1. Cancer Research UK Generic Campaign Presentation of Research Findings May 2012 Prepared for:Cancer Research UK Prepared by:Research Works Ltd, Regency House, 219a, Hatfield Road, St Albans, Herts. AL1 4TB (01727 893159) 1

2. Campaign activity  19 th March for 4 weeks  2 insertions of press per week – in both inner and outer areas for the full 4 weeks  Billboards, posters, telephone boxes and Ad-van – in inner area for the full 4 weeks  CRUK Roadshow van – 6 days in inner area  NHS iVan – 10 days in the inner area  Warrington Wolves event 30 th march – attended by 4,500 home supporters (inner area)  Direct Mail sent to inner area 28 th -29 th March * NB: inner and outer campaign areas illustrated by map 2

3. Campaign activity – Roadshow and iVan 3  The roadshow and iVan bring conversations about cancer into the heart of communities Prompted conversations between family and friends – and with staff Information distributed (500 leaflets!) even amongst those who do not wish to talk Advice and supported offered by staff for those who are concerned, as well as the opportunity to take part in BMI measurement or smokerlyzer breath test  Roadshow contacts all C2DE: from a 14 year old smoker to an 88 year old cancer survivor  Ivan volunteers targeting men

4. Campaign materials  The campaign creative was developed by consulting both the target audience and health professionals Impact was created by a headline delivering a compelling statistic and clearly identifying the subject matter – surviving cancer The motivation to act was delivered by a local peer’s ‘real life story’ A clear call-to-action concludes the story With a final reminder about the purpose of the communication ‘spot cancer early’ delivered by the url 4

5. Campaign area 5 Warrington has experienced high unemployment due to the recession. Today, about a third of the population are economically inactive (due to retirement, ill health or full-time carer status). Some areas of Warrington are experiencing increasing levels of deprivation and ageing populations There is a total population of around 200,000 the majority of whom are White British

6. Research objectives, method and sample 6

7. Research objectives  Main campaign pre & post activity: Recall of cancer communications in past month Recall of the campaign amongst the target group  Direct Mail campaign: to establish: Readership amongst the target group Initial reactions/reactions e.g. appropriateness  Both campaigns: Establish awareness of the campaign messages Impact on awareness of the improvements in cancer outcomes Impact on awareness of the benefits of early detection/diagnosis Impact on intentions to visit the GP with an unusual or persistent change Impact on confidence in talking to the GP 7

8. Research approach  The evaluation assess the impact of the campaign overall and a more in-depth assessment of the impact of the Direct Mail activity  Main campaign pre & post stage research comprising: Quantitative survey in-street Warrington pre & post activity 508 interviews pre stage & 499 interviews post stage Inner and outer campaign areas (time pressure and change in location precluded ‘control’ and ‘test’ areas) Observation – 2 days Cancer Research Awareness Roadshow & iVAN with film footage  Direct Mailing Using the Direct Mail contact lists, 70 telephone interviews completed All respondents aged 50+, C2DE and recalled receiving the mailing In addition, 12 face-to-face follow up depth interviews 8

9. Sample Pre & Post: overview  508 interviews completed pre: 275 inner v’s 233 outer  499 interviews completed post: 260 inner v’s 239 outer  Matched quota sampling in both the inner and outer campaign areas to ensure comparability pre and post: Gender Aged specified Socio economic group  Only difference between the inner and outer samples is the % of DE respondents: Inner area (60% pre and 62% post) Outer area (53% pre and 61% post)  No other significant differences in the pre and post samples were identified 9

10. Sample Pre & Post: in detail Female Pre total 52% (262)Inner 51% (139)Outer 53% (123) Post total 52% (258)Inner 55% (142)Outer 49% (116) Male Pre total 48% (246)Inner 49% (136)Outer % (110) Post total 48% (241)Inner 45% (118)Outer 51% (123) Age – 50-70 years old Pre total 65% (328)Inner 64% (175)Outer 66% (153) Post total 65% (324)Inner 64% (166)Outer 66% (158) Age – 71+ years old Pre total 34% (172)Inner 35% (96)Outer 33% (76) Post total 35% (175)Inner 36% (94)Outer 34% (81) 10

11. Sample Pre & Post: in detail (2) SEG C2 Pre total 42% (214)Inner 39% (106)Outer 46% (108) Post total 38% (192)Inner 38% (99)Outer 39% (93) SEG DE Pre total 57% (289)Inner 60% (166)Outer 53% (123) Post total 62% (307)Inner 62% (161)Outer 61% (146) Base: Pre (508) Post (499) 11

