Rhian Gladman: Hi everyone, welcome to the latest episode of the Nudges for Social Good podcast from the Local Government Association. My name is Rhian Gladman and I manage the behaviour change programme here at the LGA and what we're looking to do with this programme is to demystify behavioural insights and behaviour change and provide learning from practical projects that you can then try in your own council. So today we are excitedly joined by two guests, which is quite unusual for the podcast. So, we're going to be hearing more about Wolverhampton Council’s work to encourage physical activity, and I'm joined by Shanara Abdin from the Council and Mike Salmon from the Black Country active partnership. Hi, guys. How are you?
Shanara Abdin: Hi I’m good, thank you. How are you Rhian?
Rhian Gladman: Good. I am good. Great to have you with us here today, appreciate your time and over to you guys, really. Do you want to introduce yourselves and your role in the organization, please?
Shanara Abdin: Yes, sure. I'm Shanara Abdin. I'm a health psychologist. I work within the Public Health department as a behavioural science specialist. So my background and my work is very much applying behaviour change across everything. We do, not only in public health but wider as well.
Rhian Gladman: Great stuff. Welcome Shanara, Mike?
Michael Salmon: Yes, hi, I’m Mike Salmon, I'm the Head of Insight Health and Wellbeing at Active Black Country. We're the active partnership for the Black Country covering Dudley, Sandwell, Walsall and Wolverhampton.
Rhian Gladman: Excellent, welcome, guys. So we'll start at the very beginning, as we always do on these podcasts. So Shanara, what was the behaviour that the council was trying to change through this project?
Shanara Abdin: So the behaviour that we were trying to change was physical activity and trying to increase physical activity at a time when levels were extremely low. So within the city within Wolverhampton, over 30 per cent of our adults actually do less than 30 minutes of weekly physical activity. And as you can appreciate, this has a lot of knock-on effects on, you know, diabetes or cardiovascular disease and especially during the pandemic which is - I'm sure we'll touch up on a lot today - there's been a serious impact as a result of the pandemic. People weren't able to go out or if they were, they were only able to exercise one - exercise once per day. So this really demonstrated a need at the time. That was really really important and then we partnershiped up with Mike. So, Active Back Country, to deliver a behaviour change, intervention around physical activity.
Michael Salmon: If I could just kind of set the scene a little bit as well. So we defined an inactive person as someone who does less than 30 weekly minutes of moderate intensity physical activity, so that, the type of activity that gets you a little bit out of breath. So that could be a gentle jog cycle ride and maybe kind of breast stroke at swimming that sort of thing. And it's actually recommended by the chief medical officer that we do 150 minutes of activity a week. But yes, that threshold for an inactive person is less than 30 minutes. Wolverhampton is one of the most inactive parts of the country.
So as Shanara just said nationwide, approximately one in four are inactive. In Wolverhampton, it's much closer to one in three and I think it's really important to say it's not an issue confined just to Wolverhampton. It's kind of a regional thing. All Black Country local authorities have higher rates, of inactivity, it tends to follow socioeconomic trends, patterns of deprivation, that sort of thing. The reason this project was really important, we kind of get this data twice a year from what's called the Active Lives survey. But it's pretty subjective. People are asked how active they are. And there’s this general school of thought that people overestimate their activity levels. What this study would allow us to do is pull together more of an objective evidence base. It comes up at a really important time as well because the health and wellbeing board in Wolverhampton have recently made the decision to prioritise this issue and focus their kind of collective attention on inactivity in the city. So kind of developing that evidence base was really important at this time.
Rhian Gladman: And just for the listener, really just to confirm there, Mike. So the Active Lives survey, is that the one that Sport England produce?
Michael Salmon: Yes, that's exactly right. So it comes out twice a year, very much the best indicator that we have to show a direction of travel. But it doesn't tell us the whole pitch, as with any survey, it doesn't tell us the whole picture. The sample size is around about 500 for every local authority area, which is fine, but it means you get odd data patterns every so often and it's just always important that we kind of find wider evidence sources as well to just kind of add to that, add to that knowledge base.
Rhian Gladman: OK, so obviously as we know physical activity, big issue nationally, big issue, as we come out of the pandemic, but an even bigger issue locally to Wolverhampton from what the stats are saying here. So how did you start to go about understanding what was the barrier to the behaviour you want to see? So what was sort of stopping people being more physically active?
Michael Salmon: I think over the years, a lot of work has been undertaken to understand barriers to activity. It's not like we're starting from scratch. I think on this project a lot of research has been carried out at national level by Sport England and sector partners and we were able to draw on some of the learnings from the local past work as well. So the city council have been involved in a programme called Beat the Street, and they've also got some really good insight from a local initiative called Fit for a Fiver. On our side, we were already conducting a funded intervention in Wolverhampton. It's called Get Out, Get Active and that's a programme that we deliver that's managed by activity lines and it's exploring the potential of faith centres and faith leaders to reach inactive people and to influence inactive people. we also just prior to this piece of work, we did a fairly sizable survey just as the country was coming out of the first national lockdown, I think around about 700 responses. And what we found was that physical activity levels had dropped during COVID as we might expect. But the one group who had actually increased their levels were those who had the lowest baseline previously. So people who were inactive prior to lockdown, had actually used that one hour a day that we were allowed to go outside to be more active and increase our activity levels. And when we explored the general feedback behind that, the information that we got was that they felt less self-conscious, less people on the streets, not as many eyes on them make people feel a little bit less self-conscious and more confident to run, walk or cycle. So we knew that there was some latent demand for an intervention that allowed people to be active in a way whereby they had complete control of what they wanted to do and that kind of built into the thinking behind this piece of work.
