Archive for November, 2010

Public Health White Paper – Do “Nudges” have their own Values?

November 30, 2010

The Public Health White Paper is a significant document. It shows the wide level of political consensus for tackling health inequalities. The days of 260 copies of the Black Report being published on August Bank Holiday in 1980 with a disapproving ministerial Foreword to the document are long gone.

Key elements of this White Paper include:

  • Public Health England will be created as a service that gives more power to local people over their health, whilst keeping a firm national grip on crucial population-wide issues such as flu pandemics.
  • Funding from the overall NHS budget will be ring-fenced for spending on public health. Early estimates suggest that current spend on areas that are likely to be the responsibility of Public Health England could be in the range of £4 billion.
  • Central Government will not hold all the purse strings. The majority of public health services will be commissioned by Local Authorities from their ring-fenced budget, or by the NHS, all funded from Public Health England’s new public health budget.
  • The use of behavioural Nudges to improve public health choices and create positive social norms.
  • A health inequalities agenda focused on Health Premiums for poorer areas linked to the achievement of health improvement outcomes.
  • More effort to encourage improved health outcomes via the workplace with a voluntary Responsibility Deal for business.

Much of this will be welcomed as Public Health and the associated behaviour change agenda that comes with it, will be put on a clearer statutory footing and not be an adjunct to the “treatment” activity that is inevitably the priority of the NHS. The King’s Fund have set out a range of very useful questions that need to be asked around accountability, funding, inequalities, the role of industry and its place in the Big Society agenda.

If there is any political debate, it will be about whether we have moved on from the “Nanny State” to the “Nudge Society“. However that in many ways is a side-show. The previous government Nudged as well as Nannied, whilst it is hard not to see some proposals today being anything other than Nannying (even if it is likely to be broadly popularly supported Nannying) such as plain packaging for cigarettes and minimum alcohol pricing.

The big question to ask will be, are Nudges enough on their own?

Many Nudges tend to be structural and design changes to the wider environment, or improving incentives based on behavioural economics theory. As a result they focus on people’s ability to conduct a behaviour with the aim to make more difficult the ability to stick to a bad behaviour and easier to take up a good behaviour. This is all very good as part of any behaviour change campaign. However behaviour change research indicates that tackling people’s ability to change is not always enough. It is also whether people’s motivation to change is strong enough and they display enough self-efficacy. If only part of the equation is addressed, then short-term gains are still likely, but change through incentives may not be permanent and thus is value for money for the taxpayer really achieved?

If we need to address motivation then one of the most effective ways to understand this is through values based segmentation. This has added importance if one also hypothesises as to whether Nudges still apply in the same way if people have different needs and values, driving their level of motivation?

Let’s take a classic example of the Schiphol Airport Fly Nudge designed to reduce  spillage in male urinals at the airport. Based on substantial values analysis dating back 38 years, whilst Outer Directed males would see the fly as a clear target, would all Inner directed males with benevolent or universalist values do the same? Would those with Sustenance and Safety values see the fly as dirty and to be avoided at all costs?

When Nudges do seem to be used to address people’s emotions and perhaps their motivations, these are all about framing communications. An example of this sort of Nudge is optimistically expressing a 10% medical survival rate rather than expressing a 90% death rate. Again does this remain the same with values?

All this illustrates the need for future public health research and piloting to test out a range of Nudges and measure them in terms of values as well as traditional geodemographic measurement.

Charlie Mansell is Research and Development Officer at The Campaign Company.

The Grit Society?

November 30, 2010

The heavy snowfall does tend to bring out the best in people as they work together to overcome challenges. Whether one calls this the Big Society or more generally Civil Society, it should be welcomed by all. Perhaps as the current climate implies, we should this week call it “The Grit Society”

Since snow is pretty rare in the UK and it would be a prohibitive cost to have a whole set of public services in reserve for something that may only happen a few days or weeks a year, the snowfall does provide a clearly defined opportunity for co-production between the public sector and the public in general to ensure everyone is not inconvenienced too much.

Clearing the roads and areas outside major public buildings and registered old people’s homes seems a clear responsibility of the average Council, in many cases on good safety grounds. At the same time the sheer size of the operation of clearing the snow from pavements, does require volunteers from the public in the roads they live in.

In the London Borough of Sutton, where I live, I am pleased to see that the Council has encouraged this with free grit schemes for the public and the provision of open data information on the location of grit bins, so the public can can create information mash-ups and perhaps comment in more detail on how this service is delivered in future. I was a local Councillor in Sutton for many years and I do think the provision of gritting services and information is an improvement on the past.

However we also need to be honest in the recognition that some people will be more motivated to volunteer to help clear pavements more than others. Those people may see volunteering as a good thing in its own right. Some people might get round to volunteering because they at some stage see a lot of friend’s, relatives and neighbours taking part. And others might see this as still an issue they pay their Council Taxes for and expect greater reciprocation back from the Council. The key thing to be mindful of is that people will think about this issue in different ways depending on their values.

The issue, then, for Council’s during the cold months is to communicate a range of messages that motivates those who want to help, encourages more people to take part, but reassures those who do not see volunteering as fair compared to what they already feel they contribute. That opportunity for mindful values based communication is the way to turn the current co-operation of this week’s “Grit Society” perhaps into a wider civic participation.

Charlie Mansell is Research and Development Officer at The Campaign Company.

The Public Health White Paper and NICE Health Incentives?

November 29, 2010

With the Public Health White Paper due to be published on Tuesday, it seems appropriate to comment on the use of incentives to encourage positive Heath outcomes. Reporting over the weekend indicated that a range of Nudges, including incentives might be part of the White paper agenda.  TCC itself also recently submitted a paper to the National Institute for Health and Clinical Excellence (NICE) consultation on health incentives.

