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Aims: This article critically discusses the purpose, pragmatics and politics of conducting commissioned evaluations on behalf of public sector organisations by drawing on the experience of evaluating a community-based ‘whole systems’ obesity prevention intervention for an English local council. Methods: The study presented in this article incorporated two approaches: an evaluability assessment that interrogated the theoretical and practical difficulties of evaluating the intervention in a non-political way, and a retrospective analysis using Soft Systems Methodology that interrogated the more political difficulties of conducting such an evaluation in the ‘real world’. The information and insights that enabled these reflections came from over 3 years of working closely with the programme team, attending and participating in stakeholder events and meetings, presenting to the Council’s Scrutiny Committee meetings, four interviews with the programme manager, and multiple face-to-face group meetings, email exchanges and telephone conversations. Results: The study reveals and analyses three key inter-related challenges that arose during the evaluation of the ‘whole systems’ obesity prevention intervention: the programme’s evaluability, the evaluation purpose, and the nature, role and quality of evidence. Conclusions: The evaluability assessment was important for defining the programme’s theoretical and practical evaluability, and the retrospective analysis using Soft Systems Methodology enabled a greater understanding of the political tensions that existed. Key learning points related to the challenges that arose during this evaluation have broad applicability.

Purpose This paper looks back to look forward, through a synthesising social marketing literature over the last fifty years, and delivers a set of guiding tenets to propel social marketing’s agenda forward. Design/methodology/approach Across three strands, this paper amalgamates theoretical and practitioner evidence from social marketing. This synthesis commences with a review, summary and critical discussion of five decades of social marketing research. Across strand 2 and 3, we review 412 social marketing interventions reported across 10 evidence reviews, and 238 case studies. Findings This paper demonstrates social marketing’s use of fundamental marketing principles and capability to achieve behaviour change outcomes. Social marketers have built frameworks and processes that non-profit organisations, government agencies and policy makers seeking to enact change can utilise. This paper delivers 5 tenets that summarise the findings of the three strands and delivers research priorities for the next 50 years of social marketing research to drive the field forward. Research limitations/implications Drawing on five decades of learning, this paper proposes research priorities that can be applied to refine, recalibrate and future-proof social marketing’s success in making the world a better place. Practical implications This article demonstrates the value of social marketing science and helps bridge gaps between theory and practice and further strengthen social marketing’s value proposition. This paper provides confidence that money invested in social marketing programs is well spent. Originality/value This paper delivers a forward-looking perspective and provides social marketing academics and practitioners with confidence that it can assist in overcoming society’s most pressing issues. The paper encompasses key social marketing literature since it was founded 50 years ago. Five tenets will guide social marketing forward: (1) evidencing marketing principles (2) operatio

Background: Breastfeeding and the provision of human milk is the most accessible and cost-effective activity available to public health which is known to prevent a range of infectious and non-communicable diseases (NCDs), specifically gastro-enteritis, childhood obesity, diabetes type 2 and maternal breast cancer. However, global efforts to further improve exclusive breastfeeding rates have had limited success, in part because effective scaling‐up frameworks and roadmaps have not been developed. The UK has one of the lowest breastfeeding rates in the world; 80% of babies are breastfed at birth and only 1% are exclusively breastfed by 6 months. In Wales, whilst over 60% of women intend to breastfeed, the figure falls to 26% reporting any breastfeeding at 6 weeks, with considerable variation among Health Boards and breastfeeding rates lower among women in areas of higher deprivation, exacerbating health inequalities. Sustained intervention is required to improve the experience of breastfeeding for women, babies and families and work towards the WHO’s 2025 global target of increasing exclusive breastfeeding in the first six months to at least 50%. BBF: The Becoming Breastfeeding Friendly (BBF) toolkit was developed through highly structured technical and academic collaboration, led by Yale University and has been piloted in Mexico and Ghana. In the short term, it provides an evidence-based tool to guide countries in assessing their breastfeeding status, and their readiness to scale up. In the long term, it supports countries to identify the concrete measures they can take to sustainably increase breastfeeding rates, based on data-driven recommendations. The BBF Gear Model is made up of eight simultaneous conditions which sustain breastfeeding: the gears. This conceptual model illustrates how each gear must be sufficiently mobilised to turn the next, whilst the central Coordination gear gathers and delivers timely feedback. This report contains a set of briefings detail

In Wales, whilst over 60% of women intend to breastfeed, the figure falls to 26% reporting any breastfeeding at 6 weeks. There is considerable variation among Health Boards and breastfeeding rates are lower among some groups, exacerbating health inequalities. Sustained intervention is required to both improve the experience of breastfeeding for women, babies and families, and advance towards the WHO’s 2025 global target of increasing exclusive breastfeeding in the first six months to at least 50%. Supported by the University of Kent and facilitated by Public Health Wales, a Welsh Committee of experts worked from April 2018 to February 2019 to deliver the 5 step BBF process: a) to measure the current breastfeeding environment, and b) to develop a plan to implement recommendations to guide the scaling up of national breastfeeding protection, promotion and support efforts. This infographic presents the findings of the assessment of the Breastfeeding environment in Wales and the committee's six evidence-informed recommendation themes, based on the BBF Gear model.