Rhian Gladman: So Shanara with this actual project tell me more about sort of how it came about, how you started working with the active partnership and how it got started really?
Shanara Abdin: So we actually came across the LGA behavioural insights kind of promotion and application and we thought this would be a really good opportunity to work with Mike especially at the start of the pandemic, work with his organisation hand in hand because we didn't have capacity on our own just to do this piece of work. And we've really well thrived actually on the relationship that we have with Mike and his organization. It's an ongoing piece of work and with physical activity we thought it's probably the best time. You know this - we started the piece of work towards the end of the first year of the pandemic, so that's kind of where it came by. And then in terms of with the actual, what we were going to do? The actual development of it, you know we had conversations internally with a couple of other colleagues across the department and understanding the need and where is that need because as you can appreciate, you know physical activity can be quite broad and we obviously have to narrow it down. So what we did was, the aim really of the intervention was to increase physical activity levels across the city through a behaviour change intervention to at least 30 minutes a week, but we targeted individuals from low socioeconomic areas and people who literally did no physical activity or said they didn't do any physical activity at all. And then that's when Mike and I started working together and trying to put a specification together and then going out to tender in order to award a supplier.
Rhian Gladman: So it's very much you’re looking to focuses this intervention in the community, not in a gym or a leisure centre or, you know, the assets that are already there, actually focusing in the community something people can do. You've talked about latent demand people starting to do a bit more and you, but you're really looking to target this intervention among those lowest socioeconomic groups in the city, which obviously it's a big city, isn't it? So, you're really looking to target here. So how did you start to understand your target group, what the barriers were to physical activity, and therefore, you know, using that insight to influence what your behavioural insights trial would look like?
Shanara Abdin: Definitely. So we did a bit of a scoping kind of phase with local stakeholders to actually understand the barriers and we had ongoing pieces of work with our community champions and various other faith leaders. So we relied on kind of targeting them to understand what exactly is the barrier especially during the pandemic. So we worked with a range of teams, a range of organisations, so corporately, adult carers team, outreach team, our wider public health colleagues.
We had the children's and families involvement as well, and then as I said, the community groups and this is where we had most of the kind of effect really in terms of target population, because we worked with a range of stakeholders that we work every day with them. But this was more from a physical activity perspective and really listen to them. You know, why are people not physically active? Or what's stopping them? And then as well as that, we also worked with our local leisure centre so WV Active which are council owned leisure centres just to understand, you know, how do people get through their doors as well? So we've got both sides of the argument as well, and I know I'll let Mike come in now, but I know Mike's worked, done some fabulous piece of work in the community with faith leaders as well across the city. I don't know, Mike if you wanted to touch upon that?
Mike Salmon: Yes, we there's so - so the project I was referencing before it's called Get Out, Get Active and that's as I say, it's kind of exploring the potential of faith leaders in terms of activating people, activating people in their community and when we started the project, it looks very different now as to how it did when it started and that's because of the pandemic and we had to change our entire delivery model. But what it made for a better project essentially, whereas previously we were looking to do some kind of community outreach and find out what people in certain parts of Wolverhampton wanted to do, then use the faith center facilities themselves to host the activity and then recruit people from the local area because we couldn't do that. We couldn't do group activities. We couldn't kind of bring people under one roof. We instead engaged with the faith leaders themselves, invested in their time and their capacity and put them through a training programme. So, they almost became social prescribers as such, and they started to give advice and signpost and advice to the local community about being active, about places they could be active, about the benefits of physical activity. And it was essentially increasing capacity in the community for physical activity by working through faith leaders and it's been a really kind of good model to use. You know a lot gets talked about social prescribing as if it's something new. It's not new, the capacity is new in terms of in the system. But the concept is as old day, matching community opportunity with community need and we took all of this thinking I suppose into this programme, and we were kind of delivering it again kind of with the threat of regular lockdowns around us and we needed something that would be resilient to any of that I suppose.
Rhian Gladman: You have a really important point, wasn't it? At that time when we were working together on this project. So, you've done a lot of that insight gathering working with local stakeholders, really building up a picture of what the barriers are and what did you find?
