School of Nursing, Midwifery and Social Work

Angela TodCatherine HomerAmanda Stocks

Creative Research Dissemination for

Maximum Impact on Policy and Practice

Who we are

• Angela

• Catherine

• Amanda

Overview of workshop

• Introductions• KWILLT project

– Why?– What?– Impacts?

• Putting it into action!

Cold Related Harm…why is it an issue?

• Approx. 27,000 excess winter deaths each year

• The illness caused or exacerbated by cold

• Misery and suffering

Who is vulnerable to the negative health impacts

of cold homes?people with existing health conditions such as:

• cardiovascular conditions • respiratory conditions (in particular, chronic

obstructive pulmonary disease and childhood asthma)

• mental health conditions • disabilities older people (65 and older)

https://www.nice.org.uk/guidance/ng6/resources/excess-winter-deaths-and-morbidity-and-the-health-risks-associated-with-cold-homes-51043484869

Households and other people can be at risk

too…• People or families on a low income.• Households with young children

(from new-born to school age) • Pregnant women

The impact of Winter on Health and Wellbeing

Direct effects• Heart attacks• Stroke• Respiratory

illness• Flu• Falls• Hypothermia

Indirect effects• Depression• Stress and

anxiety• Risk of Carbon

monoxide poisoning

What is KWILLT?Keeping Warm In Later Life

projecT NIHR Research for Patient Benefit

ProgrammeThe drivers were…

• Health impact of cold• High levels of fuel poverty• Costs to the NHS• Low uptake of energy efficiency interventions• Cold Weather Plan• DH Public health Outcomes Framework

(EWD/FP)

Keeping Warm In Later Life projecT

Aim: To understand the influences and decisions of vulnerable older people in relation to keeping warm in winter.

MethodologyQualitative methods• 50 older people (aged 55-95), face to face in depth

interviews,• Temperature/humidity measurements• 25 health and social care staff, face to face in depth

interviews• Six focus groups with older people and

frontline/strategic staff (n=42)• Consultation event• Framework analysis• Thematic framework

Apply Social Marketing Principles

Using research findings – develop ‘insight’

Break down the target audience into the different types of people – ‘a segmentation model’

• What are the drivers to their behaviour• What are their thoughts, fears, perceptions• What are their barriers to change

Turning insight into action…• Develop propositions or interventions

for each segment• Considering incentives and barriers

(Competition/exchange) for each segment

• Develop the marketing mix i.e. “mix” of different interventions that will change behaviour

• Develop the tools and resources

KWILLT Findings: Themes Situation or context

factorsAttitudinal drivers of behaviour Barriers to positive behaviour

Money

Age

Social connections

Housing type and tenure

Health

Making ends meeto Competing prioritieso Prideo Struggling

I can manageo Thrifto Hardiness and Stoicism

Its my businesso Mistrusto Pride and Privacy

I'm frightenedo Personal safety/vulnerability

I'll stay as I amo Like routineo Fear and mis-trust

Awarenesso Knowledgeo Informationo Experience

Technologyo Heatingo Informationo Banking

Disjointed systemso Fragmentation or serviceso Local differenceso Lack of referral systems

Visibilityo Fuelo Moneyo Information

KWILLT Findings: the segmentation model

Segmentation group DescriptionIsolated and not wanting to

cause a botherLow income and fuel poor, over 55, socially isolated and frightened, lacks information and understanding about keeping warm, private rented housing, long term mental health problems (depressions/anxiety)

Getting by cautiously Low income household and fuel poor, over 65, some social connections but not well informed about keeping warm, privately owned house, live with a partner with chronic health problems

Dependent and poorly informed Low income household and fuel poor, over 55, limited social connections with strong cultural ties, poorly informed about keeping warm, privately owned housing, poor health and mobility and very dependent on close family.

Just about managing Can pay for home heating but values thrift , over 70, some social connections but is private and trusts few people so is poorly informed about keeping warm, social housing, physical health problems and sensory impairment

Lonely and out of touch Financially secure but lives in a cold home, over 70, widowed, and socially isolated, poorly informed about keeping warm, privately owned house, physically well but bereaved.

Proud and wants to be self-sufficient

Low income but not fuel poor, over 70, regular but superficial social connections, poorly informed but values stoicism and hardiness and think they don’t need any help, social housing, good health, minor ailments.

The Pen Portraits – bringing the findings to life!

