North West Behavioural Science Symposium Wednesday May 22nd 2019 Halliwell Jones Stadium Warrington WA2 7NE 09.30 – 15.45 Tweet us on @nwphpn using #BhSci2019
North West Behavioural Science Symposium Wednesday May 22 nd 2019 - - PowerPoint PPT Presentation
North West Behavioural Science Symposium Wednesday May 22 nd 2019 - - PowerPoint PPT Presentation
North West Behavioural Science Symposium Wednesday May 22 nd 2019 Halliwell Jones Stadium Warrington WA2 7NE 09.30 15.45 Tweet us on @nwphpn using #BhSci2019 10:00 10:15: Welcome (5 mins) Dr Sakthi Karunanithi , Director of Public
10:00 – 10:15: Welcome (5 mins)
Dr Sakthi Karunanithi, Director of Public Health, Lancashire County Council
& Opening Remarks
Dave Sweeney, Executive Implementation Lead, C&M Health & Care Partnership
10:15 – 10:20 Facilitator for the day: Mari Davis ➢Housekeeping ➢Flow of the day
Housekeeping
➢ Tweet us on @nwphpn using #BhSci2019 ➢ Please inform Mari Davis if you have any issues with promotional pictures being taken during the day ➢ Fire exits ➢ Wifi code ➢ Toilets ➢ How the room works! Table faciltators; ideas and suggestions board
Aims for the day
➢ To learn about the new Behavioural Science strategy to improve health & wellbeing ➢ To learn from existing work and interventions utilizing behavioural science approaches ➢ To consider the opportunities for a consistent and scaled approach to integrating behavioural sciences into health and care commissioning and service delivery across the NW geography – what might that look like? ➢ To network with colleagues leading on behavioural science and population health
Agenda for the day
10:00 Welcome and opening remarks 10:15 Pre-conference questionnaire – Behavioural Sciences in your sphere of work – Lucie Byrne Davis 10:35 Improving People’s Health: Applying Behavioural and Social Sciences to improve population health and wellbeing in England Strategy Launch – Dr Rory McGill and Michelle Constable 11:05 Refreshment Break 11:20 Case studies – Behavioural Sciences in Action – Part 1 12:00 Workshop 1 12:45 Social Marketing Campaigns in the North West 12:50 Lunch & Networking - 13:15 MEC launch Cheshire & Merseyside pop up presentation 13:30 Case Studies – Behavioural Sciences in Action – Part 2 14:10 Comfort Break 14:25 Workshop 2 15:15 Commitments to action; Summary and closing 15:45 Close
Agenda
10:20 – 10:35 Pre-conference questionnaire: Behavioural Sciences in your sphere of work Mari Davis
Pre-conference questionnaire
Please complete your pre-conference questionnaire as found on your table and give to Lucie, answering the following: ➢ Which County or Borough do you represent? ➢ What type of organisation are you from? ➢ How do you rank your level of understanding of behavioural science approaches on a scale of 1-10? ➢ On a scale of 1-10, how much importance is placed on embedding Behavioural Science into practice within your organisation? ➢ In your opinion, is enough being done within your organisation to embed behavioural science into practice? ➢ Do you know where to access appropriate Behavioural Science Expertise? ➢ Does your Department have a budget set aside for commissioning or directly providing behavioural science expertise? ➢ Please tell us about any specific projects or areas of practice in your organisation where they have applied behavioural science evidence or methods?
10:35 – 11.05 Improving People’s Health: Applying Behavioural and Social Sciences to improve population health and wellbeing in England Strategy Launch Dr Rory McGill, Public Health Specialty Registrar, Behavioural Insights and Evaluation Team, PHE & Michelle Constable, Chair Elect, Behavioural Science and Public Health Network
Improving People’s Health: Ap Appl plying ng beh behav aviou
- ural
ral and and soc
- cial
al scien ences es to
- impr
prove ve po popu pulat ation n hea health an and d wel wellbei being ng in n Eng nglan and
Michelle Constable and Rory McGill For the Writing Group
(on behalf of Dr Tim Chadborn)
Why a Strategy? Why bother? Why should I care?
Why?
- Our population faces complex health and wellbeing
challenges that stem from biological, psychological, economic, environmental, and social causes
- To effectively prevent poor health, we need an approach that
takes account of the whole person, social context, and wider aspects such as education, employment, social norms, and the built and online environment
- Using our expertise, we can help design and evaluate
policies, services (including digital), and communications that are centred around the people that use them
- Duncan Selbie, PHE CEO “The behavioural and social sciences
are the future of public health” & “We must reach and be meaningful to people in the lives that they are leading.”
