Aim of the presentation is to; tell you a little bit about us as a company and the Social Norms Project we ran jointly on behalf of Stockton Primary Care Trust and Stockton Council. I’m going to cover the process we went through in terms of implementing the project, and try to highlight some of the wisdom we gained along the way. At the end I’ll show you some preliminary evaluation data from the project which we feel showcases the effectiveness of the social norms approach, and then finally I’ll explain how we feel we can help other Social Norms projects around the country run successfully. NWA; Unique here today as we are ‘researchers’ rather than ‘primary care practioners’, interesting because Social Norms has it’s basis in sound research As a company, we are very passionate about research within the Primary Car setting and the Social Norms approach specifically
So just to give you a little bit of background on Stockton for those of you who are not familiar with the area…..I am a great advocate of my local area, but as it’s pertinent to the Social Norms projects, I’d also like to highlight a few of Stockton’s less positive claims to fame – the local area has a particular issue with drug and alcohol referrals in under 18’s, and the highest teenage conception rate in the country
Stockton is already aware that we have a particular issue in relation to teenage conception rates and drug and alcohol usage in young people. So in addition to knowing that they need to do something to improve these statistics there is also a need to be conscious that there are already young people out there amongst our target population who are involved in these behaviours or have been in the past, who could be inadvertently harmed by the ‘health terrorism’/ shocking images of diseased livers/ people falling from buildings, or the ‘don’t do it, it’s wrong’ type campaigns which are more traditional in this area of preventative health
So this is the point at which we joined the team, in January 2009, we were commissioned to design and carry out the whole 2 year social norms project on behalf of North Tees PCT and Stockton Council.
So, what did we do? Well, the Social Norms process as we saw it included the need to develop our own knowledge in the social norms field, because this was the first project of this type we had undertaken, and indeed at the time it was one of the first Social Norms projects being undertaken in the country. From there, we was also the need to develop an appropriate and workable research tool – which I’ll come back to in a moment, convince the schools that it was a good idea, develop a marketing campaign working as closely with the pupils as possible to ensure we ended up with something that not only conveyed the right messages but also that our target population liked/ responded to and also felt a personal ownership of. Making sure that social norms projection or intervention materials stayed fresh and interesting over the course of the project, and then finally to provide some evaluation of the effectiveness of the campaign/ social norms approach as a whole by re-surveying the pupils involved/ targeted to assess the change in behaviours and the impact of the campaign.
Wes Perkins referred to this primary survey as the formative evaluation, and I’ve put a quote from him in here because I think the emphasis of this particular quote is very interesting and important; READ QUOTE interesting because the emphasis is very strongly on the use of the data as a ‘baseline’ which you look to change through intervention, and the effective use of the data directly in that intervention. In our preliminary desk research we found a large number of projects which fell under the heading ‘social norms’ but simply collected data which they didn’t then feedback and we debated over whether they are truly then a social norms project. And the other potential pitfall here is that as researchers you design a questionnnaire from the perspective of a researcher – a compared with b could show a statistical difference etc, the need here is to very clearly show a difference between perceived and actual at a level where (for us at least) an 11 year old can see the difference, and I think we would have benefited from a greater consideration of that at the design stage. So what did our questionnaire actually include, well as the title suggests we looked at alcohol consumption, drug usage and sexual relationships, and we recorded both descriptive and injunctive norms.
Having specified the process and developed the research tool, we then needed some participants…. Of the 6 schools who turned us down – 4 were Faith schools and some issues around asking young people about under-aged sexual activity, and one other was in special educational measures at the time. (Year 7/ Year 9 were surveyed as it is a 2 year project, so these two year groups will still be in school at the time of the end of project follow-up survey when we will assess the impact of the project. Also Social Norms has been shown to be most effective with younger age groups)
We didn’t actually ask whether the pupils had had sex or not, as some of the professionals felt there may be a child protection issue attached to hold that information, we again asked pupils to estimate the percentage’s and again the estimates appear to be well above that which national research suggests is actually occurring.
Can see that while actual usage is low, perceived usage is far greater, with the average estimate of the number of people in Year 7 using drugs being more than four times greater than the actual number – so this data conforms to the first of the social norms assumptions that Wes Perkins called ‘plural ignorance’ i.e. that young people think far more people partake in negative behaviours than actually do (misconception).
Although the illegal drug data fitted well with the Social Norms model, the alcohol data was slightly different because as you can see when we asked if pupils have ever had a drink of alcohol the over whelming majority had, and peer groups estimates were actually below the actual figures – wouldn’t make a great social norm message, you thought only two thirds of your peer group drink but you were wrong actually 84% do! So we had employ one of the more interesting aspects of the social norms approach for me as a researcher in which you are deliberately selective in your presentation of the positive data alone. In this case rather than using ‘ever’ drank alcohol, we had to use measures of ‘drinking socially’ in which again perceived behaviours were far greater than actual figures.
