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Kevin Finnerty "The Dance"
- 1. The Dance Between Communications and Policy … or how the magic that ensues when both work together
- 10. Going Backstage on Social Policy
- 11. Seeing through the issue… An inside look at self-administered colon cancer screening.
- 14. Colon Cancer - The Good News
- 15. If you ’ re 50 or older, in order to prevent this…. A cancerous colon polyp
- 16. … we would like you to get this...
- 17. … and do this
- 19. What do people know?
- 20. The Bottom Line
- 23. The Magic Idea You’ re not see-through, so get your insides checked out.
- 24. The Ad
- 29. Mumps Facts
- 31. Objectives
- 35. The Video
- 39. The Gap
- 40. The Policy The expansion of this program means more kids will have access to dental care so they can grow up healthy and strong, and have the best possible opportunities for success . Minister Deb Matthews
- 42. The Research
- 43. The Research
- 45. The Research
- 46. Parental Influence Peer Influence Kids 0-5 Kids 6-10 Kids 11-13 Kids 14-17 As children age, parental influence diminishes and a stronger sense of self emerges The Approach
- 47. The Approach
- 48. The Approach Place logo ‘HERE’. Scalable communication tools to help raise the profile of the public health unit in their community/through their channels of influence
- 49. Minister ’s announcements at a public health unit.
- 52. Thank You.
Editor's Notes
- In the public sector, it ’s essential that policy and communications people involved in the creation and implementation of social policy learn to be great dance partners. The two must be intertwined. When we’re dancing in separate solitudes it does not really make for harmonious, well-choreographed social policy.
- Now, normally at these conferences you get to see the end result of the campaigns once the agencies get hold of them and work their creative magic. Certainly, in a segment later on, introduced by my colleague Yvette Thornley, you ’ re going to be treated to three such presentations on the latest crop of amazing behaviour-changing campaigns. But what about the process before the ad brief is even drafted and talent and wardrobe selects are confirmed? How do we create, shape and make palatable the substance that lies beneath and behind those great moments of communication?
- There are magical moments for us public servants, believe it or not! By that I mean the opportunity to add a little communications pixie dust to policies and programs as they are being developed. We have a saying in government: you can make a good policy great with communication. But there ’s no way to communicate a bad policy well In communicating a good policy, you need to make it relevant and beneficial for those it is intended to help.
- The “product” of many private sector companies is pretty well defined. I don’t claim it’s easier to promote soap or SUVs and I’m sure it has its massive challenges. After all, you have to get people to part with their hard-earned cash after they yield to compelling campaigns.
- Selling social change has its challenges. And it takes time. Canada has been in the forefront of advancing some incredible social policies. Relevant, beneficial, enriching for society…Such as…. Same Sex Marriage
- Giving women the vote…..it took a while in Canada. But once the momentum got started in 1916 in Manitoba it kept going until all women were able to vote in this country by 1940. It takes time for social policy to take root.
- Tommy Douglas, a Canadian legend – officially - according to the CBC ’ s the Greatest Canadian vote in 2004 for introducing universal health care to Canada in 1961. Again this took a while to catch on but by the early 1970s, the whole country lead the way with health care for all.
- So, if your product is a behaviour change how do you apply the 4Ps, the principles of marketing to that? In the world of social marketing – the discipline which helps communicators, like us, who work in the public sector to change behaviour for a societal ‘good’ – these principles (product, price, place, promotion) are of equal relevance.
- I ’m going to talk to you today about what happens upstream from the project brief that many of the agencies in this room see when we march down to the Advertising Review Board with high hopes in hand. There’s a lot of work that goes on before. It ’s a great untold story and I’m going to pull back the curtain a little to let you go back stage.
- So when I get a call about a new policy, what we get to see and what ends up in our campaigns, are quite different. Let me show you what I mean by way of some examples… The first one is about preventing colon cancer through a broad-based colon cancer screening program.
- We start with the policy challenge. In 2006, the province decided to launch a province-wide colon cancer screening program – ColonCancerCheck, the first of its kind in Canada - using the FOBT – or Fecal Occult Blood Test. It ’ s a test that people can do at home and it was deemed by health care experts to be the best way to get people screened for colon cancer. It would also save lives.
