‘Taxi!’ was a one-year pilot project developed by the Walsall Council Creative Development Team to encourage local taxi drivers to review their lifestyle and make positive changes.
Since the culture of taxi driving involves long, unsociable hours and many taxi drivers work more than one job to support their families, the project focused on encouraging drivers to make small lifestyle changes within their working lives, such as drinking more water and swapping junk food for healthy snacks.
Interventions included: a film showing how taxi drivers can turn ‘idle time’ into ‘active time’; cushions and seat covers bearing key messages; men’s health manuals; and supporting taxi companies to make structural changes to improve working conditions
- 11 out of 15 taxi drivers interviewed over the phone 5 weeks after viewing the film reported a significant change in their lifestyle, which focused on increased levels of physical exercise and positive changes in diet, as well as dedicating more time to family activity
- Several local taxi companies regularly screen the film at their drivers' base and the local Licensing Department shows the film as part of their induction programme for new drivers
‘Taxi!’ was commissioned by Walsall Council as part of the Department of Health’s (DH’s) Communities for Health Programme. Work to develop Taxi! built on a partnership between NHS Walsall and the Creative Development Team at Walsall Council. The partnership, Arts into Health, was originally established in 1994 and uses creative approaches to support people in exploring health issues and identifying and making behavioural changes to improve their health and wellbeing. Arts into Health projects are developed through a ‘themed’ approach undertaken by specialist development officers, ensuring the programme meets both national public health priorities and local health improvement plans.
In 2006 a report was produced by Bright Red Creative Solutions to review the role of the arts in men’s health within Walsall. The report included a review of a previous project undertaken by Arts into Health, called ‘Truck Stop Rock’. The project used the arts as a consultation mechanism to scope truck drivers’ health status and knowledge and pass key health improvement messages back to them in song.
The report identified some key actions, including developing a number of improvements to services, and recommended that the project should be extended to Walsall taxi drivers, thereby including a wider ethnic diversity of men.
Taxi drivers are entrusted with other people's lives on a daily basis. John Beavon, Trading Standards Manager (and a Taxi! project partner), commented that drivers are often seen as unskilled and sometimes as lower class citizens. Seriously poor health could have devastating effects not just on taxi drivers and their immediate families, but potentially on any of their customers or other motorists.
Work started on the project in September 2008. The Creative Development Team were keen to use the project to explore the links between community arts practice and social marketing principles, developing the project in a way that maximised the benefits of each approach.
A key driver for the project was the Choosing Health White Paper (2004), which broadly outlined the continued modernisation agenda for health within a changing environment. The six underpinning priorities outlined in the White Paper are all areas where men disproportionately experience adverse impact on their health. In addition, the White Paper championed the approach of addressing workplace health.
The established Walsall Men’s Health steering group was used to guide the work. Another key stakeholder that was brought on board was the Trading Standards Department at the Council, which is responsible for granting licenses to taxi drivers.
“That buy-in from Trading Standards, which had nothing at all to do with either social marketing or community arts, or health for that matter, was crucial. They were the key to the hands-on delivery from the taxi drivers.” (Kim Fuller, Community Arts Development Officer)
A review of academic research on the health of professional drivers was undertaken at the start of the project. Lifestyle factors such as smoking, inappropriate eating habits and lack of physical activity are commonly reported in professional drivers. Stress levels and conflict with customers have also been highlighted as issues.
Data about taxi drivers was gained from the Licensing Department at Walsall Council. At this time there were approximately 1,500 people working as taxi drivers in Walsall. Only 6 of the 1,500 taxi drivers in Walsall were women, which supported the project’s focus on men’s health. 87 per cent of taxi drivers in Walsall were private hire drivers working as part of a taxi company, with the rest being Hackney drivers driving traditional black cabs. For this reason it was decided the project would focus on meeting the needs of male drivers of private hire taxis in making healthy lifestyle choices. The data from the Licensing Department also showed that the majority of these drivers were from Asian backgrounds.
