1:1 support to reduce physical inactivity: not as crazy as you might think?
In my last blog I wrote about the disconnect between the powers that be in the sport world and the delivery organisations making sport happen on the ground. In this next blog, the second in a series of three on the importance of communication for the physical activity sector, I wanted to talk about another disconnect - the one which can happen between the sport sector and the very people who we want to participate in sport. In particular I wanted to focus on the concept of the hard to reach audience.
A holistic view of the whole system
To begin on a positive, the sport and physical activity sector has seen a surge in the importance of customer insight over the last decade. Participants are far more likely to be described as customers these days and many organisations have their own Insight Officers who spend a fair bit of time figuring out how to get close to these hard to reach audiences.
There is also some really cool work emerging about whole system approaches to behaviour change - where a behaviour is looked at within the real world context in which it exists and all the factors which influence it are thought about.
For physical activity this includes a myriad of questions such as:
Are the environments where people live and work pleasant and enjoyable to be in?
Do people feel safe being outdoors in their neighbourhood?
Do our workplaces support taking time to be physically active during the working day?
Is the physical infrastructure in place to help people be more active in their day to day lives? e.g. cycle paths, walking routes, parks and green spaces.
Sport England's Local Delivery Pilots (1) are a great example of this type of joined up thinking - operating in 12 local areas around the country to first map and understand the local context, rather than jumping in feet first with whatever intervention might be most effective to help those communities become more active. Yet in spite of a shift towards working in this way - which tries to ground what we do in an understanding of the realities of people's day to day lives - we often still struggle at a basic level to find and engage with the so-called hard to reach
We like what we know and we know what we like
One part of the challenge is that most of us tend to surround ourselves with people like us (2). It's not a conscious choice or any kind of slight on people who are different to us. It is more about something inherent in human nature which means we feel most comfortable around people who share similar ideas and interests to our own. This means that if I'm not a young Muslim mum, or a bisexual teenage boy and I want to learn more about that audience there is a good chance that I don't personally know many people who fit that description. This is one of the reasons why having diversity in the workforce is so important - if we want to reach and understand people from a particular background we stand a much better chance if we have people like them on our team.
Another difficulty, no matter how hard we try not to, is that we end up lumping people together - we refer to ethnic minorities or disabled people as though they are one homogenous group with the same needs and interests. When we go out and do research, we do our best to speak to a representative sample, but inevitably we end up having to make compromises and lean heavily on demographic characteristics to determine who we actually speak to.
But what is the alternative? There is only so much resource - we can't go round speaking personally with every single person... can we?
Could 1:1 support actually be a no brainer?
With public spending on complex social issues rising all the time, I find myself contemplating more and more whether we can afford not to take a more personalised approach. For example, research from the King's Fund (3) suggests that the cost per patient to treat long-term conditions, like Type II Diabetes, and the complications which can arise from them, is around £1000 annually for those with a single condition, rising to £3000 for two conditions and around £8000 for three. Against this sort of backdrop, a preventative intervention which can often be undertaken for a much smaller price tag, starts to look like a no brainer.
However there is something else which prevents us from reaching the audiences we most want to reach (both for research and to engage people in the interventions we hope will help them). What can commonly link together many of our hard to reach audiences is that they are struggling with something - for example it could be their mental health, being a new parent, financial worries or perhaps cultural differences. Speaking frankly, this means that they aren't looking for a new hobby, they don't have the bandwidth for one, and certainly not one that they've never particularly been interested in before.
I think of one family friend who has struggled with his weight for many years and is now dealing with a range of health challenges as a result. There is no knowledge gap here - he is more than aware that being more physically active could help with a lot of the challenges he is experiencing, however he doesn't know where to start and what holds him back is as much about the way he feels, as it is about what he knows.
The Power of Sport: not as self-evident as we think?
Those of us in the sport sector talk a lot about The Power of Sport and we are well versed in the compelling evidence base which shows the many ways in which it can help people who are struggling; but how can we connect to these people if we simply aren't on their radar? One to one intervention starts to look a little more attractive and maybe not so cost ineffective as we first thought?
Social prescribing is one way this is starting to emerge and is only set to grow since its placement front and centre in the NHS Long-term Plan (4). With task forces being set up around the country to figure out what this looks like in practice, it has a huge opportunity to play a significant role in improving health outcomes if it is done well (5). Social prescribing takes advantage of the point at which a person reaches out to their GP because they are experiencing a health issue. It recognises that many health conditions can have deep rooted causes which go far beyond physical health. In this case, the visit to the doctor presents a moment in time to connect those people with other services and support outside of the primary healthcare system, which includes opportunities to get more physically active.
Can we get to people before they reach breaking point?
When thinking about those who might be struggling with something in life, if they don't receive any help and support, the stress and anxiety will eventually take it's toll. This can often turn into physical or mental ill-health and this accounts for many visits to GP surgeries across the country. This makes me wonder whether there are other opportunities to reach people before they approach breaking point? For example are their opportunities to embed social prescribers within other agencies, such as schools, employers, NCT groups, faith organisations and others who may have contact with people who are struggling at an earlier point in their journey? And, in some cases, could a more 1:1 approach - whether a peer, a mentor or a buddy, make a genuine difference in improving long-term outcomes?
We are defined by our stories far more than by what we might write on a diversity questionnaire
As a final thought, we should remember that it is the stories, experiences and emotions in people's lives which define who they are and the choices they make, far more than any demographic characteristic. Whilst it is easy to generalise based on gender or age or ethnicity, we learn far more about behaviour from people with shared experiences than we do from those with shared characteristics. Perhaps this is a better way to define what we mean when we talk about hard to reach people.
On that note, I think what we have learned is that people are people - both the same and different in a whole host of weird and wonderful ways, but by listening to their stories we can learn more about why it is they do what they do.
In my final blog of this communication series I'll be looking at how we do research into physical activity behaviours and how we can do more to really get to grips with what drives people to be active or not.
If you'd like support with reaching and engaging hard to reach audiences or an informal chat about anything related to getting more people active in a way that works for them, get in touch at info@properactive.co.uk.
(1) Sport England Local Delivery Pilots (2019) https://www.sportengland.org/our-work/local-delivery-pilots-community-of-learning/
(2) Beattie, G., & Johnson, P. (2012). Possible unconscious bias in recruitment and promotion and the need to promote equality. Perspectives: Policy and Practice in Higher Education, 16(1), 7-13. doi: 10.1080/13603108.2011.61183
(3) Health Committee - Second Report: Managing the care of people with long-term conditions (2014) https://publications.parliament.uk/pa/cm201415/cmselect/cmhealth/401/40102.htm
(4) NHS Long-term Plan (2019) https://www.longtermplan.nhs.uk/
(5) Social prescribing and community-based support: Summary guide (2019) https://www.england.nhs.uk/wp-content/uploads/2019/01/social-prescribing-community-based-support-summary-guide.pdf
