Quantitative and Qualitative Research to Assess the Impact of the Alcohol Self Help Leaflet Liz Ambler Regional Alcohol Programme Manager East Midlands
Background DHEM, building on the work of a pilot in the NW region, used a Direct Marketing approach to require respondents to request a self-help booklet Approximately 4000 people requested the booklet, 600 of whom agreed to further followup, providing a viable cohort for this research
Survey Methodology DHEM provided a list of individuals to DJS research, who had requested the leaflet and opted in to providing feedback (200 by telephone, 400 by post) Telephone surveys (10-15 minutes) were carried out with 100 individuals, and a further 78 completed a postal survey (Because the telephone survey was longer, some data is based just on the sample of 100, other key questions combine the telephone and postal samples) Fieldwork was carried out in October-November 2009 (approx 14 months after the leaflet had been sent out)
Age and Gender Profile 8 7 Male Female 16-24 yrs 25-34 yrs 6 5 1 5 35-44 yrs 4 13 55 45 45-54 yrs 3 18 55-65 yrs 2 23 >65 yrs 1 39 0 10 20 30 40 50 % respondents % respondents
Frequency of Drinking % respondents 100 90 80 70 60 50 40 30 20 10 0 3 17% drinking < 3 days per week 9 5 22 80% drinking 4+ days per week 6 7 1 2 3 4 5 6 7 45 Almost half of those for whom the leaflet was requested were drinking daily. Most were drinking more than 4 days a week.
Recall and Usage Reason for Request 7 Drinking more than the recommended number of units 67 Others were concerned about my / their drinking 6 34 Drinking was affecting my/their physical / mental health 5 27 Drinking affected my / their relationships with others 4 18 I / they regularly got early morning shakes after drinking 3 12 Drinking affected my / their work 2 I/they regularly experienced blackouts following drinking 1 8 7 0 10 20 30 40 50 60 70 80 % respondents A key reason for requesting the leaflet was due to drinking more than the recommended number of units.
Those for whom the leaflet was requested have engaged with the content, calculating units and risk levels. Less engagement with the steps, or getting help beyond the leaflet. Recall and Usage Action Taken Calculate the number of units you drink 11 77 Calculate your risk level 10 63 Complete Step 1 reasons to change Complete Step 2 set your goals 9 8 28 27 Complete Step 3 know when you might slip up 7 16 Complete Step 4 plan for the times when you might slip up 6 14 Visit your GP about your drinking 5 14 Complete the Units Tracker at the back of the leaflet 4 10 Other 3 7 Visit the NHS Drinkcheck website 2 6 Called the helpline number 1 5 % respondents 0 10 20 30 40 50 60 70 80
Perceptions of the Leaflet Many of those surveyed reacted positively to both the level of information given and the layout of the leaflet particularly the language used and the lack of judgement/condescension Some commented on the momentum the leaflet gave them to face up to their problems Some felt that more information would have been beneficial (particularly local services) and that it needed to be more shocking
Impact of the Leaflet Reconsidering Views on Drinking More aware of the health risks 6 72 More aware of how much I/they drink compared to safe levels 5 63 More aware of how to control drinking levels 4 47 Any other change to drinking behaviour attitudes 3 17 I am now trying to work out why I was doing it. None of the above Don t know 2 1 1 11 I m now much more aware of my own behaviour. 0 10 20 30 40 50 60 70 80 % respondents The leaflet has helped inform 72% of readers of the health risks of alcohol, as well as helping them to understand and control their intake. Several also mentioned increased self awareness
Impact of the Leaflet Action Taken Reduced the volume of alcohol bought 8 53 Kept track of the quantity of alcoholic drinks 7 48 I ve been to an NHS Addiction Unit Had more days drink free 6 47 Talked to someone else about your concerns 5 17 None of the above 4 12 Taken any other action relating to your/someone else s drinking Stopped drinking alcoholic drinks since reading the booklet 3 2 4 6 Go out more so I m not drinking alone in the house Go to the gym to help my depression. Don t know 1 3 0 10 20 30 40 50 60 70 80 % respondents Around ½ of all respondents have reduced the amount of alcohol they buy, keep track of how much they drink, and have more days drink free. Some commented on real lifestyle changes.
Tangible Impacts on Consumption* * Calculations based on those who ordered leaflet for themselves and gave detailed consumption data Over 100 (14+ per day) 50 to 100 (7 to 14 per day) 30 to 49 (4 to 7 per day) 21 to 29 (3 to 4 per day) 11 to 20 (2 or 3 per day) 3 5 6 8 9 12 17 Before After -11% 24-12% 24 +8% 32 Over half (51%) have reduced the number of units consumed per week 10 or less (<2 per day) 22 +16% 38 0 5 10 15 20 25 30 35 40 Further analysis suggests a significant reduction in units consumed per week, although fewer of the most at risk drinkers have reduced their intake.
Tangible Impacts on Consumption* MEN WOMEN BEFORE AFTER BEFORE AFTER INCREASING RISK 46% 36% (-10%) HIGHER RISK 19% 10% (-9%) 64% 32% (-32%) 16% 10% (-6%) OVERALL DECREASE IN INCREASED RISK DRINKERS 19% FOR MEN 38% FOR WOMEN 28% There appears to have been considerable reductions in the proportion of higherrisk drinkers, although a significant proportion remain at risk
Tangible Impacts on Consumption Extrapolating the Data % who found the leaflet useful 87 % with increased awareness of health risks 72 % Reduced volume of alcohol bought / units 51 to 53 % with more drink free days 44 to 47 % reduction in higher risk drinkers 28 Based on 4,000 people receiving the leaflet: 3,480 found it useful 2,880 had increased awareness of health risks 2,080 have reduced the volume of alcohol bought / unit intake 1,800 have more drink free days 1,120 are no longer increased risk drinkers 400 passed the leaflet on to someone else
Case Study Janet** ** names have been changed Depressed drinker Divorced mother of three, lives with 14year old son Almost 20 years full time work with the NHS (Medical Secretary) She swims a lot and does aerobics and thinks she has a reasonably healthy lifestyle *The leaflet+ made me realise that wine was making me more depressed, that it was wasting my money and I put on loads of weight because of my drinking. It just ruined my whole life.