12. Sample Direct Mail  Significantly more women and DE respondents in the direct mail sample reflects deprived nature of inner campaign area and women’s role in maintaining the health of the household  70 telephone interviews with those who recalled receiving the Direct Mail 567 people were telephoned and 12% agreed to be interviewed  52% did not remember getting the leaflet and letter  11% remembered getting the leaflet and letter but didn't read it  25% refused to take part/not interested Base: (70) 12 29% 71% 44% 56% 77% 23%

13. Campaign and evaluation dates 13 Research taskDates Be Clear on Cancer Campaign Activity 30 th January to 19 th March including TV, radio, press and poster activity Pre-stage quantitative1 st – 6 th March Observational visitsCRUK Roadshow 14 th March iVan at Warrington Hospital 22 nd March Campaign from 19 th March – 13 th April Direct Mail sent 28 th – 29 th March Direct Mail qualitative interviews10 th and 11 th April Direct Mail quantitative interviews3 rd – 13 th April Post-stage quantitative12 th – 17 th April

14. Overall approach to sampling, weighting and statistics  Data not weighted – statistical analysis shows that sampling approach achieved matched samples (which was the key requirement)  Therefore, we can be confident that any significant changes pre to post are due to differences in attitude, not differences in sample profile  Statistical testing was carried out to assess whether differences between pre and post and inner and outer samples were statistically significant (using a confidence interval of 95%)  Figures marked ‘*’ denote a significant difference at 95% pre v’s post 14

15. Main Findings 15

16. Recall of cancer communications Have you seen or heard any advertising or received any communication which talked about cancer in the past month?  8%* rise in recall pre v’s post  There was higher recall across the whole sample (i.e. both inner and outer areas) amongst: Women (strong role in maintaining health of the household) 50-70 year olds (the younger end of the campaign audience) C2 group those living in the inner campaign area Base: all pre (508) post (499) * significant difference at 95% pre v’s post 16 TotalInnerOuter Pre60%59%63% Post68*%68%

17. Recall of activity – (unprompted + prompted) Can you tell me where you have seen, read or heard it? TV DM Radio National Newspaper Local Press Poster /Billboard 72% 77% 60% 10% 17% 16%* 20%* 6% 16% 3% 8% 6% 12%* 11% 21%* GP 3% 8%* 5% 20%* 3% 12%* 20%* 6% 3% 13% 17% * NET unprompted + prompted 17 Base: all recalled pre (303) post (341) * significant difference at 95% pre v’s post  The influence of the ‘Be Clear On Cancer’ campaign is clearly indicated by high recall of TV activity However, there are significant increases in recall of direct mail, local press, and poster/billboard activity post-campaign which seem more likely to be the result of CRUK activity 3%

18. Recall of activity – (unprompted + prompted) Can you tell me where you have seen, read or heard it? (2) Magazine Phone kiosk Leaflets handed out in street Ivan Hospital /pharmacy/ dentist Cancer Awareness Roadshow Local Event 3% 7% 3% 8% 1% 2% 1% 4% 2% 3% 5% 2% 9% 1% 2% 1% 2% 1% 18 Base: all recalled pre (303) post (341) * NET unprompted + prompted 2% 0% 1% * Less than 1%

19. Campaign activity – Roadshow observations  Although the Roadshow and Ivan may not feature in the quantitative results, their effect on individuals must not be overlooked 19 “I read this leaflet, so where should I go to get something checked out? Would it be a nurse or a doctor?” Conversation between an older man sitting with his family and a vicar in Warrington Hospital, discussing the leaflet and how much more hope there was of surviving cancer now than 40 years ago.

20. Campaign activity – Roadshow observations (2)  Reactions to the Gill and Eric leaflet 20 “It’s a useful piece of information to read. You can never know enough about cancer. I know we have to catch it quick to stand a chance.” “It’s useful. I will probably keep it handy in case I’m worried about anything.” “I’ll read this and pass it on to my friend.” “It’s nice to see the people looking so well and enjoying life again. It makes you a bit more hopeful doesn’t it?” “I shall read this when I get home with my cup of tea.”