Thanks to the research of Bandura, Sampson, Cialdini and others, we now know a lot about different approaches to behaviour change. However, we also know that even acclaimed behaviour change campaigns don’t necessarily translate from one group of citizens to another. `Don’t Mess with Texas’ may have worked wonders for litter reduction in Austin, but how does `Don’t Mess with Tunbridge Wells’ sound? The same applies to the issue of health incentives. People will respond to health professional’s requests to take more care of themselves in different ways, depending on their needs, emotions, values and motivations.

To run effective behaviour change campaigns, which might include the use of incentives, requires accurate targeting and segmentation with the key aim to understand the different motivational triggers for different groups.  Healthy Foundations was the Department of Health’s, recent attempt to segment the population according to health attitudes. Whilst being a step forward it falls short of its goal to become a useful tool for segmenting the population in a subject area as complex as incentives.

In the paper TCC submitted, we argued that Values Modes takes us much closer to understanding the underlying drivers that make people behave the way they do even when provided objective and factual health information.

The paper also sought to move the incentives debate on from simply whether one is in favour of it or against it, to how one might develop the scoping and insight phases to deliver a pilot with different targeted interventions according to the values of the participants. The NICE Citizen’s Council set out the pros and cons. Assuming the consultation endorses the majority decision of the Citizen’s Council, the TCC paper set out the way to deliver a more effective intervention.

Values Modes gives us a broader, more accessible and useable approach to segmentation, and therefore a much clearer understanding of the relationship between needs, values and behaviour, which could thus enable incentives to be used in the most effective way, but also communicated more effectively to those who would not be in receipt of them, thus securing wider buy-in for any pilot project.

Charlie Mansell is Research and Development Officer for The Campaign Company.He would also like to thank Nick Pecorelli for his helpful comments and contributions to the NICE paper.

What does happiness mean to you?

November 26, 2010

“there is much that it does not comprehend. It does not allow for the health of our families, the quality of their education, or the joy of their play. It is indifferent to the decency of our factories and the safety of our streets alike. It does not include the beauty of our poetry, or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials… (it) measures neither our wit nor our courage, neither our wisdom nor our learning, neither our compassion nor our devotion to our country. It measures everything, in short, except that which makes life worthwhile….”

Was this perhaps David Cameron speaking at the launch of the Government Happiness Index yesterday?

In fact it was Robert Kennedy speaking on the inability of the American Gross National Product to fully reflect the needs of society during his ill-fated run for President in 1968.

However one should not be churlish about the launch of the National Wellbeing Project yesterday. This is a long-overdue piece of public policy work as the pioneering Kennedy speech shows.

A widening of measurement beyond the rational economics of the UK Gross Domestic Product enables us to consider what really constitutes happiness.

Will this be the same for everyone or should we take account of people’s values?

A beautiful sunrise on holiday might be seen by an inner directed “Pioneer” as an aesthetically pleasing experience to savour or by an outer directed “Prospector” as a ready opportunity to get the suntan lotion out to tone the body beautiful. Both will be equally happy but for very different reasons.

As the work of the World Values Survey in this field seems to show, people are clearly happy when they satisfy their needs and can then seek fresh challenges. The satisfying of those needs determines their values, emotional state and motivation.

The danger is that without an understanding and mindfulness of all the values that exist out in society, there is a possibility that a Happiness Index is mostly likely to reflect the inner-directed values of its likely authors as well as perhaps also a set of “objective” numbers around “quality of life”. Any delving into the emotional state of the nation may be no more than an “are you happy?” question on a 1-5 scale which will only be a skin-deep study of the real values and emotions of people in the country.

A Happiness Index should not only tell us how happy or unhappy people are, it should also give us the pointers as to how we can directly improve things, in the way that values based segmentation already does within behaviour change interventions.

Jonathan Upton is the Chairman of The Campaign Company.

Patient and Public Involvement: Transforming Care through Shared Decision Making

November 23, 2010

“Shared decision making will become the norm: no decision about me without me”

The inclusion of the above line on the first page of the recent NHS White Paper was the context in which a conference titled ‘Transforming Care through Shared Decision Making’ was held last Thursday. Drawing upon a variety of clinicians, patient groups, managers and academics interested in the field of shared decision making (SDM), there was discussion of the current levels of SDM within the NHS and its potential future influence. I attended on behalf of TCC to see how far the inequalities in the provision of patient information that TCC Chairman, Jonathan Upton has recently blogged on, were being addressed.

As Dr. Angela Coulter from The Foundation for Informed Medical Decision Making noted, whilst there has been widespread support for SDM for a while now, patients’ reports have not suggested that this has necessarily been put into practice.

A general stubbornness on the part of some clinicians to acknowledge the opinions of patients was highlighted, something that was attributed to the traditional nature of medical training and the inherent paternalistic attitude of senior doctors. Whilst clinicians often see the theoretical benefits of SDM, when this inevitably leads to patients telling doctors what they themselves want, communication breaks down as doctors feel that they know best.

However, there was a feeling that the White Paper was cause for a degree of cautious optimism about the potential for a more focused implementation of SDM. Dr Coulter argued that choice was not about patients being able to choose which hospital to attend. Dr Steven Laitner further argued that SDM should in fact be much more about involving patients in making decisions about which treatments are best for them.

Professor Clare Bradley stressed the importance of distinguishing between measures such as health status, satisfaction and well-being and a more general quality of life. She argued that these have often been confused, particularly by NICE, when treatments can often improve health but actually damage quality of life.