Shanara Abdin: So we found that a lot of the barriers were around not having access or not knowing we know what to do as well and well, I'm sure we'll touch up on this, but it was a digital side of things as well, especially due to the pandemic. You know, people weren't able to go to you know if they were attending a gym or leisure centre or they weren't able to meet their friends to go for a walk. So they were very restricted. So what we had to do was kind of, think back what would work for a resident who has done no physical activity in a new world really. You know, they can't just go out and go and you know, go for a run around the block. It's not as simple as that. It was very much kind of looking at what we have here and now and COVID and the restrictions definitely had a big play in this. And this is why we actually - we’ll go through the thorough I'm sure of the intervention itself - but we went for a digital intervention and app based. I think if COVID has kind of taught us anything, it’s that more and more people now have started to use some form of digital, so whether it's a phone or a laptop or something. So more and more of our residents now are becoming digitally included, whereas pre-COVID, I'm sure that was not the case. So, it was just relying on the resources that we have now and what residents, what the stakeholders are telling us in terms of what will actually work, and this is very much a pilot. And you know very much a pilot, we've never done anything like this before. So this was and especially at a time when, you know, we needed to link this in with COVID recovery and response. We needed to get people to look after themselves, go for a walk. And so it couldn't have come at a better time, if I'm honest with you. But I don't know Mike if there’s anything else that you want to add as well.
Michael Salmon: I think that the only other thing that - and I agree with all that - I think the only thing I'd add to that is and it backed up the original research that I mentioned before, I think we found that people were ready for something kind of low intensity like you're talking about people who are currently doing nothing and to get people from doing nothing to something you can't go too far. You know, that's kind of why we settled on the intervention that we did. If we're expecting people to start running 10K in a few weeks, that's not going to happen. You've got to kind of take people along with you and small steps all along the way. And that was kind of what we were, what we're hearing as well there. There was kind of interest out there for something that was, as I say, a little bit low key, low intensity, not too scary if that's the right way of putting it. So they kind of come along on a journey with us.
Rhian Gladman: Really important. I think that's sort of evolution, not revolution, not to scare people, build it into your everyday activity. You know, all of the smaller steps you can take. So there was clear, these clear sort of barriers coming up there in terms of maybe not knowing what's available. And then there was clearly something there around actually digital would be a good thing for us. It will actually work in our lives more. It would be more easy for us to access actually. So I guess that feels like a bit of a newer piece of learning that you got through this project then maybe pre-COVID. So with all of that in mind and all of that insight that you've gained and what you've learned there and now you know where you want to target the intervention, yes. What was the intervention? Tell us more about that.
Shanara Abdin: The intervention itself was a six-week intervention based on increasing physical activity underpinned by behavioural science principles, and it was a digital intervention where individuals had to download an app. And in terms of the app, it was already available on the market, so the app that we used was called Move Spring and we did some kind of looking around having a bit of investigation really at some existing apps. We definitely didn't have time to create a new app or even have the resources, not only time to create a new app. So we used Move Spring. We thought that was the best one because it enabled us to edit it and make it localised. So we were able to add our logos on links to, you know, Wolverhampton cycle trails, for example. It's very much. Residents can look at the app and think, right, this is from the city. This is from Wolverhampton, you know this is linked to me and if you link it to behavioural science, you know we're giving the individuals the resources and exactly what you just mentioned earlier is it's a very low intensity. This was a walking app. It was a walking intervention, getting people to increase their step count and individuals who had a fitness tracker were able to sync their device to the app, so you know, for example, if you had an Apple Watch or Fitbit or whatever, you were able to link it to the app and then it automatically accumulated your step count for the day. There was challenges as well, that had daily challenges, weekly challenges, depending on what your own goal was and this was based on goal setting for behaviour change and then individuals who didn't have a fitness tracker, they were still able to partake as well. So, they were able to manually upload their step count you know. So it we kind of overcame that barrier that they didn't need a fitness tracker, they just needed access to a phone. And then we were able to support them in terms of any technical issues and the app very much, very much sorry, works like a standard app, nudges through push notifications reminding participants to be active, you know, go for a walk or it was very much that low key which Mike touched upon earlier. It's reminding people that gardening is a form of physical activity. You know housework and that low intensity, so the intervention I said was six weeks and the outcomes that we measured were step count and then wellbeing as well. So we used WEM web. So the Warwick, Edinburgh mental wellbeing scale to measure people's wellbeing as well because as you can appreciate wellbeing and physical activity go hand in hand. So yes, I mean that was the intervention. I don't know, Mike if I missed anything as well.
Michael Salmon: No, I don't think, I think kind of we didn't, we didn't pick one single model of behavioural science. I think it's important to say. The consultants that we worked with, they recommended that the project be underpinned by learnings from a number of models. I think kind of the one that we leant on the most was the idea that kind of behaviour change requires motivation, ability and a prompt. And so the motivation to improve your health, the physical ability to do a task i.e. to walk and a prompt and that prompt was a really important element in the design, so the kind of the command or the reminder to be active can come in lots of different forms and one of those we decided could be a push notification through a smartphone. So we put together the intervention the six week intervention, add two entry points that would be delivered by the smartphone. And the reason we liked Move Spring was it allowed us to send those push notifications and I think and remind me if I got this wrong Shanara, one of the kind of principles that we thought would work well was this notion of stick to it, where kind of people are motivated through the prompts to stick to something. Lots of kind of mobile based games use streaks to keep you engaged and things like that. You can see how many days in a row you've been playing. So I do a languages app and you can see you've done it for so many days and it encourages you to kind of keep on going. So the app also collected the step count data through the built in pedometer that, as Shanara said was kind of synced via peoples phones.
