Case Study

West Yorkshire and Harrogate Cancer Alliance, based in Wakefield and employing approximately 40 people, brings together clinical and managerial leaders from hospital trusts and other health and social care organisations to transform the diagnosis, treatment and care for cancer patients in the region.

These partnerships enable care to be more effectively planned and delivered across local cancer pathways. Pathways are the journeys that patients take through diagnosis, treatment and beyond.

This work is very important because every week, 250 people in West Yorkshire and Harrogate are diagnosed with cancer and 115 people die because of the condition.

Key areas of work include innovation; reducing inequalities; living with and beyond cancer; workforce.

West Yorkshire and Harrogate Cancer Alliance, with charity OUTpatients and brand and marketing agency Mobas, developed a campaign to raise awareness of the signs and symptoms of cervical cancer and to increase attendance and uptake in cervical screening by LGBTIQ+ communities across West Yorkshire.

The campaign targeted the LGBTIQ+ community aged between 24-64 years old, specifically those eligible for cervical screening and those who may be non-attenders; this is due to significant barriers to attending a cervical screening known within this patient group.

The campaign, called ’Remove the Doubt’ was delivered in two phases from May to September 2023.

Cervical screening is for anyone with a cervix between the ages of 25 to 64 years old. This may include cisgender women, transgender men, non-binary people registered female at birth, and some people with an intersex variation.

The aim was to create a campaign that tackles myths and misconceptions about cervical screening. Whether that’s eligibility, how people are treated during the screening process, or addressing community fears: we wanted to turn these negatives into positive statements and empower people. We wanted to turn the reasons people aren’t attending into reasons to attend.

We wanted to encourage people to attend by ’removing the doubt’ as to whether they are eligible. We wanted people to attend their screening to be sure, one way or the other, and are then able to ’own’ the situation and act if needed.

Some statistics that informed the campaign:
• 5% of population identify as LGBTIQ+ rises to 12% in those 16-24 (ages where cervical screening is discussed, especially later on in age bracket)
• Government Equalities Office released a National LGBT Report which surveyed 108,000 LGBT individuals and their experiences within healthcare settings. The LGBT Action Plan was created on the back of these findings, which is a Government commitment to tackle some of the biggest issues facing LGBT people
• GPPS (2022) reported that 27% of LGBTIQ+ patients avoid their GP because of stigma with 55% reporting they felt their GP didn’t understand their needs
• LGBTIQ+ patients who are assigned female at birth have poorer health outcomes (NHS Digital 2021)
• Lesbian women have higher HPV rates compared to the general population (27% compared to 16%)
• Those registered as female at birth but now have male registered GP records are not invited as part of the NHS National Cervical Screening Programme and are being missed.

Work to engage stakeholders began in June 2022 with initial campaign ideas being shared at a Calderdale Cancer Screening meeting with Integrated Care Board (ICB) colleagues and at the West Yorkshire Health Inequalities Network.

The campaign was taken to the Health Inequalities Working Group in Calderdale which involved over 40 stakeholders from the area from primary care, local place ICB, Public Health and NHSE to gain their thoughts around when the campaign was due to launch and who it would be targeting etc. That feedback was then taken to the Cancer Alliances Health Inequalities Network meeting chaired by NHS National colleagues where Hayley Snowden presented the campaign concepts and initial ideas.

She also attended a Trans Patient Awareness Session ran by NHSE National colleagues looking at language, inclusion and understanding of this patient group when delivering campaigns.

Further stakeholders included the Cancer Prevention, Awareness and Screening Steering group in Leeds, Kirklees Health Inequalities meeting, the Central Halifax PCN Board meeting and cancer locality meetings for trusts and attended and shared campaign information at an NHSE update on improving access to cervical screening for transgender and non-binary people. There was also another Calderdale and Greater Huddersfield Cancer network meeting this month where updates were shared on the campaigns progress.

The campaign was presented at the Cancer Alliance Early Diagnosis and Screening Community of Practice meeting to gain insight from other Alliances with particular interest from a UKPHR Practitioner who commended our framing of public health language and messaging for this patient group. A second West Yorkshire Inequalities Network was attended by Hayley as well as a short overview of the campaign given at the West Yorkshire & Harrogate Cervical Programme Board to inform NHSE Screening and Imms Regional colleagues. Hayley also met with several practices in the Hebden Bridge area, particularly sample taking nurses to understand the barriers of this patient group and to listen to what safety netting had been put in place by GP practices to ensure this patient group wasn’t being missed.