The conclusion was that it is often patients who are much better placed than clinicians to decide on the care outcomes best for them. By providing patients with the medical information and other ‘decision aids’ available to doctors, both the quality and productivity of service could be improved.

To this end we were shown a variety of innovative and engaging websites and interactive online decision aids. But as Dr Amir Hannan rightly pointed out, there is a danger in an assumption that information equals empowerment and argued that some people need more than just a website.

Indeed, Mark Duman of the Patient Information Forum (PIF), noted that almost 40% of adults in the UK do not use the internet every day. A large number of these are potentially excluded from such processes of SDM. Without a more encompassing approach, there is a danger that an ‘inverse care law’ might be reinforced; those that are most in need of healthcare – typically those in deprived areas – find it hardest to access – as deprived areas have a lesser likelihood of access to the internet.

As part of the more encompassing approach, one also needs to address the issue that some people, given access, still do not respond to information. As TCC Chairman Jonathan Upton recently blogged, needs, values, emotions and motivations are key drivers here and insight is required to understand which values segments of the community are least likely to respond as a result of this.

SDM clearly has a role in the future of the NHS. Andrew Lansley sees it as being right at the heart of his reform package and the attendees of this conference suggested a willingness right across the board to implement it. What must be ensured along the way is that SDM maintains the universal principles of the NHS in ensuring that it is open to all patients, and not just the proactive minority.

Danny Slater is a Research Assistant at The Campaign Company.

Patient Information – Why won’t we do what we’re told?!

November 19, 2010

“High quality health and care services depend on good information. The right person having the right information at the right time can make all the difference to the experience of a patient, service user or carer….. Information is a health and care service in its own right: it must be freely available to all who need it.” Andrew Lansley – Secretary of State for Health, Foreword to “Liberating the NHS: An Information Revolution” Consultation document – published 18 October 2010.

I have posted before on the developing issue of Patient Information, however, as the quote above demonstrates, this is becoming increasingly important with a current Government consultation on the subject.

The role of Health Information and current challenges

The effective provision of information to citizens is vital to a healthier society.

This premise is built on the assumption that appropriate and accurate information enables people to makes choices or act in a way that is in their own self-interest and improves their own lives and those of their families. The whole point of ‘information’ is to prompt people to act.  The suggestion is that there is an objective body of knowledge ‘out there’ that simply needs to be communicated clearly and individuals will process it rationally and act on it in an identical fashion.

The role of information in a health context is likely to expand further over the next few years. The Health White Paper itself refers to an “information revolution” and the Coalition Government sees transparency as a key driver for innovation and reform. In addition information is also seen as vital for any form of co-production where patients may be asked to self-care with the support of professionals.

Current solutions and their potential limitations

The work of professionals in this field has understandably – and rightly – focussed on precision, accuracy, safety and protection against possible legal liabilities.

There are still clearly substantial barriers to information equality with health literacy and digital exclusion currently seen as the principal challenges.

Simplifying information, using plain English, addressing any cultural issues and improving access through digital inclusion, undoubtedly has a significant impact. And it will continue to be a priority to provide information in as wide a range of forms as possible to ensure that people are treated equally and fairly.

However, we also know that people who have full access to information and are without basic language or literacy problems still do not respond appropriately, i.e. they don’t seem to act in line with our perception of their own best interests to the information that is presented.

Look at some common challenges that we face with health and related services that have been subject of vast amounts of information dissemination:

  • Exhortations to encourage us to give up smoking, eat more healthily and take up more exercise
  • Raising awareness of the symptoms of testicular, lung and breast cancer and subsequent prompt self-referral
  • Encouraging people to take their medicines at the right dosage and at the right time
  • Increasing the number of blood donors
  • Providing information on pharmacy opening times, availability and services offered
  • Encouraging elderly people to keep warm in winter and hydrated in the summer
  • Reducing inappropriate use of A&E services

It’s simply not credible to suggest that our failure to bring about ‘behaviour change’ in these and similar areas is because people either have an information deficit or don’t understand what they are being told or asked to do. This is increasingly understood to be the case with  ‘lifestyle’ issues but it is equally relevant with regards to those issues where traditionally the simple passage of information is seen to be sufficient, for example, when providing information regarding self-care following an inpatient stay in hospital.

If people do not respond as we would wish to the information we give them, then a central plank of public policy is flawed and an initiative that seeks to use public money wisely in fact potentially wastes it.

In the rest of the paper we explore why this happens and what one might do to address this. We need to explore how we make information more directly salient to those people currently least likely to use it.

Information and behaviour change: the need for Motivation as well as Ability

One cannot achieve a successful behavioural outcome without addressing two questions for the individual you are targeting.. They are:

  • Ability: “Do I have the ability to continue, start, adapt or stop this behaviour”? e.g. skills, tools, finance, time, physical and mental effort, knowledge and physical access
  • Motivation: “What’s in it for me, or for people like me, to start, adapt or stop this behaviour?”

Health information strategies tend to aim to focus on the first question-Ability.

This approach relates to tackling and supporting the ability of people to utilise the service or behave in the desired way by making the information as accessible as possible. In other words much of the effort has gone into building mechanisms that enable people to access information without understanding who will use the information and how its use varies between individuals. Understanding how different individuals are likely to respond will make communications more effective, achieve better outcomes and be a better use of resources.

Information and behaviour change: Values

In order to ensure people act on information we need to understand their likely levels of motivation in response to it.

TCC’s central premise is that the way people are motivated to behave – and, in this case, act appropriately on any information we give them – is strongly influenced by their values. Our approach moves forward from the idea that all people of a certain demographic or geo-demographic think the same and are motivated by the same things.