And I think the step count data was really important. It goes back to what I was saying before about having something that's objective and you know, we know people estimate their activity levels in surveys and some might overestimate, some might underestimate. But either way it's not objective, it's hugely subjective, you know you're asking how active someone is and you're essentially believing their answer whereas step count data takes that subjectivity out of the equation. And I guess the idea was that over the six weeks we would use the app and the messages to motivate people, increase their step count over time and the other important elements of the app was that it had a community element where participants could motivate each other form little groups and encourage each other, see little leaderboards to see how well people were doing, and kind of motivate each other to be active in that way.
Rhian Gladman: So I guess key learning there for other councils listening in is actually you know decision to use an app but not to actually spend time resource building your own council app. Actually, there's stuff already out there. What can we use that's already out there, that already does this for us. And so that was a key decision you've gone to use Move Spring. Were there any issues, any learning through using Move Spring?
Shanara Abdin: There was one of them was it wasn't applicable with some types of phones or if you had a Huawei phone, you weren't able to download Move Spring, so individuals had to download another like a Google app or another app in order to use Move Spring. So that was a huge barrier as well but that’s a learning curve for us. You know, we will be able to be - you know if other councils are able to use Move Spring again or even if we are at least we know for next time that, that was a barrier that definitely came up.
Rhian Gladman: Obviously other apps are available, you know. Got to say that we're not saying Move Spring was the only one endorsed by the LGA, but yeah, the other, you know it's, I think that's the point, isn't it? Rather than thinking we need a council one or an active partnership one and all that money and development, you've actually looked to the market is there something already there that will do it for a trial? This is the first time you've done this. So how did you go about recruiting people to the trial? Because that's always a big challenge, isn't it? How do we get people? We've set up an intervention, how do we recruit people to the trial? Can tell me more about that please?
Shanara Abdin: Yes, of course. The kind of typical communications route, so press releases and you know Mike kindly did a radio as well. So radio stations but-
Rhian Gladman: I mean, we need to hear all about Mike as a radio personality, definitely. Dulcet tones.
Shanara Abdin: That's it. But what, what was the key actually was social media. So we used Twitter, Instagram, but Facebook just worked wonders for us. So for both cohorts, so cohort one in June and then cohort two in August, we boosted our posts. So what that means is we actually targeted our post within Facebook across all our postcodes based in deprived areas across the city and the reach was absolutely incredible. The amount of people who, you know I think we boosted it for about a week and the amount of people who actually signed up from those areas or the reach that the post had was just honestly, it was just mind-blowing. It was something that's quite simple to do but really effective as well. And you know you wouldn't think things like this, you wouldn't think how effective boosting a post would be in Facebook. But it worked wonders and I know through Mikes organization as well; they did some targeted posts as well from my understanding Mike through press releases and I think that's what helped really because we've got our kind of you know residents on our social media or contact list. But then Mike's organization has a wider you know maybe some individuals who aren't signed up to the council mailing list and that hand in hand worked really well as well, like a double whammy really. But yes, I don't know Mike if you want to come in and add anything from your end as well?
Michael Salmon: Yes, I thought the recruitment element was the big success of the programme to be honest and really showed, demonstrated that the reach of the partnership between ourselves and the strengths certainly of the reach of the city councils kind of marketing. We had to go out and get people to sign up essentially to make it statistically sound. We needed a bare minimum of 200 people to sign up as we were told by the consultants to kind of go through the programme. We knew there’d be a dropout, so we set our sights a fair bit higher than that.
We had budget for 300 licenses from Move Spring, but that meant 600 participants because there are two entry points. So those 300 were the first round. Then we could start again with 300 new people essentially. So we used the learnings from everything that we've done recently and all that of the city council. And as Shanara said, we kind of purchased some targeted social media adverts, targeted geographically because obviously we were focusing on those deprived areas that we went through before. And so as Shanara said, went on radio to plug it. We got social care, newsletters and some content in there. And we just got really good take up. I think 593 participants in total signed up via the website that are being set up and then we have some filters in there as well. So we could make sure that people taking part were the people we wanted to take part and so they're asking the postcode to make sure they lived in the city and allowed us to prioritize based on those geographies that we were focusing on. We also asked people how active they were in a general week with a view to prioritizing people who said they were active either zero days or one days, and they also needed access to an electronic device ie a Smartphone. But you could also do it with a laptop, but it wasn't, or a computer, but it wasn't that easy. Then you'd have to put your own numbers in and it's just another kind of barrier there. So, we split those almost 600 people into two groups. So the two entry points for the trial and we just failed to make sure that all the people that we wanted to were taking part and what that meant was Group One had 222 people and group two had 190 people I think. So that was a good kind of sample of people to go from. We knew that we were kind of making it in theory statistically okay. If all those people got to the end of the process because it gave us over 400 people in total.
