Up for It
The UpforIt project was funded by the Kirklees Partnership, which consists of internal stakeholders from Kirklees Council and NHS Kirklees. Using Communities for Health funding, the Partnership established a project in collaboration with The NSMC to halt the year-on-year rise in overweight and obesity levels among 16- to 24-year-olds attending further and higher education (FE and HE) institutions across Kirklees.
Using a ‘stealth not health’ approach, the project delivered various initiatives at local FE and HE institutions that focused on improving healthy eating, cooking skills and physical activity in a fun and social way, without preaching about health. These included providing food starter packs, organising high-profile events to promote new activities such as dance classes and dodgeball societies, and using social media to engage students around interactive competitions. The UpforIt brand was created, which focused on meeting new friends, having fun and learning new skills, rather than getting healthy or losing weight.
Evaluation results showed some (although limited) behaviour change amongst the target audience. Nevertheless, feedback from students and stakeholders has been used to inform an ongoing second phase of the project, where several of the activities have been improved and are now being sustained by the educational institutions.
The Kirklees Partnership identified obesity as a major health challenge and developed an Obesity Programme Plan to introduce a coordinated set of actions to tackle obesity. As part of this plan, which focuses on enabling people who are overweight or obese to achieve and maintain a healthy weight, the Partnership decided to invest in a social marketing project aimed at one of the identified priority groups to ensure that local interventions reflect the needs of the target audience.
Early adulthood is a key stage at which many people gain significant amounts of weight. According to the 2007 Joint Strategic Needs Assessment, 33 per cent of 18- to 24-year-olds in Kirklees are classified as overweight or obese, with a Body Mass Index (BMI) of over 25. Nevertheless, this age group is largely ignored by anti-obesity initiatives, which tend to focus on children.
Recognising this gap and the untapped potential to collaborate with the three local FE colleges and University to tackle obesity, the Partnership decided to use £100,000 of Communities for Health funding to establish a two-year project to halt the year-on-year rise in overweight and obesity levels among 16- to 24-year-old students attending FE and HE institutions across Kirklees. With over 30,000 students within this age group in Kirklees and around 33 per cent classified as overweight or obese, there were potentially 9,500 students targeted by this the project.
Following a Change4Life workshop attended by The NSMC in 2007, the project was selected as one of ten social marketing Learning Demonstration Sites, receiving support and guidance from a dedicated NSMC Associate with social marketing expertise.
A steering group was formed from members within the Partnership who were able to drive the project forward. A strategic lead from Kirklees Council was identified to raise the profile of the project within the NHS and Council. A Project Manager from NHS Kirklees took responsibility for overseeing the project and reporting on progress. The Obesity Programme Manager provided technical advice and knowledge from the evidence base. Since there was initially no one within NHS Kirklees with social marketing experience, The NSMC Associate provided social marketing expertise and support to the project. At a later date, a Kirklees Social Marketing Portfolio Manager was appointed and brought into the project steering group. In hindsight, representatives from the FE and HE institutions would have been a valuable addition to the group.
A stakeholder mapping exercise (using the power/interest matrix) was completed at the start of the project to identify and engage with influential and interested individuals and organisations early on. Meetings were held with each of the educational institutions, followed by stakeholder workshops and ongoing one-to-one meetings.
To achieve the project’s aim, the steering group anticipated the interventions would focus on engaging students to become more physically active, reduce their alcohol intake, become more aware of their calorie intake from food, and develop their cooking skills.
The scoping stage began with a freelance researcher undertaking a desk review to learn more about the target audience, their barriers to healthy living, and previous and ongoing interventions used to tackle obesity. Information sources included the regional profile developed by the Yorkshire and Humber Public Health Observatory, the Kirklees Joint Strategic Needs Assessment and research from Dundee University. The review revealed how little information there was locally, nationally and internationally around FE and HE student obesity.
A market research company was commissioned in spring 2008 to conduct four focus groups with FE and HE students with a BMI of 25 or over. The aims were to better understand the student lifestyle, what the target audience thought about their weight and what might motivate them to change their lifestyle. The company also conducted telephone interviews with ten NHS Kirklees stakeholders to gather tacit knowledge of what might motivate students to adopt healthy behaviours, what challenges the project team may face, and what factors would be necessary for success.
