Aplicación de la Teoría General de Sistemas (T.G.S.)

• It is clear that informal campaign approaches based on, and in, Internet culture and which engage such elements as memes, do have resonance with certain groups of women.

Additionally, humour is seen to be an important ingredient for many. However, the content of such campaigns needs to be nuanced appropriately in order to be able to engage a wide range of women.

• In the case of this particular campaign we see that not everyone likes cats and thus the potential for engagement is limited somewhat by this. Therefore, future campaigns should consider a greater range of audience research to interrogate the possibility of finding other aspects of popular and Internet culture that may have broader appeal across diverse groups in order to maximise campaign impact. This might involve the development of a broad campaign idea that has wide appeal but with various strands that can be easily customisable to better target a variety of audiences.

• Whilst there is diversity in audience tastes, there are possibilities for reaching broader audiences with the same idea. For example, in this campaign, although not all the south Asian women we spoke with did not readily identify with the use of cats (and the culture of having pets), some did and were happy with more light hearted approaches. We suggest that a balance needs to be struck between the generic and the specific and more work is

undertaken in this area to understand such nuancing.

• Through our analysis of the best practice cases studies we were able to access, four potential guiding themes for future campaign developments are suggested:

o The use of real women and their real stories to spread the message can be helpful, but they are not always necessary.

o The use of culturally appropriate imagery, language and materials is essential where a very specific group with specific needs is required. However, the parameters of what constitutes such a group has to be laid out. As this campaign shows, there is diversity amongst groups whom are often thought to require specific interventions.

o Advertising campaigns, and particularly digital only campaigns, are not enough and community based outreach approaches need to be considered. This is particularly the case again with those groups identified as having specific needs.

o Embedded evaluation within campaigns is necessary to measure effectiveness of the health promotion and intervention for ‘who’ ‘when’ and ‘how’.

• Based upon our research of this campaign, our previous work with the LGF, our analysis of prior practice and current data regarding falling coverage rates we would suggest that investment is made in a centralised, national, large scale multi-year campaign. Ideally, this campaign would have a ‘mass market’ friendly brand, with customisable elements that would take account of different audience needs and media consumption practices. Key to this campaign would be the integration of solid continuous evaluation mechanisms. We point to some of these evaluation mechanisms in this document as related to the digital, but there are other approaches possible too if the campaign was to be larger scale. There is, for example, potential here to draw on national health agency and social media generated ‘big data’ in very fruitful ways if institutional cooperation can be mobilised appropriately.

• It is also recommended that the infrastructures and policy surrounding the commissioning, delivery and archiving of campaigns are reviewed. Cervical screening coverage rates are falling yet clearly investment is being made in interventions. That said, many interventions’ findings are not shared and best practices are lost. Moreover, systematic evaluation data is not collected to allow for meta-analyses. Given this, we would suggest that consideration is given to the development of a network across public health organisations with respect to campaign development, to share knowledge and evidence to move forward and address the decline in coverage. There is a need to develop a national archive of resources, developed and tested successful campaigns that can be transferred and replicated across different areas without ‘re-inventing the wheel’. Methods and tools which capture and evidence links between interventions and behaviour change also need to be developed as does a

framework for determining where they should be used in campaigns and where not. It is important to note of course that for some types of intervention, making direct links to behaviour change is not possible and also might not be the primary motivation. Further, the impact of long-term sustained campaigns compared to short-lived initiatives needs to be evaluated. We would suggest that much of this activity could be written into future contracts awarded to those working on campaigns, however, institutional structures are required which can provide appropriate support in areas such as the provision of access to networks and data for example otherwise initiatives may fall short.

• During our work on the campaign we have gained insights from health professionals and women of screenable age regarding the invitation letters that women receive. This feedback is negative, pointing to the letter being loaded with medical jargon and not being of the right tone. It is for many of the women we spoke with a disincentive to attend. It is therefore suggested that further work is undertaken to review the content of this letter in conjunction with women of screenable age. Moreover, it may also be helpful to consider further the mechanisms by which invitations are issued. For example, we are aware that in some households, where South Asian women reside, relatives open letters and this can act as a barrier to attendance. The question therefore arises as to whether such invitations could be extended in other ways, for example via a simple request to attend for a health check at a local GP clinic where at that point the invitation letter could be passed on or discussed in private. To be clear, we are not saying this is necessarily a practical way forward, more we provide it as an example of how thinking regarding how mechanisms of invitation might work.

Cervical Screening Report

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