Rhian Gladman: So, I guess for others listening in, tell me more about how that filtering process worked. Like how did you resource that? Because obviously, you've got loads more people coming in than you expected, which is great, the marketing has worked. Obviously, you know the targeted ads, social media ads have really worked. You've got all this influx of interest. How did you do that filtering? But can you tell me more about how you resource that please?
Shanara Abdin: Yes, so the resource kind of came from me really, within the project team only because we couldn't share - we set up a specific email address for people to sign up and complete the form. That form was then sent to a dedicated inbox and then it was a case of manually trawling through all these application forms if we want to call it that. And you know, making sure that they are Wolverhampton residents. So they pay - because what can happen is sometimes a post code can look Wolverhampton but they're not actually our resident, so we some of them, we actually have to manually trawl through and see if they were our resident or not. And then as Mike had said, you know, check their physical activity levels and if it's one or less than one, they were eligible as well and there was a lot of man hours trawling through. And as you rightly put, we weren't expecting to get that many. So the first cohort especially because it was during the kind of height of the pandemic and was still working with COVID, COVID recovery and response. And because I couldn't get Mike access due to IT issues, I couldn't get the consultants to have access to our inbox, it very much led on me going through all of the applications and the forms.
Shanara Abdin: The cohort two was a little bit easier actually because I managed to get capacity to support me in house so myself and a colleague were able to look at applications as and when they came in, whereas the first cohort I literally had to wait until like the sign ups ended only because I just could not, just how quickly they were coming through the inbox. I mean it's incredible. It was really, really great to see so many people interested, but we just didn't have that capacity to immediately respond back. And sometimes it would take, you know, if Joe Bloggs emailed one day, probably take a week, maybe over a week for me to actually email back and say, you know, we confirm, you know, we've received your application and from a behaviour change angle that was really important actually, because it's that intention gap. You know, individuals signed up so they had that intention to change the behaviour, especially cohort one. They had that delay from us or from me in terms of responding back, whereas we took that learning, as I said for cohort two and it was a lot more kind of smooth sailing, in terms of getting the emails come through and responding. I would say literally within the hour or as soon as the next couple of hours and it helped with that intention gap as well. So yeah, through the resource definitely and because we weren't able to for permissions and all sorts, we weren't able to you know get the consultants or Mike’s team permission to access our inbox. That was something that we probably didn't take on board actually at the start, so that was a definitely a good learning curve for us. And as I said, we've definitely changed it for cohort two, which made it a lot easier, but yeah.
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Rhian Gladman: So definitely an intervention at the right time for people. There was demand for it. People were looking for this. The way you've marketed it, has made it really visible to the people who wanted to do this. So, the timing was right. The motivation was there, and they've seen it and signed up to it. A bit of learning there around resourcing. Because you are looking to filter rather than, you know you're very targeted, weren't you? And in whose behaviour, you wanted to change, and then you've run the intervention twice, each for six weeks. So, two different groups. So, you've got to learn a lot there. So, what were the results? What were the findings?
Shanara Abdin: So, we increased average step count from 5000 before the programme to 7000. At the end of the six weeks and that's an average of both cohorts. And then in terms of behaviour change, what we actually found was that it was sustained from a very small minority of residents. But those residents actually reached their daily step target across the six weeks and post intervention. So after the six weeks, they actually sustained their behaviour and that was really key for us because what we also found was that the programme was supportive for individuals who are quite self-disciplined, so they thrived on that daily step count feedback. They thrived on the rewards, the push notifications and they actually needed that, you know, to carry on, to carry on with the challenge.
We also did find that individuals did underestimate their physical activity level. So, what we mean by that is if they had a fitness tracker when they signed up to the programme, they said they weren't doing any days or any minutes of physical activity at all. But then we synced their fitness tracker and it actually demonstrated that they were already doing at least say 5000 steps a day or 6000 steps. But the individual just wasn't aware that they were active already. And I think that's a real key learning to take because you would assume, and a lot of evidence shows that people actually overestimate rather than underestimate. So that's something that we would be able to take forward and it's for me, it was just a kind of a key learning that you don't think about it unless you know when you dig in a bit deeper really. And then from a wellbeing perspective, participants reported that they felt more positive as the programme progressed. So across six weeks they felt they had more positive feelings. And then we also found that individuals who lived in the deprived wards had comparable engagement levels to those who didn't.
And that was really key actually, because especially as we targeted deprived wards. So it was really interesting actually to see that finding. And then in terms of the findings totally, we did have a large number of people who dropped out and I think that's a real key learning for us for various reasons. And you know, I'll let Mike touch upon the focus groups that we did with those individuals who disengaged. But it's really key to realize that people do drop out for whatever reason. You know, if I use the second cohort, during summer holidays or some individuals may have dropped out for family commitments etc. But having said that, the findings are really important as well, so I don't know Mike if you want to come in in terms of the dropout.