21. Communication – (unprompted) 21 What do you remember about the communication?PrePost About bowel cancer38%17%* Tells you symptoms of bowel cancer12%Less than 1% Go to see the GP10%13% Check yourself/Be aware7%9% About Breast Cancer7%4% About Prostate Cancer5%6% Information on symptoms2%6%* Check for blood in poo7%5% Early detection5% Life stories about cancer1%5% Base: All recalled Pre (303) Post (341) * significant difference at 95% pre v’s post What do you remember about the communication?PrePost Go to see the GP32%25% Early detection17%20% Check yourself/Be aware10%13% Do not ignore symptoms7%10% Cancer is treatable if caught early4%7% Be more aware9%5%  In our experience, the wide range of spontaneous messages indicates a degree of engagement with the topic - cancer

22. Communication – (prompted) What were the key messages you saw, heard or read? 22 What were the key messages you saw, heard or read? PrePost Awareness of bowel cancer71%46%* Importance of early detection43%54%* Visit GP if unusual/persistent change31%40%* Cancer screening19%24% Lifestyle and cancer risk14%20% Improvement of survival rates14%21%* Signs of other cancers Base: All recalled Pre (303) Post (341) * significant difference at 95% pre v’s post  The observable increase in recall of improved survival rates seems likely to have been driven by the prominent CRUK campaign headline: ‘You’re more than twice as likely to survive cancer than 40 years ago’

23. Impact of communications: To what extent do you agree that seeing, hearing or reading this communication has encouraged you to seek advice from a GP? 90% 89% 3% 4% Agree Disagree 23 Base: all recalled comms Pre: (303) Post: (341)

24. Source of cancer communication (prompted) Do you recall the name of the main organisations behind what you saw, heard or read? CRUK PCT Macmillan Marie Curie Don’t Know 24 Base: all who recalled pre (303) post (341) PrePost Inner30%28% Outer23%21% 27% 25% 18% 13% 8% 10% 5% 3% 46% 51%  The results reflect the crowded marketplace for cancer communications. It is clearly difficult for the general public to attribute messages to particular organisations

25. Direct Mail findings 25

26. Posters – Jill and Eric 26

27. Awareness and impact of key campaign elements Post campaign – Poster  Have you seen this communication before?  Please rate how much agree or disagree with the following statement? ‘After seeing this poster, l would be more likely to seek advice if I had a persistent or unusual change to my body’ 27 46% recalled seeing the poster Recall higher in the inner campaign area 52%* vs. 39% outer area 82% agree  Nearly half recalled the poster, with higher recall in the inner campaign area where the poster sites were located Base: all post (499) * significant difference at 95% pre v’s post

28. Press – Jill and Eric 28

29. Awareness and impact of key campaign elements Post campaign – Press  Have you seen this communication before?  Please rate how much you agree or disagree with the following statement? ‘After seeing this leaflet, I would be more likely to seek advice if I had a persistent or unusual change to my body’ 29 44% recalled seeing the press advert Recall higher in the inner campaign area 51%* vs. 37% outer area 81% agree  Two fifths recalled the press advert, with recall in the inner campaign area increasing to almost half Base: all post (499) * significant difference at 95% pre v’s post

30. Direct Mail – leaflet 30

31. Awareness and impact of key campaign elements Post campaign – Leaflet  Have you seen this communication before?  Please rate how much agree or disagree with the following statement? ‘After seeing this leaflet, I would be more likely to seek advice if I had a persistent or unusual change to my body’ 31 21% recalled seeing the leaflet Recall higher in the inner campaign area 28%* vs. 12% outer area 79% agree  One fifth recalled the leaflet, with recall higher in the inner campaign area a result of the targeting of the direct mail campaign Base: all post (499) * significant difference at 95% pre v’s post

32. Campaign materials message take-out – (prompted) What were the key messages of the communications I have just shown you? Base: all post (499) 32 53% 46% 34% 24% 21% 19% 14%  When prompted, around half selected the key campaign messages: the importance of early detection and encouragement to visit the GP. A third also selected the headline message about an improvement in survival rates No statistically significant differences between inner or outer areas

33.  44% read all or most of DM 37% read some 19% glanced through it Engagement with Direct Mail – (unprompted) Why did you read this leaflet and letter on cancer? Base: all who recalled Direct Mail (70) 33 Top 5 reasons for engagement ‘It is important’33% ‘Interesting’17% ‘Wanted to read it’16% ‘Cancer in my family’13% ‘To learn’11%  Two fifths read most or all of the Direct Mail. A third chose to do so because they felt it was important  In RWL’s evaluation experience, a higher degree of engagement for an older 50 + audience is indication of success

