as a major local child health provider, will also provide key insight. It is recommended that a clear reporting structure be in place before implementation of this plan. Revolution recommends using a responsibility assignment matrix; in this case the hierarchical RACI principles will give a clear


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outline of various parties involvement throughout the project. A further matrix will be identified with clear tasks attached early in the project development:

• Responsible – Director of Public Health; • Accountable – RevolutionMarketing, Senior Immunisation Officer; • Consulted – Governance Officer, Local Strategic Partnership Board,

Primary stakeholders; and • Informed - secondary stakeholders, service providers, public.

Other key reporting lines include:

• Local strategic partnership board; • Children’s Trust (PCT Deputy Chair); • Healthier Borough Board (PCT Chair); and • Local Safeguarding Children’s Board.

In order to deliver an effective campaign, it is crucial to understand this population and to identify its key target audience. Barking and Dagenham is a unique borough, with ambitious aims and strategic objectives, and this campaign will enhance this aspiration.

R

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2.0 Situation analysis NHSBD has a Marketing, Engagement, and Communications team that will be able to support the commissioning, development, and delivery of this campaign. Evaluation is not a skill that NHSBD has in-house and may need to be commissioned out. There are strong strategic partnership links with the council, the hospital trust, and the voluntary sector. Barking and Dagenham has several children centres that will play a key engagement role. Those present within target localities will be utilized for this pilot. There is a dedicated immunisation team that is inclusive within the nursing team at NHSBD. Alongside this is a network of support agencies that access parents for a variety of reasons and through a range of methods.

2.1 Distinct Competencies

The Barking and Dagenham Partnership are well positioned in the borough with several distinct competencies; its member agencies (Local Authority, NHSBD, Metropolitan Police etc.) have exceptionally strong influence with implementing change, influencing opinions, gaining media exposure, and funding projects.

Partnership services can provide local services free of charge and support it with substantial budget. NHS has a very strong brand and a wide reaching network of supporting professionals. Due to the nature of the industry, NHS Barking and Dagenham has a valuable external perception as employing mostly highly educated practitioners. LBBD, the local authority, is the largest employer in the borough and holds contact details for almost all of its residents – giving unprecedented access. The Metropolitan Police also represent a most trusted service. Combined, these services have far superior brand recognition and influence than all other local competitors. The partners will be able to inspire attitudinal change as well as implement changes to service provision and processes. The SWOT analysis below identifies the key strengths, weaknesses, threats and opportunities associated with the MMR situation in Barking and Dagenham.


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2.2 SWOT analysis: Strengths; Weaknesses; Opportunities; Threats Strengths Weaknesses Benefits of vaccination far outweigh the risks. Free vaccination to all on the NHS. Factual evidence disproving MMR-autism link. MMR provides complete protection for child. Individual vaccinations are available if desired. Protects against all three diseases in one jab. Available from most NHS health practices. Part of a large-scale national immunisation programme. Millions of children have safely received the jab There is generally a trust in the NHS. Quick and painless. Can be given at any age (even if missed in infancy) NHS is linked to a network of local programmes that can support this plan. Parents today, overwhelmingly, want to vaccinate their children against disease. Media are interested in this issue. NHS has community-based and provider partners that can be mobilised in this effort. Persons with first-hand experience with these diseases are available to educate new generations of parents and providers who have no experience with these diseases. NHSBD willingness to tackle issue head on.

Local to access health services. Low local awareness. Low local uptake – below herd immunity. Low national uptake – below herd immunity. Historical links to Autism. Negative press and attitude. Combination of vaccinations (perceived overload immune system). Negative publicity and attitudes. Two jabs needed for maximum protection. NHS provision – negative associations. Accessibility of alternative languages. Low understanding of acronym. Little perceived threat exists because of perceived low disease incidence. Some claims against vaccine have not been thoroughly dispelled. Some religious groups oppose vaccinations. A comprehensive communication strategy will be costly and could in itself be attacked. General mistrust of government, particularly among some population groups. Monitoring procedures are lax. Budget committed to promotion.

Threats Opportunities Accessibility of services. Political shift – local and national – political shifts. Political shift – reduction in public spending. Media coverage – sensationalism and bias. Political shift – Local – BNP threat. Political shift – National – budget change. Generic budget reductions. Not reaching set performance targets. Variations in Health centre opening times. Market interference of other health campaigns Language differences Local transient population Practitioner understanding Health service capacity to deliver/handle increases Media detractors may resort to incomplete reference, misquotes, and distortions to promote their positions, making debate difficult at best. Vaccine safety could become a cornerstone for some. Evidence that lower vaccination rates will result in disease or death will not occur before a lapse in time which reduces perceived severity of risk. Close relationships and involvement with vaccine manufacturers that can be distorted in counter communication-- supporting the drug manufacturers = business interests at the expense of children.

Current drive for healthier nation. Media coverage of Autism retraction. Piggy back on larger health campaigns. Increased funds available. Summer community events. Increased public interaction/access over summer. 2010 Census pending. High media profiling of NHS services. To develop media literacy among providers and parents on this health issue and others. Younger new parents are cohort of pre-autism scare individuals who likely had the jab with no complications/worry. Develop a comprehensive, renewable system to communicate about health effects. Compel vaccine policy decision makers to address vaccine safety issues today that may affect policies for the future. Take a leadership position in advocating for this disease prevention tool. Countering this movement can save children from disease and death who might otherwise go unvaccinated. 2012 Olympics. Opportunity to embed a more effective monitoring and evaluation system.


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2.2 Past or similar efforts: activities, results, and lessons learnt; Insight The National Institute of Clinical Excellence researched the most effective ways to increase uptake of the MMR vaccination. Its recommendations include:

• Adopt a multifaceted, coordinated programme across different settings to increase timely immunisation among groups with low or partial uptake. The programme should form part of the local child health strategy and should include actions such as monitoring vaccination status as part of a wider assessment of children and young people’s health.

• Ensure PCTs and GP practices have a structured, systematic method for recording, maintaining and transferring accurate information on the vaccination status of all children and young people.

• Record any factors, which may make it less likely that a child or young person will be up-to-date with vaccinations in their patient records and the personal child health record. For example, note if children and young people are looked after, have special needs or have any contraindications to vaccination. Also note if either the parent or the young person have expressed concerns about vaccination.

• The Healthy Child team, led by a health visitor working with other practitioners, should check the immunisation record (including the personal child health record) of each child aged up to 5 years. They should carry out this check when the child joins a day nursery, nursery school, playgroup, Sure Start children’s centre or when they start primary school. The check should be carried out in conjunction with childcare or education staff and the parents.

• Improve access to immunisation services for those with transport, language or communication difficulties, and for those with physical or learning disabilities. For example, provide longer appointment times, walk-in vaccination clinics, services offering extended hours and mobile or outreach services.

There have been several previous marketing attempts to increase the uptake of the MMR jab in London. The social marketing pilot activity and other MMR immunisation initiatives in London Primary Care Trusts (PCTs) have been intended to contribute towards closing the MMR vaccination gap in London. However, given the scale of the MMR immunisation deficit across London, a strategic approach to meet the recommended 95% herd community is required. In 2004-05 the pan-London ‘Capital Catch Up’ was a major organisational achievement by all PCTs. Approximately 40,000 primary school children were immunised, including 17,000 unimmunised children. According to Tanner (2007) the programme bought time but significant epidemic risk remains in many boroughs. This involved process audit and capacity building along with direct marketing to the target audience (all unimmunized children).

Key recommendations from this programme included that continuing efforts by PCTs to raise MMR vaccination rates should focus on the immunisation of partly and non-vaccinated primary and secondary school age children, as well as interventions to support the uptake of scheduled vaccine of preschool children, and that PCTs consider how this might be achieved in both school and general practice settings. PCTs should also undertake steps where necessary to ensure that their Child Health Information Systems are functioning optimally, to provide as reliable and timely information as possible on scheduled vaccinations of children by their practices. So there are issues around awareness, attitude and behaviour modification as well as process and service provision design to maintain and improve access to new behaviour.

Most recently, the NHS London funded the “1-in-10 children with measles end up in hospital” programme. Social marketing activity undertook a wide profile of investigation and produced practical recommendations in terms of media use, street level marketing, and process adaptation. The programme consisted of significant scoping and research work and delivered a message


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through a selection of media avenues to market test the outlay and conversion rates and costs of advertising. This data, along with associated insight and scoping work undertaken as part of the project will strongly influence this campaign strategy in the absence of more local, current insight research. An extensive insight and intervention feasibility report conducted by University College London (UCL) in 2008 for Commissioning Support for London (CSL), recommended several outcomes, and subsequent work undertaken by Central Office of Information (COI) provides several enlightening suggested actions/processes relating to social marketing the MMR vaccination programme. Those that are of particular importance to inform this strategy are: UCL report:

1. Information-based MMR campaigns are needed to better educate parents about the risks and benefits of MMR vaccination.

2. Greater emphasis should be placed on the negative outcomes of failure to vaccinate.

3. Such campaigns should be presented as separate from official government sources.

4. Information should be disseminated via the media most used by parents.

5. Parents should be better utilised as MMR proponents, via multimedia forums for parents, to offer positive feedback on the lack of complications arising from their child’s vaccination, parent-led groups dedicated to the discussion of child health issues, or through advertising campaigns using well-known parents (e.g. celebrity figures).

COI report

1. Develop an integrated strategy to increase MMR uptake: CSL advise on developing a long-term strategy with a forecast of future investment.

2. Reinforce healthcare practitioners’ knowledge and skills in relation to MMR, specifically “how” health practitioners engage with parents on this topic and the information and resources available to them to do so. Healthcare practitioners need to be equipped with the skills to confidently engage in a dialogue on MMR, including acknowledging parents’ concerns and fears. Training and development in motivational interviewing and interpersonal skills have successfully been used in other areas.

Some healthcare practitioners highlighted a lack of resources available to them to effectively engage with parents on the topic of MMR. A range of information and resources are available, many on the Department of Health website. However, it appears that practitioners in the field – including practice nurses, school nurses, health visitors and GPs – either do not have access to these or are not aware of their existence. Work needs to be undertaken both to effectively share these with practitioners and ensure that they meet the needs of different segments of parents.

3. A mix of interventions targeting different audiences is needed rather than a ‘one size fits all’ approach. CSL do not recommend a roll-out of the ‘1 in 10’ campaign in its current form; however the lessons learnt from the pilot should be taken into account in the planning of future interventions. Ways to address parents’ concerns of the perceived links between MMR and autism need to be considered and developed. For both audiences interventions need to emphasise the long term and serious consequences of the three diseases, develop the understanding that it is never too late to vaccinate, and to understand the importance that two doses of MMR are


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essential.

4. For parents of low SEG audience there is an ongoing need to raise awareness of the diseases and the MMR vaccination, and address their concerns regarding the perceived link with autism. Findings show that parents in this audience can be hard to engage on the topic of MMR once they have ‘made up their mind’. However, they have better contact with health practitioners than ‘doubters’ and this relationship is an opportunity to influence their views and behaviour in taking up MMR. CLS suggest this is supported by steady low-level interventions to shift perceptions and change behaviour.

5. While the COI project did not identify access as a key barrier, other evidence

highlights that this continues to be an issue for some in lower SEG groups. As such, access needs to be addressed when developing interventions as part of a Strategy.

6. For ‘doubters’ –parents in high SEG - findings suggest that interventions are more

effective when designed to engage with them in ways that acknowledge their concerns and which then address these with appropriate information. Creating opportunities for parents to consider MMR in settings outside of GP surgeries is one route. For example, a knowledgeable and confident health practitioner could offer informal group sessions. Although a small sample, some of the parents who participated in the insight project went on to get their children vaccinated. The opportunity to discuss MMR in more depth and to voice concerns or fears was what they needed in terms of reassurance and was instrumental in changing their behaviour. A generic campaign focusing would not be effective with this audience.

