Domestic abuse is a significant public health issue affecting 1:3 women and 1:6 men, having a major impact on those directly affected and their families and campaigns to tackle it have historically focused on victim support and crime reduction rather than prevention.
Responding to the NICE Guidance PH50 Recommendations 2 and 5, local Public Health Directors delivered the Be a Lover not a Fighter campaign in February 2015 and February 2016 across areas in the North West to ‘participate in a local strategic multi-agency partnership to prevent domestic violence and abuse’ linking to partners from local authorities, NHS, domestic abuse services, police and others.
A public health social marketing approach was developed to ‘create an environment for disclosing domestic violence and abuse’, complementing existing work by engaging the wider public in the debate, encouraging talking about the issue, highlighting the impact on children and generating public support for ending domestic abuse.
Aims and objectives
In addition to educating, a broad aim of this initiative was to reduce the acceptability of domestic abuse; to take steps to ‘de-normalise’ it amongst the public, who were engaged to pledge their support to help end domestic abuse. In this way, the campaign utilised both a social norms-change approach (to contribute to making domestic abuse less acceptable) and a behaviour change campaign (to make domestic abuse less of a hidden issue by encouraging people to talk about it more).
Objectives for the campaign were to:
- Improve public understanding of the new definition of domestic abuse
- Increase understanding of the prevalence, nature and effects of domestic abuse
- Contribute to ‘denormalising’ domestic abuse and its acceptance
- Facilitate conversations about domestic abuse and gain public support for ending domestic abuse.
- Highlight the impact on children (2016)
The campaign highlighted the scale (1 in 3 women and 1 in 6 men) and nature (in particular to include emotional as well as physical abuse and that it can happen to anyone) of the issue as well as the impacts of domestic abuse, including on children.
It offered a range of ways for the public to engage, through online or social media channels and local face to face events. Advertising and celebrity endorsement supported this. Badges were used as a tool to generate discussion. The campaign used Valentine’s Day as hook for media.
The initial campaign ran in February in 2015, which included pre and post research with the public. This was refined and built on for the Phase 2 of the campaign in 2016. The research findings and the clear public support for the campaign provided strong evidence for the success of this approach by demonstrating that the messages reached the public and that the and behavioural actions were taken up. It also reported that the campaign could be enhanced by focusing messaging on the effects of domestic abuse on children, which was a good fit for stakeholder aspirations.
By putting a public health lens on this traditionally services and crime-led issue, the intention was to take an innovative approach to the issue, making it easier for people to discuss domestic abuse openly while at the same time complementing and enhancing significant and successful locally delivered campaign and intervention work carried out by the Police, local authorities and domestic abuse support services, including the established White Ribbon Campaign.
Reasons for implementing your project
Police incident data for the North West (Home Office Focus on Violent Crime and Sexual Offences, 2013/14) shows a trend of little change in incidences year-on-year both in the North West and across the areas covered by the campaign:
North West Region
In terms of public health, domestic abuse has a range of serious physical and mental health consequences for victims which can be long lasting. As well as acute and chronic physical impacts there are strong links with suicide and self-harm.
Half of all people who report domestic abuse have children. Living with domestic abuse adversely affects children’s health, development, relationships, behaviour and emotional wellbeing, which has consequences for their educational attainment and future life. These Adverse Childhood Experiences (ACEs) are strongly related to the development of risk factors for disease and social wellbeing as they get older; ‘ACEs contribute to poor life-course health and social outcomes in a UK population. That ACEs are linked to involvement in violence, early unplanned pregnancy, incarceration, and unemployment suggests a cyclic effect where those with higher ACE counts have higher risks of exposing their own children to ACEs.’(Bellis et al).
NICE Guidance PH50 states that ‘the public service burden of domestic abuse is considerable’. Reducing domestic abuse, both on an individual and family level, would have an impact on this. In addition, reducing the consequences will contribute to achievement of improving and protecting the nation’s health and wellbeing as outlined in the vision of the Public Health Outcomes Framework for England, 2013-2016.
A pre-campaign research study using random street intercept provided a robust and representative 95% CI sample (n=400) of Cheshire and Merseyside’s 2.4 Million population. This reported a low level of understanding around domestic abuse and that it is accepted as a social norm in some communities, but people did want to see it reduce and were willing to support measures to do so.
A multi-agency stakeholder event was delivered in conjunction with and supported by NICE. Stakeholders from a range of partner areas including community safety, safeguarding, the police and the offices of the Police and Crime Commissioners were engaged to offer advice on the campaign’s development as well as their support for the innovative approach.
The campaign was also tested with the target groups as part of a robust social marketing approach.
How did you implement the project
The campaign approach considered domestic abuse from a population level perspective, working ‘upstream’ to engage the public, delivered using the established social marketing Total Process Planning Model.
A segmentation excersize used insight and the geodemographic database Mosaic to identify two target groups - Municipal Dependency and Ties of Community, broadly corresponding to 15-30 year olds in socio-economic groups C2DE, although the campaign looked to deliver a reach far wider than these groups.
The creative direction was refined by concept testing with these target groups. Expertise from domestic abuse professionals was sought and incorporated.
