There’s been much valid discussion around whether the term ‘sustainability’ is a help or a hinderance in promoting engagement with the change agenda that it represents (here for instance). I agree with much of what is being said, especially when it comes to engaging consumers/citizens, but we need to quickly move the debate forward to discuss what we do about it.

I’ve seen the social marketing and behaviour change community go around and around in a similar unproductive circle, with practitioners and academics ploughing through lengthy (some would say pedantic and self-serving) debates about how we talk about what we do.

Whilst I recognise the importance of the ‘branding’ issue, it is much more important that we (as a community) reach agreement on terms and vernacular and then make them our own through appropriate and consistent use. A community divided over what can be perceived as abstract semantic quibbling will damage our efforts to engage citizen-consumers with change more than using any of the existing terminology as it stands. Furthermore, whilst we are nit-picking our way through definitions, and the concepts that sit behind them, we are expending time, effort and energy thinking change, rather than doing change.

So, do we Reposition, or Rebrand? That is, do we decide for ourselves what the existing discourse ‘means’ and then consolidate the denotations and connotations through consistent and appropriate use (Wittgenstein, if anyone’s interested), or do we Rebrand altogether: a new start, a new name and clean set of connotations?

Either way, let’s do it quickly and decisively, so we can concentrate on the task at hand. Suggestions welcome through this blog or www.twitter.com/stevenejohnson

Decision fatigue and ego depletion – implications for behaviour change

In a fascinating essay in the New York Times (thanks to Michael Rothschild for the signpost), John Tierney outlines a bank of research into ‘Decision Fatigue’, a specific example of the more general phenomenon, Ego Depletion.

Through his analysis, Ego Depletion emerges as powerful explanatory and predictive concept that sheds new light on a wide range of behaviour change issues. I’ve listed some at the bottom of the page to prompt further discussion, but for the purposes of this piece I’m going to focus on health inequalities and the crude, class-based dichotomy that seeks to account for them in terms of ‘immediate’ and ‘deferred gratification’.In very basic terms, the concept of Ego Depletion is based on the fact that agency requires energy. That is, in asserting our will or carrying out any intentional behaviour, we are drawing on a finite stock of mental energy. It therefore follows that if those stocks are running low, we are less able to assert our will and carry out the behaviour.

Tierney anchors the piece with an example from Jonathan Levav of Stanford and Shai Danziger of Ben-Gurion University. Analysing the decisions made by an Israeli parole board, they found there is a 70% chance of prisoners being paroled in the early morning slots, compared with only a 10% chance in the late afternoon slots. The differential is put down to the build up of decision fatigue throughout the day, in the face of which the panel take short cuts or default to less risky decisions.

As fascinating as the concept of ‘decision fatigue’ is, the essay becomes more directly relevant to our behaviour change context when Tierney steps back to discuss Ego Depletion more generally and the more unconscious, less rational processes associated with will power.

At the level of theory, the concept of ‘mental energy’ is intuitively attractive and has strong explanatory power. However, far from being ‘just’ a theory, modern neuroscience has located an empirical foundation for the concept linked to the amount of glucose we have available to our system.

To caricature some rather heavy neuroscience, the more glucose we have, the more able the part of our brain associated with restraint (the amygdala) is to control our urges. As we exercise our willpower, the amygdyla tires, but the part of the brain associated with seeking reward (the nucleus accumbens) doesn’t. In a literal battle of will—id vs superego—the latter simply gasses out.

(I’m sure the excruciating irony that a quick sugary snack might strengthen will power is not lost on the millions of erstwhile dieters.)

Coming back to immediate and deferred gratification: Although these concepts of have taken root in popular consciousness, they represent a scribbled caricature of human motivation that has been damaging for so many reasons, not least the way in which it has helped further divide the working class into ‘deserving’ and ‘undeserving’ camps.

At The Hub we sharpen this blunt analysis using the concept hierarchies of need. That is, the notion that as human beings (using Maslow’s model), we have stratified types of need, ranging from imperative physiological needs for food, shelter and companionship, to more refined, higher order ones associated with ‘self-actualisation’ or the realisation of potential.