7. Interventions with school-aged children and young people: There is a cohort of school

aged children / young people who have not been immunised with MMR and continue to be at risk of catching measles, mumps and rubella. Older children / young people have fewer interactions with health practitioners compared to their younger counterparts (0 – 5 year olds). However, the school environment means that they are more likely to have exposure to other children with these diseases, and so are at greater risk. In the insight with the ‘doubter’ audience we found that school entry is a trigger for them to re-consider vaccines.

8. To date, school based interventions targeting children and young people have not

been wholly successful in delivering increased MMR uptake rates. It is now suggested that insight and development activity is undertaken with school-aged children, starting with a scoping exercise to define the audience and to design the approach to test and evaluate such interventions.

The CSL evaluation brief included an objective requiring the research agency to make development pointers to inform future communications plans. These included: • Nurses, health visitors and GPs need to be equipped with training, information and

materials to help them address questions about MMR. This will build their l give them more confidence when explaining it to parents with objections.

• A specific leaflet for MMR, which addresses all the concerns. • Emphasis of the long-term, serious consequences of measles, mumps and rubella.

The views of healthcare professionals were sought and included in CSL recommendations: • Health professionals felt that there were particular problems with the second dose of MMR.

Often, the first dose was taken up because mothers were still in touch with health services, but they may lose touch, forget, or not recognise the importance of the second dose.


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• Nurses and health visitors did not feel well equipped to deal with questions from those who were concerned about the autism link. They needed the tools for tackling concerns about the perceived ‘risks’ of MMR. NICE guidance recommends that all staff involved in immunisation services are appropriately trained and that such training should be tailored to individual needs to ensure staff have the necessary skills and knowledge, for example, communications skills and the ability to answer questions about different vaccinations.

• Experience of data held by GP practices was that it was often inaccurate and PCTs were

not able to provide accurate data on who had been fully immunised, making it difficult to contact the right people. NICE guidance recommends that PCTs and GP practices have a structured, systematic method for recording, maintaining and transferring accurate information on the vaccination status of all children and young people.

Clearly, one campaign cannot comprehensively incorporate every single recommendation from previous insight and projects. This is a pitfall of using such a large study as an informer to forthcoming social marketing activity. However these be used to guide the development phase of this campaign and will support with identifying key targets and methods. Recommendations of some vital potential social marketing activities will help support the meeting of the objectives.

3.0 Target market profile The target market will be informed by previous insight research, local data, and commissioned local insight. A strategic approach will be taken to inform the segmentation, and complex population data will identify further geo-demographics. Mosaic information will supply detailed targeting of our audience and include specific attributes in terms of their media receptivity, educational levels, income, and attitudes. This will in turn inform the marketing and communications plan along with the development phase recommendations. It is envisaged that this campaign will form a base allowing for a follow-up, mid-to-long term, strategic approach to improve and maintain the uptake of the MMR vaccination at above target 90%.

3.1 Target market need assessment The MMR vaccination should ideally be administered at 12-13months old (MMR1), and again at aged 4 (MMR2) for full immunity. The University College London insight and intervention feasibility report and the CSL evaluation report found that socio-demographic factors do influence the uptake of the MMR vaccine. They advised that parents in low socio-economic group (SE) cited access to services as a significant barrier. During CSL’s 1-in-10 children end up in hospital project, both quantitative and qualitative engagement insight suggested that local parents in the low SE groups have a general understanding of the availability of MMR programmes, the perceived health effects but demonstrate low understanding of the serious consequences of not accessing the MMR vaccination. It also strongly identified that access is a recurrent issue in the low SE groups target population. There are up to five key access points where the MMR vaccination is relevant:

• Pre-birth (parental informing/educating) • Recent births (0-1 years) (standard 1st jab timing – 12-13months) • Toddlers (1-5 years) (behind optimum 1st jab timing, booster jab relevant) • Vulnerable Children (5-15 years) (unprotected and exposed)


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• Vulnerable adults (16+ years) (serious risk of debilitating disease) Mosaic population data (appendix) provides a large amount of deep-level population insight. Mosaic data identifies those groups likely to have young children in lower SE groups (i.e. low income, high benefits, council housing, low education) as most likely to fit into the profile of population groups 1 and 6. Mosaic allows us to assume specific communication strategies and to learn detailed lifestyle insight including access to health services and walking distance to general practitioners. Table 2 Key facts for population groups 1 and 6 (from Mosaic Data)

The number of births in the borough between 2001 and 2007 has significantly increased. Numbers show that this increase is across all wards and has risen by 950 since 2004, an increase of 34% (Joint Strategic Needs Assessment, 2008). There were 3,320 births in 2006/07. It is currently estimated that there are approximately 3,400 are under 1’s; and 11,400 children aged 1-4 years old (total target = 14,800 children). Figures include those from transient populations. This increase has inevitably had an impact upon ante- and post-natal services. NHS Barking and Dagenham has now employed an additional twenty midwives including three dedicated to work with teenage parents. At this stage, it is not possible to break down into births per ward, but the Mosaic data confirms that the dominant population groups in more deprived wards are under-represented in MMR uptake in the borough. It is assumed that there is a significant number of parents yet to have their children vaccinated for MMR1 and MMR2. Thames, Abbey, Eastbury, Gascoigne and Heath are areas particularly affected by deprivation, which will have a profound impact on some of the children and young people. These areas will therefore form the geographical target for the campaign. Low socioeconomic groups are associated with low income, poor education, and unskilled, routine and manual working professions. The population groups 1 and 6 tend to reflect these attributes and will form the target market for this campaign. More detailed population insight is below. In the Census 2001, 30.7% of households with dependent children were lone parents. This equates to just fewer than 7000 parents with the smallest number based in the North of the borough and the largest in Central. In 2008, it is estimated that there were 5790 lone parents. This equates to 5.6% of parents and is nearly double the figure for the rest of London.

Population group

Key facts No. of house-holds

MMR uptake?

Group 1 Married couples with children; limited educational attainment; Mainly manual skilled jobs

15,563 Significantly under-represented in BD for MMR1 and MMR2

Group 6

Large single parent families; Working class; Poorly educated; Low income; Low transport access

5,290 Significantly under-represented in BD for MMR1 and MMR2


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3.2 Identifying the target market

3.2.1 Size Following the insight and CSL recommendations, it is possible to segment the target market within the population of Barking and Dagenham will be within three specific groups:

• Expectant parents within low SEG groups. • Parents of children aged 0-1 years in low SEG groups (MMR1). • Parents of children aged 1-4 years in low SEG groups (MMR2).

Each of these parental groups will respond to very different messages, and also access services differently, and respond to different media/communication types. Population clusters will be identified within the targeted wards. Table 3 identifies the segment size of children that are routinely unvaccinated during the annual MMR programme within the selected target audiences alone. Across the target wards, withing population groups 1 and 6, there are 628 children unprotected for MMR1, and 1199 that do not receive the MMR2. Low SE groups are defined as being socio-economic groups ‘C2’, ‘D’, and ‘E’ by the Office for National Statistics.

3.2.2 Demographics, geographics, related behaviours, psychographics Following recommendations from the UCL report and intervention feasibility study, along with the needs of the borough, it is possible to segment the market to concentrate on a specific target audience. These are:

• New and expectant parents • Residents aged 20-34 years old (as the segment with the largest birth rates) • Residents in low socio-economic group (Abbey, Thames, Eastbury, Gascoigne,

and Heath wards) • White working class families/single parent families living in deprived wards.

Parents within Mosaic population groups 1 and 6 are more likely to be under-represented for MMR uptake. This will help determine how we best communicate with these groups. A group’s receptivity to media and educational genres are particular traits that will affect the effectiveness of our communications. Although identified by UCL research as a high-need target group, there will not be a specific provision for hard to reach or specific BME communities, although this work will be exclusive to white working class residents, this is the identified target segment currently most in need. This is due to the very specific needs assessment and population demographic for the area. White British children remain the largest ‘target market share’ of new births. Key target population profiles: Population group 1 Married couples with children; long-term residents; low educational attainment; mainly manual workers, ex-council housing. Population group 2 Large single parent families; working class; transient; poorly educated; high unemployment; high teenage pregnancies; low income, receiving benefits; heavy smokers; social housing; financially vulnerable.


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Mosaic data provides important evidence about IAO variables (Interests, Activities, and Opinions). Groups 1 and 6 all have high levels of dependant children, high representation of females working over 31 hours a week, and a notably high level of males working 49+ hours weekly. They are all medium to heavy TV users and have a generally low income which influences their choice of leisure activities. All have a favourable representation of children signed up to the free-swimming campaign, and all have good GP registration. Both groups have very low access to personal cars and subsequently rely heavily on public transport, walking, or work vehicles (i.e. vans). There is also a high uptake of free school meals and council support through benefits.

3.2.3 Ward Level target group: A recommendation to focus the marketing in deprived wards where there is a high representation of the lower SEG population (groups 1 and 6) as these as the most likely to have not vaccinated their children. These are Thames, Abbey, Eastbury, Gascoigne and Heath. Table 3 displays some population data about the ward residents. Table 3 Percentage of population groups 1 and 6 in target wards Ward Total

Population Number of parents of children aged 0-4 (outdated from 2001 census; +/- up to date figures available from 2011 census)

Est. %Population group 1 in wards

Est. %Population group 6 in wards

Thames 9,278 823+/- 40% 35%

Abbey >11,212 882+/- 30% 35% Eastbury >10,252 690+/- 30% 30% Gascoigne >10,137 991+/- 30% 45% Heath >9,875 828+/- 35% 40%

Total 50,754 4,214 Average: 33% Average: 38% Vaccinated children within wards

Likely vaccinated for MMR1 (79% uptake)

3329 +/- 1098 of 1390 1265 of 1601

Likely vaccinated for MMR2 (59% uptake)

2570 +/- 848 of 1390 944 of 1601

ACTUAL TARGET Children NOT vaccinated for MM1

n/a 292 336

Children NOT vaccinated for MM2

n/a 542 657

3.2.4 Final Target Market To clarify, the insight identifies the need to target one particular segment:

• Parents • Aged 20-34 years old • Ethnicity - white British • Deemed to be in a low SEG group (in socio economic groups C2, D and E). • Residents in population groups 1 and 6 • Residents in deprived wards with low MMR uptake - Thames, Abbey, Eastbury,

Gascoigne and Heath • Approximately 628 children target market for MMR1, and 1199 for MMR2.


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3.3 Stage of change Noar and Zimmerman (2005, cited in Cismaru, et al. 2008, p.2) consider using the transtheoretical (stages of change) model of behaviour change as a suitable theory to predict uptake of immunisation. Parents are likely to be in a susceptible state of mind, have an appreciation of the needs of a child, but lack knowledge of what actions to take. As there is potential for information overload at this stage of the child’s life the MMR jab must stand out as a key behavioural choice to make. Parents in this group are also likely be ‘in the system’ and already accessing health advice, consultation, pre-school services, or receiving financial benefits for new parents. In all target audience groups, maternal instinct can elevate the potential to take action. However, in the general local target group, there is a notable prevalence of smoking, poor diet, low income, and single parent households – all of which may indicate that these parents are not well informed or that they are simply unable to take the appropriate action to secure an MMR jab for their child. Many new parents are more likely to be in the preparation stage of change and hence more inclined to access the MMR vaccination if it is available. Nevertheless, parents in low SE groups demonstrate a lower awareness of the vaccination and its connotations and are contemplative, as they do not view it as an immediate issue. it is probable that they believe the disadvantages of the behaviour (the MMR) outweigh the benefits – i.e. viewing the MMR process both challenging to access and not essential for child health. Parents who do not seek the MMR2 for their children have clearly taken some action, though they have not maintained their behavior due to choice, lack of knowledge or access. It is important to re-engage these parents who have once accessed the service to “finish the job they started” by educating them and providing easy to access vaccinations. The insight report from UCL suggested that the parents in our target groups are ‘doubters’ rather than ‘refusers’, require targeted messaging in a format that they understand. This will support their knowledge and understanding of the MMR vaccination and the dangers of not taking the vaccination. Improved access will remove the barriers to getting the vaccination, while education will encourage parents in pre- and contemplative stages to consider behaviour action.