Feedback from local public health (n=50)
79% - NOT enough being done to embed BS in practice 53% do NOT know where to access support 82% - no budget for BS expertise
Vision and aims
- Framework for the broad PH system to increase
impact through greater and integrated use of behavioural and social sciences
- improve health and wellbeing outcomes
- reduce health inequalities
- improve value to the public purse
- To help coalesce and coordinate efforts of national
- rganisations to support professionals at local level
Key messages
- High-level guide with suite of evidence and theory-
informed resources and more to come
- Scope: systems and organisations acting on the social and
structural environment that affects the population and not only interventions focused on individuals
- Strong and vibrant behavioural and social science
community
- Foster further growth in transdisciplinary approaches
System map of key stakeholders
Key Content
- Why do we need this strategy?
- National and local context
- What can behavioural and social sciences
contribute to public health?
- What are behavioural and social sciences? What
key theories and frameworks do they offer public health practitioners?
- The first steps to implementation and a road map
Conceptualising the contributions of behavioural and social science disciplines
- Anthropology
- Economics
- Behavioural
- perational
research
- Psychology
- Sociology
- Other useful public
health tools
Whole systems approach: Eg Smoking
Environmental and social systems Policy Communities and neighbours Family and Friends Person / Individual Biological Legislation (smoking age, smoking bans in public places, workplaces and cars, ban on
point-of-sale tobacco product displays, prohibition of names such as ‘light’ or ‘mild’, pictorial warnings on cigarette packets), Fiscal measures, Guidelines
Changes in cultures and social norms Social support, exposure to tobacco smoke, number of people to smoke with Service Provision (commissioning of evidence based stop smoking services,
MECC, digital stop smoking interventions), Training of Health Care Professionals,
Incentivisation of patients, organisations and healthcare professionals Development of improved pharmacological treatments Environmental/ Social Planning (Smoke free places, Designated smoking areas,
Tobacco products not on display, Ban on advertising), Communications/ Marketing
(Stoptober, January Health Harms, No Smoking Day, and World No Tobacco Day)
Implementation Plans
Community of Practice
Resources
- Signposting
- Access to experts
- Frameworks & approaches
- Training curricula
Evidence
- Evidence reviews
and position papers
Practice
- Case Studies
- Templates
Strategy Document
Strengthen the workforce
Implementation of the Strategy
Public Heath England - Behavioural Insights Masterclass
Highlights of the Road Map
Priority Theme Examples of Actions
Evidence and theory Call for case studies and share on knowledge hubs Support applications for funding such as the LGA behavioural insights programme Wider system leadership Continue work to embed behavioural science into MECC Access to expertise Contact directory of behavioural science experts and public health professionals Tools and resources Develop guidance for local publichealth commissioners Capacity building
- Brief guide to employing behavioural and social scientists
in publichealth with a template job description
- Publish BehaviourChange Framework and toolkit
- Review training and whether competencies and standards
can be implementedand assessed more effectively Research and translation Continueto embed in various research funding streams Communities of practice Create online forum with resources and tools
- Survey across local government to assess needs and monitor progress
Provision of tools to help with…
- Needs assessment
- Applied Behavioural
Analysis
- Effective change
methods
- Co-creation methods
- Efficient evaluation
methods
- Transparent sharing of
results
- System improvement
Communities of practice…
North West…
(bsphn.org.uk) (uksbm.org.uk)
Behavioural science in public health
- Transdisciplinary
- Cross-sectorial
- Transparent
- Collaboratively with communities and
stakeholder The new strategy has the potential to coordinate developments and to create synergy
Than hank k you
- u to
- every
ryone who ho work
- rked
- n
- n thi
his....
11:05 – 11:20 Comfort Break
Tweet us on @nwphpn using #BhSci2019
11:20 – 11:40
Case Studies – Behavioural Sciences in Action (Part 1) - CVD Prevention Digital Exemplar, Eleanor Wilkinson & Chryssa Stefanidou, PHE National CVD Prevention Team Q&A (5 mins)
Incorporating behavioural science into an agile digital service design in public health PHE Digital: NHS Health Check
Dr Chryssa Stefanidou - Principal Behavioural Insights Advisor, PHE Eleanor Wilkinson - NHS Health Check Digital Exemplar Lead, CVD Prevention Team
May 2019
Scale of the problem
30
NHS Health Check
31
A national risk reduction programme that aims to improve the health and wellbeing of adults aged 40-74.
It is key to preventing Cardiovascular Disease, which is the leading cause of death worldwide.
Behavioural insights and NHS Health Check
Historically, the two teams in Public Health England have worked closely together to explore different elements of the NHS Health Check programme, for example looking at:
- Invitation letters
- Risk messaging
- Branding
- Telephone invitations
- Marketing campaigns
32
Digital Exemplar
➔ To Understand the NHS Health Check service from an end user, provider and commissioner viewpoint blending service design and behavioural insights research principles. ➔The project vision is to understand what service changes both digital and non-digital could improve the health check service focusing but not limited to ○ Increasing uptake of the service ○ Increasing the impact of the service ➔Conceptualise and prioritise possible service improvements as candidates for an Alpha.