Values are one’s judgements about what is important in life and the lens that you look through when you view and try to make sense of the world.

Our values are derived from our unconscious motivation to satisfy a range of needs as we navigate our way through day to day life. A need is something that is necessary for us to meet if we want to live a physically and emotionally healthy life.

Needs can be objective and physical, such as food and water, or they can be subjective and psychological, such as the need for security or self-esteem.

The key thing to understand is that it is from our ‘dominant need’ that our values – what is most important to us – are derived. And when faced with a decision it is these values that provide the unconscious ‘frame’ that kicks in and sets the context before we actually take action.

Once we understand values, we understand what makes people tick. And we can start to understand how they might perceive services, how to deliver them in an in an empathetic way that matches their values and, crucially, how to motivate them to do things.

UK based values segmentation data is based on 37 years of data collected via the British Values Survey of 8,500 nationally representative survey. The resulting values based segmentation gives us three principal values groups:

  • Settlers: motivated by the core needs of safety, security and belonging. Home, family and immediate neighbourhood are important, and the wider world often feels threatening. Change is often seen as negative.
  • Prospectors: motivated by the need for self-esteem and the esteem of others. Job progression, money and social status are important to them and although usually optimistic, they can worry for example about their status or the perceive declining quality of an environment.
  • Pioneers: motivated by ideas, aesthetics and personal development. Interested in new information and often the initiators of change. They tend to have large social networks, but individuality is more important than following the crowd.

Applying these three core values groups help us understand how people make sense of the world, what motivates them to act, and therefore means we are able to more effectively craft information and messages – whether verbal or written – which resonate with these motivations.

So what are the practical implications arising from this?

Let’s take the example of communicating a message such as the need to apply anti bacterial hand-wash before entering clinical areas in hospitals. This is usually conveyed in a single message – ‘Help us fight infection’ which in values terms is a Pioneer message that ‘it’s the right thing to do. But ‘Settlers’ might respond better to a message which uses sanction or fear – such as ‘protect yourself and your family’ – and with ‘Prospectors’  it might be to emphasise that people who do this are seen to do the right thing – ‘Set the example be a role model’.

This Pioneer message is understandably the likely approach of health professionals who – experience and evidence shows us – are predominantly Pioneer themselves.

How values based segmentation and communication might help?

If we understand levels of motivation and the importance of emotions in delivering messages there are a number of practical ways this can be taken forward.

Some organisations like the Patient Information Forum (PIF) are already exploring issues around the idea of encouraging positive pro-social behaviour change. This is an area that TCC has much experience and, along with its understanding of Value Modes, can add value to. Specifically we can:

  • Use the British Values Survey database to understand the groups that are most likely to read the information and yet fail to be motivated by it. This would be supplemented by qualitative research to explore people’s needs, values, world views, motivation and behaviour and how these views relate to accessing and acting on information
  • Produce research that would assist organisations develop more effective approaches in both written and verbal information.

Conclusions

The ability of individuals to access to information will continue to increase and will undoubtedly benefit many. Unless an organisation is mindful and seeks to understand the different values of their audience, and how this shapes their actions, the information it provides will fail to engage and connect with some of its most vulnerable client groups.

Jonathan Upton is Chairman of The Campaign Company.

Delivery that responds to needs: Safety, Security and Belonging

November 15, 2010

How does public policy satisfy human needs?  This may at first seem like a straightforward question, but are we sure we know the answer?

On a day to day to basis services are delivered which provide support to people in numerous practical ways attending to many direct physical and resource needs. Health provision is an example. Despite the current financial difficulties, this will clearly continue to main form of delivery. However, when it comes to some of the difficult challenges public bodies face, a weak point in delivery can often be around the issue of responding to emotional and psychological needs. Often this is seen as something only to be targeted to respond to a small number of people, rather than an issue that should be considered when developing public policy.

We think this is important across the board as our values are derived from our unconscious motivation to satisfy a range of needs as we navigate our way through day to day life. A need is something that is necessary for us to meet if we want to live a physically and emotionally healthy life. Needs can be objective and physical, such as food and water, or they can be subjective and psychological, such as the need for security or self-esteem. In very broad terms, from the values based research we have conducted, we believe that there are three primary needs, which – as we strive as individuals to satisfy them – drive the choices we make:

  • For some the dominant need is the first need we all have – the desire to be (and to feel) safe and secure
  • For others the dominant need is our secondary need – the desire for the esteem of others
  • For others the dominant need is our ultimate need – to seek self-fulfilment and pursue our own personal goals

The key thing to understand is that it is from our ‘dominant need’ that our values – what is most important to us to satisfy our current needs – are derived. And when faced with a decision it is these values that provide the unconscious ‘frame’ that kicks in and sets the context before we actually take action.

Once we understand values, we understand what makes people tick. And we can start to understand how they might perceive services, how to deliver them in an empathetic way that matches their values and, crucially, how to motivate them to do things.

UK based values segmentation data is based on 37 years of data collected via the British Values Survey of 8,500 nationally representative respondents – augmented by over 20.000 interviews per year.

