Achieving public health behaviour change

By Alexia Clifford

Changing people’s behaviours, especially when they are ingrained, is no easy feat. It takes audience insight, coupled with a focussed drive to raise awareness, as well as long-term engagement. Results can take years to achieve but the investment required is more than worth it in terms of health outcomes and a reduction in care costs to the state.

You’ll learn:

• How good social marketing campaigns have audience insights at their heart
• How solid measurement and evaluation enables campaigns to be more agile, responsive and therefore successful
• How personalised marketing and digital innovation can significantly help change behaviour

Change for the better

Public Health England’s (PHE) Social Marketing programmes are designed to motivate and support millions of people to make and sustain changes that will improve their health.

All of our campaigns start with insight into people’s lives. We take an audience-centred approach, which means that we work to understand how people live, how they feel about health and what it means to make good health a part of daily lives. Audience insights help inform our campaign strategies as well as the creative ideas at the centre of our campaigns.

We take evidence-based public health guidance and repurpose it. We make it user-friendly, accessible, shareable, ownable, personalised, dynamic, actionable, rewarding and, when appropriate, fun.

We use a range of behaviour change models to guide our planning, recognising that different models are suitable for different issues and audiences. For example, what may work for youth resilience may not be appropriate for healthy eating.

Rather than telling people they will feel better if they change their behaviour, we create tools that nudge people into the desired behaviour and then help them notice how much better they feel as a result.

We build on and contribute to, the evidence base for key public health challenges. Our evaluation framework allows us to pinpoint which elements of a campaign are working most effectively and what needs adjusting or improving. 

As well as looking at activity and reach across paid, earned, shared and owned channels and awareness and engagement, we look at claimed and actual behaviour change. 

Every PHE marketing evaluation follows our framework, although the combination of evaluation tools, techniques and data points varies between campaigns to reflect differences in each campaign’s objectives and structure.

Saving lives and money

The Act FAST campaign for stroke is one of our longest-running and best-evidenced campaigns – raising awareness of the symptoms of stroke and encouraging people to dial 999 when any of the signs are noticed. It was launched in 2009 and has been creatively refreshed several times.

Since launch and as at 2016, at least 5,365 fewer people have become disabled as a result of a stroke, giving a return on investment of £28 for every £1 spent. And in terms of behaviour change there has been a 78% increase in calls to 999 for a stroke, contributing to saving around 12.2k additional quality adjusted life years, a saving of over £410m in benefits to the state and reduction in care costs as a result for the same period.

An example of personalised marketing: Stoptober

Many smokers struggle to quit and need motivation and support. Now smoking rates have fallen from 20% to just over 15% of the population, smokers are also becoming harder to reach. We wanted to find the most efficient and cost effective to reach them.

We decided to use personalised marketing and the power of data to reach our audience. Personalised marketing, also called one-to-one marketing, involves using data analysis to deliver individual messages, promotions and product offerings to existing or prospective customers.

Stoptober 2016 employed a new data strategy – combining Facebook data, search and PR – which enabled hyper-targeting of smokers on social media. This involved:

• Building an Interest audience using audience behavioural data on the Facebook platform, for example users that ‘liked’ smoking related pages

• Retargeting smokers based on their engagement to previous PHE campaigns, for example those who engaged with the Stoptober Facebook video.

• Using combined survey and panel-based data to identify people who had responded as being a smoker and sending them relevant Stoptober content.

To increase engagement, we also partnered with Spotify to create a series of Stoptober playlists to reflect the various emotions that quitters experience during their 28 days - from hope, excitement and nervousness to elation. This was promoted via Facebook and through consumer PR with celebrity DJs discussing their playlists and smoking stories.

The results were impressive - we drove 16% of smokers to make a reported quit attempt and we increased the efficiency of our spend through reducing media wastage significantly (90% of social impressions were delivered directly to smokers).

An example of digital innovation: Start4Life – Breastfeeding Friend Alexa Integration

In England, almost three-quarters of women start breastfeeding when their child is born, however by weeks 6-8 this drops to 44%, making our rates among the lowest in the world. 

Online search for breastfeeding support peaks between 2am and 6am, when technology can play a complementary role to the vital support offered by healthcare professionals. We worked with midwives, health visitors and mothers to create new tools that could provide helpful advice at any time of the day or night, quickly and easily.

We developed a new ‘Breastfeeding Friend’ Facebook Messenger bot [1], an AI powered product that provides a simple interface via text-based conversations, just like interacting with a friend on Messenger. The bot is designed to provide information any time the user needs it, such as how to establish breastfeeding and check your baby is feeding well.

Over 20% of new first time mothers interacted with the Breastfeeding Friend bot during its first

month; 46% of whom signed up to receive motivational push messages, which enjoyed an exceptionally high average opening rate of 90%.

Building on this success, we partnered with Amazon to recreate this experience on the Alexa platform, moving from text-based interaction to voice interaction with Alexa. Together we built an app (or ‘skill’) for Alexa allowing mums to talk to any device running the voice assistant in order to provide help, support and advice around breastfeeding entirely through natural-voice conversation, making the experience more personal and “human”.




Alexia Clifford is Deputy Director of Marketing at Public Health England, an Executive Agency of the Department of Health. Alexia has led a number of highly successful, flagship social marketing campaigns including Change4Life, which encourages millions of families in England to ‘eat well, move more, live longer’, Stoptober, which has helped more than a million people to quit smoking and Be Clear on Cancer, which has helped to save hundreds of lives through earlier diagnosis. Alexia is a communications and marketing professional with more than 15 years’ experience across the public and private sector. She has an MSc in Mathematics from Cambridge University and an MA in Film Studies from the University of Westminster.

Twitter: @PHE_uk