33
Multidisciplinary team
34
Dr Chryssa Stefanidou- Behavioural Scientist Eleanor Wilkinson- CVD Subject Matter Expert Andrea Hewins- Product Manager Manisha Mistry- Delivery Manager Dellis Roberts- User Researcher
- Prof. Jamie
Waterall- Service Owner Megan Roger Senior Interaction Designer Callum Bates User Researcher Vicki Litherland Content Designer Iain Cooper Senior Content Designer Kate Burn Senior Service Designer
CVD prevention Behavioural insights Digital
Behaviour change in a digital service
⮚ Currently Behavioural Insights are not embedded in the agile service design process as a mandatory step ⮚ Public Health England are commissioning the development and implementation of a digital service with a Behavioural Insights Advisor as part of the multidisciplinary team
7
8
Intro to digital
Behaviour change in discovery
9
Identify target behaviours associated with the uptake and follow up of the NHS Health Check from an end user, provider and commissioner viewpoint Identify evidence base for the research questions from high-quality systematic reviews Consult with experts to identify needs of the target population Recruitment of participants according to socio-economic, behavioural and cognitive characteristics in order to reflect a diverse range of participants COM-B model of behaviour change for designing and analysing the interviews Comprehensive analysis for all identified user needs using COM-B and TDF (explore barriers and need for a digital intervention)
Develop recruitment screeners using psychological models and theories
10
Recruitment of participants according to socio-economic, behavioural and cognitive characteristics in order to reflect a diverse range of participants Diary study to monitor people’s lifestyle behaviours (smoking, exercising, drinking etc.) Assessing people’s readiness to change their unhealthy behaviours Health Confidence Scale to monitor people’s confidence in their ability to manage their own health Digital Inclusion Scale to consider the different levels
- f digital
literacy for individuals
Identify user needs through qualitative semi-structured interviews
11
The COM-B model informed the development of discussion guides to identify the barriers and facilitators of behaviours relevant to NHS Health Check
Behaviour: Start Action Plan (end users) Capability Do you think you have the skills to start the action plan? Capability Do you understand the next steps? Opportunity Do you have the support of your friends and family? Opportunity Do you have the time required to do it? Is there something to follow your progress (tools)? Motivation Do you believe that it would be a good thing to do? Motivation How important is it for you to be able to develop a better and clearer plan for doing it?
Understanding user needs through Behavioural analysis
12
Target Behaviour: Start action plan Attend referral (end users)
COM-B Theoretical Domains Framework Facilitators Barriers
Psychological Capability Knowledge
A lack of knowledge about next steps/action plan both in terms of what could do and how to do it
Social Opportunity Social Influences
Encouragement from people around them (partner, family, friends)
Physical Opportunity Environmental, Context and Resources
Access to technology; Significant life changes like moving home; Monetary incentive (ex. not wanting to waste a paid gym membership) Perception that time and location can be a barrier - finding the correct time; Perception that lifestyle services are not easy to access; Time limit on lifestyle service provision; Data privacy
Reflective Motivation Beliefs about consequences
Identification of risk and early detection of disease (ex. “prediabetes”) Potential challenges of changing lifestyles if visible symptoms don't exist
Automatic Motivation Reinforcement
Digital reminders/prompts; Seeing
- ther people's progress and
achievements
NHS Health Check User Journey
13
Target Behaviours
- End User
- Provider
- Commissioner
Facilitators + Highlights Barriers + Pain points
Moving on to the alpha phase
14
Identify intervention content which targets the influences on behaviours Provide a preliminary list of intervention functions and Behaviour Change Techniques Work closely with the service design team to translate this knowledge into engaging digital content and designs Test prototypes with embedded behaviour change techniques
Key learnings
15
⮚ We need to collaborate in multidisciplinary approaches to develop a service that is viable, desirable and feasible. ⮚ Behavioural science provides robust, validated frameworks that increase the likelihood for intervention effectiveness and can enhance the governmental digital service process. ⮚ Embedding behavioural science into the service design process can help
- vercome subjective bias (e.g. small sample sizes).
⮚ Cross-government stakeholders should increasingly interact with and draw upon behavioural insights expertise to optimise public health services.
Questions?