- The facts are pretty grim: 2 nd leading cause of cancer deaths in Ontario 7,800 Ontarians are diagnosed annually 3,250 Ontarians die each year from colorectal cancer Less than 20% of Ontarians aged 50-74 screen for early detection using Fecal Occult Blood Test (FOBT) The Canadian Cancer Society released a report in April 2006 saying that the number of colorectal cancer deaths could be reduced by 17% if 70% of Canadians, aged 50-74, had an FOBT screen every two years In Ontario: Cancer Care Ontario (CCO) pilot (March 2006) tested for FOBT through mail delivery – 1% uptake yet this was the model being considered for Ontario But there is a light on the horizon….
- The good news: colon cancer is 90% curable if detected early. So the facts were staring us in the face – we could save lives but the majority of people were just not taking the test. A major issue was the lack of understanding of the FOBT among family practitioners who believed that a colonoscopy was the gold-standard for colon cancer screening. But this is a time-consuming, expensive screening tool and for this reason, there was reluctance to use it unless absolutely necessary. So the province announced its plan to fund a five-year, population based screening program for anyone over the age of 50, the first of its kind in Canada. We knew that we had a major uphill battle to: Have a difficult conversation about cancer – no matter how much good news there was Encourage people to engage in taking responsibility for a serious health issue – for themselves, and not hand over the responsibility to their doctor, which so many of us do. Get people to line up to – let ’s face it – to do something very icky. What I mean by that is, as communicators we had a tough challenge on our hands.
- Because we needed to get through to people that if they wanted to prevent this……which, by the way, is a picture of a nasty cancerous polyp……
- … we were asking people to use this. This is the Fecal Occult Blood Test stool sample stick and smear cards.
- … and then people had to undertake the test at home. So, to recap……our policy colleagues assigned us the task of helping the government talk to the general population about a nasty cancer of the rear end which, if we ’d only just get over our embarrassment and queasiness, could be prevented, save lives and, oh by the way, to do that we want you to poop on this stick for three days running then pop it in the mail to a local lab. Then you’ll get the results back. In the mail. Good or bad. Okay? What ’s that…….oh, and you want us to send the kits via a householder (that’s unaddressed admail to those in the know) through Canada Post as a birthday surprise when you turn the big 5-0? Because that’s how they did it down under, I mean in Australia? So…..you see the challenge.
- In order to truly understand the marketplace and our target audience, we did substantial research to understand how our target viewed colorectal cancer and various screening methods. We also wanted to know what would motivate them to do what it is we want them to do – and that is screen early using an FOBT test To complicate things, we knew people were embarrassed to talk about that part of their body, the test itself is icky – you ’ve got to mess with your poop and it’s not pleasant and there are a lot of steps to go through Policy had turned up research from other jurisdictions on the recommended approach (i.e. mail delivery) and we needed to test this, in order to provide an informed opinion on how this approach would/would not work here in Ontario. Here ’s what we found out about what people knew and how they would like to be informed/educated. We learned that awareness about Colon Cancer was low (18% were very familiar with risks/symptoms, 21% were very familiar with risk factors) That on the social marketing continuum - our strategy needed to begin with building awareness before we could expect people to take any action to screen Knowledge about the disease was around late stage symptoms – We needed to educate people about early warning signs could be detected through screening And in terms of key drivers - the fact that knowing that cancer could be growing in your body – that there could be a polyp the size of a golf ball in your colon and you don ’t know it or feel it, was a motivator for early screening Knowing that colon cancer is 90% treatable when caught early was important People were much more likely to be tested if their family health care provider recommended it after a discussion (80% of 50+ said they would get tested based on their physician ’s recommendation) Family Physicians attitudes re: FOBT - neutral to non-believers – colonoscopy, the gold standard
- The success of the colon cancer screening program relies on primary health care providers ’ involvement in the screening and a focus of any cancer screening program should be on follow-up and compliance , vs test distribution Program should be delivered through an integrated delivery model, strengthening the role of primary care providers: Individuals would pick up Fecal Occult Blood Test kits from primary care providers including nurse practitioners and local pharmacists and not look to Canada Post.