Lonely, Pearle

Proud, Fred

Dependent, Meena

Getting by, Bob and Joan

Just about managing, Enid

Isolated, Pat

http://kwillt.org/index.php/pen-portraits

Ben and Joan• Mid 60s,Low income, now

retired• Ben has chronic ill health• Joan is his carer

• Children nearby but Ben and Joan don’t like to be a bother

• Some social contact• Live in an old mid-terrace

(Right to buy)• Central heating system old,

not serviced and use supplementary heating

• Pay for fuel by direct debit but don’t understand how they work

What drives their behaviour?• Thrift• Pride and being debt

adverse• Fear of disruption in

the home• Mistrust of

organisations like energy companies banks

• Fear of technology

“Oh yes, because I was trained to be frugal, it was part of my upbringing. You didn’t have a lot so you were careful with what you did have. And with the costs rising now, I’m certainly not extravagant with the heating, I’m very wary”

(Older person participant in KWILLT)

” We changed from 'Company A' to go to 'Company B', and it was a nightmare, and I spent hours on the phone trying to get money back that they owed me. And you inform them and they say oh you can ring this number and you can get help. They did nothing! They said they would but they did nothing! I had to do it all myself and I bet that went on for over six months and I said well if that’s changing I’m never going to change again. It was a nightmare”.

(Older person participant in KWILLT)

Experiences, and those of friends, shape perception and beliefs.

This can be compounded and shaped by external influences such as media.

This can make the desire or willingness to adopt positive behaviour change a challenge

“I keep tabs on all my bills and all my doings. You’ve got

to have a programme, you know what I mean. You’ve got to be a budget, know what’s coming on… I’ve

managed to pay my bills, but I do have really expensive

bills”.

(Older person participant in KWILLT)

“I can put that heater on and that’s plenty for me in the daytime, I don’t want anything else, and therefore it can’t be as expensive as heating the whole house”.

(Older person participant in (KWILLT)

Ben and Joan are thrifty, proud and fear being in debt. They want to be in control of their life but would be reluctant to ask for help. They will cut down on other things to afford fuel

They often think it’s not worth putting the central heating system on; it doesn’t work properly it will take a while to warm up. The electric fire gets warm quicker.

A day in the life of Ben and Joan• They wake up in a cold bedroom in

a cold house. • They get up and make a cup of tea which

they drink whilst making breakfast. • They use the cooker to heat the kitchen

whilst they make breakfast. • They sit in the living room to eat their

breakfast with the electric heater on• They don’t heat the whole house;

especially the bedroom as they were brought up to believe that hot bedrooms are bad for you

• They often use the electric fir…it’s not worth putting the heating on.

• Complex Picture• Behaviour is often not logical - People

don't always do what you think they will do

• Findings challenge assumptions: policy and practice

• Need to think of strategies and solutions:• Partnership working• Networking• Recognising, identifying people at risk• Assessing and referring people in need• Neighbourhoods and communities• Government: (Department of Health (2011)

Reflections

Assumptions• People aren’t cold these days• Its only the really old who are effected• Only people who are fuel poor are cold• Other people are tackling the problems• Family will help• People know that there are health impacts of

being cold• People are aware of what healthy room

temperatures are

Assumptions cont…• People know how to use technology – heating

and banking• Vulnerable people read and act on information

from organisations such as energy companies, banks and Government bodies

• People will access interventions to help e.g. Social fuel tariffs and affordable warmth interventions e.g. Green Deal

• Vulnerable people will engage with processes to obtain help

• Interventions don’t have adverse consequences

Dissemination• Pen portraits• Policy: NICE Guidance, Cold

Weather Plan, Health and Wellbeing Board Plans etc.

• E-learning• Communication tools: Winter

warmth England• Chap books

Health and policy background

• Cold Weather Plan: Public Health England

• Fuel poverty: Hills review and Marmot Review

• NICE Guidance on excess winter deaths and illness

Dissemination Links• Winter Warmth England:

http://www.winterwarmthengland.co.uk/

• KWILLT e-learning materials: http://teaching.shu.ac.uk/hwb/AHP_resources/kwillt_resource/index.htm

• WWF pen portraits and trade off model:• http://www.shu.ac.uk/research/hsc/sites/shu.ac.uk/files/4567_1415RMBC%20BR%20About.pdf

• Book of Damp

Other spin-offs• Warm Well Families• Abacus• Foundations Warm Homes Service

evaluation• Condensation research• Learning disabilities• ESRC academic seminar series

Group work• Think about your research• Think who you want to

influence – who is your audience?

• How can you reach them?• This could be, creative or novel

dissemination approaches for each audience.