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Click to read whole article Summary
Following on from earlier health promotion interventions in relation to oral cancer health promotion, this project aimed to use specific awareness-raising techniques in a defined catchment population to engage and motivate those at risk from oral cancer to seek early screening and diagnosis or elimination from follow-up in a uniquely designed screening/ referral intervention based on social marketing techniques. The intervention followed years of research and development. Information derived focus groups provided insights into the issues facing those at risk from oral cancer in a predominantly Caucasian population in an urban area in England. This information was then used to overcome barriers to presenting for mouth examination using the principles of social marketing. An at-risk population was closely monitored during a targeted social marketing intervention. It has been a success: in generating ideas, guiding development of an customer-friendly service, and encouraging the targeted at-risk population to come forward for mouth examination. The target population have welcomed the approach and health professionals have responded to the challenge to introduce a user-centred service within resource limitations.
Context
Oral cancer is a relatively rare but important disease because survival rates have not improved markedly over the years; health promotion is therefore important. Recognising the need for developments to continue in the most promising environment available, Cancer Research UK identified the North East of England as a suitable location to develop case-finding interventions further to include: How could the target population for oral cancer case-finding/screening be identified? How could they be engaged by the health care sector? Could effective communication strategies to be designed deliver the target population to diagnostic services? How could the “right” level of demand for clinical intervention be generated? How could referral pathways that satisfy the demand be organised? Could a satisfactory intervention be undertaken within resources available? Could new cases of oral cancer be identified that are above and beyond the usual spontaneous diagnostic level?

Process
A series of rounds of focus groups were undertaken with the target population: firstly, to scope the issue and determine global attitudes and barriers to engagement with services/support; then more rounds to settle practical arrangements for the screening system, including staff attitudes, communication materials and channels; then more to pre-test the proposed arrangements and to evaluate them once they were activated. Tracking studies were also carried out to determine the reach of the communication strategy. Communications with the target population were driven by the insights obtained in focus groups and harnessed by engaging high-level communications experts; a user-friendly clinical service was cited in general dental practices in the target areas, and training was provided for staff including in sophisticated communication skills and enhanced clinical examination techniques. The “sales force” for the service were likewise identified in primary care (pharmacists etc) and trained as for the dental staff. Only the clinical examining professionals were paid for. The intervention was managed and evaluated using a voucher system. Numbered vouchers were issued to front-line primary care staff and used to track the progress of the target audience through the system, and ensure that only eligible at-risk individuals would be able to enter the screening process.

Outcome
The new system was very successful. 183 men were issued with vouchers, 50 of whom were screened. Five men were later referred to clinical services for a specialist follow up.

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