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4.0 Marketing Objectives and Goals

Blair-Stevens (2005) recommends that social marketing initiatives would identify specific, achievable, and measurable goals – not just looking at behavior change but also at behavior reinforcement and maintenance (2005 – National Social Marketing Strategy for Health).

4.1 Social marketing objectives The SMART objectives of this programme are:

• By August 2011, reduce the quarterly percentage of MMR1 unvaccinated children from 19% to 10% within five key deprived wards in Barking and Dagenham (Abbey, Eastbury, Gascoigne, Thames and Heath).

• By August 2011, reduce the quarterly percentage of MMR1 unvaccinated children from 39% to 25% within five key deprived wards in Barking and Dagenham.

• By July 2011, enroll fifty local practitioners from at least 15 key locations in deprived

wards to an education/training programme to ensure communication and understanding of MMR uptake.

4.2 Goals

The wider goals for this programme are:

• To raise awareness of the dangers of not partaking in both MMR vaccinations; • To influence local parents attitudes to ensure they view the MMR vaccination as

essential protection for their children; • To ensure that parents view the MMR vaccination as a double-dose programme

for maximum protection; • Widen parents’ knowledge about the local availability and accessibility of MMR

vaccinations.


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5.0 Positioning For parents of children aged 0-5, the MMR vaccination is the best way of protecting their child from three dangerous diseases. It is vital that parents view this vaccination as a free, safe and fundamental method of protecting their child and that the NHS guarantees appropriate access to the free vaccination. Throughout this campaign Revolution will work to position the identity of the MMR as a core element of young life, to alter the external negative perceptions of the vaccination, and to identify process alterations that will improve access to this vaccination across the target audiences. Clear thought will be given to the links between the exchange process and the perceptions of the MMR by BD residents in the target groups. Currently it would appear that a large number of parents feel there is not yet any obvious benefit. This is evidenced by low awareness/education and poor accessibility of the vaccine. The exchange process can be even more clearly identified through further insight exercises within the targeted ward populations (focus groups), and further incentives may help reinforce the desire for parents to have their child fully vaccinated.

5.1 Target market barriers, benefits, and the competition

5.1.1 Perceived barriers to desired behaviour • MMR-Autism link and associated concerns • Transportation – no access to services • Low awareness of dangers of MMR without inoculation • Low health understanding • Low educational standards • Low perceived severity of not receiving MMR • Influence of grand-parents health beliefs • Employing avoidance and cognitive dissonance (“too late” attitude) • Perception of cost • Perceived threat to child’s reaction to needles • Pin-cushion effect • Overload of immune system • Mistrust in health services (including local practitioner) • Not registered with GP • Single parent household • Time constraints of visiting health service • Perception of “waiting-room” and negative associations • Working hours impeding access • Those with suppressed immune systems who may not be able to be vaccinated • Mild symptoms of the diseases which can occur shortly after the vaccination

5.1.2 Potential benefits to desired behaviour • MMR protects the child for life • The MMR jab covers three diseases in a single (2-dose) vaccination • The vaccination is free under the NHS • Vaccinations build up the child’s immune system • MMR keeps the child out of hospital • Parents not having to take time off work if the child becomes sick • The child does not have to be taken out of school if there is an outbreak • No parental or school backlash should their child be a known “carrier” and involved

in such an outbreak • Measles can kill


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• Future protection for a mother. If rubella is contracted while she is pregnant the infection can pass to her unborn child who may be badly damaged as a result

• Future protection for child. Contracting measles or mumps can lead to future health problems permanent hearing damage and infertility.

5.1.3 Competing behaviour • Parents having to work • Increasingly busy lifestyles of all family members • Single parent responsibilities may delay other duties such as vaccinations • NHS messages may be confusing • Too many other vaccinations • Other parents deciding not to immunize • Time and transport required to Health service locations • Waiting times to see the GP (perception that it will take a long time)

5.1.4 Stakeholder analysis

Revolution will engage with stakeholders and channel members in the borough to support this campaign. To complement the RACI requirements outlined earler, the stakeholder matrix in table 4 identifies key members: Table 4 Stakeholder Matrix (based on Fischbacher, 2005)

LEVEL OF INTEREST

KEEP SATISFIED

Barking Havering and Redbridge University Hospitals Trust London Borough of Barking and Dagenham (LBBD – Local authority) School Health Advisors PSHE coordinators SureStart Headteachers Benefits office Bounty parenting club (including bounty packs) ‘Social Services’ department Children’s services

KEY PLAYERS

Children centres GPs NHS Barking and Dagenham Walk-in centres NHSBD Marketing and Communications teams Immunisation leads/coordinators Maternity services Mother support groups Immunisation nursing team Playschools Home visiting teams Pre-school and Early Years service Post- and Ante-natal services

PO

WE

R

MINIMAL EFFORT

Misc community groups Youth Workers Faith health champions School Nurses Safeguarding Children team Community Centres

KEEP INFORMED

Community Communicators (LBBD) Council for Voluntary Services Pharmacists Modern Matrons Neighbourhood managers Health Champions Health Trainers Health Advocates Local media (theNews, BDPost, TimeFM)

For this campaign, a unified approach must seek to deliver the same message via all available/relevant channels. The most important stakeholders to the campaign will be the benefits office, GPs, the home visiting team and the immunisation nursing team.


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5.2 Positioning segments Table 5 displays several common concepts that effects parental uptake of the MMR vaccination, and some potential routes to influence those attitudes. Table 5 Common positioning and concepts within target populations and potential strategies

Positioning and concepts

Key themes Messages Communication outlets Communications channels:

MMR is dangerous / Measles can kill

Emphasis on safety of vaccination Emphasis on disproven MMR-Autism link

MMR protects for life MMR is safe and effective There are dangers not getting MMR

Mistaken belief that “MMR is only needed once”

Emphasis on importance of complete protection Re-frame MMR as a two dose programme – increase awareness Empahsis on dangers of only one vaccination

Two visits to the GP will protect your child for life “Lifetime protection in under an hour” Failing to get 2nd shot can render single jab it useless

Belief that it is too difficult to get MMR

Emphasis on GP access and extended opening hours Increase availability of MMR vaccination at local children centres etc

More GP’s stay open longer – emphasis on local GP to target areas – i.e. Dr Gupta is now open till 8pm to give your child an MMR jab MMR protection is easy – you can get it from your children’s centre MMR is available when you need it – at the weekend – within 5 minute walk from your

Posters in relevant positions in local venues (children centres; GP’s; schools; Post offices; Job Centres; and other channel members) Direct mail to new parents. Financial incentive to fulfill vaccination programme Telemarketing – calling parents who have yet to get MMR1 & MMR2 (call script dependant on child age and MMR history) Direct mail to parents of children in target area to get procure MMR protection Direct Mail to new parents of children aged 1-4 without MMR2 Direct service provision in locality at suitable times. Supported by Community TV’s and public transport advertising Direct mail shot to parents in all target groups informing them of mobile vaccination unit time-table. Direct mail shot of GP and children centre opening hours. Provide mobile vaccinations on target ward estates and in Children’s centres. Press release of mobile vaccination schedule and location. Develop 1-in-10 theme to suit target market through pre-testing and development Direct mail to target through GP registers Highlight average time GPs take to vaccinate a child (i.e.”5 minutes start to finish”) and associate to other less beneficial uses of time Map of ward and locations where MMR vaccinations are readily available

Communication: Benefits communications – enclosed information with child benefits mail shot

Display boards in a range of local public venues

Washroom adverts (baby changing facilities)

Supermarkets Direct mailing of birthday cards Public transport media – internal and external posters Media: Community TV Billboards Local papers – Post; Recorder; theNews Local radio – Time FM Local newspaper (theNews)

Events: Town show Market days Daggers FC matchdays Teddy Bears Picnic MESSENGERS: School Health Advisors Health Champions Community communicators Public Health Network Practice Nurses Antenatal clinics Pre-schools Adult education centres Childrens Centres GPs Post-Natal services Pharmacies Dentists Opticians Social Workers Midwives Nursery schools Modern Matrons Peers Grandmothers


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Belief that it is too difficult to get MMR

Emphasis on GP access and extended opening hours Increase availability of MMR vaccination at local children centres etc

door

Belief that MMR is not a serious problem

Emphasise dangers of the viruses to children in immediate future Emphasise dangers of the viruses to children in long-term future

MMR can put children in hospital Not being protected from MMR can lead to (i.e.) deafness, miscarriage, infertility etc. Looking forward to grandkids? Measles can cause infertility

Parents didn’t get it therefore “children don’t really need it”

Emphasise benefits of MMR vaccination Emphasise ease of getting MMR vaccination

As above

Parents assumption that its too late to get it now, child’s too old

Emphasise that MMR is available at any age

Its never too late for MMR1 or MMR2 Don’t look back – look forward Being immunised reduces the risk of persecution should they be seen to be a carrier

Parents cant afford to spare the time to get it.

Emphasise ease of access and speed of vaccination Emphasise the potential consequence and impact on parent’s time if MMR is not received and child becomes ill

MMR costs the NHS £220 per person. For your child, MMR vaccination is free – “we insist” Give up an hour today, or a lifetime tomorrow

Parents don’t know what MMR is

Increase awareness of vaccination process, and of the benefits.

As above

Belief that MMR jab would overload child’s immune system

Emphasise the safety of the combined injection Emphasise the ease of getting a triple jab rather than as 3 separate visits.

Your child is resilient, tough, and strong. Don’t let measles bring them down. Protect them immediately with the MMR vaccination

Checklist of child health at postnatal services Case study depicting worst case scenario and impact on job, life, family, finances, schooling etc – ‘a day in the life’ Birthday card for children aged 1 and 4 to ask of they have been vaccinated (mail targeting parents) Voucher mailed to parents for ‘free’ MMR vaccination Monetary incentive publicized through direct mailing Posters and mailing to reinforce parents knowledge of child’s immune system Messages placed on community TV


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Parents perception that there are too many other vaccinations

Position MMR as one of the most important vaccinations of all

There is a reason for all vaccinations on the NHS – and MMR is one of the most important MMR is the crucial, final vaccination in infancy – welcome to childhood – associate the worry free life following MMR vaccination

6.0 Marketing mix strategies (the P’s)

6.1 Product Core: The core product is the ‘benefit’, the lifetime protection that is gained from two MMR vaccination. This assurance that parents get, and the child’s defence against these potentially devastating illnesses. To provide this protection is the duty of both the parents, and the NHS and although the MMR vaccination programme is optional for all and not compulsory, it is due to lack of awareness and access that prevents parents taking up this core product, and the NHS providing it. Actual: The MMR vaccination itself and the services that provide it are actual products; this includes GP services, Pharmacies, Nurses, Mobile immunisation service, and health centres. The vaccination is widely available in terms of stocks and supply, but current service provision is not delivering the required outputs and must be developed to increase vaccination uptake. Parents to access GPs or specially arranged accessible services to have their child vaccinated twice through the NHS immunisation programme. Attitudinal shifts ensure parents recognize MMR as a fundamental parental responsibilty.

Augmented: Augmented products of this vaccination programme include customer service, practitioner education, future financial implications, child’s school acceptance, impact of diseases, assurance of protection.

6.2 Price Monetary fees, incentives and disincentives The MMR vaccination is free under the NHS but is associated with costs of travel, time off work and the expense of baby-sitters. Within the target population money is a key factor in life and health behaviour decisions. This may disengage the parents and discourage them from accessing health services.

Financial incentives are a key motivator to this target group, where money is a constant issue, and a continual lifestyle determinant.

Revolution recommends additional rewards for seeking to immunize their child could incentivise parents. This will be in the form of a beneficial reward to the child’s health or needs, this will avoid any negative brand connotations on NHSBD. There are options to link in the free-swimming


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initiative, along with sales incentives and corporate partnerships with Mothercare, Pampers, and Cow & Gate.