By working closely with a community it is possible to ascertain how this concept applies specifically to them—to delineate their particular hierarchies of need, given their social, economic and cultural conditions. This more incisive analysis gives us an understanding of ‘immediate gratification’ that becomes a springboard for effective intervention design, rather than a label to justifiy fatalism in the face of the intransigent habits of the great unwashed. That is, when a family is still struggling to satisfy its imperative physiological needs, you can begin to understand why appeals to grab your 5-a-day, get your bowel screen, see your doctor, concentrate at school etc… get crowded out.

This exact approach has directly driven intervention design in a number of our areas of our work, including child poverty and breastfeeding.

However, Tierney’s analysis of Ego Depletion adds a few more carriages to this train of thought and offers an empirical, neurological foundation. In his own words:

“…researchers argue that…decision fatigue is a major — and hitherto ignored — factor in trapping people in poverty. Because their financial situation forces them to make so many trade-offs, they have less willpower to devote to school, work and other activities that might get them into the middle class.”

In short, because the purchasing decisions that low income families make have such a significant knock-on effect, the process of weighing up the variables and executing a risky decision is exhausting.

I’m sure there are counter arguments that leverage the same same logic: professional class jobs are characterised by decision-making and its consequences, whilst manual jobs associated with routine and repetitive processes. As such, the former should be at least as susceptible to the vagaries of immediate gratification as much as the latter. However, there’s no escaping the fact that the concept of Ego Depletion offers considerable (glucose-rich) food for thought as we attempt refine our understanding of why we do what we do.

Food for thought

• If will power is dynamic, what implications does this have for the behavioural theories that we use? As far as I know only, Robert West’s PRIME theory factors in the varying levels of motivation over time.
• How can we design interventions that take account of varying levels of motivation?
• If ego depletion also linked to glucose levels, should we be incorporating eat habits and patterns into our insight gathering as a matter of course.
• Can we empower people, but simply informing them about ego depletion i.e. that they should expect dips in motivation related to decision fatigue etc?
• Can we use technology to empower through feedback mechanisms eg colour-coded arm patch, sensitive to glucose levels?

We see Ego Depletion as another example of how science is increasingly finding neurological bases for previously theoretical psychological constructs. The Collaborative Change approach is in part an attempt to respond to the new insights into human behaviour that cognitive neuroscience, behavioural economics and network theory are giving us. We see this trend continuing, challenging the behaviour change community to respond and  increasing the opportunities to understand people and empower them to rise to their challenges.

We produced this viral as part of our award-winning breastfeeding initiation campaign, Be A Star. It was a great success, leading to a 13% increase in breastfeeding initiation rates. Given the organic, word-of-mouth transmission that drove the success of the programme within grass-roots offline communities, we’ve developed this short film to serve the same purpose within the global online community. Please share this link amongst your networks.

A big thank you to Preston Mum, Laura Taylor and little Emily—the real stars of this clip.

For more information on Be A Star, see our mini case study here and the National Social Marketing Centre’s Showcase with full evaluation here

Central to the work we did was the development of the ‘Lose The Fags’ brand: a phrase, a sentiment and a visual identity that reflected and resonated with the cultural identity of the community, based on client research and ethnography undertaken by our designers. This short clip features an interview with our client on this project, Sarah Clarke, Marketing Manager at NHS Stockport, attesting to the success of the project and the ongoing legacy that the brand has secured.

As a community-based, direct engagement approach, Collaborative Change recognises the limitations of branding and communications as a driver of social change, but also champions their strengths when understood and deployed in the context of a holistic behaviour change intervention. In the current case, the development of brand and communications campaign, inspired by the community in which it will be used not only did its standard job of raising awareness, but also:

• Aligned itself with existing community value sets—it become part of the community
• Fostered group identity to galvanise new behaviours
• Created a social object—a common reference point that the community could discuss and share
• Repositioned smoking behaviour (or more accurately, cessation behaviour) to make it more aligned with community values, therefore reducing the sense that cessation would lead to ostracisation
• Externalised and articulated community sentiments that would otherwise have been left implicit in the face of adverse social norms

We are delighted to have been invited to present our Collaborative Change approach to the 2nd World Social Marketing Conference in Dublin next week (11–12 April). Held biannually, this global gathering distills a range huge array of opportunity into two short days, and we are keen to unpack it all.

