Healthy foundations lifestage segmentation: Qualitative research report
As a general observation, the qualitative data validates the findings from the quantitative phase of research. Each of the five segments broadly conformed to the motivational profiles suggested by the quantitative data.
Equally, however, the qualitative research has provided considerably more detail and depth of insight in relation to the psychological and social dynamics of each segment, as well as providing clear guidance in relation to possible intervention approaches.
The Healthy Foundations (HF) segmentation increasingly suggests that there is a spectrum of motivation in terms of positive orientation towards healthy behaviour, even though each of the segments presents specific issues in relation to behaviour and attitudes. This spectrum appears to proceed from the Health Conscious Realists, who may have the greatest potential to live ‘healthily’, through to the Balanced Compensators, Hedonistic Immortals and Live for Todays, before culminating with the Unconfident Fatalists who perhaps present the most significant challenge for those seeking to improve health outcomes.
The five HF segments are:
Healt-conscious Realists (HCRs)
Respondents from this segment consistently felt good about themselves, were independent, self-motivated and comfortable with control and exercising choice. HCRs are realistic, disciplined and goal-driven. This segment is not fatalistic and, instead, believes that health is the foundation of a good life – and that a healthy life is enjoyable and easy to achieve. These respondents prioritise feeling good about themselves over looking good to others and are typically uninterested in risk-taking, although they enjoy challenges.
This is a strongly resilient segment, which believes that ‘tough times’ drive personal development and challenges require a independent, stoic response. Consequently, this segment sees itself as in control of health choices. Most believed that they have ‘always’ been HCRs: ‘once a HCR, always a HCR’.
Interventions: This segment is independently-minded and rejects prescriptive or ‘nanny-state’ interventions. Government involvement in presenting health advice and information was seen as acceptable: but local branding was preferred, even if a service is sponsored by the NHS. They consistently welcomed the idea of health checks, but are very serious about their health and often critical of primary care quality and the lack of a relationship with a GP. This is a segment which recognises that it broadly embraces healthy behaviour and so supports enforced changes and state interventions which punish obviously irresponsible behaviours because they believe that these ‘will not affect me’. Overall, this is a ‘hands-off’ segment, which sees itself as capable of making health decisions. It can be assisted, but not instructed to try various interventions.
Balanced Compensators (BCs)
Respondents from this segment demonstrated core goals, in terms of looking and feeling good. They have an aspirational outlook, with goal-setting, planning and control over health as norms. BCs are prepared to take remedial action in relation to health and risky behaviour if necessary. This effective, compensatory response to perceived damage produced by risky behaviour is central to the segment’s outlook on health.
This is a resilient segment, which believes resilience is the product of both upbringing and strong support networks amongst family and friends. Therefore, influences are relatively few, since this segment sees itself as largely in control of its health choices. Most believed that they had either ‘always’ been BCs or emerged from the LfT segment (when they were younger and wilder). Many assumed that they would naturally develop into HCRs (even though this segment was viewed as quite unexciting).
Interventions: This segment is strongly affected by factors such as quality of environment and access to facilities. They typically reject prescriptive interventions (for example, the idea of mentoring was received very negatively) and, in many cases, wanted information only – and to be left to make their own decisions. Wellness is an appealing idea to BCs (the notion of health checks was consistently welcomed) and a linked approach to health interventions was positively received. Although enforced changes which punish irresponsible behaviours were supported, respondents typically resisted compulsion and government branding of health advice and information was also rejected. This is a segment which sees itself as able to make its own decisions about health issues.
Hedonistic Immortals (HIs)
Respondents from this segment did not see health as a core concern. Pleasure is their priority and the focus is typically on the ‘here and now’. HIs feel a disinclination to plan or consider consequences: they embrace risk, feel in control of their health and are uninterested in a healthy lifestyle per se. HIs can be enticed into bad behaviour relatively easily. The HI view of health is relatively compartmentalised, with exercise, diet, avoiding damage and cosmetic factors as the driving considerations. Overlapping bad behaviours seemed common.
This is a segment which can show resilience, but often requires support to do so. These respondents are easily distracted and influenced by the social groups that surround them e.g. support and friendship networks. Respondents typically believed that they are more resilient than in the past, but actual behaviour contradicts this view.
Interventions: This segment fundamentally mislead themselves in relation to health status and need a ‘wake-up’ call in order to initiate change. HIs are strongly affected by factors such as quality of environment and convenient, easy, access to facilities: they like instant results. They typically support prescriptive state interventions, but not for themselves. HIs want tailored, personalised, approaches, with clear goals and targets to achieve and reject any approach which focuses on ‘problems’. Wellness is an appealing idea – and the notion of health checks was welcomed, provided that these are conveniently delivered, personalised and ‘fun’ in nature. Equally, a linked approach to health interventions was positively received – but some respondents were concerned that tackling too much would inevitably lead to failure. Support, health advice and information should be presented through a trusted brand (NHS), be local in delivery and ‘enjoyable’ in character. Overall, HIs seemed to need reward-focussed incentives in order to consider changing health behaviour.
Live for Todays (LfTs)
Respondents from this segment typically live in the ‘here and now’ - there is very little evidence of planning or goal-setting. In the main, LfT lifestyles are chaotic and unstructured; values shift and fatalism is strong. Individuals are typically focused on ‘keeping busy’, the pursuit of pleasure and presenting a successful face to the world, a social front. Individual control over health is poorly understood: leading to delusional appraisals and assessments. LfTs make few efforts to be healthy and are generally uninterested in health issues.