Lets look at a recent study into needs of a specific group based on wider UK data and local insight conducted by TCC for a North of England PCT on the issue of teenage sexual pregnancy.I am grateful to Pat Dade of Cultural Dynamics, who work closely with TCC on many projects, for the following example:

Example Needs Set – Teenage Sexual Health – Research Notes based on material provided by Pat Dade

  • These young people are not the same as adults. They are confused young teenage girls caught up with emotions and needs they are ill-equipped to deal with. However we also must remember the equally confused and vulnerable teenage boys as the other half of this equation. We cannot deal with one without dealing with the other.
  • This is about a need for belonging. It’s not about the morals of bad behaviour, even if some outside their world believe it is a story of a ruined life and a future without hope.
  • These young people perceive themselves to be desperate for that belonging in a world that is leaving them behind. We may think they have all the time to make decisions, but that is not what concerns them at this point in time. The have not satisfied their fundamental needs for belonging or even for safety and security
  • First we need to tackle issues around safety and security. This is not just the provision of benefits, but also the emotional support that might need to substitute for weak parental support. Life for these young people is episodic and short-term, rather than future oriented and continuous if those early needs were satisfied and they were in a positive process of satisfying their belonging needs.
  • We also must recognise that when one seeks to satisfy these basic needs, there is little or no desire to be motivated to change things. At this stage of their life they are likely to be non-reflective. They do not want to be told their good or bad points. They are also highly likely to be on a “be satisfied with what you have got” outlook. The family role models (mother, sisters and cousins for example) are likely to lead to a sense of fatalism that leads to the non-safe behaviours you will be concerned about.
  • Without family role models the need for group role models becomes more important. Word of mouth engagement through appropriately trained and supported local people is key to connecting with this group. Reading/analytical skills are likely to be low, so leaflets and the Internet just will not suit their way of receiving and absorbing information. The role of the informal social network is absolutely key here. We need to be able to infiltrate their networks with the messages that come from relevant and trusted sources. Messages from outsiders will simply be seen as telling them they are wrong and will be just added to the list of people (teachers, adults etc) who already do that to them, often to little effect
  • Even those young people who have more security and safety in their home life are still vulnerable if their needs for belonging are not satisfied as this could lead them to undertake risky behaviours to achieve acceptance. What we find is the desire for inclusion is less strong than the fear of exclusion from their existing social networks. As a result we find the fear of exclusion from a marginalised group they already belong to is far more likely to drive behaviour than the desire to be accepted by more mainstream young people within their community. Sex in this context is much less about hedonism than a way to cement a place within their social network. Thus an appeal to abstinence as a result of the risk is a non-starter if the result is its leads to less belonging.
  • In order to create a solution, we need detailed local research into these motivators as well as how people them rationalise and justify their behaviour after. It also requires talking to the teenage boys as well as the teenage girls. The boys are likely to have similar needs of safety, security and then perhaps belonging they wish to satisfy within their own social networks.
  • Whilst schools can be providers of some information, they may not be seen as providers of security and safety to the target audience. Indeed through issues such as bullying and peer group pressure they might be seen exactly in the opposite light, leading to exclusions and involuntary absence, which may itself provide the opportunities for more risky sexual activity – eg parents out of home during the day?
  • The role of others in the process also needs to be looked at. The role of social workers working with children at risk. Often they are not trained to understand the young people’s current needs to be able to suggest alternative behaviours that can seek to satisfy the need in a safe way and thus reduce the risks. They are also not trained in the language needed to converse at the level of those needs. One of the problems is that those staff, will, like us, have satisfied those more basic needs and thus hold a set of values that is often totally not in tune with the target groups of young people. We found this when we worked in a number of communities in the North of England and East London, so our work was not just about finding and supporting positive people in the community who could convey word of mouth messages, but also ensuring the professional staff talked in the same language that addressed the psychological needs of the people in question. If they get to that level of conversation, interventions will be so much more effective.

Conclusions

What this tells us is that a target group may have a range of needs that need to be addressed at various points. Also satisfying one set of needs may lead to another set of needs arising, so there is no single magic bullet, more the need to recognise that people can change and insight and ongoing engagement needs to be able to dynamically change to reflect any changing values that may arise from new needs. Building a clearer evidence base to really understand needs in some communities is likely to be increasingly important for when local government takes the lead in future on tackling public health challenges .

Charlie Mansell is Research and Development Officer for The Campaign Company.

Building the case for working with cultural values

November 8, 2010

I have previously made brief reference to the recently published World Wildlife Fund supported report Common Cause. This report is very important as it seeks to make the case for utilising cultural values in understanding public policy challenges.

I appreciate some of the following issues might be a little arcane, but I seriously recommend reading the report itself, this blog and the article by Chris Rose that I refer to later. The debate on the report will, I believe, also be very important as to how we view many forms of behaviour change in the future.

It is firstly worth setting out core points of the Common Cause report and then looking at how far it takes us forward in understanding the issue better and where alternative values based approaches might work better.

Common Cause – Understanding Cultural Values

The report argues we are facing global challenges that are “bigger-than-self” problems. It concentrates on the example of climate change, which might not impact on most of us at a direct personal level but is nevertheless a longer-term challenge to wider society. The report also rightly recognises that our ‘Enlightenment model’ of rational human decision-making in the light of scientific study, fails to take account of the fundamental role of emotions and that understanding values is important to this as they are driven by needs and emotions.

It identifies differences between “intrinsic” values that much more easily respond to “bigger than self” problems and “extrinsic” values that relate to perceptions of others, material wealth and power. It thus argues for strengthening intrinsic values in society, so that “bigger than self” issues such as climate change are more seriously considered. In order to achieve this it suggests the use of “frames” which it describes as the mental structures that allow humans to understand reality. It recommends encouraging the use of a number of particular frames of thought to communicate specific messages in order to enhance intrinsic values, which are set out here:

  • Common interest as opposed to self-interest
  • Nurturant parent as opposed to strict father
  • Participative democracy as opposed to Elite Government

In terms of practical use, it makes the following recommendations:

  • Organisations should develop an awareness of values
  • They should transparently acknowledge they are promoting certain values
  • Even unsuccessful campaigns can have an impact if they use the right frames effectively
  • The potential for collaboration across a range of policy issues if frames are used consistently by a range of organisations
  • Organisations should recognise the impact of direct experience of public policies on people’s values
  • Campaigns may serve to inadvertently strengthen  unhelpful frames. In this case it is critical of those seeking to address extrinsic values though marketing communications that for example might promote “green consumerism”. This last point will be addressed in more detail below.

