Check Your Lungs: Improving lung health in Hull

Goldfish gasping for breath from the 'Check your lungs' campaign
“It was just like an ordinary cold; but I just couldn’t get rid of the cough. The doctor saw this little dot on my lung but that was it.

"They sent me to see a doctor at Castle Hill Hospital about the therapy, and he said, ‘it’s not necessary, you don’t need it.’

"So I said, ‘I could kiss you for that!’”
June

June’s story is one of many in the innovative Check Your Lungs campaign, to inspire people in Hull to prioritise their lung health and seek timely medical advice if needed.

An initiative from Hull York Medical School, the campaign is making significant strides in addressing the pressing health challenge posed by lung cancer and smoking-related conditions in Hull.

Hull has the highest lung cancer mortality rate and smoking prevalence in England,(1) and some of the highest lung cancer incidence rates in England.(2)

Dr Julie Walabyeki

Dr Julie Walabyeki led the project to encourage people in Hull to prioritise lung health

Dr Julie Walabyeki led the project to encourage people in Hull to prioritise lung health

Through a combination of public media campaigns, community roadshows, and collaboration with local GP practices, the Check Your Lungs campaign strove to improve lung cancer outcomes and save lives in Hull.

The initiative is part of the PEOPLE-Hull research study led by delivered by Dr Julie Walabyeki at Hull York Medical School, and funded by Yorkshire Cancer Research.

The project aimed to look at lung health in Hull and encourage those experiencing symptoms of poor lung health to visit medical professionals as soon as possible. The earlier symptoms are caught the better the chances for survival. The project also encouraged general practitioners to refer patients with serious lung conditions to the respiratory clinics earlier.

The lung health campaign is running alongside a study looking at encouraging symptomatic patients to visit the doctor as soon as possible and the earlier referral of patients with lung symptoms earlier to the respiratory clinics.

Evaluations at the end of the campaign will be used to find out whether more people in Hull know about the symptoms of poor lung health and whether the number of people attending GPs for early diagnosis of lung cancer or other conditions has increased.

Stigma, smoking, and delayed diagnosis

The PEOPLE-Hull study employed two key interventions: a public campaign and collaboration with GP practices in Hull.

The public campaign centred around raising awareness about lung health and its symptoms of poor lung health, such as cough, coughing up blood, persistent chest pain, and breathlessness.

To avoid triggering negative associations with cancer, the campaign adopted the term ‘lung health’ to encourage individuals to prioritise their lung health without explicitly focusing on smoking.

Dr Walabyeki, Lecturer in Primary Care at Hull York Medical School and the researcher on the PEOPLE-Hull study, found that there was a stigma associated with smoking, leading many individuals to avoid seeking medical help.

This delay in seeking help puts them at greater risk as smoking-related conditions often go undetected until they reach an advanced stage.

Dr Walabyeki said, “It is in clinical guidelines for GPs to ask their patients about smoking and to provide guidance on how to stop smoking, but we found in our previous work that patients did not want to talk about it.

"Some smokers did not tell their GPs the truth about their smoking status. People felt stigmatised."
Dr Julie Walabyeki

"Some smokers thought that if they did have lung cancer it was their own fault; so, some people would rather not see their GP at all.”

To combat these challenges, the PEOPLE-Hull study focused on reaching out to the public and educating them about the importance of early detection and seeking medical help.

The approach emphasised lung health rather than focusing solely on smoking cessation.

By framing the conversation around improving lung health, the study aimed to engage individuals more effectively and reduce the negative attitudes associated with lung cancer.

Lungs symptoms from the Check Your Lungs campaign
Cough symptoms from the Check Your Lungs campaign
Coughing blood symptoms from the Check Your Lungs campaign
Weight loss symptoms from the Check Your Lungs campaign

Public campaigns and community engagement

To reach the public effectively, the PEOPLE-Hull initiative conducted workshops and gathered insights to design a comprehensive public campaign called ‘Check Your Lungs’.

The public campaign included a dedicated Check Your Lungs website, activity on social media platforms, billboard advertisements in Hull, and engaging videos featuring individuals sharing their personal experiences with lung health issues. Notably, well-known local comedian Lucy Beaumont was also involved in creating a campaign video.

Comedians including Lucy Beaumont and Jon Richardson get involved with the Check Your Lungs campaign

The message from all these platforms was the same: if you spot any of the symptoms listed, see your doctor.