Michael Salmon: Yes. I also just kind of back up what you first said as I think it's a really important point about people's step counts. So, the Move Spring app allowed us to access with the users’ permission, allowed us to access their historic step count from 30 days prior to downloading the app. And that gives us an idea of what they were doing beforehand before the programme started, before it was even in their mind, I suppose essentially because we do have this assumption, a lot of the time that people overestimate their levels of physical activity. But this app told us that people who had literally filled out a form on the website saying they do less than one day physical activity a week were actually doing around about 5000 steps a day, so it does really demonstrate the importance of getting some objective data to kind of complement the surveys and all that sort of stuff that we do to pick up on the kind of latter point that Shanara has made, it's really important to draw a distinction, I think, between those who finished the programme and those that didn't, because I think kind of from my point of view, I think the learning around drop off was possibly the one that we'll use the most.
Moving forward in terms of informing future work, because if I kind of give you a flavour of what it look like, the vast majority, I think the vast majority of participants dropped out at some point apart from the ones that Shanara mentioned, that got to the end and actually did increase their step count, which was great and for cohort one, I think we originally had 222 people were sent the link to the app, just 116 actually downloaded the app. And I think that's really important to point out. So we've pretty much cut our registrations in half before we've started. Then one week later when the project started a further 28 disengaged so then we were left with 88 people responded to the push notification and every week that went down and down a little bit and until the end.
So, we quickly decided, as Shanara referenced, we quickly decided we needed to know why. And so, we reached out to some of those people who disengaged before week one, and we, well, essentially, we incentivized them to be part of a focus group and the clear feedback that we got back was that there was significantly more technical support needed if we're going to use an app to deliver a physical activity intervention. So, people might have smartphones, but the literal process of downloading an app is something that a lot of people actually find quite difficult. Then you’ve got to create a login on the system. Then you've got to sync your phone, the pedometer on your phone to the app, which was a real pinch point, probably the most significant pinch point and we, I think we just realized that there were just too many points where people had the opportunity to say forget this, you know, and like people gave themselves the reason to stop essentially. So, cohort two was slightly better in some ways. We put some specific capacity in place to help people with the download issues. But you know, we still saw that kind of quite clear drop off week by week. I think what it was, we probably left it too long between downloading the app and starting the project. I think you've got to keep people engaged or you'll lose people, so recruitment was absolutely fantastic and that's a real kind of plus point to get from this. But in terms of kind of what we did there, keeping hold of people just proved really difficult. And it's such a really important learning because it shows that there's a demand. But there's an intention gap as Shanara referenced there’s an intention gap that needs to be bridged, we had more than 500 people sign up and almost 600 people sign up. But the vast majority dropped out before the programme started so there was just too long, too many reasons to give that would get people to drop out. Part of that was just because the capacity we had. You know, we're trying to do work with public health during a pandemic. And so capacity is going to be a real problem. And Shanara was absolutely flat out on all of this in terms of kind of responding to the emails. But it was just one of those things. I think we realized after the first cohort that if we're going to do a programme like this, there just needs to be more, a little bit more hand holding, some more personalized feedback, maybe to kind of encourage engagement, encourage motivation, possibly use of incentives. That sign up should be explored to help people kind of just pull them through the programme. Lots of things that come out, lots of really fantastic learnings actually that will really kind of help us as we move on.
Rhian Gladman: That interesting point about you know, it's what we call friction, isn't it? In behaviour change. So you know if we build those, if those barriers are in front of the behaviour that we want to encourage, it's just that bit friction every time, isn't it? And it’s like you say, it gives people an excuse as well. That's a bit too hard. So, I guess that's key learning isn’t it how can we make this behaviour as easy as possible there is that intention people do want do something in this space. You put it in front of them visually with a great marketing campaign. It works as a solution, there was just those, those friction bits in front of it wasn't there. So, lots to learn there lots to take forward. Did you get any sort of qualitative feedback as well as the numbers? Did you get qualitative feedback from what people were telling you?
Shanara Abdin: Yes, we had some really good feedback actually also from individuals who actually completed the entire programme. you know, if I just give you a flavour of some of the feedback that we've got. So, the challenge helped me, helped an individual create a walking habit and they felt they had more energy, felt better and will try new things. And similarly, there was individuals who said that they didn't hit the target every day, but they still managed to get and go out and do some form of step count most days, and given that they were near on nothing at the start, this was a huge change for them. And I think it's really important, especially on the feedback to mention the quick wins that we can get. You know, as Mike said it to start, we're not you know, we're not wanting anyone to run a marathon, it's very much for individuals to realize that you know what physical activity can be easy, you know, it can just be going for a walk or going up and down the stairs, you know, even vacuuming. It's that very much telling individuals that everything we do, we do some form of physical activity a day. We just don't realize it. So, I think that was a key and I think the feedback helped, especially with individuals who dropped out as well you know and Mike said that we had that kind of qualitative feedback from them in terms of barriers and that's really good learning for us to take it forward, whether it's us, or other councils as well to learn from the way we've done things. You know and the caveat is it was during a pandemic, but it was in some ways actually worked quite well, you know. Yes, it was during a pandemic, but I think we were able to use like the relationships that we had with community groups or the vaccine work that we did. You know, we have the faith leaders. So, we were able to rely on the relationships as a result of promoting it, you know promoting the programme or working with them and stuff. So it was really, it's really important feedback that we can take forward, and I don't know Mike if there’s anything else that you want to add but.