Chryssa.Stefanidou@phe.gov.uk Eleanor.Wilkinson@phe.gov.uk
Appendix
A Behavioural Approach
1.Define the problem in behavioural terms 2.Select the target behaviour 3.Specify the target behaviour 4.Identify what needs to change Stage 1: Understand the behaviour
Behaviour Capability Motivation Opportunity
A Behavioural Approach
- 5. Intervention functions
- 6. Policy categories
Stage 2: Identify Intervention Options
A Behavioural Approach
- 7. Behaviour change techniques
- 8. Mechanisms of action
- 9. Modes of delivery
Stage 3: Identify content & implementation options
11:40 – 12:00
Cheshire & Merseyside MECC approach, Dave Sweeney, Executive Implementation Lead, C&M Health & Care Partnership & Louise Vernon, C&M MECC Implementation Lead Q&A (5 mins)
Population Behaviour Change in Cheshire & Merseyside
Louise Vernon Cheshire & Merseyside MECC Programme Lead Champs Public Health Collaborative Dave Sweeney Executive Implementation Lead Cheshire & Merseyside Health & Care Partnership
Vision in C&M for Making Every Contact Count (MECC) at scale
- MECC is a behaviour change approach that supports positive health and well
being choices, signposting the public to further information and support
- We want to see MECC flourish in every place, building on great existing local and
sub-regional work and creating innovative approaches
- The aim is to create a culture shift and focus on prevention
- Every front line contact can add up to a huge impact on population health and
wellbeing in C&M
Our approach in Cheshire & Merseyside
- 1. Systems Leadership
- C&M has 2.5 million people, nine local authorities, 12 CCGs, nine trusts, one STP
and two fire and police authorities
- In Aug 17 C&M DsPH Board agreed to help drive the delivery of MECC at scale using
a systems leadership approach with partners
- The Champs Public Health Collaborative are working with those key partners (PHE,
HEE, NHSE, LA’s, STP and voluntary sector) to create a new innovative and large scale approach
- Jan 2018 Scoping exercise report – assets and variation in practice
- NICE Behaviour Change Guidelines PH6 and
principles underpin the programme - including planning, assessment, training, programme delivery and evaluation
- 2. Co-production of the vision/strategic framework
In April 2018 partners from across C&M met to establish a shared vision/ strategic
- framework. Key recommendations included:
- 1. Create a consistent and standardised approach to MECC, with an online portal
to share resources
- 2. Establish a culture focused on prevention, this was seen as critical to enable
staff to fully utilise MECC training
- 3. Produce an effective Communication and Engagement Strategy and ensure
senior leadership ownership
- 4. Establish a Partnership Board to oversee the work on behalf of the broader
MECC network.
- 5. Develop robust and standardised evaluation methods
- 3. Distributed Leadership – Partnership Board
- Established Partnership Board co-chaired by Dave Sweeney, Executive
Implementation Lead, C&M Health & Care Partnership and Dr Charlotte Simpson, Healthcare Public Health Consultant , PHE NW and NHSE.
- Essential representation from groups across the sub region
- 3 active partnership working groups supporting the board in;
a) Training and Education b) Communications and engagement c) Evaluation
- DsPH and the SCN co-fund a programme lead post
- 4. Workforce Development
- C&M ambition to create a focus on prevention and embed a
sustainable model
- An accredited face to face training programme is one of a suite
- f learning opportunities available to everyone
- Development of a train the trainer model by September to
strengthen the approach at scale
- Suite of resources co-created and available to increase
awareness and knowledge
- Creation of a network of MECC leads and champions
- 5. Communications & Engagement
- www.mecc-moments.co.uklaunched today for colleagues to view
containing tools and support for local implementation
- Communications and engagement strategy developed from insight
through 1:1 interviews with senior leaders, MECC leads and frontline staff in all public and voluntary sector organisations
- Raising awareness and build understanding of behaviour change and
a shift in culture to focus on prevention, stimulating action
- Co-produced with focus and test groups across C&M MECC
campaign, tools and resources to support behaviour change, including an on-line services signposting portal
- Implementation leads and a new network of
colleagues will be supported to become MECC ambassadors
- 6. Evaluating impact
- Guide - C&M How to Evaluate for MECC guide developed
- Training evaluation process including impact on practice/confidence
- Communications framework - Pre, mid and post developed to evaluate activity
using a set of key indicators
- Leadership Insight project by PHE on how to support system wide
implementation of MECC
Lessons Learnt – Perceived barriers from insight work
Early indications from PHE led organisational/system insight highlights;
- Pressure/capacity
- Commissioners need to be engaged; commissioning for full impact
- Low priority in comparison to other challenges
- Benefits realisation not understood
- Simple and clear definitions needed
- Public ask and vice versa
Innovative opportunities in C&M
- Fire and Rescue safe and well checks
- PHE Insight work shared with key senior leaders (DoN’s, HRD’s)
- STP NHS Prevention Pledge to include MECC
- Pharmacy Network and Healthy Living Pharmacies
- Primary Care Network pilots development with NHSE (2019)
- PHE Dental Programme – Mouth Care Matters programme (2019-20)
- DWP potential collaboration
- Cancer Alliance collaboration on early detection
Thank you
www.mecc-moments.co.uk #meccmoments Louisevernon@wirral.gov.uk
12:00 – 12:30
Workshop One - Exploring the 8 key themes in the behavioural science strategy Mari Davis
8 key themes in the behavioural science strategy
Workshop One Questions on your tables – please use the booklet
- 1. Why is this theme a priority?