To understand the day-to-day working lives of taxi drivers, the pressures they face, and whether there have any specific health issues, a creative researcher interviewed:
- 20 drivers individually and in small groups
- Directors or managers from 15 of the 29 taxi companies operating in Walsall
- Officers from Trading Standards who were responsible for licensing taxi drivers
In addition, the creative researcher supported four drivers in filming a video diary of their working day.
“What worked really well was that I chose four companies to do video diaries for us. They had a small video camera fitted in their cab, and 4 drivers over a 24-hour period filmed themselves as they worked. I gave them a question guide and at the relevant times when they had a few minutes they stopped and spoke to the camera about what they’d just been doing and how they were feeling.” (Kim Fuller, Community Arts Development Officer)
- Drivers work long unsociable hours: Holidays like Christmas and New Year are often the busiest times for taxi drivers and they can charge higher fares. Many of them have multiple jobs working for more than one taxi company. A small percentage of them combine driving with other jobs to earn their living.
- Most drivers in Walsall are self-employed: This means they set their own income targets and work the required number of hours to meet them. A successful taxi driver working an average 40-hour week in a town like Walsall could expect to earn around £12,000 a year.
“It’s not a healthy lifestyle but you can’t afford to have a weekend off… I have had four hours off today, that’s my weekend.” (Taxi Driver)
- Many of the taxi drivers in Walsall have extended family responsibilities: In the majority of cases they are the main earner in their family.
“It [taxi driving] supports the family. I do the work – the wife looks after the kids.” (Taxi Driver)
- Drivers spend a long time ‘hanging about’ waiting for a customer: This involves either sitting by themselves in their car or waiting in a room provided by their company.
Taxi drivers reported that the following health issues affected them:
- Food and healthy eating, including not eating regularly and poor meal choices: The issue focused on what they were not eating, rather than over-eating
“We just grab food whenever we can. You can’t go home and pick up something.” (Taxi Driver)
- Lack of opportunities to take regular physical exercise:
"It’s been the same for the last 10 years – when I am free I just sit in the office… Sometimes I read or listen to music.” (Taxi Driver)
- Stress: The research was carried out at the start of a period of economic recession, the credit crunch was starting to hit and drivers reported a reduction in customers, which led to financial concern. For example, a large number of pubs closing in the Black Country resulted in less demand for taxis.
“It’s depressing when you are not busy. You can’t be bothered – you get bored. Watching a taxi driver’s life is not fun... It’s all about survival.” (Taxi Driver)
- Boredom and isolation: A lack of customers meant more time waiting for fares. Feelings of boredom and isolation may have been compounded by the press criticising local taxi drivers for their lack of customer care – in particular their inability to communicate with customers.
“When you are not so busy you get bored and depressed. It has an impact on you, your customers. You start getting ratty.” (Taxi Driver)
Barriers and motivators
- The key barrier to achieving positive lifestyle changes was the perception that being healthy costs money and takes time, both of which are very valuable commodities for drivers. Drivers perceived that taking time to be healthy would reduce the amount of time they had to work
- A major motivation to stay healthy was the need to keep working to meet financial responsibilities:
"Keep busy and healthy, continue to work and earn, attract more customers, keep earning to support your family." (Taxi Driver)
- Taxi drivers interviewed had a strong work ethic. Conversations focused on work and how busy people had been, rather than how they spent their leisure time
- The need to look healthy and communicate in a positive way with passengers was a motivator. Drivers could not necessarily choose the passengers they picked up, but customers could choose which taxi driver they wanted to use. Increasing their customer base was clearly something that would encourage the target group to make changes
- Group support was identified as something that would support and encourage taxi drivers to make changes
The research identified that the major competition facing drivers wanting to make healthy changes was the need to make money and support their family. Taxi drivers work long, unsociable hours and many juggle a number of jobs.