Michael Salmon: No I agree with that completely. And whilst I've kind of just spoken a little bit about what, what maybe didn't go right in terms of people dropping off lots and lots did go right and it was a really important project for us and one that I would see as a success in lots of ways, partly because of the kind of success of the partnership which was established beforehand, but we worked really well together in terms of kind of complementing our learnings from previous programmes and putting it all together to come up with a project that worked really well in terms of recruitment and kind of develop learnings for the next iteration, whatever that might look like and kind of what comes next. So, you know, really, really positive one from our side of things as well.
Rhian Gladman: I want to go back to that point around digital engagement Shanara. You mentioned that there wasn't a difference between the different socioeconomic groups in terms of people actually taking up a digital intervention. I think that's a really important point for digital exclusion, isn't it? digital inclusion and has that sort of, has that changed, maybe some of the councils approaches around digital interventions? Is there rich learning there?
Shanara Abdin: There is definitely, I know wider with our kind of corporate team. They are looking on, you know, we've got a specific digital strategy now and it's all that infrastructure and I think COVID’s actually been a massive help in that in all of us realising that more and more people are now digitally included you know pre-covid there may not have been but at least we realized now that they are and we can kind of jump on that we can utilize that you know as whether it's as an intervention or just generally getting the communication out to individuals, you know and I think that's the key thing because pre COVID we had that digital exclusion we a lot of us just assumed that individuals weren't especially from a deprived ward didn't have the resources or the capability to you know use some form of digital kind of aspect really. But then through COVID we’ve offered training we’ve offered, you know, free technology, all sorts. And I think that's helped and we were able to kind of flourish using that. I mean this intervention only worked because it was digital. If it wasn't digital, I don't know how we would have done it because especially when we kicked off, we couldn't do face to face interventions anyway. And the good thing about this digital side of things was that people were able to do it on their own accord, so they didn't have, like, specific sessions that they had to, you know, zoom into or join into. It was very much individuals can do it in their own time, can do it with their friends or if they want to do on their own, you know, they we offered that through the Move Spring app. And I think that's really key, and it was key learning for us. I mean this is the first time we have ever done a first digital behaviour change intervention. So the things definitely innovative and that I think that's the impact really from this that, it was a first time pilot and we've learned a lot and there's a lot that we can take from all this into different aspects of the work that we are all involved in.
Rhian Gladman: So, I guess that's my next question, you've led me beautifully onto Shanara. So, what are the next steps for the council, for your partnership with the active partnership? From what you've learned through this project?
Shanara Abdin: Yes sure, so if I start about what our next steps are for the council and then Mike can come in. So, for us from a council perspective, it's very much further work on around the intention gap that we discussed earlier. So, for residents who want to increase their physical activity, it's demonstrating just how quick it really is that you can be physically active. As I said, gardening, vacuuming, you know, we're doing some work around, active retirement internally. So, it's just reminding people that, you don't need like a full gear to go for a walk or to be physically active. And then the major piece of work that we are involved in is so - Wolverhampton’s part of the Government's health incentives pilot study. So that's from the Office of Health Improvement and Disparities. And that actually consists of an app which consists of residents increasing their physical activity levels. But this focuses on healthy eating as well and it's based on incentives using an app. And at the moment we're in the early stages, so you know we're asking residents to sign up, but we are able to take learning from our WV gets active piece of work and I do appreciate sample size for our piece of work is a lot smaller than this health incentives pilot that. But nonetheless we are still able to thrive on those you know learning so target, the community groups, food banks, various kind of stakeholders really to increase uptake for the health incentives pilot as well. So, that's where the, that's where we're kind of leading for the next steps and I'll hand you over to Mike now, who will talk about all the things-
Rhian Gladman: I was just - yes, I just it's that key point, isn't it? Like you’re saying around the motivation, the access, you know those key behavioural, sort of skills, really, aren't they? You need that motivation. You need to know it's there and it needs to be easy for you to build into your life. I think that's they’re the key things you've learned from this project that could go into that wider health incentives programme, aren't they?