34. Message take out from Direct Mail – (Unprompted) Can you describe what this mailing on cancer was about? Base: all who recalled Direct Mail (70) *All other responses less than 10% 34 60% 26% 23% 17% 10%  Three fifths spontaneously identified one of the key campaign message communicated by the Direct Mail: be aware of symptoms. A quarter identified ‘go to the doctor’ and the importance of early diagnosis as campaign messages

35. Message take out from Direct Mail – (Prompted) What were the key messages of the direct mailing on cancer that you received? 35 100% 97% 37% 7%  Prompted recall of the campaign messages about the importance of early detection and the need to visit the GP rose to 100% Base: all who recalled Direct Mail (70)

36. Direct Mail – qualitative feedback  The Direct Mail was an extremely effective way of communicating with an older, C2DE audience. It was positively rated as ‘personal’, ‘engaging’ and ‘informative’  Eric and Gill were clear strengths: ‘localness’ was a significant factor, as was the use of an identifiable ‘peer’  Respondents recalled Eric and Gill from the outdoor and press elements of the campaign 36 “If it’s come to your door, with your name on it, then it’s meant for you.” “I opened it and thought, ‘Oh, it’s the Warrington woman.” “It really brings it home because it’s someone local.”

37. Direct Mail – qualitative feedback (2)  The positive tone of the creative was very much appreciated  The ‘good news story’ about survival rates increasing also achieved impact “She looks really well and happy with life. It looks like she has a rucksack on her back, so she could be going walking, so it shows you can be fit afterwards.” “This really hit me [the headline]. It’s just over 40 years ago my dad died of cancer. Maybe if he had got it now he might have survived it. It was quite a personal message for me here.” 37

38. Direct Mail – qualitative feedback (3)  Qualitative evidence suggests that the campaign messages were clearly understood “It gives you the spirit to see your GP if you are worried about any of the symptoms.” 38 “It’s telling you to get to the doctors. The earlier you go, the better it is to catch it.” “I don’t spend my time thinking about looking for signs of cancer, so to receive this in the post is a good reminder – a nudge that maybe I should be getting something looked at.” “Eric is telling the men that they need to go to the doctor. Some men just think they are immune to it. He is pointing out that you are not on your own when you get it – there are people out there to help you.”

39. Direct Mail – qualitative and quantitative  There was evidence that the leaflet was being shared amongst family and kept “We [husband and wife] got our letters on the same day so we read them together.” 39 “I have put my leaflet in the drawer – it looks like a handy bit of information and I may want to refer to it again.” “I showed it to my daughter and she thought it was good too. It was the bit about finding out early that we talked about because then you have more chance of survival.” What did you do with the leaflet and letter on cancer?  79% kept it for themselves  21% threw it away Did you speak to anyone about this leaflet and letter on cancer?  66% spoke to family and friends  34% did not speak to anyone Base: all who recalled Direct Mail (70)

40. Attitudinal findings from pre and post data 40

41. Call to action: if you had a persistent or unusual change, how likely would you be to visit your GP?  A significant shift in propensity to visit GP post stage 41 Pre stage – all very likelyPost stage – all very likely 85% total91%* total 83% inner89%* inner 88% outer92% outer Base: All pre: (508) post: (499) * significant difference at 95% pre v’s post

42. Perceived barriers to help-seeking Emotional Barriers – Yes 42 Emotional barriersPrePostCAM WholeInnerWholeInner Worried33%31%39%*40%*37.1% Scared21% 16%*17%23.2% Embarrassed12%13%8%*9%17.4% Lack of confidence7%6%7% 9.6% Base whole: All Pre (508) Post (499) * significant difference at 95% pre v’s post Base inner: All live in inner campaign area Pre (275) Post (260)  An increase in worry as a barrier to help-seeking likely to be the result of encouraging personal thought, but there was a notable drop across the whole campaign area in feeling scared and embarrassed

43. Perceived barriers to help-seeking Service Barriers – Yes 43 Service barriersPrePostCAM WholeInnerWholeInner Difficult to make an appointment 25% 30%36%36.5% Wasting time11%12%9%7%*26.1% Difficult to talk to5%4%6%5%13.9% Base whole: All Pre (508) Post (499) * significant difference at 95% pre v’s post Base inner: All live in inner campaign area Pre (275) Post (260)  There is an observable increase in the difficulty of making an appointment being a barrier to help-seeking, particularly in the inner area where the extent of the barrier reflects the national data  Decrease in those saying that wasting time was a barrier significant in the inner campaign region