Based on these insights, the behavioural goal of the project was to encourage Walsall taxi drivers to make small, inexpensive, positive lifestyle changes, such as:
- Drink more water
- Swap crisps and junk food for fruit and vegetables
- Stretch and walk instead of sitting in the car
- Spend more time with the family in an active way
The definition of active time was important to the project partners who were from health and arts backgrounds. There was a recognition that this was not just in traditional health terms (like increased levels of physical activity), but also in cultural terms – it would be equally valid for drivers to spend time reading, learning another language or some other cultural activity.
The steering group did not require any measurable targets to be set, but requested information about the changes drivers made to their lifestyle as a result of participating in the project.
When the project team began work on Taxi!, they had an initial idea based on previous work – to use a comedy event that discussed the insights gained about the working day of a taxi driver as a way to explore health messages. However, the research with taxi drivers challenged this assumption and highlighted that humour would not be an acceptable mechanism for health messages with this target audience.
“We’d got an idea initially that we might use comedy as an intervention, because we’d had some successes with it before in the men’s health programme where we’d turned the script of what the men were saying into a stand-up comedy sketch. We thought that taxi drivers would have lots of comic moments, and so we could invite the men to come see the comedy and talk to them about health. But it became really obvious when we were doing the work that the taxi drivers in Walsall didn’t see the same kind of humour that we could. We thought that people being drunk in your cab and having to deal with people like that could be funny, but we didn’t find a taxi driver who found anything like that funny. So quite early on we changed our plans and decided that wouldn’t work.” (Kim Fuller, Community Arts Development Officer)
It was clear from the research that any intervention would need to combat and reduce the barriers to positive lifestyle changes identified by the taxi drivers. Because taxi drivers were concerned about the financial and time costs of being healthy, it was decided the interventions would focus on small, inexpensive changes that could be made when they were waiting for fares, and how ‘idle time’ spent with families (such as watching TV) could be exchanged for ‘active time’ (such as kicking a football around with the children).
The primary intervention developed was a 20-minute film entitled ‘Have you been busy?’. The script for the film was developed from the insight gathered from taxi drivers during the scoping phase and was performed by an Asian actor playing a taxi driver to act as a positive role model. The film is an 'in-car' video diary of a taxi driver, who reflects on the negative aspects of his job and describes the difference he has made to his life by turning 'idle time' into ‘active time’.
All of the taxi companies have a small waiting area for their drivers, where films are regularly shown on a television. Subsequently the film was based on a cinema trailer, which could be played at set times during the working day.
“The important thing was to get that insight in a relevant way back to the taxi drivers. We produced the film with an actor playing the part of a taxi driver, and his script based on all of the things taxi drivers had told us in both interview situations and our ‘fly on the wall’ camera. So we scripted a short film, which is not much longer than an advert really, and the taxi driver changed from his bad habits, which were the bad habits that the local drivers had told us that they’d got, and he spoke about how small changes in his lifestyle have eradicated those bad habits.” (Kim Fuller, Community Arts Development Officer)
The use of a film as an intervention was based on the theory that behaviours can be learnt through watching others, thinking about the behaviour, and then trialling it (Social Learning Theory – Akers and Ronald, 1973). People are most likely to imitate behaviour if they see it leading to positive outcomes in another person. Subsequently, the film encouraged taxi drivers to make a personal connection with the character in the film, who benefits from small lifestyle changes, so they would be motivated to make small lifestyle changes themselves. To ensure the taxi drivers related to the driver in the film, the script used the interviews and the video diaries created by Walsall taxi drivers so the language used was the same. The film was also shot in Walsall at local venues frequented by taxi drivers.
Scatter cushions and seat covers
A set of custom-made scatter cushions and car seat covers were developed for taxi companies to have in their taxis and at their bases. These materials were developed to support the health messages and act as reminders of ways to make positive health choices. The scatter cushions and seat covers had the following messages printed on them:
- 'Have you been busy…being more active?'
- 'Have you been busy…spending time with your family?'
- 'Have you been busy…enjoying more fruit, vegetables and water?'
Improving working environments
Another key element of the project was work with taxi companies to develop practical ways of helping their drivers improve their health.