- At this stage we were heavily engaged with our agency partners – BBDO and National
- We focused on the strategic insight from our research – that you don ’t know what’s going on in your body until it could be too late – since there are usually no obvious early warning signs This led us to the “magic idea” and the key message that became central to all the creative we developed
- We worked with our advertising partner BBDO to develop the magic idea – it was simple. You ’re not see through, so get your insides checked out. We also worked with our PR partner, National, to leverage this idea at the community level.
- Play TV spot.
- Incidences and Intention to Screen Within a four month period (February to June 2008) we saw a 10 point increase among Ontarians saying they were screened for CRC and for those who had not been screened, a full three-quarters (75%) now intended to be screened. How people are being screened? Prior to the program launch, only 5% of Ontarians had used an FOBT Kit as a means to screen, with colonoscopy as the predominant screening method. In June of 2008, this figure had increased to 22% and colonoscopy usage had dropped 10 points. In-market performance For the first nine months of the program over 400,000 ColonCancerCheck branded FOBT kits were delivered to health care providers and 280,000 were completed by Ontarians.
- Through research we were able to not only show how a made-in-Ontario solution was the only way to go - to respond to requests to adopt the approach of other jurisdictions. The research also gave us some really good data about who the early adopters (critical to any SM campaign) were and therefore how we would construct the plan for the short and long-term. We focused only on the 50+ Ontarian. We did not dilute our efforts. We knew what the barriers and drivers were for the target audiences – including health care providers – so were able to create tools and information that addressed them directly. The creative, thanks to our great agency partners BBDO, hit the right note with the target to introduce a light touch without going heavy on the humour. Not an appropriate approach for this topic. Critical was the dovetailing of all communications and marketing efforts with the operational rollout which involved numerous ministry staff, Cancer Care Ontario and other stakeholders.
- Between 1970 and 1996, infants were immunized against Measles, Mumps and Rubella with a single vaccination. Beginning in 1996, this was changed to two doses which offers more protection. There was a small catch up component to the vaccination program; however, this still meant that people born between 1970 and 1990 were susceptible to the mumps.
- In the meantime across the United States and Canada, there continued to be localized outbreaks of mumps, particularly with kids in college and university. Concentration in this group was mainly due to close living quarters, social habits, going to bars, sharing drinks, hooking up. The Disease Mumps is an acute viral infection characterized by fever, swelling and tenderness of one or more salivary glands, usually the parotid glands (in front of the ears). Complications of mumps infection can include hearing loss, pancreatitis, orchitis (inflammation of the testicles), meningitis/encephalitis and spontaneous abortion. Mumps is spread by direct contact with respiratory droplets, or the saliva of an infected person. The incubation period is usually 16 to 18 days but can range from 14 to 25 days. A person is infectious to others for up to 7 days before to 9 days after the onset of parotitis.
- So, in 2008, the Ontario government made a decision to fund a 1-year catch-up vaccination program to help prevent further outbreaks of mumps in colleges and universities as there had been several across Canada and more cases were cropping up in Ontario. But we faced a few barriers. Vaccination model Usually, vaccinations like this are delivered through regularly scheduled public health clinics through schools. There are no regular clinics in colleges and universities. This mumps catch-up vaccination was over and above that schedule and it was a one-shot deal. Public health didn ’t have the infrastructure – funds and staff – to do this The best people to administer the shot was the family health practitioner BUT Most people at risk of catching and spreading mumps in the target age-group of 18-24 were at school which means they ’re away from home and their usual caregiving team of mom and doc. Attitude They are young and they are healthy They often don ’ t have regular medical check ups Timeframe Short implementation time frame - had impact on overall uptake; limited # of campus clinics planned in an 8 week period Budget Budget cuts affect performance – impact of eliminating parents and providers as key influencers
- Primary Program Obectives To decrease the number and severity of mumps cases Offer mumps-containing vaccine given as MMR (combined measles, mumps and rubella) to all students attending a post-secondary institution to complete two doses for optimal protection Secondary Program Objectives: To ensure access to immunization through physicians ’ offices, nurse practitioners, and community health centres including university and colleges Program area estimated based on other vaccination programs directed to young adults an uptake of 40% of 1mm adults 18 - 25 or 400,000 people. But we needed to do some work to manage this expectation, given what we knew about other factors such as timing, availability of health care providers to give the shots, motivating students away from home etc. So we turned to research to help us.