As behaviour change practitioners, we believe this event should be more of a confluence than a conference: a merging of streams, rather than a discussion of themes; a workshop rather than a talking shop; a crucible of interaction, collaboration and participation.

With this in mind, we’d like to introduce the Collaborative exChange: a simple concept to help us all unlock the full potential of this event. Rather than simply using our exhibition stand as 3-dimensional brochure, we aim to develop it as a catalyst for a range of collaboration opportunities amongst our fellow delegates. This will include:

• Mapping networks of interest and ambition within the conference community
• Facilitating connections
• Enabling discussion across the conference campus
• Running flash-mob seminars, based on delegate priorities, not the conference organiser’s

By collecting a few details from delegates at the stand, via Twitter or over email we will begin to develop an understanding of the conference community.  Through the same face-to-face and digital channels we will then begin to develop and facilitate collaboration opportunities, real time and post-conference. Follow www.twitter.com/socialchangehub and #wsmcollab for updates and dialogue.

If you’d like to be part of this open-ended process and track where it takes us, please send the following brief details to steven@socialchange-hub.co.uk.

• Name
• Organisation
• Email address and/or Twitter feed
• Main behaviour change focus (health, environment etc..)
• Burning issue (the single most significant challenge you face in your behaviour change practice.

If you’re also attending the conference, please visit us at stand
Green / Yellow 7

• How social marketing will fall out of favour as a label and a practice as a result of the need to diversify behaviour change approaches.
• The influence of emerging research in the behavioural sciences, most notably behavioural economics and the Coalition’s focus on choice architecture and ‘nudging’.
• The need to place participation and partnership at the heart of behaviour change interventions, inline with our Collaborative Change approach.

The purpose of the presentation was to encourage our behaviour change community to look to the future as well as celebrate the past. The arrival of the Coalition and a new set of social change priorities will change the behaviour change landscape beyond recognition, not just in terms of shrinking budgets, but in terms of a philosophical shift in the foundations of our practice.

With this in mind, I thought it important that this conference didn’t become a self-congratulatory portfolio of case study presentations, but rather a forum for practitioners to discuss some urgent, burning questions. The presentation is available for download here.

As some delegates missed the presentation due the room being at capacity, the original presentation, complete with diagrams and illustrations, is now available for download here

Introduction

“When people are given the chance and treated as if they are capable, they tend to find that they know what is best for them, and can work out how to fix any problems they have and realise their dreams.”
—Nesta 2010

“If I’d have asked my customers what they wanted, they’d have asked for a faster horse.”

—Henry Ford

The scale, scope and speed of change that is currently being driven forward by the Coalition government presents those of us involved in the healthy communities agenda with challenge and opportunity in equal measure.

Given that it is our new government—the challenges it faces and the response it is formulating—that is defining the parameters in which we discuss the future of the healthy communities agenda, I took the opportunity to re-read the Coalition programme on the train to this conference. In doing so, I came across the following statement that encapsulates the main points I want to make today.

“The Government believes that we need action to promote public health, and encourage behaviour change to help people live healthier lives. We need an ambitious strategy to prevent ill-health which harnesses innovative techniques to help people take responsibility for their own health.”

Behaviour change is essential

Firstly, what is explicit in this statement is the fact that long-term behaviour change must be central to our efforts to deliver on public health priorities. In terms of health outcomes alone—without factoring in other knock-on life chances and quality-of-life consequences—we need to change our behaviours.

