Uncovering behavioural barriers to early cancer diagnosis for PHE


Public Health England (PHE) is an executive government agency tasked with improving the nation’s health and well-being. Its Be Clear on Cancer Campaign was created to improve the public’s awareness of cancer and its symptoms in order to encourage more people to ‘present’ at their GP sooner, since early detection vastly improves cancer outcomes.

But the campaign was about to turn 10 years old, and numbers of early presenters had dipped. PHE was no longer sure if it was delivering on the campaign’s promise to reach ‘the right people, at the right time, in the right way’. It was time to rethink why people don’t present earlier. 

PHE had decades of research on cancer and behaviour change, but was looking for something deeper. Traditional approaches tap into conscious reasons for why people behave a certain way, but cancer is a profoundly difficult topic. The truth is difficult to articulate.

To unlock the unsaid, we knew we had to compare what people were saying externally with what they were feeling and thinking internally. Our approach was designed to explore two parallel worlds: personal and public discourses of cancer.

1.    We used Digital Forensics to find out what people were saying online – anonymously and unprompted. Our linguistic model scraped about 500,000 public comments and conversations to identify why people did not present earlier.    

2.    We used Semiotic analysis to identify the underlying cultural meanings of cancer. Once we accessed how people understand cancer culturally, we could unlock the invisible forces influencing people’s opinions and decision-making and keeping them from presenting earlier

The two strands then came together to give us a deeper understanding of the subconscious barriers to earlier presentation, and the cultural reasons that they exist. We found that each semiotic narrative of cancer helped explain each barrier to presentation. Now that we knew why each barrier existed, we could figure out how to overcome it.

The world of cancer was often presented as a swing between two extremes and because of this, people do not want to know whether they have it in the first place. Cultural representations of cancer leave people feeling that it must be defeated through an epic struggle, and to suffer from cancer is to surrender from life. In culture, cancer is The Bogeyman. 

But we found a way out. Between each pair of tensions is a balanced way of discussing cancer – what we call the ‘spine’. For example, cancer is not a life-or-death battle, but an ongoing, multifaceted experience. Each of these more neutral ways of presenting cancer aligned with a barrier from the linguistic model, addressing each with a more measured narrative around the experience of cancer.

For each narrative, we identified granular best-practice visual and language cues to execute future campaigns that cut through the emotional barriers. This served as a toolkit for creative inspiration.

This toolkit is applicable not only to PHE, but to any cancer charity or organisation. What’s more, the combined approach can be applied to any behaviour change problem – not only in the healthcare space –that requires fresh insight.