The key findings from the research were that:
- Target audience members did see the benefits of a healthy lifestyle and appreciated that their current lifestyles needed to change, but they lacked the motivation to do so
- A lack of cooking skills, tight budgets and the perception that healthy food and gym memberships are too expensive also deterred students from eating healthily and exercising more
- Several factors competed for students’ time, attention and inclination to change, including hectic study and social calendars, laziness, a strong takeaway and drinking culture, unhealthy options in the canteen, television and the internet
- Most of the target audience wouldn’t engage in ‘health-related’ activities directly linked with the NHS, which were seen as being aimed at old people or obese children
- Lack of confidence was a particular issue for female target audience members. For males, weight was not seen as a key priority at this point in their lives and they tended to either deny or accept their weight gain
A key insight was that the target audience wanted a variety of fun, social activities that were not delivered by the NHS, were not patronising and wouldn’t label them as ‘fat’ or ‘obese’. The steering group therefore avoided further segmenting this group and targeting interventions in a way that would single out those who were overweight or obese. Drinking was seen as a ‘rite of passage’, so any overt attempts to reduce alcohol consumption would be off-putting. The team therefore focused on education around the calorie content of alcohol.
The key behavioural goals developed to support the project’s aim of tackling student obesity in Kirklees therefore avoided paternalistic messaging and focused on encouraging students to increase their physical activity and cook healthier meals from scratch.
Findings from the primary research were fed back to key stakeholders in a creative development session. Stakeholders included staff from the Council and PCT, local FE and HE establishments, Student Union representatives, sports and fitness managers, and the Yorkshire and Humber Healthy University Network. The group carried out a behavioural analysis to identify what incentives might be attractive to the target audience, what barriers might exist to changing their behaviour, and what issues would directly compete with the desired behaviours and influence the outcomes. Mood boards were also created to help explore different segments of the target audience, what might motivate them to change, and potential propositions.
Each stakeholder brought a wealth of knowledge and experience to the project, although working with a large stakeholder group proved to be challenging at times. The steering group created a supportive environment to ensure stakeholders felt valued, and supported organisations to partner with each other to work more effectively in implementing the interventions.
As the research suggested that students would engage with activities that revolved around having fun and socialising with others, rather than directly improving their health, the steering group decided to take a ‘stealth not health’ approach. This meant promoting exercise and healthy eating in an engaging, appealing and motivating way, which fit with students’ lifestyles and highlighted the advantages to them (such as quick, easy and cheap food and the chance to meet new friends), without preaching about health.
“It is an age group that is so often turned off by government bodies and the NHS. It does not want to be lectured to and so we had to encourage healthier lifestyles without mentioning health – that is not easy. We knew we had to do it in a non-traditional way.” Lynne Cliffe (Project Manager)
To maintain engagement with key stakeholders and to help develop and refine the marketing mix, a solutions group was formed with those who had most influence and interest from the wider stakeholder group.
A number of potential intervention options were tested with the target audience in summer 2008. This was done by a market research company using four focus groups – one male and one female HE group, and one male and one female FE group. All participants had a BMI of 25 and over.
The most attractive propositions included dancing and non-traditional sports activities that don’t require any skill, wellbeing MOTs (assessment), and quick recipes using store cupboard ingredients and linked with delivery of fruit and vegetable boxes. Activities associated with drinking, such as pool competitions in the Student Union bar, were rejected when it was proposed they could be done without alcohol. Interventions that provided distinct alternatives to activities that usually involve drinking were therefore recommended. Students also mentioned the value of receiving “tangible and free stuff”.
Based on this feedback, behavioural goals were refined to:
- Students will increase their levels of physical activity by attending dance classes and joining dodgeball societies
- Students will learn how to cook from scratch and make healthy food choices
- Students will increase their knowledge of healthier lifestyles as a result of attending health MOT sessions offered within the college setting
- Students will increase their awareness of the calorific content of alcoholic drinks and takeaways
Working with a PR agency, the project team developed the following interventions:
Food starter packs
Research suggested that the most appropriate time to establish healthy behaviours was at the beginning of students’ degrees. Trying to influence established lifestyle behaviours of second and third year students would have limited impact.