I flag this up in particular because ‘unexpected’ results and having to be deliberately selective has a particular impact on the forms of feedback you use – immediate forms of feedback such as voting handsets at the data collection with immediate graphs need to be used with great care, because if you get an unexpected result, you can inadvertently feedback inappropriate data
OK, so we’ve got our data and selected our positive social norms messages, the next key aspect is to feed this information back to the pupils who provided it in an eye-catching and engaging way and also in a way which makes it apparent that “it’s their information, it’s about them personally”. This was something we spend a lot of time trying to work out within the office, how do we make it obvious where the information came from/ that its true and how do we personalise the posters to each school without making it seem as though it’s the school telling them? Turns out the easiest way was just to ask the pupils!
We held short (30 minute) focus groups with pupils during school hours and we owe a lot of thanks to the pupils who attended because they came up with some fantastic ideas for the campaign
From the focus groups the ‘you said…’ branding was developed in addition to the strapline ‘it’s true coz you told us’. Primary form of marketing is posters displayed within the participating schools.
As you can see our contact details are on the bottom of each slide, if you would like a copy of our presentation slides you can just email me and I’ll send them to you direct. Or if you think of any additional questions later, please just email or drop us a line and we’d be happy to help.
(Sex) Drugs and Alcohol - Catherine Wilburn
(Sex,) Drugs and Alcohol:
Social Norms in Stockton Schools
Research Executive, NWA Social Research Ltd.
Background on Stockton…
North East of England, it is the largest Unitary Authority in the Tees
Population 191,500, Households 79,100 and 25,700 school age
Has a unique social and economic mix, with areas of disadvantage
placed alongside affluence.
Local Area Agreement - Reduce substance misuse among young
people; 2009 - 103 drug/53 alcohol referrals.
Reduce the number of conceptions in under 18 year olds;
Jan - Nov 2009 - 209 conceptions, 46% resulted in termination.
Why Social Norms…
Wanted a project which would delay/prevent the onset of risk taking
behaviours, without having a negative impact on anyone who may
already be engaging in risky behaviour.
Approach had to be evidence based, and developed from authentic
Wanted to adopt a health promotion approach which was different.
Become “experts” in Social Norms! Designing a workable research tool
Getting the schools to opt-in to the project/ Surveying the pupils
Designing a marketing campaign to feed the results back to the pupils
which they like/ feel a sense of ownership of
Constantly refreshing the intervention materials to keep the messages
Resurveying the full sample after 2 years to measure effectiveness
“Formative Evaluation - Aim is both to create a baseline measure of
behaviour/ attitude and to collect the ‘metadata’ needed to produce
effective ‘Social Norms’ messages from this baseline”
Descriptive norms (Current personal behaviour) and
Injunctive norms (Current personal attitudes towards behaviours)
Perceived behaviour of your peer group
Offered to all 14 main-steam secondary schools
in the Borough - taken up by 8
Total of 1603 pupils surveyed;
764 Year 7’s (11 to 12 years)
839 Year 9’s (13 to 14 years)
Held focus groups with pupils involved in the project
to get their input into;
The “brand” identity – the look, the colours, the name
How best to personalise the posters for each school
What forms the marketing should take
Preliminary feedback on the positive messages we had chosen
for their school
The ‘Social Norm’
Data on each poster
personalised for each
school using schools
slang name e.g. it’s
true coz’ Blakey told us
of 100% - 100 items,
those who agreed in
one colour, those who
didn’t in another
areas of the
sticks = ICT
in this case
Posters in School Pens
Social Norms is effective!
Value of the Social Norms approach beyond the intervention itself;
Large baseline dataset
Allows for wider planning of curriculum and resources
Findings can be used to support applications for ‘Healthy
However, there are hidden pitfalls which prospective projects should
be aware of…
Potential Pitfalls to avoid...
Focus always on the data collection as an integral part of an
Creating a baseline you can measurably change
Terming the measures so they are easily understood
Issue of ‘Faith’ schools
Asking inappropriate questions of young people..?
Potential Pitfalls to avoid...
Key in projecting the messages effectively
Avoiding ‘dangerous’ mechanisms with immediate results
Constant refreshment to maintain interest
Using a medium/design teenagers engage with
Choices between formats
Facebook vs Twitter
Stressballs and Cupcakes vs Highlighters
Likelihood of repeat usage/ impact on the school environment
How we can help you to take ‘Social Norms’