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:

★☆

2

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

★☆

3

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

★☆

4

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).

★☆

5

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.

★☆

6

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

★☆

7

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.

★☆

8

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

★☆

9

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.

★☆

10

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

★☆

11

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

★☆

12

• 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

★☆

13

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

★☆

14

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

★☆

15

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

_______

A

____________

C

_________________

I

★☆

16

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.

★☆

17

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.

★☆

18

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

★☆

19

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

★☆

20

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.

★☆

21

• 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)

★☆

22

• 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

★☆

23

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.

★☆

24

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.

★☆

25

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.

★☆

26

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.

★☆

27

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

★☆

28

• 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
POWER
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.

★☆

29

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 2
nd
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

★☆

30

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

★☆

31

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

★☆

32

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.

★☆

33

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.

★☆

34

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 dataPopulation group
Receptive Non-receptive
Group 1 TV; Radio; Posters Magazines; Newspapers; Internet
Group 6 Posters; Telemarketing; TV Magazines; Internet; Broadsheet newspapers

★☆

35

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
• Phone boxes (CBS Outdoors) – within target wards and near children’s centres and health
• Lamp-post banner advertising – within target wards and near children’s centres and health
• 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

★☆

36

• 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

3. MMR Social Marketing strategy - Barking and Dagenham - SW project

3. MMR Social Marketing strategy - Barking and Dagenham - SW project

Recommended

Recommended

More Related Content

Viewers also liked

Viewers also liked (6)

Similar to 3. MMR Social Marketing strategy - Barking and Dagenham - SW project

Similar to 3. MMR Social Marketing strategy - Barking and Dagenham - SW project (20)

3. MMR Social Marketing strategy - Barking and Dagenham - SW project