A social marketing campaign for early years practitioners to increase awareness of the importance of vitamin D and healthy start supplements

Aims

• To support the Croydon ‘Joint Health & Well Being Strategy’ by increasing awareness of vitamin D through a social marketing campaign.
• To encourage and promote positive behaviour change around the subject of Vitamin D within a variety of settings including children centres and health centres
• To increase awareness of ‘high-risk’ groups and support NHS priorities in seeking to address health inequalities within the Borough

Objectives

• To create a short, picture-based film raising awareness on vitamin D and the use of Healthy Start vitamins
• To distribute the film together with an overview and healthy start leaflets to a minimum 10 GP surgeries, health centres, children centres, schools in the London Borough of Croydon
• To ensure that all centres exhibiting the social marketing campaign in Croydon had access to information and support concerning Vitamin D
• To assess knowledge, impact, healthy starts leaflets distributed and potential cascade effect of the social marketing campaign

Local population demographics

The London Borough of Croydon was chosen because it records higher than average numbers for many acute risk factors associated with vitamin D as well as having only a 3.5% uptake of the Healthy Start Vitamin Scheme. In addition 44.9% of Croydon residents come from Black and Minority Ethnic backgrounds.

Baseline assessment and patient involvement

We completed an initial consultations with eight early years collaborations (totalling nineteen children's centres) across the borough to ascertain the need for a vitamin D awareness intervention. Key findings from this consultation showed that:

• A high proportion of children’s centres were identified as having ‘at-risk’ families
• There was a lack of knowledge around vitamin D guidelines, with no centres having received training on the subject to date
• Confidence in raising the issue of vitamin D and discussing its importance with families was found to be low across the majority of sites. This is especially worrying as research shows that many parents access children’s centres for advice and support and to improve the health and wellbeing of both them and their child; especially around areas of nutrition.

(Croydon Children and Families Partnership, 2012).

Stakeholder Involvement

Prior to the social marketing campaign we were awarded a grant to develop and deliver training on the importance of vitamin D to early years staff in the London Borough of Croydon. More than 100 early years staff received training and the outcomes were positive.The training, however, identified a further need to educate local families on the importance of vitamin D and to spread the message wider than just early years. Therefore working with key early years staff, those both trained and yet to receive training, the public health lead and key members of the community, we put together a steering group to help guide the creation of the video. The steering group was consulted throughout the process and their input was crucial to the final outcome.

Use of NICE Guidance

NICE guidance suggests key ‘at-risk groups’ and directed us on defining priority community venues where vitamin D information should be disseminated. This allowed us to ensure the intervention was in line with recommendations and tackled health inequalities whilst promoting health and wellbeing. Additionally by understanding which groups were most atrisk as identified within the guidance, we were able to tailor the message and the video to target those most in need.

Recommendations from NICE guidance also directed the key learning objectives of the campaign and confirmed our evidence-based advice and information. Finally it strengthened conversations with the Public Health team and assisted in building the case for vitamin D to be incorporated into their on-going public health strategy.

Key Steps

After the baseline assessment, our first step was use key contacts in the borough to put together a mini steering group of influential partners and at-risk families to consult on the film’s content and design. This was done in-line with the NICE guidance recommendation 4, to ensure a multi-agency approach, working with relevant community groups.

Next we worked with a production company to develop the video footage consulting with the steering group and service users throughout. NICE guidance recommends using a ‘culturally appropriate’ approach therefore the film was done using animals instead of people, thus not targeting any one ethnicity, and was picture-based so those with English as a second language could still understand the key messages.

Once the film was complete we identified key centres, GP practices and websites that could ‘host’ the footage referring back to the list of potential service users identified in the NICE guidance recommendation 10. We then distributed the film to 10 centres for a pilot run.

Centres were asked to play the film and obtain feedback and evaluations from service users.

After a month the feedback and evaluation forms were collected and data was collated.

Barriers

Our initial barrier was convincing key stakeholders that vitamin D was an issue within the borough. By referring to the NICE guidance ‘Background’ section and the local data we had obtained from Croydon public health, we were able to show a clear need within the borough and used this to influence our key contacts.

The next barrier we faced was convincing sites to take part in the pilot and fill in the evaluations. We were able to get the children’s centres on board as many had previously received our training and were keen to take part however GP surgeries proved trickier and in the end whilst three agreed to take part only one provided meaningful feedback. In future, we would overcome this problem by using the pilot feedback to bring public health on board and use thier influence to influence the GP surgeries and other community venues.