The report has been welcomed by organisations like the RSA, however it is clear even from their comments regarding the existence of intrinsic values during the last World War, which are surely survival and safety motivations and values, that many people are still unclear as to what is meant by intrinsic and extrinsic values and particularly how they have evolved over the last 40-50 years. We would argue that values based segmentation is more complex than that.

Using Values even more effectively

The authors of Common Cause recognise in their Foreword on page 6 that it is clearly a “work in progress”. The report is absolutely right to raise the importance of using values and then utilising frames to communicate values laden messages. It is, however, far too trapped by its own deeply held intrinsic values to recognise that in order to achieve a wide distribution  of the values it favours, people and society are very likely to often hold extrinsic values first.

The World Values Survey shows how these cultural values have evolved over the years. If one recognises this is a vast dynamic evolving process impacted by many resource and contextual factors, trying to “convert” people through frames into holding intrinsic values can then be seen as a very difficult thing to achieve in any sensible timescale. The report also raises a whole range of ethical issues in this field. Who decides it is right for authors and their supporters to “impose” their values on something that is likely to evolve anyway through numerous forms of interaction including people’s own social networks as well as the impact of NGO campaigns. It also seems to be rather unfocused in strategic terms since it then faces the vast logistical challenge of the need to “convert” a lot of people!

Others with substantial expertise working in this field share similar views to us on this. The noted environmental campaigner Chris Rose, has just published this critique of Common Cause, which we strongly concur with. Chris is an expert in the field of values based campaigning and communicating and makes the point that there is a vast difficulty in starting change by changing values; rather than seeking to work with the grain of existing values and communicate and create behaviour that resonates with each values set. In order to do this one needs to conduct deep insight using a clear segmentation system with effective and clear metrics that the Common Cause typology currently lacks, but which does already exist as a result of the 37 years of data collection for the British Values Survey.

Building on some of Chris Rose’s arguments what might be a more effective use of values in tackling issues within public policy? Here are a few pointers:

  • Understand the full range of values. Common Cause lumps together Extrinsic and Safety values and thus does not recognise that people have a wider range of needs to be satisfied than is actually expressed in their report.
  • Winning broad support requires effective segmentation in order to win support across all values sets. Common Cause does not have clear metrics across all values sets.
  • Understand and Focus on the needs – when a need is met it gets overtaken by new needs. It is needs and the emotions associated with them that drive the development of values. Addressing needs is much more likely to work compared to the various forms of “Reflexivity” that Common Cause and even the RSA’s behaviour change publication Steer tend towards advocating. The danger with these latter approaches to change is that we simply end up with intrinsically motivated people talking to other intrinsically motivated people as they are most likely to be reflective on these intrinsic conceptual “bigger than self” issues. Tackling people’s needs also often requires collective action by public bodies that is likely to be beyond the resources of campaigning NGO’s.
  • Sell the action required not the problem. A problem such as climate change may well be too conceptual for those focused currently on satisfying extrinsic or safety needs. Actions are much more likely to be made easily tangible and closer to home, whereas “bigger than self” problems are often intangible and a long way away from people’s daily lives.
  • Change outcomes in order to lead opinion, rather than change minds at the level of deeper attitudes and beliefs. This requires the use of other tangibles like technology and market which are more likely to be “believed” by those with extrinsic and safety needs than conceptual universalism embodied in intrinsic values. Utilising these tangibles in green terms may then create short bursts of cognitive dissonance, which is corrected when opinion finally follows the newly adopted behaviour.

Whilst Common Cause is a significant advance, there is a potential danger it will lead us partly into a cul-de-sac and demobilise campaigners for change. What happens when people with different values still choose to ignore the conceptual “bigger than self” frames the report recommends? This is not to say people should not seek to encourage intrinsic values. As someone who holds them myself, I generally share the view that it is good for more people to hold them, as society will then be more like the one I would like it to be. However, compared to the authors of Common Cause, I am also “mindful” of other values and recognise my values would not be in the increasingly prevalent position they are but for the many who built our society over the years mainly with different values to myself. I also recognise those other values are still strongly represented in society as well. Pat Dade of Cultural Dynamics, a long-standing practitioner in the use of values based segmentation has also has raised the issue of “mindfulness” saying that one of the problems with the report it that it: “is based on the “unawareness” of the authors of their own values set  and the unconscious assumption that their “viewpoint” is the “right viewpoint” – the very thing we try so hard to be aware of and beware of!” Thus we do need to recognise, as Chris Rose indicates the difference within our strategies between our own long-term support for changing values to be in line with our own values and shorter term actions required to change behaviour.

Nevertheless, as well as a good basis for a debate, what Common Cause could enable NGO’s to do, is to even more effectively communicate to people who already hold intrinsic values and get them to do even more on “bigger than self issues”, such as responding to climate change. There is nothing wrong with that. However, we must be realistic that it will do little to address the current needs, emotions, motivations and values of the 60% of the UK population who do not primarily hold intrinsically motivated values.

We therefore think this is an important document and a very important debate and we will return to explore the elements within Common Cause in more detail in coming weeks. Despite some of the disagreements set out here, I am sure all those taking part in the debate would agree that the first step is clearly mainstreaming a values based approach, which Common Cause is a good first attempt. However in taking this mainstreaming forward I hope the debate concentrates on the need to ensure that we use values based communication more effectively.