- 2. Where and in what way are we already doing this?
- 3. What are we not doing?
- 4. What further actions might we take?
Tables 1 and 9 ……….. start with priority theme 1.. then 2 etc Tables 2 and 10 ………..start with priority theme 2.. then 3 etc Tables 3 and 11 ………..start with priority theme 3..then 4 etc Tables 4 and 12 ……….. start with priority theme 4..then 5 etc Table 5 ……….. start with priority theme 5.. then 6 etc Table 6 ……….. start with priority theme 6..then 7 etc Table 7 ……….. start with priority theme 7..then 8 etc Table 8 ……….. start with priority theme 8..then 9 etc
12.30 – 12.45
Workshop One plenary session Mari Davis & Chairs
12.45 – 12.50
Social Marketing Campaigns in the North West Paula Hawley Evans, Health and Well Being Programme Lead/Public Health Specialist, (PHE North West) introducing a Showcase film on behalf of Claire Troughton, Regional Marketing Manager (PHE North West) https://campaignresources.phe.gov.uk/resources/
12:50 – 13:30 Lunch & Networking:
13:15 – 13:30 - Optional pop-up presentation - MECC launch Cheshire & Merseyside Tweet us on @nwphpn using #BhSci2019
13.30 Introduction to the afternoon session:
13:30 – 13:50 Case Studies – Behavioural Sciences in Action The power of combining behavioural science and social marketing, Sue Cumming, Liverpool City Council, Head of Behavioural Insight & Change Q&A (5 mins)
Public Health Liverpool
The power of combining Behavioural Science and Social Marketing
Sue Cumming, Head of Behavioural Insight & Change, Public Health Liverpool, Liverpool City Council
This Session…
Much of the global burden of disease arises from unhealthy behaviours BUT….. We still struggle to change behaviours Our behaviour is often not deliberate and considered
By understanding drivers of behaviour including attitudes, motivations, barriers and psychology we can create shortcuts in the brain to change behaviour
BUT….. Habitual and unconscious AND ….. In line with how we perceive other people to behave
BEH EHAVIOUR
MOTIVATION AUTOMATIC REFLECTIVE
REFLECTIVE AUTOMATIC
Problem Solving Effortful Logical Planning Slow Habit Impulses Emotional Automatic Fast
Behaviour occurs as an interaction between three necessary conditions
AUTOMATIC REFLECTIVE
Behavioural Insights Nudge Theory Insight and Social Marketing
BI preference for Randomised Controlled Trials SM uses marketing channels at scale BI uses routine data, literature, psychology and qualitative research, then tests SM uses market research and commissions interventions
AUTOMATIC
Behavioural Insights Nudge Theory Insight and Social Marketing
AUTOMATIC REFLECTIVE
Tools for Nudge
MINDSPACE
Messenger
Incentives Norms Defaults Salience Priming Affect Commitments Ego
Reducing Obesity in Children Campaign to reduce sugar consumption in 4 – 11 year olds
AUTOMATIC REFLECTIVE
38.8% of 11 year olds are obese or
- verweight
34.6% of 5 year olds have decayed teeth 2 children a day (on average) under age 10 have to be admitted to hospital to have teeth removed
INSIGHTS
Parents simply don’t know how much sugar their children are consuming. Food labels are bewildering and parents find it hard to understand how much sugar is in their children’s food Single items e.g. breakfast cereals don't appear to be high in sugar Parents of under 18s are more likely to believe that if a sugary cereal has other nutritional benefits, its ok to have for breakfast Parents are not aware of the Maximum Daily Amount of sugar
REFLECTIVE
Much of sugar consumption is through ‘mindless consumption’ – dependent on the environment
AUTOMATIC
The Liverpool sugar reduction journey
EVAL ALUATION - Obese or ove verweight ht prevalence – year 6 childr dren
Source: PHE, NCMP profile
EV EVALUATION
- Over 85,000 visits to our website www.savekidsfromsugar.co.uk since launch 19/6/17
- 16,500 completion of our online sugar checker that shows the total amount of sugar a
child has each day from a cereal, snack and drink.
- In November 2017 a representative population survey was conducted with parents of
children aged 4 -11 to evaluate the campaign. Total number of interviews 310:
- 65% of parents recalled seeing the campaign
- 67% of parents who recognised the campaign said they did make a change as a
result of the campaign
- 9 in 10 parents say the campaign will have an impact on them.
