Understanding behaviour change in context: examining the role of midstream social marketing programmes.

Nadina R Luca,Sally Hibbert,Ruth Mcdonald

doi:10.1111/1467-9566.12951

Abstract

This research examines how midstream social marketing programmes that adopt a relational and community-based approach create opportunities for individuals to make incremental changes to health behaviour. Specifically, it applies Bourdieusian theory to explore how interactions between community healthcare workers (CHWs) and members of the public generate impetus for change and foster individual agency for improved health. Qualitative interviews were carried out with members of the public and CHWs engaged in a Smokefree home and cars initiative. The findings suggest that although CHWs are challenged by resource constraints, their practices in working with individuals and families build trust and enable dialogue that bridges smoking-related health insight with home logics. These interactions can promote individual agency with a transformative effect through small changes to smoking-related dispositions, norms and practices. However, tensions with the habitus of other household members and other capital deficits can inhibit progress towards embedding new practices. The study concludes that interventions built upon community relationships show potential for addressing limitations of information-focused campaigns but there is a need to also respond to key social structures relating to the field of action for new health dispositions to become embedded in practice.

Highlights

This paper applies Bourdieusian theory to explore how social marketing programmes that adopt a relational and community-based approach create opportunities for individuals to make incremental changes to health behaviour
We start by briefly describing the social contexts of community healthcare workers (CHWs) and members of the public, in terms of field and habitus, that were prominent features of the background to their interactions relating to the Smokefree programme
We advance two themes, relating to social capital expressed through trust, connections and adaptive practices and, show how such interactions may act as sources of disruption and triggers for individual agency and reflexivity, leading to changes to norms, new smokefree dispositions and practices in the context of the home field

Summary

Introduction

This paper applies Bourdieusian theory to explore how social marketing programmes that adopt a relational and community-based approach create opportunities for individuals to make incremental changes to health behaviour. Social marketing scholarship and practice has responded to these criticisms by espousing a shift towards a relational paradigm that advocates co-creation with citizens and other network actors mediated by a midstream (i.e. community oriented) service approach to the development and implementation of programmes (Dibb, 2014; Luca, Hibbert and McDonald, 2016; Russell-Bennett, Wood and Previte, 2013) Scholars that support this shift recognise that social theory provides a suitable conceptual foundation to explore the relationship between social structures and health inequalities and reveal novel approaches to address the context of behaviour (Cherrier and Gurrieri, 2014; Luca, Hibbert and McDonald, 2016). There is a lack of research on how interventions implemented by health institutions can create small disruptions that afford opportunities for changes to health dispositions, norms and practices

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