The catch your breath campaign was aimed at older couples and people with relatively low incomes. Despite suffering from multiple chronic diseases, they rated their health as good to middling, revealing very low expectations of their well-being.
'We knew we could improve the quality of life for these groups,' says Liverpool's director of public health Paula Grey. 'We just had to convince them that living with a cough didn't have to be a normal part of their life.'
ChaMPs public health network worked with Dr Foster Intelligence on behalf of NHS North West to develop and implement the campaign. With one of the UK's highest rates of chronic obstructive pulmonary disease, the strategic health authority wanted to provide something more lasting than a quick, temporary rise in the numbers of people contacting smoking cessation services.
Catch your breath used a three-stage approach to reach more than 4,000 households in the Liverpool, Knowsley and Halton areas. The stages were:
warm-up: a local poster and leaflet campaign to raise awareness of the disease, its causes and methods of prevention;
telephone health champions: a telemarketing campaign offering written information, referrals to smoking cessation services and a follow-up call;
follow-up and analysis: all information requested was sent out and a post-campaign survey completed.
The campaign's results greatly exceeded expectations. Sixty-five per cent of households contacted requested an information pack - the target had been 10 per cent.
'We knew we were doing something right when the numbers started coming through,' says Martin Machray, project manager from Dr Foster Intelligence. 'This is the type of project we need as an example to use in other areas of poor health.'
'The project was a success because the first step we took was to listen to the community, followed by putting plans into place to act on their suggestions,' adds project lead Dr Diana Forrest, Knowsley director of public health.
Focus groups quickly established that the target audience felt the benefits of inaction outweighed the benefits of action, especially around stopping smoking and treating smoker's cough and breathlessness.
Change of tack
Many people were tired of the repetitive, negative messages they received from their GP about quitting smoking and wanted to find other, more positive ways of putting across the messages. Although smoking was the norm among group members' peers, they were increasingly aware of the negative perception smoking had in society.
It was generally accepted in the focus groups that quitting smoking was not for them because they were 'too far gone' and 'the damage has been done', as well as smoking being 'one of the few pleasures of life'. As one focus group member said: 'Kippers are smoked and they last longer than fresh ones.'
The project team decided the campaign would work because it:
offered simple solutions to a problem;
involved the area's strong social networks by using local heroes and success stories;
was presented independently of the usual NHS brand.
By encouraging residents to dress for the weather, stay warm at home and take general precautions like getting a flu shot, the campaign was able to present smoking cessation as part of the way to better health, not the only way, and thus promote a stronger understanding of the symptoms and causes of COPD.
The British Lung Foundation's Breathe Easy network was used to disseminate the message, alongside stories of local people successfully kicking the habit and improving their health. Examples include:
'Catch Your Breath, like Eddie, an ex-paratrooper and retired sales manager. He's got emphysema and is keeping warm this winter.'
'Catch Your Breath, like John, a painter and decorator from Liverpool. He quit smoking and can now run for the bus.'
'Catch Your Breath, like Lynne, a retired nurse from Runcorn. She wraps up warm in winter so she's less likely to pick up an infection.'
Leaflets and posters contained tips about managing breathing, ways to get enough exercise and keep warm and quick recipes.
The campaign resulted in:
87 per cent of households with smokers requesting a quit-smoking pack;
30 per cent of households with smokers asking to be referred directly to the smoking cessation services;
65 per cent of households contacted asking to be sent an information pack;
47 per cent of households contacted asking for a follow-up support call.
'We were delighted with the response,' says Dr Forrest. 'We could see that for this particular target audience, telemarketing was really effective, and would be worth using again in the future.'