Charlie Mansell is Research and Development Officer for The Campaign Company.

The Lords discussing behaviour

November 2, 2010

The House of Lords Science and Technology Committee has this afternoon started its inquiry into the effectiveness of behaviour change campaigns. Peers will investigate the ways in which the government seeks to change public behaviour in key policy areas and have started off by questioning civil servants about whether ministers’ approach has been “evidence based” and effective. Areas set to be explored include public campaigns to reduce smoking and obesity and to encourage recycling.

Nick Pecorelli has submitted evidence to the Committee on behalf of TCC, regarding the need to focus on motivational factors on top of the already well-known mechanisms to improve ability for people such as choice architecture changes, also known as Nudges. Nick’s paper argues that in order to understand motivation, one needs to segment to understand the dynamics around individual’s current needs and values.

The results of the Inquiry, along with December’s Public Health White Paper, will no doubt set the agenda in the field of behaviour change over the coming years and we have welcomed the opportunity to contribute our views to it.

Charlie Mansell is Research and Development Officer for The Campaign Company.

The Big Society: understanding its back-story to take practical action now!!

November 2, 2010

People are naturally asking what the Big Society means to their real lives? Too often the answer is soundbites and political argument. At best it is expressed as theory, or perhaps some examples of local volunteering.

However, in order to understand it we need to look, not just as to how it is currently defined, but also whether it represents a long-term trend in how service delivery might be developing in the context of changes over the last 30 years. In other words we also need to understand the Big Society’s back-story.

Only then can we see what we then need to put in place that goes with the grain of those long-standing trends.

This quite long and detailed posting seeks to stimulate discussion on all those issues. It certainly does not pretend to have all the answers, however it may at least explain the roots of the concept more clearly as well as set out an approach to it that could then be adopted, not just in the distant future, but in the next six months.

The Big Society – As currently defined

First of all let’s not get hung-up about the actual term. Perhaps it should be talked about in terms of an expansion of Civil Society as I recently blogged here. Indeed rather than use the words Big Society, the Government has just published a strategy for Building a Stronger Civil Society which explains that the core elements are:

1. Empowering communities: giving local councils and neighbourhoods more power to take decisions and shape their area.

2. Opening up public services: the Government’s public service reforms will enable charities, social enterprises, private companies and employee-owned co-operatives to compete to offer people high quality services;

3. Promoting social action: encouraging and enabling people from all walks of life to play a more active part in society, and promoting more volunteering and philanthropy.

What this means in reality seems to include the following so far:

  • Transparency – publishing a wide range of data sets including public expenditure and salaries of senior staff
  • Free Schools
  • A national Citizen service
  • Employee owned co-operatives with a ‘right to bid’
  • Elected Police Commissioners
  • Radically reform the planning system
  • New powers to help communities save local facilities through a right to bid
  • Train a new generation of 5000 community organisers
  • A national ‘Big Society Day’
  • Regular community involvement a key element of civil service staff appraisals
  • Devolution of powers with councils given a general power of competence and a full review of local government finance
  • Support the creation and expansion of mutuals, co-operatives, charities and social enterprises, and support these groups to have much greater involvement in the running of public services
  • Use dormant bank accounts to establish a Big Society Bank, which will provide new finance for neighbourhood groups, charities and social enterprises

Whilst the Big Society has the strong support of the government and has some public support according to polls, there is significant scepticism and some opposition.

Perhaps people need to understand the long-term trends more? That also provides an opportunity to sketch out a new model of delivery, that reflects these trends, some of which comes from helpful discussions with leading practitioners in the field from the London Sustainability Exchange.

The Big Society – Back-story

Let’s first of all examine the evolution of public services that may explain why the Big Society, or whatever one calls it, is the logical culmination of existing trends in society.

The Traditional Welfare State

Figure 1: Traditional Welfare State

Figure 1 is a simple model that was up to 30 years ago the traditional form of the local public sector, with commissioning and delivery often residing in the same organisation. End users got what they were given and had little say in the provision of service. This reflected the values of the time. Over 70% of the population held Sustenance driven values with a strong respect for those in various forms of authority told them, from health and education professionals through to retired colonels through to shop stewards, depending who you might interact with most.

The Current State

Figure 2: The current Commissioning/Delivery/End User model

Over the last 30 years, as Figure 2 shows that the boundary between commissioner and deliverer has developed and become very distinctive as a result of CCT, Best Value and other commissioning initiatives. Whilst some co-production has evolved as well, in the main the end-user is still often seen as a passive consumer and thus also there remains a clear boundary between them and the providers.

The Future Big Society

Figure 3: The future - Delivery/End User Co-production

What the Big Society in effect proposes (Figure 3) is instead of the two boundaries there will be just one single boundary between commissioners and an increasing combination of provider/end-user delivery in various forms of co-production. This is the logical evolution of processes that have been developing over the last 30 years. Some of this is driven by things such as technology and education as well as politics and economics.

We would also, perhaps more controversially, argue that it also reflects a shift in values. Those values mean people do want more choice, purpose and autonomy in their lives and public services need to fulfill those changing needs and values. This is what the Big Society could address. I’m not sure even its own authors have framed the debate in those terms yet?

However, whilst the inner directed will participate and highly motivated outer directed people will seize opportunities that arise, places with a higher than average level of Sustenance driven people are likely to see the disappearance of certainty that will occur with the end of one boundary as a potential threat to their lives. Thus as well as motivating those who want to take part, one also has to segment and reassure those who are likely to be fearful, before it turns into hostility. Reassurance is actually as important as participation at this early stage, in order to make it easier to change behaviour to greater participation later. This is clearly not being addressed at all at present.

