National Social Marketing Centre

Case Study Contents

Project overview

This project was part of the NSMC's learning demonstration sites scheme. While each of the ten learning demonstration sites considered all eight benchmark criteria, they should be viewed as pilot sites where new ways of working were tested, rather than as definitive examples of social marketing best practice.

This project, commissioned by Kirklees Council and NHS Kirklees with support and guidance from the National Social Marketing Centre (NSMC), aimed to halt the year-on-year rise in overweight and obesity among 16 to 24-year-olds attending further and higher education (FE and HE) institutions in Kirklees.

Scoping work was undertaken to understand students' lifestyles and their attitudes and behaviours around nutrition and physical activity. Among the insights gained was that students favoured interventions that didn't focus on health and were fun, social, quick and easy.

The project team therefore decided to use a ‘stealth not health' approach to promote healthier lifestyles. Working with an external marketing agency, the Up For It brand was developed, incorporating various initiatives that were delivered on FE and HE campuses, such as healthy cooking starter packs for first year students, health and wellbeing assessments, a dodgeball tournament, cooking events, and dance classes.

Budget: £100,000

Results overview:

• Physical exercise - The project helped to improve physical activity provision in a variety of non-traditional forms and venues. According to a post-implementation street survey of 372 FE and HE students, 21% of respondents said they now did more exercise than they did six months ago, while 61% said they did about the same amount of exercise. Findings from questionnaires and interviews completed with students after they attended the dance and dodgeball events suggested an increased interest in continuing with dance (particularly amongst females) and dodgeball (particularly amongst males).
• Healthy eating - 96% of respondents to the street survey indicated they ate at least one portion of fruit and/or vegetables in a typical day, but only 18% claimed to eat the recommended five plus portions a day. 23% of respondents reported they now ate more portions of fruit and vegetables a day than they did six months ago, but 67% reported no change in the amount they ate. Feedback on the cooking starter packs and events was positive, particularity from female respondents, who felt the initiatives had given them the confidence and skills to cook more of their own food.
• Health MOTs - 75 students attended for a health check. 68 of these students agreed to have their BMI checked - 10% were classified as overweight and 9% classified as obese. This offered an ideal opportunity to signpost our target audience to the interventions offered.
• Website and Facebook - The project was innovative in its use of social media and text messaging as a way of engaging and communicating with the target audience. Between September 2008 to June 2009, the website received approximately 9,500 hits. Between September 2008 and May 2009, 123 members joined the Up for It Facebook group.
• Yorkshire and the Humber Healthy University Network Awards 2008 - Runner Up, Partnership category
• NHS Communicating Health Awards 2009 - Finalist, Best Social Marketing Campaign category

Background and policy context

Obesity is responsible for more than 9,000 premature deaths each year in England. It is an important risk factor for a number of conditions and chronic diseases. Prevalence of obesity has trebled since the 1980s and well over half of all adults are overweight or obese. The prevalence of obesity in children under 11 years-old increased from 9.9% in 1995 to 13.7% in 2003. Obesity in both adults and children is more common among lower socio-economic groups.

In July 2004, the Government set a Public Service Agreement target to halt the year-on-year rise of obesity in children aged under 11, and is committed to reducing obesity in the population as a whole.

National trends in obesity are reflected in the Kirklees area. Between 2006 and 2010, prevalence of obesity is expected to increase from 27.6% to 31.5% in North Kirklees, 25.1% to 29% in South Kirklees and 25% to 29.8% in Central Kirklees. Early adulthood is a key stage at which many people gain significant amounts of weight. According to the 2007 Joint Strategic Needs Assessment, 33% of 18 to 24-year-olds in Kirklees are classified as overweight or obese, with a BMI of over 25.

The Kirklees Partnership, which consists of internal stakeholders from Kirklees Council and NHS Kirklees, identified obesity as a major health challenge and developed an Obesity Programme Plan to introduce a coordinated set of actions to tackle obesity. This plan focuses on enabling people who are already overweight or obese to lose weight. It also includes complementary plans to prevent obesity through improving diet and increasing levels of physical activity. The plan recognises that partners must invest in social marketing approaches to ensure that local interventions are consumer-centric and reflect the needs of the target groups.

Based on the worrying levels of obesity in 16 to 24-year-olds and the lack of anti-obesity initiatives targeted specifically at this age group, the Kirklees Partnership decided to use Communities for Health Funding to set up a project to tackle obesity in male and female 16 to 24-year-old students in further and higher education (FE and HE) institutions. The Kirklees Partnership also recognised that there was untapped potential in collaborating with the four local FE colleges and university to tackle obesity in young adults.

The opportunity to work with the NSMC evolved from a workshop held locally. The purpose of the workshop was to understand and share the insight that had been gathered to inform Change4Life, the national obesity prevention campaign.

