ADPH London London Childhood Obesity Exchange Cultural Insights and the Normalisation of Obesity 1
Outline – 14 th June Introductory Presentation 9.30 Welcome and Introduction to the event 9.40 Understanding our audiences 10.00 Using Behavioural Insights to Tackle childhood obesity 10.30 Cultural Insights and Application in Lambeth 11.00 Q&A and sharing of insights & projects in the room 11.15 Coffee and Exchange of Knowledge and Ideas Facilitating Action... 11.30 Working together to understand levers and challenges for communities. 12.00 Developing ideas and commitments to make small changes to make a big difference. 12.20 Into Action ... Resources and support to implement change 12.30 Close and Ideas Exchange 2
ADPH London Introducing the Issue Sarah Cork – Brilliant Futures & iPiP 3
What’s the problem? A Health Survey for England finding that 9/10 mothers and 8/10 fathers of an overweight child described them as being about the right weight. And with increase in overweight and obesity rising, we are normalising the Issue, with a rising % unable to recognise when someone is overweight or Obese and not as concerned. 4
It’s a complex problem, with many cultural and attitudinal influences and influencers... • People tend to overestimate what obesity means in terms of adult body size. • People who are obese are often the object of stigmatising attitudes. • The majority (80%) said that those who are obese themselves should take responsibility, 53% agree that “most overweight people could lose weight if they tried” • In relation to the causes of obesity; Overall, 82% feel that modern lifestyles are too sedentary, while 91% feel that fast food is too easily available. • Younger respondents and those from a black or minority ethnic (BME) background were more likely to feel that healthy food is too expensive and that people have too little time to make healthy meals 5 British Social Attitudes Survey, 2015, Public Health England
We need to understand where people ‘are at’... ... Get into their world... Beliefs Knowledge? Attitudes Facts? Benefits & Buts Where from? Barriers Motivations Aspirations Feelings Values Who & what influences? Fears Lifestyle, social norms, messengers ….? What Where Do? Go? Great Weight Debate 2016 6
The commercial world sells food through emotional appeal... We need to get into their world too. Benefits & Buts Barriers Motivations Aspirations Feelings Values Fears Great Weight Debate 2016 7
And understand different cultural behaviours and influences – the ‘System’ is different for different populations... • The graph presents national data on obesity prevalence by ethnicity from the NCMP. • The gap between obesity rates in White British and most other ethnic groups is widening nationally. • In London, 41.8% of the population are from BAME groups, which is almost 3 times higher than the England average (14.6%). • Although there is variation across London - The proportion of the population from BAME groups ranges from 13.6% in Havering to 72.4% in Newham.
“I never really thought about it. Ethnic Minority Communities: Now that you mention it, it just makes you think about how many Bangladeshi and Pakistani Families people and how many children there are in my family who have a weight problem.” “I just don’t let him out. Being ‘big’ is seen as a sign of health I worry about him going and wealth “My mother -in-law is out on his bike and obsessed about feeding then hanging around my child. She keeps Scratch cooking of traditional the shops with his saying he is too thin when meals is widespread but not friends. You just don’t I know he is healthy and all cooking practices are know what they will be has a good weight” Healthy Weight, Healthy Lives healthy tempted to get into. That’s when they go bad.” Parents do not control children’s consumption of Western convenience foods Parents place a high priority on their children’s educational attainment and on the maintenance of cultural and Great importance is placed on the religious values provision of sufficient quantities of food “I would love to be able to “The problem isn’t our go swimming or take the home food. Now you have kids but there is so much Mothers and children do these halal chicken and else to do. There’s the not have time to be chip places on every cooking for the mother-in- physically active corner. It’s just too easy law, looking after my when you come home on a sister who is disabled and Friday night to grab after running around after something from these Physical activity is not a four children, I’m places as a treat for all the cultural norm exhausted.” family.” 9