Non-monetary incentives and disincentives While the MMR vaccination is free, the audience views the vaccination as costly in other ways. They associate it with long waits at the doctors, persecution if they have missed the ideal immunisation age, and unnecessary as they are not fully aware of the risks of not getting their child protected. They may also view the jab as unnecessary for their children. The price of the MMR jab is weighed up against the protection of one’s baby’s health, and the research shows that in this target market, the if the MMR-Autism scare does have an impact, although the real problem is access, availability and awareness.

The greatest incentive for the programme is that the MMR jab will safeguard their child for life. The 1-in-10 campaign identified a need for parents to appreciate the danger and impact measles, mumps and rubella can have when children are not protected. Free and easy access will provide a basic incentive for exchange, especially if framed as a valuable opportunity rather than as an arduous requirement.

6.3 Place There are key times to convey the messages to parents. Immediately pre- or post-birth, and again when their child is at the optimum age for the vaccination – i.e. 12-13 months or 3-4 years old. This would suggest that direct marketing to parents at these specific times would be an effective means of communicating. Revolution recommend that mobile MMR services are offered at local children’s services and centres within the target wards. This will require a mobile nursing team and van, along with a timetable of sessions at local hospitals, clinics, shopping centres, and other high footfall public areas. Extended operating hours for GP surgeries will be piloted to offer increased access at familiar venues. Home access services within the borough will also be utilized using the mobile service. The Family Nurse Partnership programme is a new (May 2010) pilot initiative by NHS that may provide avenues to promote the MMR vaccination directly to parents. Revolution will explore this avenue in the development phase.

Staff education will occur within either the monthly Protected Time Initiative (all local practitioners meet with primary care directors once a month and are required to attend by contract) or through specifically designed additional training sessions at key under-performing local practices within the target areas. It is recommended that this be annual training commitment in order to keep abreast of latest developments in public opinion, the MMR programme activity, changes in local service provision or needs, and staff changes. Parent education will be ongoing for the duration of the campaign and complement promotion based on children’s birthdays. This will inform parents through receptive channels and inform them to the main messages and service selected during local development and pre-testing. These services will be taken to the public, and the promotion strategy will inform them of this venture. Note: Access - taking services to the market: NICE guidance recommendations to improve access to vaccinations include extending clinic times/hours and ensure sufficient availability of appointments. It notes that logistical difficulties associated with large families and children not being in contact with primary care services prevent children and young people from being up-to-date with their vaccinations.


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Access has been strongly identified through the insight research as a barrier to MMR uptake, both in terms of access to information (knowing about the vaccination) and logistics (being able to get to locations where children can be vaccinated). It is recommended that NHSBD also invest in potentially implementing the Birmingham Active Patient Model as recommended by NHSBD immunisation lead. This is a model of bringing a service to the target population, as is being recommended here to improve access. Parents in the target groups are unlikely to voluntarily access services if they don’t have to. Their view of the NHS as an emergency service, rather than as a health protection provider, hinders their enthusiasm to access their GP until something goes wrong. To challenge this and to implement a “no excuses” scenario should reduce the number of parents that fail to have their child MMR vaccinated. As mentioned already, this provision of mobile services will be a key outcome of this campaign, and attendance uptake provides a firm measureable outcome.

6.4 Promotion The role of marketing communication is to guide the audience through the stages to differentiate, remind, inform and persuade. Differentiate – to distinguish NHSBD services; to demonstrate a unique local MMR provision service available to target residents. Remind – to remind local people about the benefits of the vaccination; to remind residents about how they can access the services offered by NHSBD; to remind parents to get their child vaccinated (twice); to remind parents that failure to do so may result in severe illness for that child. Inform – to inform residents of the benefits of the services and choices open to them; to inform practitioners of their roll in supporting positive behavior change. Persuade – to persuade residents to choose the right health service for their child; to persuade parents to respond to external ‘calls-to-actions’ that facilitate their access to the MMR vaccination. Coordinated approach Essential to delivering a successful marketing campaign is a coordinated and phased approach. The campaign will be planned, communicate a consistent message and be uniform in design. By combining more than one element of the marketing mix the message is communicated more powerfully, gains increased exposure and connects with greater impact. Each element of the marketing mix will be considered as the program is developed and primary and secondary research will used to elucidate and clarify the final product, price, place, promotion and subsequent decisions. To avoid blanket marketing and ineffective bulk media purchasing, population insight can guide our methods of communication. Table 6 shows optional Mosaic communication strategies for this target audience.


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Table 6 Receptivity to media in population groups 1 and 6, according to Mosaic population data

This campaign will utilize existing active resources where appropriate including existing contracts and services, commissioned agencies, partner provider services, and corporate associations/partnerships. Key objectives will still be attained but costs will be kept to a minimum. Revolution will also contract an independent media-buying agency to purchase cost-effective, targeted media. There are many local marketing communication tactics, presented below in their totality. Those most relevant to our target market segment will be identified using insight, primary research commissioned by Revolution, and Experian population data to justify expenditure and to ensure the marketing mix is relevant and effective. Direct marketing through personally addressed door mail-shots, or telemarketing is identified as a likely successful tool in Mosaic for the target audiences. Patient records, children’s birth register, and school databases will be employed for this purpose. Data protection and information governance is highlighted as a sensitive issue. Revolution will work closely with the Information Governance Officer to ensure agreement of data usage at the highest corporate level. The CSL project utilized several different methods of conveying the MMR message. It also determined conversion costs per immunisation, although their evaluation technique was identified as inherently flawed these are displayed in table 7.

Table 7 Cost per conversion from CSL 1-in-10 project (COI, 2009)

Medium of communication Relative cost per vaccination

Inserts £16.50 (most cost effective)

Direct Mail £20.00 (cost effective)

Door Drops £25.00 (reasonably effective as support device)

Outdoor £30.00 (deemed ineffective)

Face to Face £35.00 (deemed ineffective)

This information correlates with the communication strategies identified in the local Mosaic population data which suggests that the more cost effective options above are indeed received well by these target groups and are therefore justified as potential marketing methods.

6.4.1 Communication strategies There will be a phased approach to the communication following the simple outline in table 8.

Communications strategies identified by Mosaic data Population group Receptive Non-receptive

Group 1 TV; Radio; Posters Magazines; Newspapers; Internet Group 6

Posters; Telemarketing; TV Magazines; Internet; Broadsheet newspapers


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Table 8 Phased approach of communications to be utilised

Advertising – to raise awareness, educate the market and persuade the market Revolution Marketing will work closely with the Partnership to contract a specialist media buying agency. Research shows that effective local media advertising opportunities for this market, when appropriately targeted for the audience geo-demographic include:

• Bus advertising – streetliners (side of buses), rear liners and inside – targeted on bus

routes through target wards, and near children centres and health services (Appendix A shows the available bus route advertising) to promote increased access points of vaccination.

• Bus shelters – within target wards and near children’s centres and health services, near maternity wards.

• Scrolling bus shelters – within target wards and near children’s centres and health services, near maternity wards.

• Titan/CBS street posters – within target wards and near children’s centres and health services, near maternity wards.

• Phone boxes (CBS Outdoors) – within target wards and near children’s centres and health services, near maternity wards.

• Lamp-post banner advertising – within target wards and near children’s centres and health services, near maternity wards.

• Newspaper advertising – insert in local papers - The NEWS and The Post • Local engagement publications – church newsletters, neighbourhood managers magazine

“Community Matters”, CVS community publications. • Ticket Media – bus ticket and train ticket advertising. • Dagenham FC match day programme advertising. • Local Community TV – for expectant, and new parents. • Event marketing - may be used in very selective circumstances for specific groups of hard

to reach communities (i.e Dagenham and Redbridge FC events), but is generally considered as ineffective.

• Local radio – TIME FM 107.5 - 30 second advertisements with promotional message – call to action to access mobile unit – population group 1 are particular receptive to radio.

The following were considered but determined as ineffective for this audience, or not cost-effective:

• Website, and online marketing – due to low internet usage and the nature of this message • SMS marketing – due to lack of contact details for the target market

Phase

Tool Objective

1 Advertising Raise awareness, brand reinforcement, risk reduction

2 Public Relations – Press coverage

Give message credibility

3

Direct Marketing Build on awareness and reinforce message

4

Direct Marketing Call to action – mobile or local service access

5 Personal sales promotion Reinforce the message and access hard to reach groups, follow up specific groups


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• Event marketing – as suggested by the CSL outcomes, this was an ineffective way to target the audience, and a costly channel. Although a receptive channel for the target groups, there are no opportunities to communicate via commercial TV

• Billboard advertising (20ft x 10ft and 40ft x 10ft; 36, 48 and 96 sheets) – due to the population using public transport, there are only limited billboards within view of public transport in the target wards. They are also high cost and not likely to deliver cost-effective results.

Public relations – to raise the profile of the MMR vaccination, and the campaign, enhance perception of the MMR and disseminate information.

NHSBD have a Communications and Media Manager who can assist in developing a media plan for campaigns that support our marketing efforts. Editorials in the Your Health section of the local paper “theNews” will be used to reinforce the campaign message and support the overall strategy. Media releases are often picked up by multiple private publications including “The Romford Recorder”, “Barking Post” and “The Yellow Advertiser”. Revolution will work closely NHSBD to secure positive media coverage of the MMR campaign in line with local health resources and engagement activities and events. Press releases and editorial will be timed to support ongoing campaign messages and events along with follow-up articles reporting outcomes in a transparent manner.

Campaign activities, particularly those involving children, often secure positive media exposure that further supports the campaign and advances recognition levels. Other local publications may be used to convey messages in a PR/editorial context – including church newsletters, neighbourhood publications, and community magazines like monthly Local Involvement Networks publications.

Sales promotions – to stimulate trial; and increase usage

Where appropriate, Revolution will employ the use of sales promotions to provides opportunities to introduce residents to their local health services. Feeling they are receiving something of value for free can stimulate more interest and usage. Although the MMR vaccination is free, the impact of not having it could result in significant financial and emotional distress. It is important to position the vaccination as a desirable product. Other sales promotions the Revolver recommends are developing links with Pampers to offer free pack of nappies with MMR jab; place a coupon in the printed media to offer priority appointment for MMR vaccinations; refer a friend scheme and receive a childcare voucher.

Sponsorship and Events The annual Dagenham Town Show in July provides an important and unique opportunity to increase awareness of NHSBD services and the MMR vaccination. There is greater potential to explore sponsorship possibilities including health road shows, family days, awareness days and national events such as World Vaccination Day. Liaising with BHRUT and LBBD will identify further potential event and sponsorship opportunities. Revolution recommends sponsorship of dedicated promotional events relevant to the population and located in the target wards. These include a family day located at the local children’s centres (locations in Appendix B) or a ‘Teddy Bear’s Picnic’ in the local green spaces in the target wards, through which the gathering of the target audience would allow both dissemination, and a central access point to place the mobile immunisation services to deliver on-site MMR vaccination. Direct marketing Revolution recommends using direct marketing tactics for the target audience. Direct marketing allows enquiry tracking and conversion rates and provides a clear return of investment


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evaluation. Revolution will seek to exploit direct mail in a format that complements the message tones identified in the secondary research. Revolver recommends initiating a birthday card program for parents of children aged 1 year and 4 years, and linking this up with a sales promotion such as Pampers coupon following vaccination attendance. Telemarketing will also be used to contact the target audience directly, with Revolution contracting specialist telemarketing agency to deliver a specialist script that will be developed in conjunction with a sample of the target market. As previously mentioned, there are several local database that will enable Revolution to gather direct marketing details for this campaign – the birth register, GP health records, child health records, and child benefits database. Using these existing contacts will remove the need to purchase specialist data and reduce costs.