Methods mix

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Customer Orientation

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Insight

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Behavioural goals

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Segmentation

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Exchange

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Competition

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Theory

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Partnerships

Up For It was a partnership project headed up by Kirklees Council and NHS Kirklees (Public Health Directorate), who have a strong history of collaboration.

Key partners included:

• Kirklees Council - Provided Communities for Health funding and were a key stakeholder in steering the project
• NHS Kirklees - Provided internal capacity in the form of a project manager and support from a newly appointed social marketing manager and obesity specialists
• Local FE/HE institutions, including lecturers, college principals and catering staff - Helped promote the interventions to students
• NSMC - Provided strategic social marketing expertise to support scoping, delivery and internal capability building
• Student Union representatives - Gained buy-in from students

To ensure learning, development and implementation are sustained beyond the project's end, NHS Kirklees has provided ongoing support to maintain relationships and coordinate work with other partner organisations involved in obesity initiatives. Brand guidelines have been established and use by partners will be monitored and reviewed. Partners are being encouraged to sign up to an Up for It manifesto. Final-year students from the university have been recruited to work on placement in the college, to engage and contribute to the ongoing delivery of interventions.

Evaluation and results

Enventure Research Ltd. was commissioned to evaluate the interventions. The specific evaluation objective was to understand the impact of the social marketing project on the target audience, particularly any relevant changes to behaviour.

The evaluation included a mix of qualitative and quantitative methods.

Qualitative methods

The qualitative elements were intended to provide in-depth understanding of motivations and behaviour in terms of lifestyle and weight management in the target audience.

Focus groups and depth interviews
Data was gathered using semi-structured group interviews and individual depth interviews. Participants were recruited through the events and activities delivered as part of the social marketing project. Sample size was determined by data saturation, the point at which no new themes are identified. The findings of the focus groups have not been quantified; instead descriptive words such as ‘most' and ‘few' have been used to describe the findings.

Quantitative methods

The quantitative research was designed to provide an indication of attendance at events, including demographics and motivation to attend, as well as overall healthy eating and exercise data, collected through a street survey.

Street survey 
A street survey of 372 students (186 from New College Huddersfield, Greenhead College and Kirklees College; 186 from University of Huddersfield) was conducted between 20 May to 5 June 2009. Interviewers were located in areas of high footflow on or near the university and college campuses. The data was analysed using descriptive statistics, percentages and means.

• Physical exercise - Based on the findings from the street survey, 76% said that they exercise at least one to two times a week. When asked to compare their current exercise habits with six months ago, 61% said that they were about the same. Encouragingly, 21% said that they now did more exercise. These figures are supported by the post-event and dance classes questionnaires
• Healthy eating - Based on the survey findings, 96% of respondents indicated that they ate at least one portion of fruit and vegetables in a typical day. 31% claimed to eat three portions a day and 18% claimed to eat the recommended five plus portions a day. However, when asked if their intake had increased within the last six months, most respondents reported they ate the same amount. Despite the lack of reported changes in eating habits recorded by the survey, feedback from the cooking events was positive, particularly from female respondents, who felt the events had given them the confidence and skills to cook more of their own food
• Brand recognition - Only 26% of survey respondents were aware of the Up For It brand, and of these, 46% didn't know what it was. 67% of all respondents were also unaware of any of the Up For It events, when a list of the events were read out to them. 89% of those who were aware of events said they had not participated in any of them.

Questionnaires at events and activities
After each of the events and activity sessions, participants were asked to complete a short questionnaire, which asked about their satisfaction with the event, how they became aware of it, if they would attend a similar event, and if they would use the new skills they learnt.

Freshers' Fayre

• Two focus groups were conducted with students who had received a cooking pack at the Freshers' Fayre
• All of the students in the focus groups recalled receiving the recipe bags of ingredients at the Freshers' Fayre
• Several respondents said they had made meals using the recipe cards and some had also devised their own meals using the ingredients
• Some students said they would have preferred to receive recipes for meals similar to the type of food they were used to at home, such as cottage pie, sausage and mash, stew and corned beef hash
• The majority of students said they had used all the utensils and ingredients in the pack, and many commented they had enjoyed being introduced to herbs and spices that they had never cooked with before

'Dance Your Ass Off' event

• 41 questionnaires (31 females and ten males) were completed after the event, and 5 in-depth telephone interviews were conducted with females at a later stage
• The concept of the ‘Dance Your Ass Off' event was received favourably by most of the female respondents. Male respondents commented that it was ‘an event for girls'
• A number of students reported that they usually went to the Camel Club (the night club where the event was held) on a Thursday night anyway, so they would be there regardless of whether an event was being held
• Respondents tended to have found out about the event through a friend (30%) or via Facebook (22%). However, just over 20% of respondents were unaware that an event was taking place and were at the venue for the club night. Respondents were most satisfied with the ‘cost of entry' for the event and least satisfied with 'pre-event publicity'
• Encouragingly, three in five respondents felt they were more interested in dance as a result of attending the event, and just over a third were interested in attending the dance classes run by the dancers at the event (the Sheffield University Dance Society Street Jazz Group)
• The most frequent reason given for not wishing to attend the classes was not having any interest in street dancing
• Disappointingly, despite the level of interest expressed in street dancing during the event, numbers at the subsequent dance classes were low, as many respondents who had attended the first event said they were unaware of further classes taking place