Hayley also presented the campaign to the Core20PLUS5 Leadership group for West Yorkshire, which included colleagues from across the region in various roles and organisations.

The initiative involved a social media campaign across all social media platforms including paid adverts. It also included ‘out of home’ advertising involving posters and leaflets displayed at train stations, bus stops and billboards.

The campaign also featured educational webinars for health professionals as well as attendance at the Happy Valley arts and Pride festival in Hebden Bridge, West Yorkshire.

Overall, the campaign displayed exceptional engagement rates and audience targeting, solidifying its success in reaching and resonating with our intended demographic.

The campaign saw a total of 40,468 impressions. Of these, there were 1,752 engagements (likes/shares) and 649 reactions (comments). The average CTR (click through rate) for this type of health related social media post was estimated at 5.96%; this campaign achieved an 11.67% CTR on it’s most impactful post.

Outdoor advertising impact was measured within key locations across Calderdale, Leeds and Wakefield using 48 sheets in high traffic areas. The impact of outdoor advertising is measured using analysis of traffic data (foot and vehicle), census information, consumer surveys and experienced researchers. Total impacts (views of the assets) from this campaign were estimated to have reached 4.84 million people and over 750,000 estimated to have acted on the messaging – a calculation using DEC (daily effective circulation) and VAI (variable adjustment index).

Phase 1 of the campaign targeted certain areas of Calderdale where the LGBTIQ+ population was highest and it ran between May-July 2023. Phase 2 of the campaign targeted the wider Calderdale area and ran between July – September 2023. In phase 1 we saw an additional 61 samples taken in a specific practice located within the area of Happy Valley Pride as a result of the promotional event. Across the entirety of the campaign, the average cervical screening coverage for Calderdale increased by 1% (69.7% – 70.7%), we saw increases of up to 2.6% within certain practices local to the campaign delivery in phase 1. During this time the England average for cervical screening coverage dropped by almost 2%; a significant achievement for Calderdale and this campaign achievement compared Nationally.

In the months after the campaign the cervical screening average continues to steadily rise, it is up another 0.4% since September, another great achievement as national figures continue to decline.

– Worked to develop influencer packs (outreach to influencers in the communities we targeted to directly post and share the campaign with a ready made tool kit). This will be done at certain times of the year in line with national campaigns and in Pride month etc to ensure the messaging continues with recognised content.

– The patients used in the photographs for this campaign have agreed for their imagery and content to be used in a new campaign being delivered by the Cancer Alliance in 24/25 which will look to target the same LGBTIQ+ population group but with an angle of increased HPV vaccination uptake. Using the same models will build on the user-generate content from this campaign with an added bonus of patients recognising the patients used in the campaign and trust it.

– Other Cancer Alliances have used the campaign content to deliver work in their local areas; we purposefully didn’t add our Cancer Alliance logo on there so that these resources can continue to be used nationwide and continue the success.

This is the first time any Cancer Alliance or Pubic Health team have targeted a campaign at the LGBIQ+ community due to the stigma attached. We were brave enough to create a campaign that, although sparked political debate, potentially saved the lives of those who would not be invited for screening as part of the national programme.

– First time a trans man had been used in a healthcare campaign to raise awareness of the stigma and challenges these patients face in the primary care system.

– Patients in the campaign are from the local area and are recognised and trusted members of their community, giving the campaign instant authenticity, this hadn’t been done before in the LGBTIQ+ arena.

– Training provided to healthcare professionals alongside the campaign ensuring the staff delivering the screening appointments knew the barriers these patients faced and how to treat and speak to them with respect and professionalism, a significant barrier raised in the patient engagement sessions.

– Attendance at local events, such as Happy Valley Pride, staffed by local GP practice staff helped to continue engagement within the campaign with our target audience ensuring questions about signs and symptoms and cervical screening could be answered by local health care professionals they would then see for their appointment.

– Using UGC (user-generated content) enhanced authenticity and trust, as real users shared genuine experiences and opinions. This encouraged active participation leading to an increase in the organic spread of UGC, generating higher visibility and attracting new followers, ultimately boosting overall engagement rates.

– The best length for a social media video is typically short, ranging from 15 to 60 seconds, depending on the platform. This will help shape future campaigns when looking at social media content.

– Women aged 65+ contributed significantly to engagement compared to the target age groups of 25-49 (younger cervical screening cohort). OUTpatients thought this could be because typically older lesbian women within LGBTIQ+ communities are often trusted members of that patient group and often share messages about health with others.