Berkshire East PCT ... Using marketing to improve health
"This is a tool that can find out about where Asian businesses are, what television programmes people watch, what newspapers they read - even what cars they drive."
Mike Attwood, Chief Executive of Slough PCT
Health Minister John Hutton beside Slough's Diabetes bus with local MP Fiona MacTaggart, and Mike Attwood and Geoff Cutting, Chief Executive and Chair of Slough PCT respectively, plus members of the local community
Certain ethnic minority communities have long been labelled 'hard to reach'. But when Slough Primary Care Trust wanted to raise awareness about diabetes among black and minority ethnic communities, it was simply a question of changing tactics. Rather than rely on the traditional health service methods of getting health messages across, the Trust decided to turn to the marketing techniques of the private sector.
"We needed a better understanding of how we could communicate more effectively," explains Mike Attwood, the Trust's Chief Executive. "Using these methods allows us to be much more intelligent about how we target people."
The Trust already had a working relationship with Dr Foster, an independent medical research company. So when the company suggested its unique health needs mapping tool might help the Trust find out about the lifestyles of black and minority ethnic communities, managers saw it as a golden opportunity to help their work on diabetes.
Marketing tool
The computer programme is the only market research tool that combines information about hospital admissions and medical treatment for particular conditions with data on the socio-economic background of a particular area's population. "This is a tool that can identify where Asian businesses are, what television programmes people watch, what newspapers they read - even what cars they drive," says Grace Vanterpool, Diabetes Specialist Nurse, who is leading the initiative. "It is fantastic because we can use it to map where we have increased incidence of diabetes in the community and how that relates to ethnicity, age and a range of other factors."
People from black and ethnic minority communities are between two and five times more likely to suffer from type-two diabetes than people from other backgrounds, but research shows that a large number do not know that they suffer from the disease. "There is local and national evidence to show that people from ethnic minorities often use services much later than other people," says Grace. Sometimes people don't know they are diabetic, which means they are more likely to turn up at an A&E department in a mess later on. We need to catch them earlier to prevent them becoming ill in the first place." This is a particular issue for Slough, where 30 per cent of the population are from ethnic minority groups. Between seven and ten per cent of the city's population suffer from diabetes, compared with a national average of four per cent.
Action Diabetes
Though around 5,000 people in the city are known to suffer from diabetes, its demographic profile indicates that there may be another 1,000 people who are unaware of their condition - part of the estimated one million people in Britain who do not know they have the disease. If left untreated, diabetes can lead to coronary heart disease, kidney failure, nerve damage and blindness.
The Trust's work with Dr Foster is part of its 'Action Diabetes' initiative which aims to tackle the problem by identifying sufferers as early as possible. Funded by the Department of Health, the pilot project was launched in October (2004) by Health Minister John Hutton. Slough hopes that the knowledge Dr Foster provides of where and how its population works, rests and plays will help it target those most at risk - people from ethnic minorities.
"Our work with Dr Foster allows us to combine what we know about health statistics with what they know about broader social demographics," says Grace. "If we know that people from the Pakistani community listen to a particular local radio programme or hire videos from a certain shop, we know those are good places to put health information."
Early results
The knowledge gathered from the mapping tool has already been put to good use. In October (2004), the Action Diabetes team completed a three-week tour of the city with a diabetes bus staffed with volunteer 'health counsellors' from the Asian community, many of whom have personal experience of the disease, and medical staff. Staff carried out tests for the disease, gave out information and offered advice on diet and exercise. Of 672 people seen on the bus, three people were identified as suffering from diabetes and a further twenty were identified as at-risk of the disease and referred to their GPs for further tests. A detailed audit of the project is to be carried out in the coming months.
The pioneering work with Dr Foster played a key role in choosing the bus's locations around the city, which include a bingo hall, supermarkets, community centres, hospitals, leisure centres, mosques and shopping centres. "We are being able to target our health promotion work at places where people naturally congregate," says Grace. "These are places where people are relaxed and more likely to take in information."
The Trust already knew that Asian people frequently did not attend appointments at its diabetes clinic in Windsor, for example, partly because of prohibitive travel costs. They are now using the mapping tool to find a more suitable home for a new intermediate clinic which will help people manage their symptoms. Catherine George, Joint Director of Service Delivery, is keen to stress this aspect of the work, which she believes demonstrates a long-standing commitment to change. "This is not a once-and-for-all, like so many initiatives," she says. "It has longevity."
Grace agrees. "When people go to white, middle-class Windsor, they feel nobody understands them and they get frustrated," she says. "We want to get communities to shape the services that they want to use. It's not rocket science, it's about listening to people."