New Media (digital; online; social networks): Social networking is a tool used by younger generation parents in population group 1, with Facebook and Bebo being most popular sites (Mosaic, 2010). Targeted marketing to our specified target audience is possible through this media, although the ineffectiveness of the Internet as a motivational tool for this audience would make any signposting and calls to action difficult. It may be useful, as a promotional tool to inform parents to the risks of MMR, and/or to the increased accessibility to the vaccine as initiated through this campaign, though this would prove difficult to evaluate accurately. Revolution recommends this a potential option for a small cluster of the target audience. Other more general Internet promotion is unlikely to be effective as figures show low web usage, access and receptiveness within the target groups. The CSL project also reported poor usage of the Internet site, and SMS text services were reported as not returning on investment. Therefore SMS marketing is not considered an effective communication method for this campaign. Nevertheless, as the cost is minimal, campaign information/messages and mobile vaccination details will be updated on all local public websites, as well as home-screens on local service (i.e. library) public computers to gather any unexpected catchment with minimal effort. Personal selling/ Engagement – to inform; to persuade the market Evidence demonstrates that social marketing campaigns must be underpinned with a robust outreach element or touch point for local people to access easily. Telling people to get their child immunized without providing accessible services at a time and place convenient to target parents will not lead to positive behaviour change. The ability to add a clear and easily achievable call to action as the first step to adopting a healthier lifestyle will increase the success rate of any social marketing campaign.

Key channel members (along with selected other key stakeholders) can assist with personal selling and engagement of the local population. These include:

• Community pharmacists • GPs • Dentists • Opticians • School – school nurses, PHSE teachers, school health advisers • Youth clubs/youth workers • Community communicators • Health champions/trainers • Leisure centres • Council for Voluntary Services • Children centres’ managers • Community centres’ managers • Libraries


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• Licensed premises (pubs and clubs) • Neighbourhood managers • Midwives • Family Nurse Partnership • Employers

Local employers will also be used to support the campaign in the long-term. Revolution recommends that relationships are built with large employers to develop a maternity leave pack. A carefully selected and presented package of incentives and information that include a child check list (including MMR vaccination). Employers must also be engaged to commit to allow time off for parents to access health services to have the vaccination. The Partnership may consider providing funding to encourage employers to sign up to this commitment. Partnerships could be cultivated with local or national women's groups, parent/toddler groups, pre-schools, corporate sponsors (i.e. Bounty), medical organizations (i.e. pharmaceutical companies Pfizer and Sonafa Aventis have a large local plants), or media outlets.

The policy aspects of the campaign might focus on increasing access to MMR through improving the availability of the vaccination, building in provider contract clauses in primary service practitioners to encourage their sign up and commitment.

6.4.2 Messages It is strongly recommended that any development of themes, concepts and message positioning undergo rigorous pre-testing with the target audience prior to further development. Insight research and population data can strongly influence how we position the messages and themes in a way most likely to have a positive impact on the population. The outward marketing strands discussed above will also be developed to deliver the most effective way to communicate the message.

The CSL project attempted to raise the profile of the diseases themselves as a contributor to child hospitalization but this proved unsuccessful in positioning the message of fear to parents. Parents found it was not relevant to their needs and so the campaign did not have the desired impact. The insight does show that parents are susceptible to carefully positioned messages of support and financial incentive.

As the primary barrier for parents in the lower SE groups is access, this campaign will revolve around service provision, redesign and education. This will be supported by selected use of media that appeals to the audience and is expected to have a more successful conversion rate.

Message development recommendations (to be pre-tested and developed) are within the Implementation section recommendations below but the main themes are:

-‐ To inform of benefits of, and need for, the MMR immunisation -‐ To inform of access improvements for ease of immunisation

As particular wards will be targeted, all communication strands must be tailored to meet the needs of that geographic area – i.e. only on public transport that operates within each particular ward, poster sites and services within those wards. This will ensure a targeted, localized approach.

It is important to build partnerships with services/agencies/companies that already interact with the target market. Revolution recommends that these will include:

• Preschools – option to offer discounts to children with full MMR protection; offer of MMR voucher to those who are not immunized so they can remedy the situation (NHS subsidising the pre-schools)


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• Partnerships with the bounty programme developed/expanded to ensure provision of clear, concise and effective MMR literature.

• Other corporate ties sought through the Start4Life campaign, and New Start programmes.

• The corporate partnerships currently being developed with Disney should be utilized if successful.

• Potential to link with large corporations such as Cow and Gate, Pampers, Asda, Mothercare etc.

Note: To ensure a cohesive approach, these partnerships will complement or be complemented by a range of external communications wherever applicable (i.e. PR activity through NHSBD).


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6.5 Physical As part of the development phase, Revolution will also make steps to ensure that the physical elements are considered. This includes ensuring that the buildings or mobile services where the vaccination is offered are clean and professional. Waiting areas are comfortable, sociable and stocked with both parent’s entertainment material, and toys etc for children to pass time. Creche facilities where applicable will be examined to ensure that other children are safely occupied during MMR vaccination. All staff will be requested to wear correct uniform and name badges to ensure external perception as professionals. The locations will complement the Partnership and NHSBD brands wherever possible, to guarantee that the public experience of the service is efficient, professional and potentially even enjoyable to both parents and children.

6.6 Processes Revolution will examine the processes involved in obtaining MMR1 and MMR2 in the locality. The call to action used through the campaign will be either for accessing one’s GP, or the mobile services. It is essential that there is a clear access route for parents to obtain the vaccinations through either of these services, for example, GP surgeries have manned local landline numbers, they can speak to someone during extended hours to book an appointment and raise any concerns. If there is a voicemail system, there are clear protocols to return a call within a reasonable time. There will also need to be appointments available, and working with NHSBD, Revolution will link in with ongoing booking system optimisation to ensure that this supports the campaign. Revolution will ensure that mobile services will be fully accessible to the local population, including disabled access and locations with reasonable public transport or walking distances. Mobile services will be in places as publicized for the complete duration that is promoted to ensure that parents expectations are always fulfilled. Revolution will test market the processes involved in the attainment of MMR vaccination from the public’s perspective. This will form part of the insight research, and the evaluation report.

6.7 People Revolution will ensure practitioners are trained in customer service to enhance the patient experience. Practitioners are the first point of contact in the patient journey and it must remove any barriers and inhibitions that may provide patients reason to not access services for the first or second vaccination.


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7.0 Budget

7.1 Costs for implementing marketing plan, including evaluation

It is difficult for Revolution to attach a full budget to this project but estimated costs are attached below within the proposed action plans in section 8.1.

Provision of the accessible and convenient mobile services will understandably incur higher costs, but would be positioned to achieve the targets so justifying the outlay and becoming cost effective overall. Judging by the CSL project, vaccination promotion can cost as little as £20 per media to vaccination conversion, although that campaign was on a larger scale and bulk buying of media space most likely reduced the cost per conversion. Conversely, however, it was less targeted than this campaign so there is potential to improve on this cost.

Other likely costs will include incentives, subsidizing of other services, and media printing and purchasing. Again, these are outlined in the action plans below, but more accurate costings would be provided during the insight and development phases to determine the most effective use of expenditure for the target audience. Commissioning costs of insight, focus groups for development, evaluation, and service provision will undoubtedly be considerable. Production costs and media costs will be incorporated into the proposed budget.

7.2 Any anticipated incremental revenues or cost savings Savings will undoubtedly be made in the long term should the uptake of MMR vaccinations increase resulting in a reduction of the costs of services supporting MMR-affected individuals and their treatment. There will be a decline of service output dealing with the diseases, as well as an impact upon schools, parents, and follow-up case handling of outbreaks. An increase in uptake will potentially save lives. There will also be a reduced impact work absence and school closures due to infection.


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8.0 Implementation Using all of the available insight and data and the above suggestions, it is now possible to compile an action plan for a deliverable social marketing campaign. Access to services will be the key to this campaign. It will be the primary tool to increase uptake and will be supported by various marketing, media and advertising opportunities. There are several key considerations that will shape the development of this campaign as it evolves from this strategy. Revolution, in discussion with the Partnership will:

• Conduct further insight into the local population to affirm recommendations • Hold focus groups to interpret insight, propose messaging and positioning • Use local population to pre-test all visual concepts and messages • Engage stakeholders to support campaign delivery • Consult local population on the implementation plan • Consult local target population through development, delivery, and evaluation phases • Consult target population for the best location for mobile vaccination services • Deliver campaign within agreed budget and timescale.

Mentioned throughout this strategy there are several recommendations. These are some specific recommendations for reference:

• Advertise using specific targeted media for audience geo-demographic • Conduct primary research to gain further understanding of the audience • Pre-test material concepts and methods of communication • Create access points to inform new parents while within services • Educate practitioners • Provide vaccinations at accessible locations to enable new mothers the opportunity to

have their child immunised without the problems of travel • Further incentivise the action • Normalise the vaccination to increase vaccination appeal and reduce parent’s mental

barriers • Utilise database contacts of new parents to enforce reminders through direct marketing • Utilise events to target parents using pre-tested messages and mobile service provision • Deliver a ward level, targeted campaigns to promote vaccination through methods

discussed above • Conduct direct mailing of pre-tested birthday cards on 1yr, and 4 yr birthdays to remind

and incentivise MMR1 and MMR2 The action plan below (8.1) identifies recommended actions for this campaign.


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8.1 Action plan Action Aims Outcome Timeline

(assuming project commences Sept 2010)

Cost Notes

Engage stakeholders

Gather buy in from stakeholders to support delivery of campaign message

Stakeholders to represent brand embassadors (MMR) Stakeholders to support development of campaign and support dissemintation of messages

September 2010 onwards

No associated costs

Develop message from insight and dedicated focus groups with specialist research staff

Interact with 50 parents within target market to support development of campaign. Provider agency: Burns and Company

Identifying messages that are successful within target group. Providing insight for successful positioning and development.

September – October 2010

£2,300 Commission agency to deliver and lead on focus groups (including reporting) - £2000 Parent attendance incentives - £300

Development of resources

Develop concept from insight and focus groups and sign off following final development with focus group and consulted parties.

Using existing design contract to deliver initial concepts and visuals for discussion. Pre-testing of concepts and messages.

October –November 2010 Sign off November 30th 2010

£1,000 Inclusive of existing contract – no financial commitment

Staff/practitioner education

Train practitioners in positive support for parents and communication methods to ensure parents return for second dose.

Increasing communication between practitioners and parents; increasing uptake and understanding of MMR Gaining understanding of how local providers view the vaccination and their interactions with parents and children to investigate if personal barriers need to be overcome. Similar insight to be conducted for antenatal and post-natal services staff.

Completion by December 2010

£3,000 est. External research agency commissioning

Develop incentive scheme for MMR vaccination

Provide parents with incentive to get child MMR1 and/or MMR2

Promoting the incentive in all promotion and media. Increasing attendance at mobile services and at GP practices.

December 2010 £5,000 (£20 per vaccination).

Incentive: focus groups to identify desirable and sensible types or amounts etc

Media space purchasing

Gain cost-effective media space through targeted media outlets.

Transfering messages through communication strategy

31st December 2010

£7,500 Dependant on most effective methods determined in focus groups Media buying agency employed


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Print direct mail Use insight to position and distribute effective messages

Using mailshots to ensure key consumer groups are continually kept informed of current trends.

December 2010 – January 2011

£2,500

Outcome and methods to be determined through focus group.

Utilise via media communication channels

Convey pre-tested message and information to target groups

Media to Inform parents of mobile service provision and access to vaccination (i.e. half page advert in theNews with mobile provision timetable, or incentives for visiting GP for MMR vaccination) Informing and educating parents of importance of MMR vaccination (i.e. Bus Stop advertising) – outlined in Promotion section Increasing attendance at mobile services and at GP practices Bus advertising – target bus routes that travel through target wards and close to children’s centre and GP surgeries. Internal bus advertising – ‘Passenger’ advertising above buggy area to communicate with target audience.

January 2011 Inclusive in media purchase costs above

Engaging consumer groups

To inform and educate parents to the benefits of immunisation To raise the uptake of the MMR vaccine

Informing parents of key information i.e,: mobile service provision and access to vaccinations, benefits of MMR vaccinations. Increasing attendance at mobile services and at GP practices.