In the old system there were clearly defined roles with the local authority at one end and the end-user at the other. Everyday folk who weren’t ‘users’ were just excluded unless they received services.

In the future Big Society everyone is potentially involved. Services users and everyone else. How does that new model work?

  • There would be social enterprises owned by the community to support people micro businesses, or time banks . This could be a network of some scale if the will is there to develop it immediately.
  • Statutory funded services may be delivered primarily by user led organisations and micro businesses – they will deliver  some services. These mini businesses will be owned by the people who use them. This ownership will have to conform to a model and meet minimum standards.
  • Where there isn’t statutory need (ie where people cannot automatically get services) Time banks would enable people to still access services. Some people will donate time to work in the community and this needs to be far better enabled than at present.

Starting to make it happen….by March 2011?

Figure 4: A new operating model

If the need for urgency is to be addressed that model (figure 4) needs to be made concrete, sooner rather than later. The Spending Review of 20 October may not be popular, nationally or locally, but one cannot simply ignore it or just be reactive to it. There is a need for local authorities to be seen as to be on the side of their community in a proactive way in these difficult times.

In the end all the improved communication in the world will count for nought, if the behaviour of the Council is to then to do little in response to the changes. If good words are not matched by deeds, then trust is hard to establish.

Therefore an urgent and practical action could be the establishment of an “enabling social enterprise” for the local authority as a signal of its intent to act now!

The organisation could be based on existing voluntary sector models, or more of a voluntary/private sector partnership business to inject the additional urgency and innovation that may be required in the next 6 months. Such a business could be set up in weeks to respond to the current financial pressures. This organisation would be charged with creating and supporting user led organisations, micro businesses and time-banks that establish and maintain services which are consistent with the needs of the people within the local community. The questions any local authority needs to ask this coming month as it develops it budget plans for 2011, are:

  • Do they have a voluntary sector with the energy and local capacity to take on that role instantly?
  • Is that voluntary sector naturally suspicious of the changes and feel “they already deliver this”?

If the answers to these questions are not positive at present, a local authority with very little time to deliver savings, provide services and respond to new government initiatives is going to have to act fast.

A single enabling social enterprise that is described here could act as a commissioning hub and market place for commissioners to relate to, resource support and a vehicle for knowledge transfer for organisations and individuals who are involved in receiving or providing services.

The exact structure of the social enterprise and the pace at which it is created would be determined through quite urgent local consultation. There is of course the potential of the overarching social enterprise being constituted as a provider cooperative, though that might only secure enough early capital to operate in a few places.

Although the social enterprise will deliver hard resources – training, coaching, templates – it will also focus on the creation of a self-sustaining, local authority wide network. This would build on existing work on personalisation and volunteering. It would support these individuals within the community who have the ability to act as hubs who can promote and cascade the informal learning, support and mentoring that is necessary for the project to succeed. This peer-to peer approach is effective in both cost and embedding a change in behaviour such as taking greater control of services. This approach encourages powerful social learning through observation.

The fundamental aim would be to use the commissioning framework to support local communities to set up micro businesses, co-production schemes and time-banks.  Many local authority staff who are voluntarily leaving in the next few months, may still want to be valued as a trusted volunteer or might want to create a micro-business.

Whatever external support is brought in, it would still involve finding a locally based partner who is already embedded within the community and building on their capacity to engage individuals to participate in a proactive time-bank system.

That new social enterprise would achieve value for money through:

  • charging for services that it provides to micro businesses, user led organisations and time banks;
  • applying for funding from statutory, private and third sector bodies as well as individuals to fund projects and developments;
  • exploiting the network which will be a rich source of knowledge, information and experiential data;

As well as the structures to enable people to take advantage of the opportunities, there is also the need for an integrated behaviour change strategy to ensure that every part of the community is motivated to play its play its part in developing, delivering, owning, managing or supporting the new services

When it comes to behaviour change, two strands – ability and motivation -  are interrelated, interdependent and underpin the goal of creating vibrant community inspired services that delivers those services holistically from first point of need and into statutory funded provision. Other earlier blog postings have covered the difference between ability and motivation in more detail. Too often public bodies have strong framework for nurturing people’s ability, but none for helping develop individual and community motivation.

A seriously supported Timebank at local level could ensure:

  • The skills, time and contributions of all members of the community will be equally valued; the time being shared will be identified by and for the community to ensure participation and  legacy;
  • Facilitate a comprehensive social marketing  and behaviour change campaign: to increase participation in social enterprises and establish a platform for micro-business development;
  • Help amplify the advocacy element of local groups, strengthen community infrastructure, improve cohesion and galvanise active citizenship (as a segue to employment opportunities);

Local Councillors could also be given a role in being a local public face of local timebanks –  a local manifestation of the Big Society and social entrepreneurialism.

Conclusion – The Fierce Urgency of Now!

Establishing an organisation should not take a long time. A private not for profit could be established and registered in a month or two if the will is there. The current financial opportunity provides the opportunity to create some urgency to drive change forward rapidly. This requires a clear timeline and milestones.

The current system of public services delivery will continue to evolve and the Big Society is one way to describe it. Fundamentally for social entrepreneurship to succeed it needs the development of social enterprises to send the message that it is a highly valued social activity that the whole community should be proud of. Developing a strong local social enterprise, absolutely identified as that local authority’s social enterprise to support and develop others would visibly demonstrate a behaviour that will match all the words a local authority will publicly express on this subject in the coming months.

Charlie Mansell is Research and Development Officer for The Campaign Company. I am grateful to my TCC colleagues Gwilym Morris and Kevin Huggins-Cooper for some of the initial thoughts that led to the development of this more detailed posting.


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