Objective: To describe the experience of being diagnosed and living with mild to moderate Parkinson’s disease (PD). Method: Semi-structured in-depth interviews with people with Parkinson’s (PwP) in 11 European countries. Results: Interviews with 60 PwP (52% male) with a mean age of 63 (SD 8.1) years and a disease duration of 9.6 (SD 6.9) years were analysed. PwP often delayed help-seeking due to lack of awareness of symptoms, and there was sometimes a delay in specialist referral. The diagnosis typically came as a “shock”, making PwP unable to absorb all the information, but having a diagnosis for the symptoms was sometimes described as a “relief”. Prompt referral to a specialist, a clear and sensitively communicated diagnosis with reassurance about life expectancy, and a follow-up appointment with a PD nurse or other health care professionals a short interval after diagnosis were all positively viewed. Many reported worries and negative experiences with medications and wished for more time and information before initiating these. Reactions from family, friends, and work colleagues when communicating the diagnosis were typically positive. During ongoing care, longer appointments with specialists and provision of information from health care professionals, patient organisations, and self-help groups were considered important to many PwPs and helped them feel as if they could “take control” and manage their disease more effectively. Conclusions: Taking into account these findings has the potential to improve the experiences of PwP through improved communication, tailoring of appointments and information provision including self-help approaches. ? Introduction The impact of Parkinson’s disease (PD) on patients health-related quality of life has been studied extensively, demonstrating that all aspects of physical and emotional functioning can be affected in PD even at the earliest stages of the disease (Schrag et al., 2000). Management of PD aims at improving quality of

Self-management strategies are designed to improve lung and respiratory health through structured self-management plans with regular practitioner reviews. Strategies have not however focused upon how patient support groups and advocacy networks can help with the management of these conditions, therefore it is unknown what impact they may have on patient self-management. A qualitative study was designed to help understand what impact the British Lung Foundation’s (BLF) Breathe Easy (BE) groups have with patients managing their lung and respiratory conditions. A semi-structured telephone interview schedule was developed to study the network. Topics covered included: perceptions about the BE groups; current referrals systems and integration pathways; benefits of attending the BE groups; and integration of the BE groups into the respiratory pathway. Key themes explored included: shared patient experience and peer-support; patient self-management and self-education, attendance of healthcare professionals, and the impact of integrating BE groups into the respiratory pathway. BE networks were shown to support self-care initiatives for people attending the groups and members expressed a social and educational benefit. BE networks were working with the local NHS to become an integral part of the respiratory pathway, yet, there was evidence of resistance from the health service in incorporating the networks.

Formative research is a vital component of the social marketing process. Unless you understand the problem you are addressing from your target audience’s perspective, and gain insight into what would motivate your target audience, you cannot change behaviour. There are numerous research methods which can help you gain this crucial understanding, however some methods are more appropriate than others, and the methods used must take into consideration the audience type and/or topic area. This chapter uses a series of case studies to explore how different research methods have been used to gain the key insights and in-depth understanding of the target audience required to develop effective behaviour change programs. The research methods covered in this chapter include focus group discussions, individual interviews, observations, and photo diaries, plus the use of new technologies including text messaging and video booths.

This study aimed to identify and describe the motivators for underage, curbside drinking leading to antisocial behavior and to use these insights to develop a suitable intervention to tackle this. A cross-sectional study was conducted with youths and key stakeholders. “Street drinking” was identified as the most common recreational activity for youths and was motivated by a lack of appropriate leisure services, peer pressure and behavior, and the local accessibility of alcohol. Antisocial behavior was a major theme associated with street drinking. Few studies have examined the root causes of youth drinking and antisocial behavior. Our findings show that deprivation, social bonds, and the symbolic capital attached to alcohol along with its relative cost and availability enhance its appeal to the young, and provide some illumination to the relationship between these related problems.

OBJECTIVE: The correlates of parental burden in schizophrenia may differ between ethnic groups, but few studies have examined this in a UK setting. Our aim was to identify the correlates of burden in a UK sample of first-generation North Indian Punjabi Sikh parents and their white British counterparts. METHOD: Test the association of burden with a series of clinical, social and service use variables and control for potential confounding factors in a model predicting drivers of burden in a combined sample of the above. RESULTS: The strongest correlates of burden were patient symptoms and parental distress. Differences in correlates of burden between the groups emerged when individual components of service use and parental social network were tested. The group comparisons also revealed differences in expressed emotion (EE) and social networks. CONCLUSION: The similarities in sources of burden between the groups could be explained by a commonality of sociocultural and economic experience, resulting from the successful acculturation and affluence of this British Sikh group. The differences between the groups may be related to enduring cultural factors such as kin support, since larger family groups were associated with low burden in the British Sikh group. The nature of EE in this British Sikh group may explain why it was not associated with burden in this sample.

The objectives of this study were to systematically review and meta-analyze the research literature on the association of common neurological disorders and violence. Keywords relating to neurological disorders and violence were searched between 1966 and August 2008. Case–control and cohort studies were selected. Odds ratios of violence risk in particular disorders compared with controls were combined using fixed-effects meta-analysis with the data presented in forest plots. Sensitivity analyses were conducted to identify possible differences in risk estimates across surveys. Information on risk factors for violence was extracted if replicated in more than one study. Nine studies were identified that compared the risk of violence in epilepsy or traumatic brain injury compared with unaffected controls. For the epilepsy studies, the overall pooled odds ratio for violent outcomes was 0.67 [95% confidence interval (CI) 0.46–0.96]. For traumatic brain injury, the odds ratio was 1.66 (95% CI 1.12–2.31). An additional 11 case–control studies investigated factors associated with violence in epilepsy and traumatic brain injury. It was not possible to meta-analyze these data. Comorbid psychopathology was associated with violence. Data on other neurological conditions was limited and unreplicated. In conclusion, although the evidence was limited and methodological quality varied, epilepsy and traumatic brain injury appeared to differ in their risk of violence compared with control populations. Longitudinal studies are required to replicate this review’s provisional findings that epilepsy is inversely associated with violence and that brain injury modestly increases the risk, and further research is needed to provide information on a broader range of risk factors.