•  A quarter of adults and a sixth of children are now obese
•  Over 10% of the population drink to hazardous levels
•  84,000 deaths every year in the UK from smoking
• We need to change behaviours

However, if we are to understand the full significance of this statement, we need to unpack its implicit suggestions, as well as note its explicit statements. Firstly, behaviour change, health inequalities, healthy communities—these agendas are not only about improving health outcomes, they are equally about reducing the huge costs incurred in dealing with a unhealthy, ageing population.

• Obesity set to cost NHS £10bn per year by 2050
• Wider costs to estimated to reach £49.9 billion per year
• Alcohol misuse : betwee £17.7 bn and £25.1 bn per year.
• Smoking: £5.2 billion in 2005-06 (NHS alone)
• We need to cut costs

So whilst the need to improve health outcomes and inequalities is pressing, arguably the need to cut costs is imperative and urgent.

Secondly, what is also implicit in the above statement is the suggestion that the things we have been doing so far to affect behaviour change have been less than effective. “We need an ambitious strategy to prevent ill-health which harnesses innovative techniques…” We need to do things differently.

Our efforts to educate, persuade and channel citizens into new behaviours have, in the main fallen short. I make this point at a general level—there are so many inspiring intervention and initiatives that have made important progress and delivered tangible outcomes, but the upshot is that we have failed to deliver on the key challenge:

• The gap in men’s life expectancy in 05–07 was 4% wider than 95–97
• For women, this gap was 11% wider.
• National Audit Office, July 2010 concludes that we are unlikely to meet Labour’s 10% reduction by 2010.

I’m sure this irony is not lost on anyone here—the irony that in order to deliver more effectively on behaviour change, it us us that need to start doing things differently.

It is easy to see how some of the most earnest efforts to change behaviours have served to further widen the health inequalities gap. Whole-population, mass-media approaches without sufficient segmentation can be effective in motivate citizens higher up the socio-economic scale—those more demanding, articulate, engaged citizens—but fail to touch the communities that lack the conditions conducive for change. As a result, we improve health outcomes for more advantaged groups and further alienate the disadvantaged. The health inequalities gap widens.

Finally, what is neither implicit nor explicit in this statement, but needs to taking into consideration, is the fact that behaviour change is not just about public health. If we are to deliver on social exclusion, climate change, crime and disorder and other urgent priorities, we must work hard to get the behaviour change formula right.

Why are we struggling with behaviour change?

The issues we have discussed above beg the question, where are we going wrong? Why are we falling short in delivering on behaviour change? In response to this question, I’d like to argue that many attempts to influence citizen behaviours have been hindered by three inter-related biases:

1. A bias towards a model of human behaviour as being self-directed rather than contextually determined.
2. A bias towards insight based on blatant needs rather latent needs.
3. A bias towards interventions focused on persuasion rather than empowerment.

Bias 1: self-direction vs contextually determined

Our understanding of human behaviour has been through a step-change over the last two decades. The more progressive academic institutions and businesses have begun to dismantle the silos in which research has traditionally operated, fostering a more inter-disciplinary approach that more directly reflects how humans actual think and behave; an approach that reflects the inter-dependent relationships between mind, brain, body and society.

Research in sociology, psychology, behavioural economics and cognitive neuroscience has largely dismantled and reassembled our traditional understanding of what drives and defines human behaviour and decision making. However, in reflection of Kuhn’s classic model of paradigm shift, we are still operating under the ancien regime. In short, what we know about human behaviour has progressed beyond recognition, but the ways in which we attempt to change it, have not.

In the face of growing scientific evidence to the contrary we have persisted in operating with a paradigm that understands behaviour as being self-directed, rather than contextually determined. A paradigm based on the notion of a rational, self-aware, autonomous individual— the homo econimus construct of classical economics which assumes a causal relationship between attitudes/beliefs and behaviour—that what we do directly reflects what we think, what we want, what we value, mediated only by rational self-interest and our static, consistent preferences.

The dominance of this paradigm has blinded us to the fact that internal psychological constructs such as attitudes, beliefs, personal preference etc are only minor players in an infinitely more complex context that, in its totality, provides the true foundation of human behaviour.