The campaign also included community roadshows at shopping centres, supermarkets, and community venues in Hull, as well as having a presence at popular Hull events including the Humber Street Sesh festival and events at Hull museums.

These roadshows aimed to engage with the community directly and raise awareness about lung health. Attendees were encouraged to complete a symptoms questionnaire, and those who reported experiencing symptoms and had not seen a doctor received a card which they could show their GP practice, advising they require medical attention within seven days.

Dr Walabyeki explained, “The purpose of the card was to expedite their appointment with a GP; we wanted to help people with these symptoms get seen quickly, and by showing this card at their surgery it helped the patient to be seen within a week.”

In addition to the card, people were given health packs which included the symptoms to be aware of, where to get help, and details of stop smoking services, although this was not the focus for the campaign.

During the time working on the roadshow, there were several visitors who returned to share their news.

Dr Walabyeki said, “We had one person who had a red reading on the carbon monoxide test at the roadshow who came back the same day to say they immediately booked a GP appointment.

"Another person visited us later to thank us; they went to their doctor after the questionnaire showed they needed to see a GP and were then diagnosed with a pulmonary embolism.

"And a member of a focus group was reported to have gone to see their GP immediately after the discussion with breathlessness, and was found to need a pacemaker. Hearing those anecdotes while we were out in the field was really heartening.”

GP-specific campaigns

The PEOPLE-Hull study faced significant disruptions due to the Covid-19 pandemic and the NHS Lung Health Checks programme in Hull. The original outreach efforts which began in 2019 had to be halted, resulting in a delay in the planned activities. However, the initiative resumed in 2021, focusing on campaigns in 6 participating GP practices in Hull, covering a significant portion of the Hull population.

GP practice-specific campaign material

GP surgeries displayed campaign material featuring their own doctors to encourage patients to make an appointment if they had any lung health symptoms

GP surgeries displayed campaign material featuring their own doctors to encourage patients to make an appointment if they had any lung health symptoms

Practice-specific media campaigns were launched within these practices, featuring messages from GPs and other health practitioners. Practices employed banners, TV screens, online resources on their websites and some sent out text messages to inform patients about the importance of seeking medical help for respiratory symptoms. GPs were given access to resources on the checkyourlungs.co.uk website.

Dr Walabyeki explained, “These messages from known figures within the practices were developed to connect directly with their patients. Different practices then adopted various strategies according to their individual capacity, to ensure patients who presented with these symptoms received prompt medical attention.”

Future outlook

As the PEOPLE-Hull study has now closed, the research study team are continuing to collate and analyse data to determine the impact of the project on patients' behaviour. This analysis will include the number of patients seeking medical help for respiratory symptoms, referrals to secondary care, and the timeliness of GP appointments.

The study's mixed-methods evaluation is complex, including interviews with patients about their symptoms, experiences seeking medical help, and the outcomes of their appointments; focused ethnography, where researchers will observe behaviours within practice waiting areas; focus groups with receptionists, healthcare practitioners and practice staff; and a consensus development exercise, meeting with GPs and practice managers to provide insights into attitudes and barriers faced by different patient groups.

Professor Una Macleod, Dean of Hull York Medical School and a member of the research team working on PEOPLE-Hull, said “By reframing the conversation around lung health and emphasising early detection rather than focusing solely on smoking cessation, our study aimed to help reduce the stigma associated with smoking and lung cancer, and encouraged individuals to prioritise their lung health.”

“The Check Your Lungs campaign has laid the groundwork for a healthier future in Hull, where individuals prioritise their lung health and seek timely medical care, resulting in saving lives and improving outcomes for the community.”

Dr Kathryn Scott, Chief Executive at Yorkshire Cancer Research said, “Findings from the Check Your Lungs campaign will help improve the early detection of lung cancer in Hull and beyond.

“Seven in 10 lung cancers are diagnosed at a late stage in Yorkshire. By finding lung cancer earlier through screening and understanding the best ways to encourage people with symptoms to seek medical advice, we can save lives.”

For more information about the Check Your Lungs campaign and the PEOPLE-Hull research study, please contact Dr Julie Walabyeki. Dr Walabyeki is a member of the Cancer Awareness, Screening and Diagnostic Pathways Research Group.

References

1. Office for Health Improvement and Disparities. Public health profiles. 2023 © Crown copyright 2023

2. CancerData. 2023