500 1000 1500 2000 2500 Jan-19 Feb-19 Mar-19 April
Save Kids from Sugar web hits 2019
USING NUDGE, INSIGHTS AND SOCIAL MARKETING Campaign to motivate higher risk drinkers to drink less
AUTOMATIC REFLECTIVE
- 1 in 3 people in Liverpool are drinking above the national alcohol guidelines of 14
units per week. This is above the national average for England of 1 in 4
- For those aged 40 – 64 Liverpool has higher than
national figures for the number of hospital admissions related to alcohol - 1945 people per 100k people compared to 877 for England
Liverpool data
INSIGHTS
Limits often see as ‘scaremongering’. Some feel that they are set artificially low “14 really means 28” People disengage with info on ‘Units’ Most people don’t realise how much they are drinking People disassociate with the long term health risks
- f drinking
People are motivated with the short term effects such as effects on appearance REFLECTIVE
Normalised own behaviour – perceive other people drink more than them
People strongly believe they are in control of their drinking and that they drink less than ‘heavy drinkers’ or ‘alcoholics’. This results in them lacking any sense of risk or urgency to drink less
AUTOMATIC Much of Alcohol consumption has become habitual and automatic
People sensitive to being identified as someone who needs to cut back on alcohol
❑ Potential red line to be introduced on weight gain ❑ Realisation that heavy drinking reflects own behaviour ❑ Challenge habitual drinking as lacking control
People want validation that their drinking is within a healthy level, but find units confusing and off-putting Triggers
What’s been achieved one year later
- 25,500 drinks checker completions. 2,000 completions per month.
- 91,100 website users, 14,500 of these are returning users
- GP referral pilot – 330 Patients
Barriers and Enablers in the application of behavioural science to tackle Public Health.
Enablers
- ‘Nudge’ topical
- Behavioual Insight Team
- LGA Grant Funding to run trials
- Evidence creates acceptance
Barriers
- Takes more effort
- Budgets
- Expertise
THAN ANK YOU
Questions?
13:50 – 14:10 Taking A Whole System Approach to Obesity, Julie Holt, Public Health Specialist, Oldham Council Q&A (5 mins)
109 109
Oldham’s journey towards a whole system approach for obesity
Utilising behavioural sciences to improve health and wellbeing event 22nd May 2019, Warrington
Julie Holt,
Public Health Specialist, Oldham Council
110 110
Overview
- Scale of overweight and obesity issue in Oldham –
adults and children
- Start of the journey – previous strategy
- Whole system activity – stakeholder event
- Pioneer site for PHE Whole System Approach to Obesity
(WSO) supported by Leeds Beckett University
- Next steps - planned activities in Oldham
111 111
All age overweight and
- besity
112 112
Excess weight in adults in Oldham 2016/17
Overweight and obesity (Excess weight) Adults (18+) England average 61.3% Oldham average 66.4% almost 7 in 10 Oldham’s population of 18 – 64 years is 137,000 Over 91,000 are overweight or obese
113 113
NCMP results for children in Oldham 2017/18
Definition Reception year Year 6 Oldha m England Oldham England Healthy weight 75.2 76.6 62.3 64.3 Overweight 12.3 12.8 12.9 14.2 Obesity* 10.9 9.5 23.4 20.1 *Of which is severe
- besity
3.0 2.4 4.7 4.2 ‘Excess weight’ Overweight and
- besity combined
23.2 22.3 36.3 34.3
114 114
Energy imbalance between calories in and calories out
Cause of obesity – simple view
115 115
116 116
How active are adults in Oldham?
Adults (16+) 2016-17
Oldham England
- No. of respondents
1010 198,911 Active 55.9% 62.6% Fairly active 12.5% 12.3% Inactive 31.6% 25.1% Oldham England
- No. of respondents
1007 196,675 Participating at least 2 x per week 71.8% 77.2%
Adults (16+) 2017-18
117 117
How active are children and young people in Oldham?
Sport and physical activity levels Activities taken part in over the last week Academic Year 2017-18
Activity levels Oldham C&YP in School years 1-11 England C&YP in School years 1-11 Active every day 60mins and over 9.1% 17.5% Active across the week 60 mins/day but not every day 20.9% 25.7% Fairly active 30-59 mins /day 24.9% 23.9% Less active less than 30mins /day 45.3% 32.9%
118 118
Causes of obesity – a complex system
119 119
Previous activity in Oldham
- ‘Healthy Weight, Healthy Lives for Children in
Oldham 2010-2015’ Strategy
- Based on Foresight report
- Some activity undertaken
- Scale and capacity challenges
- Obesity rates have continued to rise
120 120
Obesity prevention
‘The aim of obesity prevention is:
‘to stabilize the level of obesity in the population, to reduce the incidence of new cases and, eventually, to reduce the prevalence of obesity.’
