Staff drinking causes problems for two-thirds of employers and more than 77% see alcohol as a major threat to employee wellbeing. Despite this, the Chartered Institute of Personnel found that over 40% employers don’t have alcohol policies and most (84%) don’t run health awareness programmes for their staff. While the direct cost to business of this is significant, the indirect consequences may be even greater.
Increasing numbers of employers have alcohol policies to make sure employees are sober during working hours and to identify workers with a drink problem. But employers’ efforts to put measures in place to actually change behaviour and attitudes are limited. They usually revolve around raising awareness and education programmes or ‘catch and cure’ discipline processes. Few measures, if any, are proven to address attitudes and behaviour in a way that makes employees change for the long term.
Credible Evidence
There are many theories around how to change behaviour. Many focus on influencing individuals’ behaviour.
How to influence groups is less well researched. However, evidence is growing and there are more and more examples of group behaviour change programmes, along with proof of their effectiveness.
A combination of core theories informs BreathScan’s approach in the UK:
- Becker’s Health Belief Model (1974)
- Ajzen and Fishbein’s Theory of Reasoned Action (1975)
- Ajzen and Fishbein’s Theory of Planned Behaviour (1986)
- Prochaska and DiClemente’s Trans-theoretical Stages of Change Model (1986, 1992)
- Triandis’ Theory of Interpersonal Behaviour (1977)
Ajzen’s model uses three variables to demonstrate the direct influence they have on intention to behave. It reflects how our attitudes are shaped by what we perceive as ‘normal’ and how this can different from the ‘actual’.
It also provides a guide as to how our intention can influence our behaviour.
This is a useful summary of the process someone goes through when they adopt a new form of behaviour. It is important to note, however, that human behaviour rarely follows an exact pattern. People may go through all the stages of the process but some will skip some stages, relapse and rejoin at a different point in the sequence. A supportive or enabling environment is critical to success in the trans- theoretical model
Social Marketing
Social marketing (the systemic application of marketing to achieve positive behaviour change) is one of the Department of Health’s key tools for tackling public health issues. The BreathScan programme is not a social marketing project in itself. But it does use some social marketing conventions and principles. In particular, we believe likelihood of success increases substantially when a project is based on actual insight and substantial detail about the behaviour of the target group.
Social Norms
There is growing literature to suggest that social norms influence peoples’ individual social comparisons (how they assess their behaviour against others around them) and this in turn influences how they actually behave. There is a strong pull to comply with the perceived social norm within any group (this may be particularly strong in new friendship groups).
People’s perception and beliefs about the quantity and frequency of others’ drinking will influence the amount of alcohol they consume.
The social norms approach aims to correct misperceptions many people have about how others behave around alcohol. The goal of a social norms campaign is to promote healthy behaviours that correspond to peers’ actual behaviour.
Initial research suggests that while a social norms approach can have some success alone, multi-faceted approaches (social norms plus another intervention) are more successful in changing attitudes and behaviours.
The social norms of drinking at university are an area of great interest. Research shows that students normally overestimate how much their peers drink (Perkins, 2007). Research also shows that people who misperceive what others drink tend to consume a lot of alcohol themselves (Perkins, 2007). US studies consistently reveal that students overestimate how much others drink and how much they approve of drinking, which makes excessive drinking seem common and acceptable (Borsary and Carey, 2001).
Social norms are formed as a result of many influences that interact and can change over time.
The Evidence To Date
The evidence of how effective social normative interventions are is mixed.
Much of the research to date has taken place in schools and colleges. Due to their closed environments, it’s easier to monitor behaviour and collect results. There is scope to extend research into other closed environments such as the military.
There is consensus that students misperceive drinking norms. However, simply correcting these misperceptions won’t necessarily result in positive changes in drinking behaviour.
Currently, however, there is only one published web-based social normative intervention with UK participants. Unfortunately this does not provide a strong evidence base because of low rates or participation. Further studies are ongoing though, and literature will increase over coming years.
People working in the higher education sector recognise that student drinking is a problem, but universities don’t have alcohol–specific policies for students. Instead, cultural norms dictate attitudes to alcohol consumption across the university, including at senior management level. Reducing alcohol misuse needs a university commitment to deliver interventions and combat mixed messages. This would clearly translate to other industries and organisations of similar nature.
The World Health Organisation (WHO) Health Evidence Network report on alcohol control suggests that effective prevention requires action on prices and regulation of supply. As part of a comprehensive approach, health promotion and social marketing programmes can create the context in which such controls can be legitimised, rather than just trying to compete against the alcohol industry’s huge marketing budgets and know how.
Evaluating Behaviour Change Approaches
One of the most significant challenges for behaviour change programmes is how to assess their effectiveness over a prolonged period. Where schemes have been completed they have often relied on output-related measures (e.g. we delivered 1000 leaflets or had 2000 participants) rather than outcomes (e.g. 90% of participants lost weight or gave up smoking).
Clearly behaviour change approaches will achieve greater impact if they can evidence how much money has been saved (e.g. the NHS saved £1 million as a result of few admissions to hospital, or ‘If you spend £1 on prevention you can save £2). This kind of approach is necessary if we are to demonstrate cost benefit analysis (or return on investment) of a scheme. Often there is considerable anecdotal feedback or short-term results. However, the academic world is keen to establish methods that will generate data that it can use to fight for long-term public health improvements.
Alongside support, BSI provides a suite of cost effective, simple, accurate products to help organisations and businesses carry out non-invasive screening in the workplace. This improves business efficiency and the wellbeing of the workforce.