- Know your target audience: CIB custom quantitative research indicated that expectations of high uptake was optimistic : Little perceived risk or susceptibility : Awareness for the disease and its severity are low Low motivation to act: Only 35% of students surveyed said they were very likely to get the shot (low motivation to act) Highly mobile cohort: There is a high degree of difficulty targeting this highly mobile age group some of whom may reside out of province Soft knowledge of vaccination history: Sketchy knowledge of vaccination history will require coordination between parent and child adding a difficult dimension to vaccination uptake We also learned through our quantitative research that this target group had little knowledge about mumps as it was perceived as an infant disease and they didn ’t really know or remember anyone being sick with mumps. Parents themselves were not vaccinated against mumps when they were young and may have become sick with the mumps and ‘survived unscathed’ like many other common childhood diseases – explaining their low level of concern. We also learned that parents and health care providers were key influencers of this age group but the young adults were basically in control of the decision to vaccinate or not Still, it was important to reach these influencer groups to support participation in the program. However, the overall budget was reduced considerably and a decision was made to do a good job against the primary target rather than spread ourselves thin against all three audiences
- Our qualitative research helped us understand that while there were some symptoms/complications of getting mumps as an adult that made our target group pay more attention (males – swollen testicles and females – their appearance) the one consequence of getting mumps was that a person would have to stay home and be isolated for 9 days. That meant missing out on all sorts of things like sports, exams, parties, hanging out – “9 days - that means 2 weekends!”
- At this stage we were heavily engaged with our agency partners – Rain43 and Hill & Knowlton Our communications objectives were to: Create awareness among 18-24 year olds (bulls eye target) that they may not be fully protected against Mumps Create awareness of the medical complications of getting Mumps as an adult Motivate 18-24 year olds to get their second mumps shot Work with the PHUs to promote awareness of the campus clinics and encourage participation Drive the target audience to Ontario.ca/mumps to get more information We learned from the research that students wanted to know that the messaging was coming from a credible source like the Ministry of Health and not some pharmaceutical company in disguise We built an integrated marketing plan utilizing paid, earned and social media, online, on-campus and guerrilla marketing all built around a core insight discovered through qualitative research: ISOLATION We worked side by side with public health units to increase the successful delivery of on-campus clinics We surrounded our target audience with motivating mumps vaccination messages where they lived, schooled and played Pre-promotion advertising blitz on campus Pre-promotion grassroots campaign Collateral Clinic promotion
- We also created this viral video which captured a lot of attention and got the ball rolling, so to speak, with vaccination for this hard-to-motivate group. [Play Mumps video.]
- Long line-ups at most clinics Deterred some students Students were turned away when clinic hours were over Some clinics ran out of vaccine Over 1,000 vaccinations administered each week of the campaign Many students were in programs that required them to be up-to-date on their vaccinations (ECE, Nursing, etc) Commuter schools tended to have lower uptake - students would visit their healthcare provider for the shot The Results: It ’s estimated that over 30,000 vaccinations were administered throughout the duration of the campaign (Jan – Mar). 83,695 total video views across all channels and still growing Hockey – 87% Party – 13% Hundreds of positive social media mentions 68,125 visits to ontario.ca/mumps Received coverage on nearly every major news broadcast station and media property in Canada Appeared in Huffington Post as one of the wackiest public service announcements ever 2 page spread article in June ’ s Marketing Magazine 60% of students who got their mumps shot agreed that the campaign influenced their decision to do so
- Good dental health is directly linked to good overall health Cavities are the number one chronic disease of childhood Almost all oral/dental disease is preventable A significant portion of the population does not have access to regular dental care Twenty-five per cent of children experience 80% of all dental decay Lack of access to regular dental treatment significantly impacts overall health and socioeconomic success
- A significant portion of low income families are neither on a government assisted program or belong to a private dental plan through their work – these are the ‘working poor’ Hard working and proud, they essentially lack access to regular dental care
- As part of the Poverty Reduction Strategy, this program is designed for the working poor. For families with a net adjusted income of $20,000.00 and who do not have access to a dental plan or other forms of dental health coverage. Preventative dental care and treatment will be offered free of charge to children 0-17 through public health unit dentist clinics. The program is meant to close the gap so that all Ontarians in need have access to dental care.