The film was initially screened at a celebration event in the summer of 2009. Fifty people attended the event, including taxi drivers and representatives from NHS Walsall and Walsall Council Trading Standards Department. A copy of the film was then delivered to 20 taxi companies to show to their employees in waiting rooms. Each taxi company was also given a set of scatter cushions and seat covers and copies of a men’s health manual to leave in each waiting area for drivers. In total, the film was seen by approximately 450 drivers. This launch event was also an opportunity to conduct the first part of an evaluation questionnaire with the taxi drivers who attended.
In addition, the film was given to the licensing team of the Trading Standards Department to show to taxi drivers at induction and training sessions. An unintended consequence of the project was the increased positive attitude of taxi drivers towards the Trading Standards Department, which provides them with their legal licences to operate as taxi drivers. Rather than viewing them as primarily a legal enforcement body, many drivers felt that the department was now also concerned with their wellbeing.
“The taxi drivers, when they found out that Trading Standards were supporting this scheme, which was ultimately about improving their health, their attitudes towards Trading Standards changed. They saw them much more as a nurturing organisation, rather than a ‘slapping you wrist’ type of organisation.” (Kim Fuller, Community Arts Development Officer)
Another key element of the project was work with taxi companies to develop practical ways of helping their drivers improve their health, such as providing water dispensers and treadmills at the drivers' base, subsidising gym memberships and organising a football team. The project team visited each company twice to provide guidance and support on how to implement such initiatives. Health promotion workers from the Healthy Workplace scheme run by NHS Walsall also agreed to follow up the visits to support companies and individual taxi drivers to sustain the approach.
At the project launch, taxi drivers were invited to fill in a short questionnaire before seeing the film, which included the following questions:
- What kind of exercise do you do every week?
- What do you eat in an average day?
- Do you have a partner and children? What do you do as a family?
- Is there anything that makes you feel fed up at the moment?
Twenty-eight legible questionnaires were completed. Five weeks after watching the film, a team of researchers rang each of the 28 initial respondents to interview them over the phone. Fifteen drivers responded to the invitation to talk to a researcher and participate in a semi-structured interview. The other 13 did not respond to the phone call – this was because they had a different number, were unable to converse over the phone (language barrier), or were unavailable after several attempts.
Of the 28 drivers who completed questionnaires before seeing the film:
- Eleven said they did no physical activity at all, and the rest averaged once a week playing football, going to the gym, etc
- Almost all said they ate a lot of takeaways at work and seldom had more than one meal a day (including breakfast) at home, which was usually curry
- Almost all had a family at home and most said they spent little time with them, and if they did it was to go shopping or to do some other necessary activity
- Eighteen said there was something that made them feel ‘fed up’ at the moment – issues included the credit crunch, long working hours, too much time doing nothing (while waiting for fares), traffic wardens and family issues
Of the 15 drivers who were interviewed 5 weeks after watching the film, 11 reported a significant change in their lifestyle since seeing the film. These changes focused on increased levels of physical exercise and positive changes in diet, as well as dedicating time to family activity. However, four reported no significant changes.
Increased levels of physical exercise
“Since that night I’ve joined a health club and I have to say I’m feeling much better. I’d recommend that film to all drivers.” (Taxi Driver)
“Since I saw that movie I’ve joined a gym and I’m running a couple of miles a week. It really did change my life and made me look after myself a lot more.” (Taxi Driver)
“I’ve started to walk to the base every morning, which is about a mile, and I’ve started playing cricket with my sons.” (Taxi Driver)
Positive changes in diet
“I eat less rubbish at the base because I’m thinking more now about what I eat.” (Taxi Driver)
"I’m eating much better than I was before and feeling much better for it. I’ve dropped the junk food.” (Taxi Driver)
“I’m definitely walking more after seeing that film, and I’ve started eating salad and drinking more water.” (Taxi Driver)
A small number of people who engaged in conversation with the researchers talked about the barriers still facing them.