To launch the campaign and support students in cooking meals from scratch, free starter packs would be distributed at the University Freshers’ Week. These would be eco-friendly shopping bags containing cooking ingredients, utensils, recipe cards and storage boxes. In exchange, students would be asked for their contact details, age, gender and (optional) weight and height. This would generate a customer database from which to target and tailor promotion and activities to at-risk groups.
Viral video competition
Capitalising on the popularity of reality television and YouTube, a viral video competition was designed to create brand awareness and engage the target audience. Students would be asked to create a short entertaining film that gets students to cook creatively or be more active.
‘Dance Your Ass Off’
According to research with students, going out, having fun and partying are important activities, with dancing popular among both males and females. A high-profile event was planned to introduce the brand UpforIt, encourage HE students to dance more as a fun form of exercise and to launch a series of dance classes. DJ Chris Lake would be invited to headline the event and create a buzz amongst the student population. A local dance group would be invited to showcase their talents, run a dance class and encourage students to enrol for future dance classes.
Health and wellbeing MOTs
FE students involved in the primary research indicated that they would welcome an informal, holistic health MOT in a non-medical environment. This intervention would be promoted as an opportunity for students to discuss any issues of concern with the nurses, without any overt references to weight or obesity. The nurses would signpost students to the UpforIt website and communication materials, as well as mainstream health services.
Dodgeball societies and tournament
The objective of this intervention was to create a new dodgeball movement amongst students in Kirklees and appeal to those who were reluctant to take part in more conventional and organised sports. Students would be encouraged to create a dodgeball team and enter a dodgeball tournament. Those who registered their teams on the UpforIt website would receive a free starter pack containing rule sheets, team instructions and dodgeballs.
‘Take on the Takeaway’ and ‘Come Dine with Me’
Based on the popular television shows Take on the Takeawayand Come Dine with Me, the aim of this intervention was to encourage students to get in the kitchen and enjoy cooking healthy dishes. The intervention was developed to correct myths that healthy cooking is time consuming, expensive and not tasty.
The first part of the intervention would involve hosting an interactive Take on the Takeawayevent with a Yorkshire celebrity chef to demonstrate how you can cook a quick and tasty meal from scratch at a lower price and in less time than it takes a takeaway to be delivered. Recipe cards would also be made available at the event and on the UpforIt website.
At the event students would get the opportunity to sign up for the Come Dine with Me initiative, where they would be encouraged to host dinner parties for their peers and post their cooking experiences on Facebook.
Brand development and promotion
The PR agency created the ‘UpforIt’brand, with a set of associated sub-brands (such as ‘Cook It’ and ‘Film It’), which was distinct from the NHS and positioned as an exciting new campaign that promised to bring fun, entertainment, sports and food to the students of Kirklees.
These activities would be promoted as opportunities to meet new friends, have fun, learn new skills and receive freebies. Since students are driven by incentives and rewards (and online fame), prizes would be awarded to the best viral video and best dinner party host, and students who took up a health MOT would be entered in a prize draw for a Nintendo Wii Fit. To reduce any barriers, interventions were offered at no/low cost and at convenient times and locations. Drawing on the success of the ‘Truth’ anti-smoking campaign in the USA, UpforIt hoped to create a social movement amongst students towards healthier behaviours, which would eventually become the norm.
A SWOT analysis identified online channels and institutional IT networks as an opportunity to reach large numbers of students. The PR agency created a website to promote UpforIt , with sub-pages containing information on each of the interventions. A Facebook page was also created to provide an interactive platform for students to engage with the campaign.
UpforIt was run across four institutions – Huddersfield New College, Greenhead College, Kirklees College and Huddersfield University – during the 2008/09 academic year. It was launched during Freshers’ Week with more than 2,000 healthy cooking starter packs handed out by members of the project team and PR agency.
Ahead of the activities delivered throughout the academic year, students were texted details of when, where and what was happening. Desktop messaging on college and university computers was also used to promote activities, as well as provide healthy lifestyle tips. Students were signposted to the UpforIt website, which received more than 9,000 hits a year, and the Facebook page, which attracted over 120 fans in the first year.
A risks/issues log and project plan was developed, which identified leads for each of the interventions. The Project Manager, who was accountable to the steering group, had overall responsibility for monitoring and coordinating the interventions during implementation, while commissioned providers delivered specific interventions.