As we will see, there is a rapidly emerging literature from a number of disciplines that is making this model obsolete and forcing us to understand behaviour as a phenomenon determined at least as much by external environmental and social influences as by the choices and decisions of the individual.

Bias 2: Latent needs Vs blatant needs

Any successful attempt to influence citizen behaviour must be premised on a thorough and accurate understanding of that behaviour.

However, as human beings, we are frustratingly opaque—not just to others, but even to ourselves. A rapidly emerging body of social and cognitive science is showing how we are inherently irrational, lacking in self-awareness and inextricable from our external context— ‘nudged’ about by hidden hands of environmental and social influence.

And if the human condition makes understanding behaviour complex, by the time we have overlaid the complexity of our modern society and the issues that we face, it starts to appear almost unfathomable.

In order to respond to this complexity, the Collobarative Change approach differentiates between the blatant needs and the latent needs of our citizens.

Blatant needs operate at the surface level and can be readily articulated. They exist within conscious awareness and are drawn from memory of our own experience. However, the cognitive psychology community is now in broad agreement that around 95% of our thought, learning and memory—the drivers of our behaviour—operate outside of our conscious awareness. As such, it becomes necessary to dig deeper into these drivers and begin to unearth latent needs.

Latent needs are those that exist below conscious awareness, are not conducive to articulation (at least not in words) and hold the key to successful service and intervention design.

Digging deeper

Traditional quantitative and qualitative research methodologies play a vital role in understanding citizen needs. However, in light of this discussion so far, they are limited in two distinct ways.

Firstly, those methodologies that are executed in group settings (eg. Focus groups) become distorted by social influence, intimidation and conformity effects. Secondly, we humans do not have sufficient insight into our own subjective states to reliably self-report our feelings, motivations and preferences.

Whilst two conclusions could provide an argument for the need to go beyond social research, we must be clear that Collaborative Change does not replace social research. Indeed the insight that these methodologies can yield are pre-requisite to the design of a successful participatory approach.

As such, deep dive ethnographic or more traditional qualitative research techniques would normally be employed to gain an understanding of the community’s needs in relation to the particular issue.

Using this insight it then becomes possible to design interactive co-creation sessions and tasks using personas, scenarios, metaphor elicitation etc. Taking this approach, we become engaged in activities that give us the tools to articulate needs in non-linguistic ways and in discussing the ‘creations’ we open a window on deeper, unarticulated needs as well as more direct, literal responses to the question at hand.

Immersing participants in scenarios in this way not only keeps them engaged in the process at hand, but also allows them to project their reactions and responses away from their own identity, circumventing the natural psychological defences that can make self-reporting so problematic.

Bias 3: Persuasion Vs empowerment

It follows that if we have an understanding of human behaviour focused on internal psychological constructs and research methodologies that focus on those them, then we will have an approach to modifying human behaviour biased towards the same variables.

This tendency is best summed up as an over-reliance on persuasion at the expense of empowerment. That is, approaches leveraging rational and emotional arguments to shift beliefs and attitudes at the expense of efforts to engage and empower individuals to make a change within the context in which they operate.

This over-reliance on persuasive techniques can be best understood in terms of a focus on education, awareness-raising and information provision, in the absence of simultaneous efforts to raise efficacy and confidence, build capacity within communities and create services that respond to the genuine needs of communities as they negotiate the behaviour change journey.

Believe it or not, most people know what’s good for them. They know that drinking, smoking, eating fatty, sugary foods and not taking enough exercise is damaging to their health. And at one level or another, of course they want to live longer—be more active with their family, see their grandchildren grow-up etc. In most cases, the knowledge and the motivation for change, if deeply buried, are there.

In this context, efforts to persuade, blackmail and shock citizens into doing things different are patronising at best and unethical at worst.

Another way of framing this bias towards persuasion rather than empowerment is a marked tendency to use social advertising rather than true social marketing.

Social marketing is a powerful, systematic process for bringing about long-term behaviour change. At The Hub, the social marketing paradigm has played a huge part in defining our approach to social change. It is a robust, flexible process, equipped to take full account of the complexity of human behaviour and formulate appropriate responses.