“There were some really good messages in that film and I’ve decided I’m going to join a gym straight after Ramadan. It’s not a good time to start while we fast, but seriously, I’m joining up after.” (Taxi Driver)
Response to the project from taxi companies
Ten weeks after the first screening of the film, a Community Arts Development worker visited 20 taxi companies in Walsall (some of which had been involved in the initial research and others that had just attended the original screening of the film) to talk to company managers about the changes they had made as a result of participating in the project.
Three of the companies visited had made significant changes to the drivers' base as a result of their involvement in the project. Changes included: installing a water dispenser and pool table; paying half of staff gym fees; installing a treadmill; starting a five-a-side league; and allowing the drivers to use an internet point while they waited for fares.
Since the project finished, the Licensing Team of the Council’s Trading Standards Department has continued to use the film in the induction session for new taxi drivers and during training programmes. Because all licensed taxi drivers take part in an induction programme, this means all taxi drivers in Walsall should see the film. The council will not grant a private hire operator's license unless it is satisfied that the licensing conditions will be adhered to. Although health and wellbeing of taxi drivers is not part of these conditions, the film encourages taxi companies to take steps to look after the wellbeing of their drivers. Drivers have mentioned that linking health to their ability to get a license to drive a taxi is an important incentive to make positive lifestyle changes.
“Trading Standards have adopted the film, and they show the film to every new taxi driver that comes in. They also use it in their re-training, I think it’s annually. They’ve realised now how important health is to their drivers. I see that as the legacy.” (Kim Fuller, Community Arts Development Officer)
While there is interest in rolling this project out to groups of men working in other sectors, there is unfortunately currently a lack of funding to do so.
Community arts meets social marketing
Taxi! illustrates how the two approaches complement each other. Social marketing has provided a framework to ensure the creative approach taken by Community Artists is rigorous and robust. Previous work has focused on using the arts as a tool to consult or scope work. Social marketing has enabled the team to see ways of developing creative interventions that can result in sustainable behaviour changes.
In turn, the creative approaches used by the team have helped ensure the scoping stage of a project is not just one that extracts information from people, but involves them in a creative dialogue. For example, the use of video diaries was key in gaining insight into the day-to-day lives of taxi drivers.
At various stages assumptions were made about the final intervention. For example, initially it was felt the final drama would involve stand-up comics. Using The NSMC’s systematic Total Process Planning framework, these assumptions were challenged and appropriate ideas were developed that responded to the insights gained from the research.
Engage with your target audience in their own language and setting
The research with taxi drivers involved entering a predominantly male and (in this case) Asian environment. These characteristics must be considered when engaging with your target audience. Although this project was led by women, the team decided to employ a male filmmaker so that the filming with taxi drivers, which was often conducted in the evenings, was carried out by a man and a woman.
“You have to be able to speak to people on their own terms. If you go to a taxi company with a clipboard, then they’ll think you want something, rather than trying to give them something. You have to be able to talk like a taxi driver and use the right language and be appropriate. In this instance, being appropriate for me included things like dressing properly. Being aware of wearing a longer skirt or trousers, a high neckline, little things like that made a big difference to them and shows mutual respect.” (Kim Fuller, Community Arts Development Officer)
Managing partners’ expectations
As the project developed, a number of partners started to see the potential of the project and wanted to use the intervention to achieve a number of outcomes. As a result, the questionnaire lost some of its focus and information became more difficult to get from phone interviews with drivers. In hindsight, focusing on one behavioural goal and gathering information to see if that had been achieved may have been more effective.
Identifying behavioural changes
Phone interviews were used to gain some information about behavioural changes. There were some problems with this approach, including not being able to talk to drivers attending the original screening because of wrong phone numbers or reluctance to talk on the phone, either because they were busy or did not have the necessary language skills. One way of avoiding these issues would be to undertake one-to-one interviews with drivers in their cars. This could take place as they were driving, which would also mean they would receive a fare and be reimbursed for their time.