This is a segment which shows little evidence of resilience in relation to life challenges, with respondents often seeking distraction from problems through risky or damaging behaviour. Equally, LfTs are unreliable judges of their own capacity for resilience, with many assuming that they are independently-minded when this is clearly not the case. Key influences on health behaviours are friends and family. Environment is also important and many LfTs find it hard to distance themselves from their established locality and current social situation. Overall, LfTs are seemingly happy to take significant risks with their health (and more broadly also), but rarely acknowledge this inclination.
Interventions: These respondents are strong supporters of relatively draconian interventions, but not for themselves. There was mild interest in the idea of health checks - on the basis that knowledge may drive change - but this thinking was not well-developed. LfTs find it hard to identify a realistic starting point for change. This segment is expert in generating a ‘smoke-screen’ around the idea of change. LfTs were, however, interested in interventions which offer structure – since this is seen as a specific weakness in LfT lifestyles. Most like and trust the NHS brand – so interventions should be delivered by local channels, but branded as NHS. Finally, LfTs typically supported a linked approach to interventions, recognising that many of their own behaviours are over-lapping and mutually supporting.
Unconfident Fatalists (UFs)
Respondents from this segment showed a strong focus on the ‘here and now’, since the future seems daunting. UFs were typically pessimistic, fatalistic in outlook and trying to escape from the problems of everyday life through unhealthy behavioural choices. Most do not believe that they can be either healthy or happy and lack any sense of control over health (since illness seems inevitable). All exhibit low self-esteem and general dissatisfaction with their lives – feeling trapped in a vicious circle of psychological problems and damaging behaviours. Aspirations are low. Respondents are often negatively affected by traumatic life events and many demonstrate repetitive and obsessive patterns of behaviour.
This is a segment which shows very little evidence of resilience in relation to life challenges. In many cases respondents try to cope alone and become isolated – leading to withdrawal, eventual inertia, the use of damaging behaviour as a compensatory escape mechanism and depression. Influences on health behaviours were essentially personal in nature – poorly-managed stress, low self-esteem, lack of motivation and a depressive outlook all combine to drive (in some cases) compulsive unhealthy behaviour. UFs were easily influenced into adopting negative behaviours by their peers.
Interventions: These respondents are aware of their problem behaviours, but not motivated to make changes. UFs are fundamentally immobile in relation to health status and need a ‘wake-up’ call in order to initiate change. State of mind is important: stress and depression shape most responses to health challenges and a critical challenge lies in creating an appetite for change amongst UFs. Overall, UFs are sceptical about state interventions in relation to health, although many UFs clearly believe that compulsion may be the only way to initiate change in their own behaviour.
UFs typically want sensitively-handled, tailored, personalised approaches, with clear goals and plenty of ongoing support and monitoring. This segment is timid and frequently ‘backs off’ from services – and only NHS primary care seemed to offer a realistic starting point for change. Equally, it is important for UFs to see that similar ‘people like me’ are engaged with any health interventions. UFs, however, are typically inclined to respond negatively – so that, since many like and trust the NHS brand, interventions should be delivered by local channels, but branded as supported/funded by the NHS.
The objectives for the qualitative research were to:
- Complement the quantitative data and explore in more depth the relationship between lifestage, Index of Multiple Deprivation (IMD) and personal motivations across the segments
- Develop a more in-depth, citizen-centric, holistic view of the motivation, lifestyles and behaviour of each segment 'in their own words' and 'through their eyes'
- Seek to understand the reasons for an individual falling into entrenched patterns of health-related behaviour and attitudes
- Examine people's general attitudes towards life, their priorities and aims
- Explore attitudes towards health in general and what people perceive as constituting 'health'
- Uncover in-depth perceptions of 'health' in people’s day-to-day lives, including where health 'fits' into their overall outlook and view of life
- Explore the concept of resilience
- Explore the relevance of the key constructs of motivation in people’s lives, such as: fatalism and self-efficacy, short-termism, risk-taking, self-esteem and levels of aspiration
- Understand more about how scial norms form and operate to provide barriers or leverage for behaviour change
- Gain insight as to people's view of what health interventions can do for them in terms of, for example, costs, benefits and possible drawbacks
- Provide general guidance as to the efficacy (or otherwise) of multiple health-related issue interventions
- Test the efficacy of potential intervention strategies and their uses
- Explore the role of government in healthcare promotion and interventions
The research was commissioned as part of a wider project by the Department of Health (DH) Social Marketing and Health-Related Behaviour Team to construct a segmentation of the English population based upon health-related behaviour and attitudes, using quantitative and qualitative methods. The research forms part of the DH social marketing programme and its Ambitions for Health strategy.
In-depth qualitative research commissioned as part of the Department of Health's Healthy Foudnations Programme, which developed a segmentation of the adult population of England based on behaviour, attitudes and lifestyle.
Across different lifestages
- Focus group sessions - 52 focus groups conducted over 3 months, broken down acrss the 5 HF segments
- Immersion depth interviews and video 'pen portraits', filmed simultaneously 9 respondents from each HF segment were selected to participate in immersion depth interviews
- 52 focus groups, each with between 2 and 8 respondents (c. 432)
- 45 immersion interviews completed in total
June to December 2009