However, despite the tireless efforts of the National Social Marketing Centre (NSMC) to raise awareness and build capacity around its use in a public health context, too many behaviour change projects that start out as genuine social marketing initiatives turn into advertising and communications campaigns.

(There are number of understandable reasons for this that are covered at length on the Collaborative Change blog). And whilst effective, relevant communications and information provision have an important role to play throughout the behaviour change journey and can be a powerful method of rebranding behaviours in line with existing value sets, social advertising, in isolation, cannot drive long-term sustainable behaviour change.)

Underestimating the challenge

As a result of these biases, we have been operating with reductive model of behaviour change that has meant that we have fundamentally underestimated the gravity of the challenge. Not just how difficult behaviour change is for us, but how difficult it is for the people with whom we seek to engage.

Human behaviour is mind-boggling complex and if we are to succeed in understanding and influencing it, our work must respect and reflect that complexity. Humans are complex. Behaviour is complex. Change is difficult.

So faced with the inherent complexity of human behaviour and reductive models of dealing with it, it is unsurprising that our attempts to change it have not been as successful as they could have been.

Challenges – opportunities in disguise.

We have seen why we need to put behaviour change at the heart of attempts to deliver on public health. However, we have also seen that, to succeed, we need to update our thinking and refine our models: we need to ‘do’ behaviour change differently—more effectively, more efficiently, in ways which respect and reflect what we now know about the complexity of human behaviour.

However, if behaviour change itself makes for a daunting challenge, by the time we have overlaid the wider political and economic context that we currently find ourselves in, we could be forgiven for giving up and going home.

At the point at which we are under most pressure to deliver on behaviour change, we are not only seeing our budgets shrink, but we are potentially heading for a period in which economic downturn could exacerbate demand for the very services that are being cut.

We are under pressure to respond to an intensifying situation with less resources—the incessant mantra: more with less, more with less—more effective services and interventions with less money and manpower.

But whilst these are undoubtedly challenging times, they are also exciting times to be working in this field. Whilst the jury is still out on the commitment and motives behind the Coalition’s big society vision, there is the real possibility that we currently have the political will to enter a new era of social change—an opportunity to redefine the citizen-state relationship and build behaviour change approaches built on equity, participation and collaboration.

In addition—as we have seen—we are seeing a rapidly emerging body of new science (and the re-popularisation of some old science) that throws new light on human behaviour and offers us new opportunities to influence and empower changes in it.

So that’s the context: Behaviour change is essential if we are to deliver on the healthy communities agenda and wider social change priorities. However, behaviour change needs to change—it needs to become more efficient, more effective, more reflective of the real human condition. Unfortunately, this increased pressure on us to deliver on behaviour change is exacerbated by shrinking budgets and political uncertainty.

It is in this context that we begin to see clearly how Collaborative Change—a participatory approach to behaviour change—offers us a way forward.

What is Collaborative Change?

Why Collaborate?

Collaborative Change: the principles and process

Mini case studies

After all, who knows more about what a public service should look and feel like than the public itself. And who is better placed to determine what will work in a particular locality than the people who are woven into its very fabric?

Fortunately, as compelling as this common sense perspective is, the empirical evidence base for a Collaborative Change approach continues to grow and consolidate. In addition to the evaluation of our own projects, we are continually discovering new research and best practice that (sometimes retrospectively) add further strength to the case.

Last week I came across a paper by Nina Wallenstein titled ‘What is the evidence on effectiveness of empowerment to improve health?’ Following a meta-analysis of over 500 articles and papers focused on participatory approaches to empowerment in a health setting,  Wallenstein concludes that:

“Citizen participation seems critical in reducing dependency on health professionals, ensuring cultural and local sensitivity to programmes, facilitating capacity and sustainability of change efforts, enlisting community stakeholders in programme improvement and enhancing the productivity, effectiveness and efficiency of programmes and enhancing health in its own right.”