44. Perceived barriers to help-seeking Practical Barriers – Yes 44 Practical barriersPrePostCAM WholeInnerWholeInner Too busy4%5%2%2%*21.1% Other priorities8%10%4%* 17.5% Transport6%9%5% 5.1% Base whole: All Pre (508) Post (499) * significant difference at 95% pre v’s post Base inner: All live in inner campaign area Pre (275) Post (260)  Decrease in those saying that having ‘other priorities’ was a practical barrier significant across the campaign area as well as in the inner campaign region only  Decrease in those saying that being ‘too busy’ was a barrier significant in the inner campaign region only

45. Attitudes to cancer – strongly agree 45 Attitudes to cancerPrePost WholeInnerWholeInner More likely to survive cancer now than 40 years ago 75%70%84%*83%* Cancer diagnosis early is more likely to be treatable 72%71%80%*76% People who’ve had cancer can expect to continue a normal life 50%45%51%47% Cancer diagnosis is a death sentence 5%6%3% Going to the GP early makes no difference to changes of surviving 4%5%2%1%* Cancer diagnosed early makes no difference to chances of surviving 3%4%3% Base whole: All Pre (508) Post (499) * significant difference at 95% pre v’s post Base inner: All live in inner campaign area Pre (275) Post (260)

46. Conclusions 46

47. Conclusions  Overall, disaggregating spontaneous recall of specific BCOC and CRUK campaign activity is difficult, given that the two campaigns were running very closely together and the general public’s difficulty in attributing the provenance of specific cancer communications  However, there are significant post-campaign increases in recall of local press and DM activity which seem more likely to be the result of CRUK activity, particularly given than recall of BCOC TV and radio activity is decreasing post-campaign  The significant increase in recall of improved survival rates seems likely to have been driven by the prominent CRUK campaign headline: ‘You’re more than twice as likely to survive cancer than 40 years ago’ 47

48. Conclusions (2)  Prompted awareness of the CRUK campaign materials provide greater understanding of the success of the campaign: Half recalled the poster, with higher recall in the inner campaign area where the poster sites were located Two fifths recalled the press advert, with recall in the inner campaign area increasing to half One fifth recalled the leaflet, with recall higher in the inner campaign area a result of the targeting of the direct mail campaign When prompted, half selected key campaign messages: the importance of early detection and encouragement to visit the GP. A third also selected the headline message about an improvement in survival rates 48

49. Conclusions (3)  Quantitative and qualitative findings from the Direct Mail activity demonstrate that this was a key component of the campaign Two fifths of those who recalled the Direct Mail activity read most or all of the Direct Mail A third of those who recalled the Direct Mail activity chose to read the Direct Mail because they felt it was important Three fifths of those who recalled the Direct Mail spontaneously identified one of the key campaign messages: to be aware of symptoms. A quarter identified ‘go to the doctor’ and the importance of early diagnosis as campaign messages Qualitative feedback suggests that the Direct Mail channel as well as the positive tone of the creative and choice of a local peer to deliver the messages were key ingredients in the success of the mailing 49

50. Conclusions (4)  Statistically significant changes in attitudes towards cancer have been identified: Decrease in those saying ‘wasting time’ was a barrier to help seeking in the inner campaign area Decrease in those saying that being ‘too busy’ was a barrier in the inner campaign area Decrease in those saying that having ‘other priorities’ was a barrier across the campaign area, as well as the inner area Increase in those agreeing that one is ‘more likely to survive cancer now than 40 years ago’ across the campaign area, as well as the inner area Increase in those agreeing that cancer diagnosis early makes it more likely to be treatable across the campaign area, Decrease in those strongly agreeing that going to the GP makes no difference 50

51. Recommendations  The ‘localness’ of the campaign is a key ingredient in its success: The local, human interest case study approach engaged The survival angle hooked the audience The communication approach successful for a older DE audience And the media planning ensured repeat exposure to the campaign  Although the campaign has a generic message (in that it is not cancer specific), it is specific in terms of localness  The choice of media was appropriate for the target audience, local press reinforced by the direct mail 51