- 36 individual units working independently to rollout a single provincial program. There was a glaring need for a common voice to mitigate public confusion on who is eligible for the program. And moreover, the program was designed before doing research with the target audience to understand their needs/wants/barriers/beliefs and motivators. Before CIB began to develop it ’s social marketing strategy – we knew we needed to get a deep understanding of the lives and dental habits of these families that we were trying to influence and change behaviour.
- First we needed to understand the factors that made our target audience poor dental health managers. Through research we learned that they: Don ’t plan ahead for their dental visits Wait for a dental emergency to arise before seeing a dentist Do not correlate good dental health to good overall health Shop around for the best price
- Parents and children experience anxiety around dental visits and view this as a barrier to receiving care – they avoid going We learned that the relationship with one ’s dentist was similar to the relationship with one’s doctor and that our families wanted to have the option to stay with their own dentists in order to participate in the program. Moreover, we found that awareness and understanding of the role of public health units was soft and many families did not feel comfortable only being able to receive dental services from a PHU Low income families wanted the service to be delivered by their regular dentist with whom they had a relationship with and trusted. They were not about to give that up. . This insight led to a refinement of the program delivery to provide more services outside of public health unit clinics on a fee-for-service basis. A client card was developed to take to a private dentist or hygienist participating in the program for easy payment.
- Our target told us that most government programs are extremely complicated to access and it is demoralizing to have to fill out all the forms and answer all sorts of personal questions only to find out that you don ’ t qualify after all. We created easy access to the program by offering a single point of entry and coordinate it across 36 different public health units. : We provided a 1-800 # and a digital hub to triage eligibility questions and direct people to their local public health unit to complete the process.
- We also learned that inherently, every parent wants to be a good parent and that most parents understand the importance of regular dental care for their children. However, the biggest barrier to receiving regular dental care was cost. Dentists are expensive. Sometimes it is a decision between putting groceries on the table and hoping that a tooth ache goes away on its own. The fact that this program was free to eligible families, would be a great motivator to participate.
- We also learned that the younger the child was, the more influence parental behaviours would have on a child adopting good oral health practices. We needed to build a social marketing framework to: Break the cycle of poor oral health habits that were being passed on by generation to generation. We wanted to focus on parents with young children 0-5 – teaching the parents how to teach their kids good oral health habits – like brushing and flossing every day - so that this behaviour could be passed on to their own children and their children ’s children and so on.
- We needed to create a positive brand for a dental program designed for low-income families without stigmatization – Healthy Smiles. Note that nowhere does it say: “Low Income” or “free”. This was important.
- We created a comprehensive tool kit for public health units to promote the program while at the same time ensuring consistency in brand look and feel and key messages.
- The program is just rolling out across the province. Now hundreds of children who didn ’t have access to regular dental care do!
- It ’s been a long haul but we’re finally, slowly, pulling away from social change by news release. The last 11 years have seen us go from a news cycle focus, through the one-way-push-out “public education” era to social marketing. OPS communications staff play a major role in clarifying the business goal and laying the foundation for the strategy so we get a sound end product by fully integrating with the policy process, end to end Upstream involvement of social marketing expertise in the policy process improves end product Midstream engagement of those who are critical influencers Downstream implementation using the full marketing mix, and the 4Ps principles of product, price, place and promotion Research, research, research is the key to great social change marketing. It ’s also the critical success factor in building credibility for us as social marketers with our policy colleagues. They understand and believe evidence and data instead of – shocker! – communicators!! In addition to research, ROI is key to showing results over time and the value of continuing – or not. If you have trouble understanding how this is done, I can tell you we ’ve done it.
- How many here get their flu shot every year? How many got it this year? It ’s still not too late by the way!!! Thankfully we have better data than this show of hands! 11 years of it, in fact and from this we can tell how the program is working and, more importantly for us, what kind of impact our communications strategy is having. We know we can influence behaviour through social marketing practices and have developed our own means of gauging it. For example, we have analysis that shows the impact the different media mix has on whether people get their flu shots. You ’ll be hearing a bit more about flu later but I just wanted to share with you that there’s a correlation between media investment and flu shot uptake. Our uptake this year on the flu vaccine in about 24% when we would normally be in the low 30 per cent range. One of the key reason is the absence of television advertising which is viewed by one of our key audiences – seniors.