121 121
Comprehensive approach to prevention
- Should address both dietary habits and physical activity patterns of the
population;
- address both societal and individual level factors;
- address both immediate and distant causes;
- have multiple focal points and levels of intervention (i.e. at national,
regional, community and individual levels);
- include both policies and programmes;
- build links between sectors that may be otherwise viewed as
independent.
123 123
Stakeholder Event, Chadderton Town Hall 19th November 2015
124 124
Oldham Priorities
Physical Childhood excess Adult excess Diabetes inactivity weight weight Heart disease Poor eating / Poor oral health Strokes drinking habits Cancers
125 125
Asset based approach
- Asset v deficit approaches
- What are assets?
- What are assets for health?
- Asset based tools and techniques
126 126
127 127
128 128
129 129
Roundtable discussion 1 Opportunities for action to address overweight / obesity and enable healthy weight
Enabling and supporting behaviour change:
- around physical activity and play
- around eating and drinking behaviours:
Supportive environments:
- around physical activity and play
- around healthy eating and drinking
- wider aspects including built environment /
green space / housing and active travel
130 130
Roundtable discussion 2
131 131
Barriers
Several themes were identified:
- accessibility
- communication,
- education,
- funding,
- regulation
- services.
132 132
Priorities identified
- 1. A multi-agency strategy
- 2. Communication, education and
health promotion.
- 3. Information on services and
activities
133 133
Whole System Approach to Obesity
Oldham was a ‘pioneer site’ in the Public Health England funded programme supported by Leeds Beckett University. The aim of the programme was ‘to explore how a local area could use all its levers, resources, leadership and relationships to create a more effective, sustainable, system- wide approach to tackling obesity’.
134 134
135 135
136 136
WSO activity
- Attended trainings
- Used and reviewed manual
- Held 2 multi-agency workshops in November 2017
137 137
Mapping the causal system – topics explored
Table number Facilitator/s 1 2 3 4 5
1 Anna Tebay Convenience foods Lack of physical activity Lack of awareness: healthy choices portion sizes Lack of skills to prepare healthy foods Low income 2 Oliver Barnes Joint Parenting skills/ knowledge/ understanding of healthy diets Access and availability of unhealthy fast food Perceptions of what a healthy diet is Physical activity – emergence of technology Low income 3 Gloria Beckett Cultural values and beliefs Social norms Reduced skills and education East access to take away/ convenience foods Poor mental health 4 Lianne Davies Learnt behaviours passed down for generation to generation Availability of fast foods Conflicting policies - not being consistent Technology Advertising 5 Dominic Coleman Cultural influences Joint Large numbers of takeaways and unhealthy food Low incomes Infant feeding / breast feeding / antenatal care Physical activity – access for all
138 138
The food environment – hot food takeaways
139 139
Behaviour change through the life course - Pre-conceptual, maternity and early years
- Pregnancy advice
- Breastfeeding
- Healthy Start
- Early Years
140 140
Food and drink choices
141 141
School aged children
- ‘Whole school approach’
- School Governors’ training
- Foster carer’s training session
142 142
Play and Physical activity
- Promote play
- GM Moving
- Schools - sports
development, daily mile, ‘Health champions’
- Park runs
- Walking – ‘Walking for
health’
- Cycle – Infrastructure
development
143 143
Adults
- NHS Health Checks
- National Diabetes Prevention
Programme
- Get Oldham Growing
- Weight Loss Voucher Scheme
- Prediabetes cooking programme
- Community activities:
– Slimmin’ without women – Man V Fat
- MECC
- Health literacy
144 144
Opportunities for prevention
- Planning
- Licensing
- Environmental Services
- Children’s services
- Adult Social Care
- People Services- Fit for Oldham
- Thriving Communities – Place Based Initiatives / social prescribing
145 145
The proposed 5 waves of public health
146 146
Support and treatment - care pathways
- Training of staff to raise the issue with individuals, families and carers
- Embedding play, physical activity and healthier eating in care pathways
- Need to agree clear weight management care pathways for pregnant
women, children and families and adults with access to commissioned services and alternatives to meet needs
147 147
Senior leadership support Data and intelligence Partnership and collaboration Dedicated time and commitment from the team implementing the approach and the w ider system netw ork Dedicated time and resource to support development of w orkforce capacity Accountability and governance structures
Outputs Activities and Participants Short term
- utcomes
(1-2 yrs.) Medium term
- utcomes
(2-4 yrs.) Long term
- utcomes
(5yrs+ yrs.) Inputs
Collate and use data and intelligence to develop a narrative that makes the case for change and demonstrates how health inequalities w ill be addressed Health in all Policies Approach being implemented across the Council Provide leadership to persuade stakeholders to take action Community engagement in the approach Collaboration w orking across departments and w ith other
- rganisations
Development and implementation of a localised obesity action plan that identifies, prioritises and aligns actions(including policies and programmes) across stakeholders Engage stakeholders to support a w hole systems approach to tackling