'Take on the Takeaway' event

• The concept of the 'Take on the Takeaway' event was favourably received by female respondents interviewed, compared to male respondents, who had never heard of the chef James Martin and were unaware of the 'Take on the Takeaway' television programme
• People who attended the 'Take on the Takeaway' event tended to have heard about it through a friend (38%) or because their catering lecturer had arranged for them to come (22%)
• Feedback from the event was positive, with the highest scores achieved for ‘encouraging me to try cooking new dishes'; the ‘amount of people here'; ‘raising awareness of healthy cooking'; and ‘encouraging me to cook instead of ordering a takeaway'
• In the telephone interviews, respondents said they were very impressed with James Martin's demonstrations at the event. Nearly all of these respondents said they would try the recipes themselves
• 100 information packs were handed out at the event and 13 entries submitted to the 'Come Dine With Me' challenge
• 55 recipe cards were downloaded from the Up for It website

Dodgeball tournament

• 25 students took part in the dodgeball event, all of whom completed a post-event questionnaire
• Having seen the film by the same title, male respondents were particularly enthusiastic about the idea of playing dodgeball
• Most respondents found out about the event at college, university, the Student Union, or via a friend
• The main reasons given for starting a team was that ‘friends were coming' or ‘wanted to do it' (76%) and the ‘opportunity to try something new' (52%)
• Respondents thought the event was best at ‘encouraging me to try new activities' and ‘promoting dodgeball as a good form of exercise'
• Seven in ten respondents said they would consider playing dodgeball again. The reasons given for not wishing to play again included ‘lack of facilities', ‘not enjoying the game' and the view that it was ‘too hard'

Health MOTs
Interviews with school nurses who carried out the health checks indicated that:

• 75 students attended for a health assessment
• 68 of these students voluntarily had their BMI recorded
• 10% of these were classified as overweight and 9% obese
• Students were surprised about the amount of sugar in fizzy drinks and the need to increase their water intake
• 1 student was motivated to seek help to lose weight
• School nurses felt that students would rather spend money on going out and having fun than opting for healthier food and increasing physical activity
• Nurses recommended that students get involved in family shopping to increase their awareness of healthy food

Up For It microsite online traffic
Approximately 9,500 hits between September 2008 to June 2009

• ‘Cook it' page - 2,326 (July 2009)
• ‘Move it' pages - 3,351 (July 2009)
• ‘Dodge it' page - 1,402 (July 2009)
• ‘Film it' page - 462 (July 2009)

Facebook group members
Between September 2008 and May 2009, the Up for It Facebook group had 123 members join (56% male and 44% female).

Lessons learned

• It’s important to win the hearts and minds of the internal team and to have the capacity to develop a sustainable approach
• It’s vital to have full stakeholder engagement and buy-in, and to give stakeholders the opportunity to help shape and develop the interventions
• Keep revisiting the insight with stakeholders and the target audience to help refine the interventions
• Be realistic about what can be achieved with the resources available – select the target group that is contemplating change
• Don’t underestimate the strength of internal competition and social norms. Many students adopt unhealthy behaviours because they’re seen as part of a stereotypical student lifestyle and a right of passage
• Communicating with this target audience can be complex. They are sophisticated and there is intense competition for their attention

Phase 2

Building on social marketing skills and knowledge gained by the project team and drawing on the evaluation findings from the initial phase of Up For It, improvements have been made to the project in a second phase, which is ongoing and outside of the NSMC's learning demonstration sites scheme. Some of the changes include:

•  To strengthen the marketing and engagement strategy, an Up For It brand identity guidance document has been developed and shared with key partners. The aim of this document is to increase the use of the brand and improve brand recognition, which will hopefully improve the uptake of the dance sessions and other initiatives. To further support student engagement, taster sessions are being held in halls of residence to make access to the dance classes easier for students, and student representatives have been recruited to gain ownership and buy-in from the target group.
• To support the cooking initiatives, a local chef has been commissioned to deliver practical cooking demonstrations, using recipes based on what students are used to eating at home.
• We have formed a strong partnership with the management team of the student accommodation association, who now have overall responsibility for promoting the 'Come dine with me' challenge to students in halls of residence, thereby creating sustainability for this initiative. The management team are also marketing the Up For It brand via their internal Facebook group.