Cultural Insights from Literature Study with children from ethnically diverse sample of young children and parents in London: • Dislike of school meals • Lack of knowledge of guidelines and negativity towards physical activity education at school among girls. • Parents feel physical activity is role of schools. • Influence of neighbourhood (lack of safety – gangs & dogs, fast food outlets). • Places of workshop key focal points for social support. • Want to retain traditional practices. • Family roles and responsibilities and religion as facilitators and barriers: - importance of family meals - reliance on convenience stores for traditional foods. • In South Asian families homework prioritised over physical activity. • Black Caribbean and Black African families reporting dads associated with treats / fast food / takeaways and influence of wider family. • Needing to study food labels for halal ingredients for example as opportunity. • Places of worship as focal point and often ‘food point’. – more focus between healthy eating and religion than physical activity and religion. Rawlins et l, 2012 10
Working with different beliefs, values, attitudes in different communities... JOGG Rotterdam carried out research on how to encourage Turkish and Moroccan mothers increase childrens ’ water consumption. Based on qualitative research they developed the message ‘You are a good and strong mum when you give your children water at least twice a day’ www.epode-international-network.com
Working with different beliefs, values, attitudes in different communities... An Insight Driven Approach in Action: White working class families – working full time, time- poor, ‘just managing’. Reliant on freezer. Were ‘cooking’ meals every night – take something from freezer, put in oven – therefore ‘cooking’ messages not getting through. All shopped at same supermarket – ASDA. Therefore... Promotion with local ASDA – using existing offers on frozen food to shift ‘up a traffic light’ and then make meal from scratch to freeze. www.brilliantfutures.org
Giving people a healthy version of what they want... In their world.. Tasty Buds Carribean Takeaway https://vimeo.com/108575962 #FDPHwebinars
ADPH London Using Behavioural Insights to Tackle Childhood Obesity The Opportunity Sarah Golding Public Health England, Behavioural Insights Team 14
Using behavioural insights to enhance NCMP feedback: a randomised controlled trial London Childhood Obesity Exchange, May & June 2017 Sarah Golding ESRC Research Fellow PHE Behavioural Insights Team
‘Behavioural Insights’ 16
COM-B Model of Behaviour Psychological capability Capability Physical capability Reflective motivation Motivation Behaviour Automatic motivation Social opportunity Opportunity Physical opportunity 17 Michie et al. (2012)
18 18 Behavioural Insights in Public Health England.
Methods: Developing a behaviourally enhanced NCMP feedback letter
Study Design Cluster Randomisation 283 Schools (10,661 Yr 6 pupils) Intervention Control Behaviourally Routine (2014/15) enhanced feedback feedback letter letter (i) Uptake of WMS
Study Design Cluster Randomisation 283 Schools (10,661 Yr 6 pupils) Intervention Control Behaviourally Routine (2014/15) enhanced feedback feedback letter letter (i) Uptake of WMS
Control Feedback letter Family Lifestyle Club (FLiC) flyer (OW / VOW) Local activities leaflet Change4Life tips sheet 22 Presentation title - edit in Header and Footer
Control letter: Overweight and very overweight + A local activities leaflet + FLiC flyer + Change4Life tips sheet
Control Intervention Feedback letter Behaviourally enhanced feedback letter (incl. social Family Lifestyle Club (FLiC) norms statement) flyer (OW / VOW) Local activities leaflet FliC flyer (OW / VOW) Change4Life tips sheet Local activities leaflet Chang4Life tips sheet ‘Map Me’ images (OW / VOW) Pre-populated booking form (VOW) 24 Presentation title - edit in Header and Footer
Intervention letter: Overweight + A local activities leaflet + FLiC flyer + Change4Life tips sheet + Map Me body image scales + A call to action to look at the images over the page and an explanation about the images.
GIRLS
Intervention letter: Overweight + A local activities leaflet + FLiC flyer + Change4Life tips sheet + Map Me body image scales + Social norms statement about overweight and very overweight children being in the minority.
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