January – March 2011

£2000

Direct marketing

Send birthday cards to parents of children aged one and four

Accessing birth data from GP records and birth register. Increasing attendance at mobile services and at GP practices

January - April 2011

£1,000 (£400 per 1000 mailings

Only targeting parents in target group and wards – but could be rolled out over wide area if successful.

Use advertising and informative literature to best advantage

To promote the incentive to a wide audience

Using local newspaper “The News” to distribute relevant supplements, fliers and leaflets advertising local initiatives High visibility of such material within all mobile services and GP practices. Regular and consistent advertising of services

February – May 2011

£500 (£25/1000)

Targeted only within specific wards

Mobile service provision

Commissioning accessible services for local provision Provider: EMS

Provide mobile service for a number of days (inc. weekends). Increase number of vaccinations given within

February – May 2011, possible extension 20 full days on site mobile

£25,000 est. (£1,000-£1,500 per day for external

£400-£600/day saving if internal staff used to deliver service with logistical support


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Healthcare target population. provision agency full spec service)

Full external campaign evaluation (10% of budget)

Provide full evaluation and written report

Providing future insight for further MMR marketing. Justifying expenditure to decision makers and senior staff.

May - July 2011 £4,780

External agency commissioned (Burns and Company)

Deliver follow-up workshops for professionals

Knowledge transfer workshops held by Revolution for local health professionals

Transfer project outcomes, learnings and future recommendations with local professionals Increase awareness of campaign success/learnings among professionals

July 2011 £1,000 Two sessions top be delivered over one day at accessible premises

Revolution on-board management costs (10% of overall budget)

Deliver campaign objectives and manage services within budget and timescale

Throughout £5,558 Agreed at contract stage

Estimated total budget suggested:

£55,580 + £5,558 £61,138.00 +VAT

This estimated figure is for dicussion with the Partnership.

Revolution has compiled an initial project management chart to outline the implementation of this strategy (Appendix C).


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9.0 Evaluation Plan

9.1 Purpose and audience for evaluation Kotler and Lee (2008, p.42) highlight the need to create an evaluation plan before beginning creating an implementation plan and acquiring budgets and funds. Revolution Marketing is aware of the importance of evaluation and its integration to the social marketing approach. It is vital to determine if marketing communication goals in relation to messages, targets, media, timing and objectives have been achieved. Evaluation will be used to inform key decision makers as to future work and commitment of resources and funds. It will also support the NHSBD position as local leaders of the NHS and be effective at influencing behaviour change. As a key performance indicator and a major strategic target for the borough, the evaluation of this campaign will inform all future work to assist strategic commissioning and act as insight for successful social marketing activity. Formative and process-based evaluation process will:

• Quantify costs per vaccination • Assess the impact of this campaign on MMR uptake in the target market. • Identify reactions to communication media used and identify for future use those which

proved effective. • Measure conversion rates of media communication and mobile service provision. • Support NHSBD in understanding of the barriers to the MMR vaccination and what

would encourage the population to get their children vaccinated. • Inform NHSBD of Healthcare Professionals perceptions of the MMR vaccination and

how they can support the uptake though education and professional development. • Justify future financial support through the Partnership board.

Revolution will present a summary of findings to the partnership board and also as a workshop to professonals following completion of the project. Using the audience’s experience and perceptions of these issues, both qualitative and quantitative methods of evaluation will be utilized to better understand their viewpoints. This will be a vital aspect in appreciating an understanding of how to influence behaviour towards a behavioural goal, in this case increasing the take up of MMR. It is intended that the findings of this project are used in conjunction with existing evidence to inform the design and delivery of future interventions. The marketing strategy will look to develop and embed an evaluation system geared to finding appropriate ways to measure effectiveness. There is rarely one perfect measure so a variety of mechanisms will be used. This system will seek to evaluate campaigns holistically by:

• Measuring uptake of MMR vaccination through GP reporting mechanisms will contribute to vaccination uptake figures.

• Referral codes – any subsidies or incentives will relate to a documented referral route and identify the patient journey – from awareness to actions. This will allow Revolution to identify cost-benefits and conversion rates of the marketing mix and quantify sales promotions.

• Budget will be identified in relation to conversions – and reported in a per vaccination or percentile increase basis.

• Marketing mix – by ensuring that communications fit in with the marketing mix.


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• Ensuring a financially sustainable programme where follow up is both encouraged and available.

9.2 Evaluation of the marketing mix to inform the overall outcomes and process The communication channels will be evaluated in more specific detail to offer deep-level insight into the impact of each method and inform future adaptations of this campaign. Evaluation of Advertising – to report cost-effectiveness of print and broadcast media:

• Recall tests assess whether visuals and messages were memorable • Recognition tests assess how accurately information can be reprocessed • Likeability tests can be useful indictors of uptake of service use • Tracking studies address perception on an ongoing basis • Responses gained as a result of visits, returned coupons/offers etc.

Evaluation of sales promotions – conversion rates and uptake

• Channel member feedback provides quantitative information • Voucher/coupon redemption coded to assist measurement of response cohort

Evaluation of PR

• Awareness – market research to assess levels of awareness in the market • Attitude – using research to judge if attitudes have changed positively or negatively • Media coverage and tone – number of column inches achieved, types of headings and

tone of coverage • Response generation –telephone response or website hits following PR coverage • Service uptake reported as a direct result of PR activity.

Evaluation of direct and interactive marketing communications

• Response rate – number of responses to a mailshot • Attendance to tailored services (i.e. uptake of mobile vaccinations) • Conversion rate – the number of responses that are converted to MMR uptake • Cost per enquiry and/or uptake – to calculate the overall effectiveness of a mailshot

Evaluation of sponsorship/supporting events

• Media exposure measurement –measure media coverage of sponsorship activity • Pre-testing and post-testing of awareness in relation to activity • Feedback from participants – qualitative feedback from customers and other

stakeholders to determine effect on public opinion/perception

8.3 What will be measured: output/process, outcome, and impact measures The key to defining evaluation criteria will be the measurement of the uptake of the MMR vaccination seen to be a direct result of this campaign. The results will then be measured on a cost per vaccination basis, and an increased general awareness – measured through quantitative evaluation. Attendance at tailored mobile vaccination services will be provide direct evaluation as it will be a unique provision and all uptake will be as a result of this campaign. Evaluation will confirm achievements measured against current service provision and uptake of the MMR vaccination, and the objectives agreed at the start of this project. The key outcome, as outlined in the objectives, will be to directly effect personal change; exert social influence on key partners and stakeholders; and highlight areas of policy, procedure, service delivery and provision needing improvement to increase the uptake of MMR during and after the delivery of this campaign.


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9.0 Appendices

APPENDIX A -‐ Targeted advertising opportunities in selected wards OTS (opportunity to see) figures in thousands. The codes represent the following:- 6 = bus shelters 506 = scrolling bus shelters 305 = phone boxes 48 = billboards size 20ft x 10ft 96 = billboards size 40ft x 10ft Prices are:- All bus shelters = £110 per panel per week plus £20 production. Phone Boxes = £60 per box per week plus £22 production. 48 billboards = £200 per billboard per week plus £100 production. 96 billboards = £550 per billboard per week plus £250 production.

Ward: Gascoigne and Abbey Postcodes: IG11 7 ; IG11 8;

Size

(sheet) Address Postcode Product OTS 6 St Pauls Road opp The Victoria Pub 40m E Of Gascoi IG11 7AF Adshel (Uk) 239 6 St Pauls Road opp The Victoria Pub 40m E Of Gascoi IG11 7AF Adshel (Uk) 205

48 Freshwharf Estate, North Circular Rd Jct Highbridge Rd IG11 7BP Pinnacle 757 48 Freshwharf Estate, North Circular Rd Jct Highbridge Rd IG11 7BP Pinnacle 757 96 Freshwharf Estate, North Circular Rd Jct Highbridge Rd IG11 7BP Pinnacle 520 96 Freshwharf Estate, North Circular Rd Jct Highbridge Rd IG11 7BP Pinnacle 520

305 o/s 32 Ripple Rd Barking IG11 7PG Adshel Connect 119 305 o/s 349 Ripple Rd Barking IG11 7RR Adshel Connect 8

48 Alfreds Way/E.Ham Barking By Pass Bp Adj King Edwards Rd IG11 7TS

Clearchannel Billboards 306

6 Alfreds Way, 96m E Of Movers Lane, o/s 20, 6m E Of IG11 7XU Adshel (Uk) 155 6 Alfreds Way, 96m E Of Movers Lane, o/s 20, 6m E Of IG11 7XU Adshel (Uk) 162 6 London Road O/S P/W 17/19 45m W Of Linton Road IG11 8AA Adshel (Uk) 177 6 London Road O/S P/W 17/19 45m W Of Linton Road IG11 8AA Adshel (Uk) 177 6 London Road O/S P/W 23/25 63m W Of Linton Road IG11 8AA Adshel (Uk) 177 6 London Road O/S P/W 23/25 63m W Of Linton Road IG11 8AA Adshel (Uk) 177 6 North Street Opp 14-16,N Of East Street 70m S Of L IG11 8AE Adshel (Uk) 209 6 North Street Opp 14-16,N Of East Street 70m S Of L IG11 8AE Adshel (Uk) 136

305 o/s 32 London Rd Barking IG11 8AG Adshel Connect 24 6 London Road o/s P/W 16/18 (Pie And Mash) 47m W Of IG11 8AJ Adshel (Uk) 178 6 London Road o/s P/W 16/18 (Pie And Mash) 47m W Of IG11 8AJ Adshel (Uk) 178 6 North Street, The Broadway 40m S Of East Street O/ IG11 8AW Adshel (Uk) 180 6 North Street, The Broadway 40m S Of East Street O/ IG11 8AW Adshel (Uk) 163 6 London Road, Opp 150 o/s Tesco Supermarket 101m E IG11 8BB Adshel (Uk) 376 6 London Road, Opp 150 o/s Tesco Supermarket 101m E IG11 8BB Adshel (Uk) 376

305 o/s 33 Station Parad Barking IG11 8ED Adshel Connect 38 305 o/s 15 Station Parad Barking IG11 8ED Adshel Connect 0

6 London Road Opp 7 20m W Of Linton Road IG11 8HE Adshel (Uk) 104 6 London Road Opp 7 20m W Of Linton Road IG11 8HE Adshel (Uk) 104 6 London Road, opp Harvey House Flats, 35m W Of Nort IG11 8JE Adshel (Uk) 166 6 London Road, opp Harvey House Flats, 35m W Of Nort IG11 8JE Adshel (Uk) 166 6 Station Parade, 35m W Of Wakering Road, O/S Statio IG11 8RY Adshel (Uk) 131 6 Station Parade, 35m W Of Wakering Road, O/S Statio IG11 8RY Adshel (Uk) 131 6 Longbridge Road Os 92 'tatoo World' 29me Of & Opp IG11 8SF Adshel (Uk) 184 6 Longbridge Road Os 92 'tatoo World' 29me Of & Opp IG11 8SF Adshel (Uk) 184


49

6 Longbridge Road o/s No 97 21m W Of Park Avenue IG11 8SL Adshel (Uk) 246 6 Longbridge Road o/s No 97 21m W Of Park Avenue IG11 8SL Adshel (Uk) 246 6 Longbridge Road Hulse Avenue 15m E/O & Opp, Opp 16 IG11 8SS Adshel (Uk) 164 6 Longbridge Road Hulse Avenue 15m E/O & Opp, Opp 16 IG11 8SS Adshel (Uk) 164 6 Longbridge Road o/s 148 35m E Of Stratfield Garden IG11 8ST Adshel (Uk) 239 6 Longbridge Road o/s 148 35m E Of Stratfield Garden IG11 8ST Adshel (Uk) 239 6 Longbridge Road,71m W Of Upney Lane,24m E Of Ventn IG11 8UP Adshel (Uk) 135 6 Longbridge Road,71m W Of Upney Lane,24m E Of Ventn IG11 8UP Adshel (Uk) 135 6 Longbridge Road Opp Faircross Parade Adj To 'royal IG11 8UP Adshel (Uk) 131 6 Longbridge Road Opp Faircross Parade Adj To 'royal IG11 8UP Adshel (Uk) 162