- besity
Actions in place to target health inequalities Develop collective stakeholder
- w nership of the issue through
development of systems map that depicts obesity causes in the local area Prioritised and aligned set of actions being delivered to tackle obesity across the local system, that address health inequalities Feedback loops betw een activities and
- utcomes
Systems thinking practice being integrated across the Council Assumptions Central Government action will enable/ amplify local action on tackling obesity. Systems change will impact on
- besity related outcomes
Local delivery & implementation will vary to ensure suitability and relevance to local circumstances Activities are cyclical – not linear
- and feedback loops will
be key Systems behaviours embodied by the local authority and local stakeholders Collaborative w orking across departments and w ith other organisations Improvement in intermediate markers of health and inequalities (healthier eating and physical activity) Transferable w orkforce skills and capacity related to systems w orking developed Community and other assets being used effectively Reduction in child and adult obesity in the local areas Reduction in health inequalities Improvement in w orkforce productivity Savings
- health and
social care
Systems change Health outcomes
Whole Systems Obesity Logic Model
148 148
Strategic approach
- Oldham Council (Health and Wellbeing) Directorate Senior Management
Team – Briefings and detailed papers/ presentation
- Scrutiny Committee – Presentation/ workshop
- Elected Members development session planned
- Portfolio Lead Health and Wellbeing – meetings/ briefing papers
149 149
Strategic activity – Next steps
- Multi-agency steering group
- Strategy and action plan
- Focus on opportunities:
– Council responsibilities and functions – Training – Communicating consistent messages – Public sector workforce - Council and NHS – Community and Voluntary Sector – Place-based resources including greenspace
150 150
Aim
‘A local whole systems approach responds to complexity through an
- ngoing, dynamic and flexible way of working that enables local
stakeholders to come together, share an understanding of the reality of the challenge, consider how the local system is operating and where there are the greatest opportunities for change. Stakeholders agree actions and decide as a network how to work together in an integrated way to bring about sustainable, long term change’.
151 151
Contact details
Julie Holt Public Health Specialist Oldham Council Email: julie.holt1@oldham.gov.uk
14:10 – 14:25 Comfort Break
Tweet us on @nwphpn using #BhSci2019
14:25 – 15:00
Workshop Two - Mari Davis How do we take a shared and scaled approach to integrating behavioural sciences into health, care and public health commissioning? Service delivery across the NW geography – what might that look like?
Questions on your tables
Action 1: Identify the barriers and enablers
- Barriers – what will hold us back?
- Enablers – what will propel us forward?
Action 2: Identify the opportunities and how we might make this work Opportunities:
- In our organizations
- With partners in our local area
- With partners in the NW region
➢ 15.15 – 15.35
- 1. Identifying our personal, organizational & regional commitments to
actions in the strategy
- 2. . Post-conference questionnaire & evaluation form
Identifying our personal and organisational commitments to action
- What can we each commit as first steps to taking action
- Write on your post it and put your name on the post it
- Share with a partner for 2 mins each
Post-conference questionnaire & Evaluation form
Please complete your pre-conference questionnaire as found on your table and return to Marie, answering the following: ➢ Which County or Borough do you represent? ➢ What type of organisation are you from? ➢ How do you rank your level of understanding of behavioural science approaches on a scale of 1-10? ➢ On a scale of 1-10, how valuable was the symposium in enhancing your knowledge of how behavioural science can be embedded within your
- rganisation? In your opinion, is enough being done within your organisation to embed behavioural science into practice?
➢ On a scale of 1-10, how valuable was “Improving People’s Health: Applying Behavioural and Social Sciences to improve population health and wellbeing in England Strategy Launch” in enhancing your knowledge of how behavioural science can be embedded within your organisation? Does your Department have a budget set aside for commissioning or directly providing behavioural science expertise? ➢ On a scale of 1-10, how valuable was “Case Studies – Behavioural Sciences in Action (Part 1)” in enhancing your knowledge of how behavioural science can be embedded within your organisation? ➢ On a scale of 1-10, how valuable was “Workshop One” in enhancing your knowledge of how behavioural science can be embedded within your
- rganisation?
➢ On a scale of 1-10, how valuable was “Social Marketing Campaigns in the North West” in enhancing your knowledge of how behavioural science can be embedded within your organisation? ➢ On a scale of 1-10, how valuable was “Case Studies – Behavioural Sciences in Action” in enhancing your knowledge of how behavioural science can be embedded within your organisation? ➢ On a scale of 1-10, how valuable was “Workshop Two” in enhancing your knowledge of how behavioural science can be embedded within your
- rganisation?
15:35 – 15:45
Chairs Summaries and closing remarks Safe journey home