A range of dance classes were promoted to FE students, including salsa, street dance and bhangra. The Council’s Physical Activity Development Team ran street dance classes in a local nightclub for HE students. These were promoted at the Dance Your Ass Off event, which was organised by the PR agency and held in February 2009 at the Camel Club in Huddersfield. Tickets cost £3, but 20 pairs of free tickets were offered to UpforIt Facebook fans. Over 300 University students attended the event. Unfortunately the dance classes promoted at the event were eventually dropped due to logistical problems (such as the venue not being opened in time for the start of the classes), which led to low attendance in the subsequent weeks.
During the second term, the project team visited the colleges and University to encourage students to set up dodgeball societies. A dodgeball tournament was held in June 2009, which attracted one team from each of the four institutions.
As part of a lifestyle week held for students at New College in February 2009, 75 students took part in a free health MOT. The lifestyle week was also used to promote the UpforIt brand and other activities.
In May 2009, the PR agency organised a Take on the Takeaway event at Huddersfield University Union, where 300 students gathered to watch celebrity TV chef James Martin cook up a healthy version of a takeaway dish quicker than it could be delivered. The event was used as a high-profile launch for the Come Dine with Meinitiative. Celebrity endorsement (from James Martin) helped to generate a lot of media coverage for the events and the project, including features in the Huddersfield Examiner and local television.
Due to a range of factors, plans to run a market stall on the University campus to provide affordable and accessible fruit and vegetables fell through. Local market traders were approached about the idea and were very supportive. However, changes in the economic climate and logistical problems prevented them from becoming involved. In addition, internal barriers were encountered within the University, which prevented the intervention from going ahead.
A research company was commissioned to evaluate the interventions, using a mix of qualitative and quantitative methods. Focus groups and follow-up phone interviews with students who attended the events and activities provided in-depth understanding of the target audience’s motivations and behaviour in terms of lifestyle and weight management. A street survey conducted with 372 students on FE and HE campuses in June 2009 provided overall healthy eating and exercise data. Since baselines weren’t gathered earlier in the project, the survey asked respondents to compare the amount of exercise done and fruit and vegetables eaten to six months ago. Questionnaires collected after events and activities provided an indication of who attended and their thoughts.
Feedback from the focus groups suggested that the food starter packs were a success, with the majority of students saying they had used the recipe cards and utensils or devised their own meals with the ingredients. Some students said they would have preferred to receive recipes for more ‘traditional’ meals, like the ones their mothers made at home. These included sausage and mash, stew and corned beef hash. These ideas were taken on board and added as recipes on the website.
In terms of improving students’ diets, particularly increasing consumption of fruit and vegetables, 96 per cent of the respondents to the street survey indicated that they ate at least one portion of fruit or vegetables in a typical day. However, only 18 per cent claimed to eat the recommended five plus portions a day, indicating there was still work to be done to improve students’ diets. Encouragingly, 23 per cent of respondents reported that they ate more portions of fruit and vegetables a day than they did six months ago, but 67 per cent reported no change in the amount they ate. Feedback on 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.
According to the street survey, 21 per cent of respondents said they did more exercise than they did six months ago, while 61 per cent said they did about the same amount. The Dance Your Ass Off event was favourably received by most of the female participants in the focus groups, while male respondents were particularly enthusiastic about the dodgeball tournament.
While feedback from those who attended the events was largely positive, it is impossible to say at this stage whether the interventions will have brought about a sustained behaviour change. However, one in four students taking part in the street survey recognised the UpforIt brand. This was encouraging given the extreme competition from big brands for this target audience. Participation rates for some of the activities were disappointing; only one entry was received for the viral video competition. A potential reason for this low take-up may have included the effort required to produce a video and the focus on healthy cooking and physical activity. Thirteen entries were received for the Come Dine with Mecompetition; however each dinner party has an average of four people taking part, showing the potential reach of this type of intervention. Feedback from students suggested that stronger promotion of the brand and what it stands for and pre-event publicity was needed. One recommendation was to produce a calendar of events and distribute them to students at the start of the academic year.
On the other hand participation rates for the health MOTs exceeded expectations. Of the 75 students who took up a health MOT, 19 per cent were from the target audience, suggesting that this can be a successful way of engaging overweight and obese students to provide support and advice. A number of these students also engaged with the dance classes and expressed an interest in the dodgeball tournament.