Bus routes in area: No.62 GP locations No.368 No.173 No.687 No.387

Route EL1 Childrens centres:

Route EL2 No.287 Ward: Thames Postcodes: IG11 0 Size (sheet) Address Postcode Product OTS

48 Alfreds Way Cnr Jenkins Lane Opp Showcase Cinema IG11 0AD Clearchannel Billboards 444




6 Alfreds Way 251m E Of Gasgoigne Road 49 M W Of Kin IG11 0AT Adshel (Uk) 448 6 Alfreds Way 251m E Of Gasgoigne Road 49 M W Of Kin IG11 0AT Adshel (Uk) 162 6 Alfreds Way Directly Opp King Edwards Road 55m W O IG11 0BB Adshel (Uk) 162 6 Alfreds Way Directly Opp King Edwards Road 55m W O IG11 0BB Adshel (Uk) 162 6 Bastable Avenue 128m W/O Stapleford Way, 10m E/O H IG11 0LP Adshel (Uk) 6 Bastable Avenue 128m W/O Stapleford Way, 10m E/O H IG11 0LP Adshel (Uk) 6 Bastable Avenue 2m E/O & Opp Stapleford Way, 21.5m IG11 0NQ Adshel (Uk) 6 Bastable Avenue 2m E/O & Opp Stapleford Way, 21.5m IG11 0NQ Adshel (Uk) 6 Bastable Avenue 60m E/O & Opp Glenmore Way; 148m W IG11 0QS Adshel (Uk) 6 Bastable Avenue 60m E/O & Opp Glenmore Way; 148m W IG11 0QS Adshel (Uk) 6 Ripple Road, In Lay-By, opp Rippleside Industrial IG11 0RJ Adshel (Uk) 633 6 Ripple Road, In Lay-By, opp Rippleside Industrial IG11 0RJ Adshel (Uk) 633

96 Ripple Rd Adj Biffa East London Depot & Nr Tesaco Serv Stn IG11 0RJ Clearchannel Billboards 681

6 Ripple Rd,70me Of & opp Lodge Ave,O/S Platform Bui IG11 0RJ Adshel (Uk) 163 6 Ripple Rd,70me Of & opp Lodge Ave,O/S Platform Bui IG11 0RJ Adshel (Uk) 163

48 Maybells Commercial Estate, Ripple Rd Opp Barking Rugby Club IG11 0TT Clearchannel Billboards 277

96 Maybells Commercial Estate, Ripple Rd Opp Barking Rugby Club IG11 0TT Clearchannel Billboards 492

6 Ripple Road, In Lay-By, O/S 7 Rippleside Industria IG11 0TY Adshel (Uk) 430 6 Ripple Road, In Lay-By, O/S 7 Rippleside Industria IG11 0TY Adshel (Uk) 430 6 Ripple Road 150m E Of Gale Street o/s Goresbrook L IG11 0TY Adshel (Uk) 361 6 Ripple Road 150m E Of Gale Street o/s Goresbrook L IG11 0TY Adshel (Uk) 361 6 Ripple Road, Adj To Footbridge Morrison Road, 300m IG11 0TY Adshel (Uk) 373 6 Ripple Road, Adj To Footbridge Morrison Road, 300m IG11 0TY Adshel (Uk) 160 6 Ripple Road,o/s Leisure Park o/s Warner Cinemas 75 IG11 0UB Adshel (Uk) 381 6 Ripple Road,o/s Leisure Park o/s Warner Cinemas 75 IG11 0UB Adshel (Uk) 160


50

6 Alfreds Way Westbound On Slip 142m W/O River Road IG11 0WD Adshel (Uk) 108 6 Alfreds Way Westbound On Slip 142m W/O River Road IG11 0WD Adshel (Uk) 119

Bus routes in area: EL1 EL2 No.387

Ward: Eastbury Postcode: RM9 4

6 Lodge Avenue O/S 422 20m N Of Stamford Road RM9 4ED Adshel (Uk) 164 6 Lodge Avenue O/S 422 20m N Of Stamford Road RM9 4ED Adshel (Uk) 127 6 Hedgemans Road O/S 438/440 45m E Of Gale Street RM9 4LJ Adshel (Uk) 191 6 Hedgemans Road O/S 438/440 45m E Of Gale Street RM9 4LJ Adshel (Uk) 132 6 437 Porters Avenue Dagenham Essex RM9 4ND Adshel (Uk) 100 6 437 Porters Avenue Dagenham Essex RM9 4ND Adshel (Uk) 100 6 Gale Street 69m N/O Rusper Rd Outside P/W 60/62 RM9 4NP Adshel (Uk) 6 Gale Street 69m N/O Rusper Rd Outside P/W 60/62 RM9 4NP Adshel (Uk) 6 Lodge Ave, 70m S/O Woodward Rd Opp 364-366 RM9 4QX Adshel (Uk) 164 6 Lodge Ave, 70m S/O Woodward Rd Opp 364-366 RM9 4QX Adshel (Uk) 164 6 Woodward Road o/s 180/182 50m W Of Ellerton Road RM9 4SU Adshel (Uk) 55 6 Woodward Road o/s 180/182 50m W Of Ellerton Road RM9 4SU Adshel (Uk) 55 6 Woodward Road o/s 177/179 35m E Of Canonsleigh Roa RM9 4TA Adshel (Uk) 60 6 Woodward Road o/s 177/179 35m E Of Canonsleigh Roa RM9 4TA Adshel (Uk) 108 6 Ripple Road 35m E Of Renwick Road 42m E Of Ph Ship RM9 4XA Adshel (Uk) 436 6 Ripple Road 35m E Of Renwick Road 42m E Of Ph Ship RM9 4XA Adshel (Uk) 488 6 Lodge Avenue O/S P/W 455/457 43m S Of Maplestead R RM9 4XL Adshel (Uk) 134 6 Lodge Avenue O/S P/W 455/457 43m S Of Maplestead R RM9 4XL Adshel (Uk) 97

Bus routes in area: No.368 No.687 No.287 No.62 No.673 Ward: Heath Postcodes: RM8 1; RM8 3; RM10 7

6 761 Becontree Ave,Dagenham RM8 1AA Adshel (Uk) 35 6 761 Becontree Ave,Dagenham RM8 1AA Adshel (Uk) 35 6 Green Lane o/s P/W 1138/1136 115m W Of Wood Lane RM8 1AA Adshel (Uk) 164 6 Green Lane o/s P/W 1138/1136 115m W Of Wood Lane RM8 1AA Adshel (Uk) 164 6 Green Lane Opp 1146 Post Office 46.5m W Of Whalebo RM8 1AD Adshel (Uk) 109 6 Green Lane Opp 1146 Post Office 46.5m W Of Whalebo RM8 1AD Adshel (Uk) 109 6 Whalebone Lane South o/s 38/36 36m N Of James Aven RM8 1BB Adshel (Uk) 167 6 Whalebone Lane South o/s 38/36 36m N Of James Aven RM8 1BB Adshel (Uk) 167 6 Valence Avenue o/s 221-223 85 Yds N Of Green Lane RM8 1DB Adshel (Uk) 76 6 Valence Avenue o/s 221-223 85 Yds N Of Green Lane RM8 1DB Adshel (Uk) 76 6 Wood Lane o/s The Three Travellers P/H E/O & Opp W RM8 1DP Adshel (Uk) 307 6 Wood Lane o/s The Three Travellers P/H E/O & Opp W RM8 1DP Adshel (Uk) 162

96 Whalebone Lane South Jnc Wood Lane Dagenham RM8 1DR Clearchannel Billboards 569

6 Wood Lane o/s 537/539 o/s Ph The Three Travellers RM8 1DZ Adshel (Uk) 143 6 Wood Lane o/s 537/539 o/s Ph The Three Travellers RM8 1DZ Adshel (Uk) 190 6 LT-Whale Bone Lane South o/s B&Q Opp164-174 Flats RM8 1JA Adshel (Uk) 87 6 LT-Whale Bone Lane South o/s B&Q Opp164-174 Flats RM8 1JA Adshel (Uk) 165 6 Wood Lane, Opp Central Park 100m E Of Gosfield Roa RM8 1JX Adshel (Uk) 144


51

6 Wood Lane, Opp Central Park 100m E Of Gosfield Roa RM8 1JX Adshel (Uk) 144 6 Green Lane o/s 786 (News Plus) 35m W Of Burnside R RM8 1LA Adshel (Uk) 122

506 Green Lane o/s 786 (News Plus) 35m W Of Burnside R RM8 1LA Adshel (Uk) 122 506 Green Lane o/s 786 (News Plus) 35m W Of Burnside R RM8 1LA Adshel (Uk) 122 506 Green Lane o/s 786 (News Plus) 35m W Of Burnside R RM8 1LA Adshel (Uk) 122

6 Green Lane O/S The Matapan Ph 74m E Of Winifred Ro RM8 1PH Adshel (Uk) 102 6 Green Lane O/S The Matapan Ph 74m E Of Winifred Ro RM8 1PH Adshel (Uk) 102 6 Green Lane, 35m, W/O Walnut Tree Road, O/S 938 RM8 1QU Adshel (Uk) 250 6 Green Lane, 35m, W/O Walnut Tree Road, O/S 938 RM8 1QU Adshel (Uk) 250 6 Green Lane, O/S 878, opp 775 40m E Of Bonham Road RM8 1RP Adshel (Uk) 156 6 Green Lane, O/S 878, opp 775 40m E Of Bonham Road RM8 1RP Adshel (Uk) 131 6 Valence Avenue O/S 162 30m S Of Mayfield Road RM8 1ST Adshel (Uk) 86 6 Valence Avenue O/S 162 30m S Of Mayfield Road RM8 1ST Adshel (Uk) 224 6 Valence Avenue opp 115 S/O Burnside Road RM8 1TR Adshel (Uk) 76 6 Valence Avenue opp 115 S/O Burnside Road RM8 1TR Adshel (Uk) 76 6 Green Lane, 23m W/O Green Way o/s 731/733, 50m E O RM8 1UL Adshel (Uk) 197 6 Green Lane, 23m W/O Green Way o/s 731/733, 50m E O RM8 1UL Adshel (Uk) 118 6 Green Lane O/S Nos 679/681 55m E Of Greenside RM8 1YJ Adshel (Uk) 97 6 Green Lane O/S Nos 679/681 55m E Of Greenside RM8 1YJ Adshel (Uk) 97 6 Green Lane O/S P/W 824/826 33m W Of Chittys Lane RM8 1YR Adshel (Uk) 217 6 Green Lane O/S P/W 824/826 33m W Of Chittys Lane RM8 1YR Adshel (Uk) 217 6 Green Lane, 15m W/O And opp Mayfield Road O/S No. RM8 1YX Adshel (Uk) 236 6 Green Lane, 15m W/O And opp Mayfield Road O/S No. RM8 1YX Adshel (Uk) 236 6 Wood Lane o/s 277, E Of Winmill Road 55m E Of Graf RM8 3AA Adshel (Uk) 176 6 Wood Lane o/s 277, E Of Winmill Road 55m E Of Graf RM8 3AA Adshel (Uk) 176 6 Wood Lane O/S 61 25 Yds W Of Bushgrove Road RM8 3BP Adshel (Uk) 185 6 Valence Avenue Opp 571, At Groveway 63m N Of Wood RM8 3BS Adshel (Uk) 70 6 Valence Avenue Opp 571, At Groveway 63m N Of Wood RM8 3BS Adshel (Uk) 70 6 Wood Lane O/S 226, opp 261 25m W Of Boxall Road RM8 3EP Adshel (Uk) 268 6 Wood Lane O/S 226, opp 261 25m W Of Boxall Road RM8 3EP Adshel (Uk) 187 6 Valence Avenue o/s 365 55m S Of Becontree Avenue RM8 3HX Adshel (Uk) 115 6 Valence Avenue o/s 365 55m S Of Becontree Avenue RM8 3HX Adshel (Uk) 66 6 462-464 Becontree Ave,Dagenham RM8 3JA Adshel (Uk) 85 6 462-464 Becontree Ave,Dagenham RM8 3JA Adshel (Uk) 54 6 Wood Lane o/s 187/189 25m E Of Charlecote Road RM8 3LH Adshel (Uk) 196 6 Wood Lane o/s 187/189 25m E Of Charlecote Road RM8 3LH Adshel (Uk) 142 6 Wood Lane, O/S P/W 154 37m E Of Verney Road 10m W RM8 3LH Adshel (Uk) 199 6 Wood Lane, O/S P/W 154 37m E Of Verney Road 10m W RM8 3LH Adshel (Uk) 145 6 Valence Avenue o/s 432 30m N Of Lindisfarne Road RM8 3QL Adshel (Uk) 54 6 Valence Avenue o/s 432 30m N Of Lindisfarne Road RM8 3QL Adshel (Uk) 54 6 Dagenham Road o/s P/W 708/718 40m E Of Park Drive RM10 7BL Adshel (Uk) 50 6 Dagenham Road o/s P/W 708/718 40m E Of Park Drive RM10 7BL Adshel (Uk) 50 6 Rainham Rd Nth O/S Civic Centre S Of Wood Lane RM10 7BN Adshel (Uk) 152 6 Rainham Rd Nth O/S Civic Centre S Of Wood Lane RM10 7BN Adshel (Uk) 178 6 Rainham Road North 27m W Of Stour Road opp Dagenha RM10 7BN Adshel (Uk) 198 6 Rainham Road North 27m W Of Stour Road opp Dagenha RM10 7BN Adshel (Uk) 166 6 Wood Lane Opp Gosfield Rd At Civic Centre RM10 7BN Adshel (Uk) 174 6 Wood Lane Opp Gosfield Rd At Civic Centre RM10 7BN Adshel (Uk) 147 6 237 Oxlow Lane Dagenham RM10 7BQ Adshel (Uk) 81 6 237 Oxlow Lane Dagenham RM10 7BQ Adshel (Uk) 132 6 Rainham Road North o/s 223/225 60 Yds N Of Ashbroo RM10 7DX Adshel (Uk) 310 6 Rainham Road North o/s 223/225 60 Yds N Of Ashbroo RM10 7DX Adshel (Uk) 310

