To what degree can government alter public attitudes towards their own general health? Qualitative research
Summary of findings
Respondents believed that behaviour change is influenced by a set of factors, including:
- Risk, urgency and focus for change
- Simplicity and level of effort required
- Potential rewards and necessary sacrifices
- Practical and access issues (cost, facilities)
- Family, peer groups and local norms
- National and cultural attitudes
However, the behavioural status quo is believed to be maintained by powerful influences such as:
- Commercial pressures
- Need to 'have fun' or live now
- Peer norms
- Lifestyle constraints
- Lack of guarantees
- Time pressures and convenience
Equally, it was felt that drivers for behaviour change can also be powerful, such as:
- Responsibilities and family
- Self-esteem and image
- Feeling well or unwell
- Immediate health concerns
- Media messages
- Government messages
The government, it was generally felt, should be:
- Respecting individual choices and freedom in relation to health behaviour
- Providing accurate information about health issues
- Offering guidance about positive, health-enhancing choices and options, at both national and local level
- But also directly controlling health choices and behaviours that have a significantly negative impact on society as a whole (for example, drink-driving, binge drinking, use of illegal drugs and deliberate lifestyle choices that cause harm and 'cost the taxpayer')
- Otherwise, 'keeping a distance'
Overall, therefore, the state should be an influencer and advocate for health behaviour at both local and national level.
So, the state should be:
- Generating educational initiatives and information campaigns at both a local and national level (and providing real practical support as part of this)
- Drafting legislation that protects society at large from the harmful impacts of those who live deliberately unhealthy lives
- Controlling commercial organisations (especially retailers) that might be seen as actively promoting unhealthy choices
The state should not be:
- Interfering in domestic lifestyle choices
- Instigating broad-brush health measures that affect everyone without discrimination
- Trying to 'frighten us' into behaviour change (does not work)
- Rewarding bad behaviour or unhealthy lifestyles
- In short, staff believed that the state should encourage individuals to take responsibility for their own health by both positively influencing lifestyle choices from within communities and from a broader cultural perspective
- Staff strongly distinguished ‘the State’ from ‘the NHS’: there was resistance to the NHS shouldering the responsibility of addressing the ‘unhealthy’ behaviour of the nation
- Staff were sceptical about ‘quick fixes’ and emphasised the value of longer-term change. The respondents felt that the state has a right (and for some a duty) to intervene in life choices to create societal change in relation to health
- Staff opinion regarding appropriate levels of intervention differed in terms of the strength or authority of intervention
- Strong interventions are felt to be needed in relation to smoking and obesity (exercise and healthy eating)
- Smoking: There was strong support for a continued emphasis on expressing cultural disapproval via legislation (e.g. banning smoking in cars with under 18s present) and advertising
- Healthy eating: Was perceived as a question of education, complemented by encouraging healthy choices e.g. promotions on ‘healthy’ foods, banning of vending machines in schools
- Exercise: Those from primary care settings who had experience of prescribing exercise (e.g. gym memberships) reported poor results. Creating opportunities for people to include exercise in their busy lives was considered the most practical way forward
- More collaborative interventions are needed in relation to alcohol: There was very little appetite for intervening in drinking behaviour, other than penalties for frequent Accident & Emergency use
The research aimed to address the following issues:
- Understanding what helps with bringing about behaviour change
- Understanding what has, in the past, helped people to change their health behaviours and why
- What would help, why and who should deliver it
- Are attitudes based on rational thinking or decision-making?
- Are effective responses likely to be based on tapping into people’s emotional responses or instinct?
- Do people tend to go for ‘default’ options, as behavioural economists sometimes argue?
The Department of Health (DH) wished to commission research to look at potential behaviour change: this work aimed to determine in what ways and to what degree the government might be capable of altering public attitude towards its general health.
- Would people best respond to rational, scientific evidence or emotive scenarios?
- Conversely, might one (or both) be counter-productive, inducing the public to embrace a rejection of such a prohibitive stance?
- If so, would this position be common across all socioeconomic and age groups?
Qualitative research was required to inform DH policy in this area.
Qualitative research looking at potential behaviour change to determine in what ways and to what degree the government might be capable of altering public attitude towards its general health
16 to 74 years
- Nine extended workshops and nine immersion depth interviews
- Segmented by age, gender, socioeconomic group and Healthy Foundation status
- Three workshops
- Recruited from primary and secondary care