Costs

The working costs for this project, including initial consultation, the production and distribution of the video and evaluation were £5000. However, now that the video has been developed costs would be limited to distribution, which could be done over the internet for little to no cost. A budget for monitoring and evaluation should also be allocated.

Outcomes

Outcomes were measured by asking participants to fill in a short evaluation after watching the video. The evaluation set to determine a) if participants had increased their knowledge on vitamin D and the Healthy Start scheme and b) if participants were going to start taking a supplement as a result of the video.

We received 186 completed survey responses in relation to the video. Most were from families with children under 5 or pregnant/breastfeeding women and 63% were from people identifying themselves as a black or minority ethnic (BME) group meaning that the intervention had reached those deemed most ‘at-risk’ by NICE guidance. Of survey respondents, 68% had never heard of the Healthy Start scheme and 63% were not currently taking vitamin D supplements despite NICE guidance placing them ‘at-risk’.

Of respondents, 72% were able to relay back the key messages after watching the video, including the sources of vitamin D and the identification of ‘at-risk’ groups. Additionally, 56% of those not currently taking a supplement stated that they would now speak to their Health Care Professional (HCP) about starting supplementation.

Additionally, sites were asked to monitor how many Healthy Start leaflets were given out as a result of the video. Over the pilot sites 180 Healthy Start leaflets were given out over the trial month with most sites reporting that they had previously given out very few or in most cases, none at all.

Expectations

We felt the above results exceeded our expectations. We were quite surprised to find out that 68% of people had never heard of Healthy Start vitamins and 63% of those ‘at-risk’ were not taking supplements. The fact that 56% of those will now start supplementation is astounding and shows that when done on a wider scale the intervention has the potential to significantly impact vitamin D intake in the borough.

When we made the video we designed it to be used in LCD screens in waiting rooms and common areas. However, we were surprised to hear that many children’s centres used it during their parent groups as part of a structured learning activity. Additionally, we had reports of a GP using it during a 1:1 visit to relay the message of vitamin D to a patient with low levels of English. These reports led us to re-assess the scope of the video and the additional ways in which it could be used to support learning.

Impact

Based on the above outcomes, were the video to be implemented borough-wide it should lead to an overall increase in the uptake of Healthy Start vitamins and vitamin D supplement use in general. This would then lead to a decrease in vitamin D deficiency within the borough and a reduction in NHS costs for treating both vitamin D deficiency and the associated comorbidities.

Key Learning Point 1: Creating ‘Buy-in’

The key barrier we faced was convincing the venues that vitamin D deficiency was an issue in the borough that needed to be addressed. Because Vitamin D deficiency isn’t as visible or high profile as many of the other public health priorities people tend to know very little about it and thus don’t understand the implications low vitamin D can have on a population. We were able to partially overcome this by providing training to early years staff prior to the intervention however this may not be feasible for all boroughs from both a cost and time perspective. Another key way we overcame this was to ensure that vitamin D was a public health priority in the borough before beginning the intervention. We were then able to call on the public health lead to support the intervention and convince others of its worth. We also garnered the support of the children’s services lead who then relayed the message to all the children’s centres. By acquiring the support of key public health and early years contacts and disseminating the message from the top-down we were able to bring all the early years sites on board. Unfortunately, we were unable to find a key figure within the GP surgeries to support and disseminate our message. Had we done so, perhaps the contribution and involvement from the GP surgeries would have been greater.

Key Learning Point 2: Video Dissemination

Another key barrier we faced was the physical distribution of the video. The video itself is too large to send as an email attachment however we were reticent to distribute it through a public domain such as Youtube. In the end, we hand delivered the video to the pilot sites on either CD or memory stick, depending on what the site requested. In future, to save time and cost, a distribution site such as WeTransfer or a private web domain with a password could be set up to disseminate the video to those involved.

Key Learning Point 3: Sharing Nationally

Because of the success of the pilot campaign and the simplicity and cost effectiveness of the intervention we feel there is potential to share it with other boroughs in the hopes of forming the cornerstone for a national campaign. This would satisfy NICE PH56 recommendation 3 ‘Develop National Activities to Increase Awareness about Vitamin D’ as it complies with all the recommended messages and meets the accessibility and adaptability requirements. We would recommend that anyone looking to implement a vitamin D campaign in their area to get in touch to see how the video may fit within their requirements.