305 o/s 31 Stansgate Rd Dagenham RM10 7LU Adshel Connect 0

6 275 Oxlow Lane Dagenham RM10 7NH Adshel (Uk) 56 6 275 Oxlow Lane Dagenham RM10 7NH Adshel (Uk) 56 6 Wood Lane o/s Morrisons Supermarket, 12m S/O & Opp RM10 7RD Adshel (Uk)


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6 Wood Lane o/s Morrisons Supermarket, 12m S/O & Opp RM10 7RD Adshel (Uk) 6 LT-Wood Lane o/s 348 Adj 308 E Of Halbutt Street RM10 7RS Adshel (Uk) 145 6 LT-Wood Lane o/s 348 Adj 308 E Of Halbutt Street RM10 7RS Adshel (Uk) 145 6 Wood Lane, Opp Danette Gardens o/s 439a 50m S Of H RM10 7RT Adshel (Uk) 175 6 Wood Lane, Opp Danette Gardens o/s 439a 50m S Of H RM10 7RT Adshel (Uk) 209 6 Heathway opp 633/635 30m N Of Oglethorpe Road RM10 7RU Adshel (Uk) 94 6 Heathway opp 633/635 30m N Of Oglethorpe Road RM10 7RU Adshel (Uk) 111 6 Oxlow Lane O/S 126 E/O Heathway RM10 7SH Adshel (Uk) 87 6 Oxlow Lane O/S 126 E/O Heathway RM10 7SH Adshel (Uk) 87 6 Heathway O/S 456 15m S Of Eastfield Road RM10 7SJ Adshel (Uk) 88 6 Heathway O/S 456 15m S Of Eastfield Road RM10 7SJ Adshel (Uk) 88 6 Dagenham Road, 150 Yds W Of & opp Hardie Road, 36 RM10 7UR Adshel (Uk) 48 6 Dagenham Road, 150 Yds W Of & opp Hardie Road, 36 RM10 7UR Adshel (Uk) 48 6 Rainham Road South 30m S Of Oxlow Lane, opp 254 Op RM10 7UU Adshel (Uk) 166 6 Rainham Road South 30m S Of Oxlow Lane, opp 254 Op RM10 7UU Adshel (Uk) 184 6 Rainham Road South O/S 443-447 (Flats) 50m N Of Vi RM10 7XB Adshel (Uk) 290 6 Rainham Road South O/S 443-447 (Flats) 50m N Of Vi RM10 7XB Adshel (Uk) 162 6 Rainham Road South O/S 466 45 Yds N Of Foxlands Cr RM10 7XB Adshel (Uk) 320 6 Rainham Road South O/S 466 45 Yds N Of Foxlands Cr RM10 7XB Adshel (Uk) 320 6 Rainham Road South o/s 580, S Fo Foxlands Cres 45 RM10 7XS Adshel (Uk) 280 6 Rainham Road South o/s 580, S Fo Foxlands Cres 45 RM10 7XS Adshel (Uk) 280 6 Rainham Road South O/S 499-533 (Car Showroom) 55 Y RM10 7XS Adshel (Uk) 269 6 Rainham Road South O/S 499-533 (Car Showroom) 55 Y RM10 7XS Adshel (Uk) 269

48 335-351 Rainham Road South (City Archive Supplies) Dagenham RM10 7YA Clearchannel Billboards 137

6 Oxlow Lane, Adj To Church Health Clinic,140mw Of R RM10 7YU Adshel (Uk) 47 6 Oxlow Lane, Adj To Church Health Clinic,140mw Of R RM10 7YU Adshel (Uk) 47

Bus routes in area: No.103 No.174 no.953


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APPENDIX B – Children Centres in target wards

Children's Centres

Ward: Address:

Abbey Abbey Children's Centre North Street Barking IG11 8JA

Eastbury Eastbury Children's Centre Blake Avenue Barking IG11 9SQ

Eastbury Castle Green Children's Centre Gale Street Dagenham RM9 4UN

Gascoigne Gascoigne Children's Centre 124-128 St Ann's Barking IG11 7AD

Thames Sue Bramley Children's Centre Sue Bramley Centre Bastable Avenue Barking IG11 0LG

Heath Furze Children's Centre 1a Farrance Road Chadwell Heath Romford RM6 6EB

Heath William Bellamy Children's Centre William Bellamy Infant School Frizlands Lane Dagenham RM10 7HX


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APPENDIX C -‐ Project management plan

Project management plan (not comprehensive at this stage) Action Lead

responsibility Support

Sep

t 201

0

Oct

201

0

Nov

201

0

Dec

201

0

Jan

2011

Feb

2011

Mar

201

1

Apr

il 20

11

May

201

1

June

201

1

July

201

1

Project objectives sign off

Partnership board & Revolution

Commission insight report

Revolution Immunisation lead

Hold focus groups

Commissioned agency (Burns and Company)

Revolution

Practitioner education programme

Revolution GP contracting team; NHSBD

Develop concepts

Revolution NHSBD design team

Commission mobile vaccination provider

Revolution Priority Stakeholders

Purchase media space

Media agency Revolution

Commence dissemination of messages

Revolution

Acquire direct mail details

Revolution GPs, Child Health records

Commence direct mailing of birthday card

Revolution Partnership; Royal Mail

Mobile service vaccination delivery

Commissioned agency (EMS)

Revolution; Immunisation lead; children’s centres

Evaluation Revolution Stakeholders and target audience

Knowledge skills workshops


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10.0 References Andrews, M., & Boyle, J. (2002). Transcultural Concepts in Nursing Care. Journal of Transcultural Nursing, 13 (3), 178-180. Boyce, T. (2005). Sowing the Seeds of Doubt: The MMR and Autism Story. Unpublished undergraduate dissertation, University if Cardiff, Cardiff. Cameron J. & Littler H. (2005). Vaccine-preventable and childhood disease. HPS Weekly Report; 39, 286–7. Cismaru, M., Lavack, A., Hadjistavropoulos,,H, & Dorsch, K.(2008). Understanding Health Behavior: An Integrated Model for Social Marketers'. Social Marketing Quarterly, 14(2), 2- 32. Commissioning Support for London (2009). Increasing the uptake of MMR in London: Report of social marketing project. Retrieved December 13, 2009 from: http://www.healthcareforlondon.nhs.uk/the-london-childhood-immunisation-project Cullen, J. (2005). Why parents decide not to vaccinate their children against childhood diseases. Professional Nurse, 20 (5), 31-33. DeWilde, S., Carey, I.M., Richards, N., Hilton, S.R. and Cook, D.G. (2001) `Do children who become autistic consult more after MMR vaccinations?' British Journal of General Practice March, 226-227. Department of Health (2004). Choosing Health. HMO Stationary Office: UK. Elliman, D & Bedford, H. (2007). MMR: Where are we now. Arch Dis Child, 92, 1055-1057. Fischbacher, M. (2005). Social Marketing: Stakeholder analysis. Retrieved February 2, 2010 from: http://openlearn.open.ac.uk/mod/resource/view.php?id=323079 Friederichs, V., Cameron, J. & Robertson, C. (2006). Impact of adverse publicity on MMR vaccine uptake: a population based analysis of vaccine uptake records for one million children, born 1987-2004. Archives of Disease in Childhood, 91,465-468. Health and Wellbeing Strategy (2009). Retrieved December 7, 2009 from http://www.barkingdagenham.nhs.uk/news-and-publications.aspx GLA Population Estimates & ONS Experimental Ethnic Estimates (2006). Retrieved January 25, 2010 from: http://www.statistics.gov.uk Goldacre, B. (2008, Aug 30). The MMR Hoax. Guardian. Retrieved Feb 1, 2010 from: http://www.guardian.co.uk/society/2008/aug/30/mmr.health.media Grilli, R., Ramsay, C. & Minozzi, S. (2002). Mass media interventions: effects on health services utilisation. Cochrane Database of Systematic Reviews. Retrieved 12th December 2009 from: http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000389/frame.html Health Protection Agency. Confirmed cases of measles, mumps and rubella 1996-2007. 2008. Retrieved December 13, 2009 from: www.hpa.org.uk/infections/topics_az/measles/data_mmr_confirmed.htm.


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Kotler, P. & Lee, N. (2006). Social Marketing: Influencing behaviors for good (3rd Ed.). Sage: USA. Mosaic (2010). Population pen-portraits. Unpublished internal document, Barking and Dagenham Partnership. NICE (2009). Reducing differences in the uptake of immunisations. Retrieved January 2, 2010 from: http://guidance.nice.org.uk/PH21 Peltola, H., Patja, A., Panikki, P., Valle, M., Davidkin, I. and Paunio, M. (1998). No evidence for measles, mumps and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study. The Lancet, 351 (9112), 1327-8. Poland, G. & Jacobson, R. (2001). Understanding those who do not understand: a brief review of the anti-vaccine movement. Vaccine, 19, 2440-2445. Taylor, B., Miller, E., Lingam, R., Andrews, N., Simmons, A. & Stowe, J. (2002). Measles,mumps and rubella vaccination and bowel problems or developmental Regression in children with autism: population study', British Medical Journal 324: 393-396 UCL (2008). How Can MMR Uptake Be Increased? A Literature Review And Intervention Feasibility Study. Retrieved October 4, 2009 from: http://www.healthcareforlondon.nhs.uk/assets/Children-and-young-people/UCHL-How-can-MMR-uptake-be-increased-Final-report-to-NSMC.pdf Wakefield AJ, Murch SH, Anthony A, et al. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet, 351, 637–41. //ENDS

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