It is hardly necessary to unpack this conclusion in any detail to realise how well-aligned these approaches are to our current big-society, fiscally-restrained context: local sensitivity, reduced dependency, capacity building, sustainability, increased effectiveness and efficiency…

More specifically Wallenstein points out that participatory approaches yield positive community impacts along two distinct ‘pathways’. On the one hand, they deliver improved health outcomes and, on the other, the empowerment process builds social capital and community resilience.

When empowerment is considered as an end itself, it has been shown to bring positive impacts at the individual, organisational and community level. Examples cited by Wallenstein include great sense of self and collective efficacy, stronger group bonding, formation of sustainable youth groups, increased participation in structured activities leading to improved mental health and school performance. Again we can immediately feel the resonance with social change priorities in the current political context.

Wallenstein’s best practice review also provides further support for the distinction we make between token participation and meaningful participation, concluding that “participation alone is not sufficient for empowerment.” As we have outlined elsewhere, meaningful participation is only achieved if the community is engaged with the issue in the context of their current values and empowered to articulate their needs, make decisions and advocate.

Whilst the evidence base for the benefits of empowerment is strong, Wallenstein admits evidence related directly and specifically to improved specific health outcomes is less voluminous and less clear. This clearly underlines the need for social change programmes to become more evaluation focused and for us to continue to strive for more innovative ways to isolate and measure behavioural impacts.

Kickash is a campaign-cum-service that has not only been designed and delivered by young people in a school setting. It’s an excellent example of the Collaborative Change approach and exemplifies the 5 principles of engage, motivate, empower, trust and ownership.

It revolves around a core group of 30 mentors (aged 15+) in each school. Splitting into 3 working groups to cover communications, trading standards and cessation, this group is responsible for delivering a wide range of interventions to year 8 students in the school’s affiliated primary schools.

The communications team has developed the brand and promotional campaign and are responsible for awareness raising. The enforcement team has been working with trading standards on test purchasing exercises and is responsible for under-age sales and illicit tobacco. The cessation team has been trained to level 1 and is actively involved in referring young people into service.

Kickash is currently active in 5 schools across the county and Diane ultimately aims to increase this number to 10.

It was developed and prototyped through what she calls a ‘pathfinder? school’—a school that was already engaged and that had a mentoring scheme already in place. Through co-design sessions, groups of year 8 students developed a ‘job description’ for their ideal smoking cessation mentor. This specification was then used as the basis for the recruitment of the core group of 15-year-olds from the secondary setting.

In line with the Collaborative Change approach, students were engaged within the context of their own values. Diane explained that recruitment posed no problems as students drew a passion for the issue from personal experience: a family member / someone they know dying from a smoking-related illness.

Building on this personal drive, Diane developed extrinsic motivations to facilitate meaningful, ongoing participation. Above and beyond the opportunity to make a difference, the students in question recognised the value of being involved in terms of their academic performance, personal development and future career.

The initial process evaluation undertaken by Diane has revealed a wide range of academic and personal benefits for the mentors who have taken part, including increased confidence, improved academic performance and greater self-esteem. Furthermore, she is currently working to have participation in the programme accredited by an independent body to bolster the positive impact on the mentors academic record.

The mentors have been empowered through a range of training sessions related to tobacco control approaches in general and specific to their own individual working groups. They also have access to specific skills and guidance such as a graphic designer and local authority press officer to further develop their skills. And throughout the entire process the mentors have a ‘reference group’ on hand, comprised of a wide range of stakeholders (including senior level schools representatives, PCT, trading standards and the Stop Smoking Service) to guide activity and bring further capacity.

Trust has been established through the open, transparent and highly structured way in which the programme has been developed. Diane has allowed the group considerable autonomy, but within a framework that is strong and supportive enough to manage risk.

As a result, ownership has been transferred—the young people are successfully managing and running their own intervention.

I’m not sure on how and to what extent the project is being funded and therefore how sustainable the model is from an economic perspective, but in many respects, Kick Ash embodies the Collaborative Change approach perfectly. I look forward to the evaluation!

More information

http://bit.ly/9w6r7J

http://bit.ly/bkfyjU

http://bit.ly/bZPyPq