This integrated, multi-channel campaign employed a mix of tactics, including:
- Campaign website: www.lovernotfighter.org.uk
- A4 Posters
- Badges & badge cards
- PR & celebrities
- Social media: Facebook, twitter, Instagram
- Advertising: Bus / Radio
- Face to face local public engagement events.
In 2015, the campaign was delivered across a 2.4M population through a collaborative partnership approach led and funded by the Champs Public Health Collaborative in Cheshire and Merseyside. The campaign was commissioned, managed and co-ordinated by the Champs support team, with creative input and delivery supported through an external agency, Mint Umbrella.
In 2016, a model of investment facilitated other local areas benefitting from this collaborative approach, providing ‘opt-in’ options responsive to local priorities. This led to the inclusion of Lancashire areas in the campaign. The Phase 2 campaign was again supported by investment collectively from the Champs Public Health Collaborative and from Public Health England North West Centre.
Areas where the campaign was adapted include:
1). The focus was developed to move the messaging away from ‘exacerbating factors’ (stress, alcohol, worklessness) and towards ‘impacts’ for Phase 2, based on the public research and input from a range of partner experts.
2). Problems with engaging the whole range of existing stakeholders were overcome by delivering two domestic abuse CPD events and setting up a ‘virtual’ advisory group; virtual because this was an additional ask of staff from partner organisations at a time of stretched resources.
3). As a new campaign with an innovative approach, some stakeholders felt excluded and even challenged. For Phase 2, stakeholders were engaged a) sooner and b) with specific tasks and responsibilities to improve impact locally, delivered through a nominated ‘local lead’.
The campaign has been carefully monitored with a mix of data providing rich insight into the campaigns’ effectiveness.
The 2015 pre and post campaign public survey, significant at Cheshire & Merseyside level (95%CI), reported on views and opinions around domestic abuse generally and the campaign specifically.
Across 6 weeks, the campaign reached 39% of the 2.4M Cheshire & Merseyside population in almost all sectors of the population, equating to almost 1M which is impressive.
The survey results also told us that:
- The campaign had a strong impact through making people think more about domestic abuse, in particular the importance of talking about it
- Local residents’ understanding of domestic abuse, especially being emotional as well as physical increased, though people still underestimate the scale in both men and women.
- Whilst police are seen to have the main responsibility for tackling domestic abuse, the campaign helped people recognise that it is everyone’s responsibility.
- People felt that the impacts on children were a strong motivator in ending domestic abuse, contributing to the recommendation to refocus the campaign around both children and wellbeing in the 2016 campaign.
The 2015 public reach exceeded expectations. Adopting a collaborative approach in this way has produced significant cost savings through economies of scale. The campaign delivery cost per person reached was £0.07 which is an estimated as almost an eighth of the possible costs if the campaign was delivered in and by a single local authority area (£0.50pp).
Marketing metrics report on the outputs and qualitative factors, including (2015):
- 57 pieces of media coverage featured across Cheshire and Merseyside with a total reach of 3.5m people and a PR value of £74,623.58.
- Public comments and pledges of support were recorded and overwhelmingly positive.
- There were over 2,500 unique website visitors and over 2000 pledges of support.
- Social media (Facebook, Twitter, Instagram) activity was particularly successful; many posts went viral, with up to 200 ‘likes’ and ‘shares’ per post, significantly higher than expected for a campaign of this nature.
At the mid-point of the 2016 campaign public and stakeholder engagement, in particular social media engagement, was already out-performing that of 2015.
As a partnership approach, local partners have also delivered their own locally-led activity. Additional results will be available after the campaign ends (March).
Key learning points
Learning from the campaign in 2015 helped develop and refine the campaign in 2016 (covered above). In addition, key learning for future similar work would be:
Local leadership is key to success
The local areas where the campaign performed best were those with the strongest public health leadership on this issue and where good partnership working embraced innovation.
Build a model that allows local choice
Building on the work in 2015, the 2016 campaign was modelled on an ‘opt-in’ funding basis. This was successful in that it produced stronger buy-in from the local partners involved. This model provided a core list of deliverables for the collaboratively commissioned work and an additional but equally important list of talks for a nominated local ‘lead’ person, usually from public health or communications departments with local authorities.
Get partners engaged early
People’s inputs from different points of view are an asset to development. To avoid potential confusion and gain support from stakeholders working in the field with a novel approach such as this, it is important to engage as many people as possible early.
Relate plans to recognised theory and models – and talk about it
Ensure that at the heart of the approach the work is grounded in good theory and a tried and tested process – in this case social marketing theory. But the use of social marketing techniques in the development of campaigns that segment, develop approaches for and then engage specific audiences is a specialist field which was not universally understood by partners. They remain undervalued as tools for behavioural change and need to be presented as part of a good multi-agency approach.
Accept that innovation takes time to be accepted
Doing something new can be met with real positivity or real challenge – get good evidence, apply good theory, evaluate well and disseminate the successes, and innovation that works can move towards accepted good practice.
Collaboration brings benefits
The economies of scale and shared learning from a collaborative partnership approach can benefit all partners financially and by having a bigger impact, as well as fostering partnerships for future work.