Shanara Abdin: Yes, totally. It's giving individuals that, you know the knowledge and the capability that there is this programme or there is this app and if individuals want to go ahead with it, they've got that intention that will link in with their motivation to carry on and then opportunity. So, it could be individuals you know maybe they for language barriers, they just aren't aware of how to access the app. So it's where training comes in. It comes with working with our community groups to translate information in different languages because you know if anyone can do physical activity in terms of going out for a walk, it's all very much kind of linking in with health inequalities as well. So, if individuals who for example, are disabled and how do we work with them to get them on board on a programme like this? So yes, definitely, it's all around the capability of individuals and giving them the motivation and the skills to actually go off and do it. So that's the whole point really of the intervention these six-week interventions that we do, it's you know, we give them the skills and then. The ideal is individuals carry on that behaviour post six weeks after we've left them. You know, they've maintained that behaviour and it is difficult. It's not easy to change people's behaviour, you know, and you can have individuals relapse in the sense that, you know for six weeks, yes, totally on it, going for a walk and then for something for some reason something happens. They stop going for their daily walk and then they're back in terms of not doing physical activity. So yes, totally. And that's what we're taking forward in all the pieces of work that we're doing.
Rhian Gladman: Sorry, Mike, I interrupted.
Michael Salmon: No, not at all. Yes, I mean, it's a huge year for the partnership. So, we've got the Commonwealth Games in the West Midlands this year. Now the bulk of that's in Birmingham. But there's plenty going on across the wider West Midlands met area. So, we've got the Aquatic Centre in some of the cycling time trial starts and finishes in West Park in Wolverhampton and we're working in the Black Country to enable a legacy of physical activity from those games. So, there's going to be delivery taking place in all of our local authority areas and the principles of behaviour change are playing a massive part in all of that. We've developed a behaviour change framework that will essentially underpin our approach to engagement and WV gets active has hugely kind of supported the thinking behind part of the developments of that framework and the learnings that have come out of this programme are kind of around ensuring there's a personal touch and that people are supported every step of the way. You know, it's really prevalent in that primary - there's no, there's no one size fits all, and we've got capacity in place that can kind of almost act as a triage and service. So, that kind of people are signposted to the offer that's most suitable for them. So, it's going to be a really exciting year and working on this programme with Shanara has really kind of taking our thinking to a new level on this.
Rhian Gladman: Yes, I think the strength of your partnership really has been a huge factor in the success of this project. So yeah, I think just a really good template for how other councils and active partnerships across the country can work together on behaviour change. it's been a great project. So, my final question is, if I'm a council listening to this, if I'm a busy councillor or council officer thinking, yes, this is something we need to do, how do I get this project into place in my own authority so what would be your top three tips for somebody at another council looking to implement a similar project to WV gets active?
Shanara Abdin: Okay, so my first tip would be don't reinvent the wheel, so if there's a programme, if there's an app that's already on the market, I mean it doesn't have to be Move Spring and you know any other app, look into it. And you know, it'd be great if all of councils can get a dedicated app localized, but let's be realistic. There's a lot of work and time that goes into that. So, utilise an app that's already out there and even better if you can localize it to, with Move Spring, we were able to localize it, to make our residents, aware that you know what this is Wolverhampton based. It's, you know, made for created for our residents, so that would be my top key kind of tip. Don't reinvent the wheel. Go with what's out there, you know and try it. Trial it out, you know, it could be that you do a pilot with a smaller cohort, smaller residents and then kind of cascade it out to everyone and that's where our scoping phase came into play. Really, you know we were able to trial the app. And I know Mike, and I had a play with it. It was a new thing for all of us. Not many of us are used to an app. But yes, that would be my suggestion. Don't reinvent the wheel. Use something out there I think I don't know Mike if you want to come in.
Michael Salmon: Yes, I think I've only got one really, which doesn't add to three. So, sorry Rhian but be bold and be prepared to fail. I think because kind of, the things you learn on the way will still advance your thinking and if you see everything as kind of an iterative process over time, you don't have to get it absolutely spot on the things that you do get right like there's so many things out of this programme that we're taking on that we know we got right that can support us in other things. And just because all 500 people who registered didn't increase, that doesn't matter as much as what we got right and what we can take on to the next thing because there will be a next thing. So yes be big, bold, and be prepared to fail. That would be my take.
Shanara Abdin: Yes, I think I can actually make it to three tips now. Thinking out loud, just utilize your existing partnerships. So honestly, we could not have done this programme without Mike and his team you know, so you utilize those relationships that you already have, the partnerships that you already hold and it just makes it a lot easier to do a piece of work and all of this was remotely. You know, we haven't met our consultant, they're based in London. All of this completely remotely. And I think that's something that we have to take away is that we can deliver interventions remotely and it is possible, but we do need that partnership in order to make it work.
Michael Salmon: Echo that completely good show.
Rhian Gladman: Guys, thank you so much for your time, Shanara and Mike. Really appreciate you taking the time to come on and share your learning about the WV active project and wish you well in the future with your behavioural change and behavioural insights endeavours. Thanks again guys.
Michael Salmon: Thank you.
Rhian Gladman: Okay, so if you'd like to learn more about the behavioural insights projects, that you can try out in your council, please do visit our website at www.local.gov.uk and search for behavioural insights. We'll have the report from the project that Shanara and Mike were talking about from Wolverhampton on our website, so you can have a look at that. And we also have a host of other nudges for social good that you can learn from and use. Please do share this podcast with your colleagues and your friends as well and many thanks for listening.