Personalised social marketing of multi-dimensional physical activity profiles in at risk men & women

The NHS Health Check is a major public health initiative targeting men and women aged 40-74 years. The aim of this initiative is to identify people who have an increased risk of diseases such as heart disease, stroke, diabetes and kidney disease. Patients are invited by their healthcare provider approximately every five years and around 2.2 million men and women a year will attend. The intention is to offer personalised advice and support to those identified as at increased risk; and thus help them to help themselves. The costs of this initiative will lead to savings to the NHS if enough people make improvements to their lifestyle and/or receive new medication or treatment that they would not normally have received.

Physical activity is a very important part of lifestyle. For those men and women identified as at risk of chronic disease through the NHS Health Check, physical activity can have a very powerful positive effect on future risk. However, people find it hard to judge their physical activity status. Many people have the perception that they are more active than is actually the case and this prevents them from seeing the need for change. It is also difficult for people to know whether a change in their behaviour has had a meaningful impact on a given aspect of physical activity (some people may overestimate the impact of the introduction of a new behaviour and/or counter forces such as substitution or compensation may lessen the net effect). At present, it is estimated that only 5% of people identified through the NHS Health check will change their physical activity. Physical activity has potentially so much more to offer people who have been told that they have an increased risk of chronic diseases; and thus has much more to offer the NHS and its partners.

We are learning more about physical activity and health all the time. It is becoming increasingly apparent that there are multiple ways to harness the protective properties of physical activity because there are various dimensions to this behaviour that are independently important. Thus, we do not all have to do the same thing (one-size does not fit all). Rapid developments in technology mean that we can now portray simple and/or sophisticated physical activity 'profiles' and personalised illustrations of current physical activity dimensions. In turn, this means that we can promote (market) a smorgasbord of personalised physical activity choices (in the context of existing personalised behaviour) with options tailored to an individual's need and preferences.

In this research, we want to find out how the users (patients and healthcare workers) would like the information provided from technological advances in physical activity measurement to be portrayed (Phase 1). There are various highly-visual ways to depict personalised physical activity profiles and there are many different options and alternatives. The aim is to develop a definitive physical activity profiling tool and approach that we can use in a trial. We will seek external advice in this development phase (e.g., National Social Marketing Centre). After this development work, in a subsequent 12-month trial, we will examine whether personalised social marketing of physical activity profiles is more effective at increasing physical activity and reducing risk than standard care in 216 men and women across the South West (Phase 2). The premise is that most patients do not understand their current physical activity behaviour and the options that are open to them; and that a long-lasting change in physical activity behaviour requires greater empowerment and self-determined engagement (people need to experience an understanding of their behaviour and the options so that they can make informed-decisions about their physical activity).

We aim to translate the investment of resource in the NHS Health Check into a meaningful change in physical activity behaviour in individuals identified as at risk.

The roll-out of the NHS Health Check through general practice represents a considerable investment of resource in order to identify at risk individuals. This public health initiative is underpinned by the relevance and power of personalised information and physical activity is advocated as a primary strategy for patients to reduce their risk. The major challenge is to develop approaches that are effective at changing behaviour in this priority group and that can be readily implemented in primary care.

Physical activity is a rather complex behaviour. There are multiple dimensions (aspects) to physical activity behaviour that all have the potential to improve health. This can sometimes lead to confusion but it also means that there is the potential to generate novel and exploitable opportunities. We now have the technology to capture this information and thus provide patients with personalised feedback on the multiple dimensions of physical activity behaviour that they can change and use (harness) to play a role in reducing their risk (e.g., physical activity energy expenditure, time engaged in moderate intensity activity, sedentary time etc).

We have piloted different formulations for integrated physical activity profiles that reflect various (multiple) physical activity dimensions. We will work with the users (patients and healthcare practitioners) to generate a preferred option (personalised and visual feedback in the form of a physical activity profile) that represents biologically important dimensions of physical activity behaviour. We will then determine whether we can use feedback from these profiles and social marketing techniques to help patients identified as at risk in the NHS Health Check to understand the problem (their low physical activity) as a step towards becoming self-determined in their engagement (i.e., autonomous).

There is a direct route to implementation of the findings and a change in practice as an adjunct to NHS Health Checks.

The primary beneficiaries of this research will be patients identified through the NHS Health Check, healthcare practitioners who work with these patients plus the wider UK economy through NHS and employer savings (as well as charities and other relevant organisations). The NHS Health Check represents an innovative strategy to identify people who are at increased risk of chronic disease and this is a central component within a broad public health portfolio. An estimated 2.2 million patients per year will attend for a Health Check with ~1 million or more having one or more risk factor for future chronic disease. The NHS Health Check will cost ~£332 million per year to deliver at full roll-out with a net economic saving of ~£3.5 billion. According to the national impact assessment of the NHS Health Check and the newly-released 'ready reckoner' tool, most of these savings will be derived from the new-diagnosis of people who need treatment. At present, it is estimated that only a rather disappointing 5% of those people identified as at risk will engage in long-term physical activity. Within this context, it is noteworthy that as the NHS Health Check continues into the future there will be fewer cases identified (only those people who reach 40 and new cases that have developed in the population who are invited for a re-test after 5 years will be discovered). The consequence is that there will be a lower health gain at a higher cost. Thus, in the future, it will become even more important to develop evidence-based strategies (such as lifestyle change) to continue to exploit the health and financial gains derived from investment in the NHS Health Check. In short, if we can increase physical activity amongst higher risk individuals identified via the NHS Health Check, this will generate meaningful benefits to patients and healthcare providers now and in the future; as well as reducing healthcare and employer costs.

Technology-enabled personalised social marketing of physical activity profiles could become part of a GPs toolbox and adjunct to the NHS Health Check initiative as a strategy to reduce the future burden of chronic disease. NHS Health Checks will be part of Public Health England and embedded in primary care. Thus, there is a direct pathway to impact and the appropriate systems/procedures and other resources (e.g., people) are available to deliver this impact (via implementation and a change in practice). In the current trial, we will understand the effectiveness of this approach. The resources developed during this trial will be available for evaluation and implementation by other regions (i.e., a change in regional practice). The results will also inform decisions about a possible national, multicentre definitive trial to provide definitive evidence prior to potential rollout (i.e., a change in national policy). Ultimately, this approach will be one tool in an array of bespoke public health strategies to ensure that healthcare practitioners have the right intervention/strategy for the right patient.

The secondary beneficiaries of this research include any other population where physical activity is advocated (but poorly adopted) such as children and the general public. The social marketing of personalised physical activity profiles could become an adjunct to other initiatives and interventions. Furthermore, the concepts, tools and understanding from this project may have broader reach. Innovation in physical activity data handling to generate physical activity profiles using focussed technological development has commercial and public health application (monitor development, integration into websites etc). Furthermore, these concepts may be transferable to other settings (e.g., profiling or labelling certain jobs, recreational activities and so on) to enable mass population-based social marketing alongside the work of other agencies (e.g., food labelling).