Insights gained from this project are being used to inform development of commissioning specifications for future services across all obesity activity in Kirklees. NHS Kirklees has redesigned its weight management provision and is implementing a primary care weight management service that is consumer-driven.
Building on the social marketing skills and knowledge gained and the evaluation findings from the initial phase of UpforIt, improvements were made in a follow-up phase that ran from September to June 2010. This phase focused on developing sustainable, evidence-based interventions that became embedded in FE and HE settings and were self-funded. Initiatives included:
- Recruiting student ambassadors to gather ongoing feedback, create ownership and build credibility amongst peers, as well as to encourage the target audience to engage with activities
- Holding dance taster sessions at University halls of residence in the two weeks prior to Freshers’ Week, to improve access and reduce competition. Seventeen students attended the taster sessions and five students attended regular classes throughout the term. However, the classes proved to be an unsustainable business model in the long term, so students were signposted to alternative provision
- Commissioning a local chef to deliver practical cooking demonstrations, using recipes based on what students are used to eating at home. A total of 16 students attended the taster sessions delivered in the 2 weeks prior to Freshers’ Week and 3 further cooking classes. The level of uptake made the classes unsustainable beyond the initial run at the start of term
- Greater signposting to external providers of dance classes and alignment with Dance4Life and Eatwell4Life
- Offering further health MOTs, which saw an increase in the number of appointments taken (87) compared to the previous year (75)
Although the project is now complete, the partnership work is so well embedded that many of the activities are being taken on by the colleges and University as part of their routine programmes. Dance has been incorporated into the curriculum at some of the institutions and the Come Dine with Me initiative is being managed within University halls of residence by accommodation provider DIGS. The University and New College continue to work together to recruit final-year University students to work on placement at the College to engage with students and deliver the interventions. The health MOTs have become embedded within the college and will now be offered annually.
Staff from the council and NHS Kirklees continue to support the activities where they can and the Project Manager is still available to support the project. Branding guidelines have been developed and shared with key partners to increase use of the brand and improve brand recognition, which will hopefully improve uptake of activities.
Findings are being shared with related public health programmes, such as food, physical activity and alcohol, to help inform future commissioning of services. Results will be disseminated to all stakeholders and a range of professionals to encourage wider ownership of obesity initiatives. The project has been written up in a full report and as a case study on The NSMC and Local Government Improvement and Development (formerly the IDeA) websites.
“This project allowed us to utilise previously untapped partnerships within HE and FE organisations to address the challenge of obesity. The insight continues to inform planning and commissioning decisions within the Obesity Programme and has been shared locally, regionally and nationally to enable other areas to meet the needs of this target audience when commissioning services”. Liz Messenger (Obesity Programme Manager)
Targeting students for behaviour change can be complex as there is intense competition for their attention. It is crucial not to underestimate the strength of competition and social norms, as many students adopt unhealthy behaviours that they believe are part of a stereotypical student lifestyle.
On reflection the target audience was too large and the project aim too ambitious to achieve with the resources available. It would have been more realistic to focus on one institution or education sector (either FE or HE), or a segment that was most ready to change, such as females, and setting short-term measurable targets.
Implementing within an academic timeframe, where access to students is limited to September to April, and working with educational institutions, which often have complex structures and processes, can be challenging and time-consuming. To help minimise delays and barriers to the project, stakeholders who have influence at the right level and across the organisation should be involved and clear planning done in advance.
Addressing other environmental factors, such as the high concentration of bars, clubs and fast food outlets, could prove very fruitful in the long term for tackling student obesity. Greater efforts could be made with Kirklees Council to explore more strict criteria for planning approvals within the town centre.
The project was innovative in its use of social media and text messaging as a way of engaging and communicating with the target audience. Social media plays a big part in students’ lives and proved to be most successful in spreading the word about the campaign.
“Being a learning demonstration site enabled us to introduce the social marketing approach to not only NHS Kirklees, but wider partners. The project team developed their knowledge and skills and are now working with other programmes undertaking social marketing projects in a mentoring capacity. The insight, pre-testing and evaluation reports have contributed significantly to our evidence base on this target population.” Claire Troughton (Social Marketing Programme Manager)