Case Study Janet** Before the Leaflet In 2008 she became depressed with her repetitive routine, stopped going to the gym and turned to alcohol It was every single night. At the worst point I was drinking two bottles of wine a night, it was absolutely ridiculous. When I look back, I think What an absolute state. I was absolutely off my head, texting and calling people, crying down the phone because the wine had made me depressed. When she saw the leaflet advertised she requested it in the hope it would shock her into taking action I knew it went through all the pitfalls of alcohol, and the medical conditions it can cause and I thought that, maybe by reading it, it might shock me and give me some ideas on what I can do to cut it down.
Case Study Janet** Thoughts on the Leaflet She was impressed with the level of information and it confirmed that her drinking was beginning to impact on her health The main thing was how much you should be drinking, and it gave all the units, and what the safe guide was. It gave a free helpline number. I think I called it to get some advice, but the real shock was what safe drinking was and about how it s more detrimental for woman.
Case Study Janet** Impact of the Leaflet She hasn t stopped drinking completely but the leaflet has made her aware of what falls within the limits of safe drinking I m still drinking almost every night, but within the safe guidelines. I ve got a little plastic cup and I know how much to pour and it s a couple of *Weight Watchers+ points, but it s not in the huge quantities I was having before. She believes that the leaflet could benefit from motivational testimonials to show people in a similar situation that the advice can work I d definitely show the leaflets to others in a similar situation and just tell them my story and I d say that if they ve got a problem then they need additional help.
Case Study Bob** Boredom drinker 64 year old man, twice married, divorced and now living alone Has 2 grown-up daughters and 3 grandchildren Works as a civil engineer, has no financial worries and is a keen gardener Considers himself in good health Some nights, after I d had about 4 or 5 cans, when I moved onto the spirits, I was drinking probably half a bottle of vodka.
Case Study Bob** Before the Leaflet Would drink every night alone at home from about 8pm onwards, having finished the housework, as well as at weekends with friends I was on my own, I m still living on my own now. It was more for comfort; I got into the habit, rattling around in a big 4 bedroom house. I still go out now on a Friday night down to my local. I used to drink a lot not falling down, but I d be wobbly. A gang of middleaged divorced men, we d all just have a good drink. Despite having a compulsory annual medical as part of his job, he hid his drinking from the doctors I did tell them (the doctor) a few fibs before I cut right down. I think that was just cowardice on my part.
Case Study Bob** Thoughts on the Leaflet He had a complete understanding of the risks of heavy drinking and alcohol units, but hoped the leaflet would give advice on cutting down and stopping drinking I d looked at other things in the doctor s surgery, things on the wall, but this was a little bit more in-depth. He read the leaflet from cover to cover, filling in the sections. He wasn t shocked at the content but was surprised at how many units he was drinking I knew, after I went through the leaflet and having spoken to my daughter, I knew I was on that road to getting deeper in. The leaflet was the final nail in the coffin, to say you re on your way.
Case Study Bob** Impact of the Leaflet It hasn t stopped him drinking completely, but he no longer drinks alone, just in the pub with friends on a social basis I haven t stopped drinking altogether but I m not getting drunk and I m not getting wobbly. I ve cut down and, from having 8 or 9 cans a night, I don t bother. It s just a Friday night now and I don t get wobbly then because of the price and I don t want to lose my job. Overall the leaflet made him aware of what he s doing to himself and he has cut his consumption significantly. He also keeps track of what he drinks when he does go out I know what my limitations are now, I know what I m doing.
Key Messages Recall of the leaflet is surprisingly high (96% recall receiving it), particularly given the time elapsed Feedback on the leaflet is generally very positive: The messages around risk level and safe unit consumption levels are powerful, and a shock to many The leaflet was generally regarded as well presented and accessible In particular, people liked the fact that it wasn t judgmental or condescending More detailed information on further support available would also be welcomed
Key Messages The leaflet appears to have been a prompt to seeking further help for some, with 17% opening up to someone else about their concerns The key reason for 67% of those surveyed who requested the leaflet was concern about drinking too many units The findings showed that recipients of the leaflet were often drinking at dangerous levels, with many (80%) drinking 4+ days per week. Nearly half (45%) were drinking every day Further analysis and qualitative feedback suggests that a large proportion of the sample was characterised by older (aged 44+) drinkers, often drinking at home alone to relieve boredom or depression
Key Messages Those who requested the leaflet for someone else had particular concerns about alcohol s effects on colleagues relationships and health The case study examples demonstrate that the leaflet has been life changing for some, and a catalyst for change for many Despite these successes, a significant proportion of the sample remain higher risk drinkers, and these individuals often suggested that further support is necessary to lead to real behaviour change Most suggest that face-to-face support may be what is required for more extreme cases, and any future campaigns should provide more detail about local support networks a similar leaflet could be enough of a catalyst to encourage individuals to seek support
Acknowledgements and Further Information Research carried out by DJS Research http://www.djsreseach.com A copy of the full report can be found at: http://www.alcohollearningcentre.org.uk/_library/direct_ Marketing_in_the_East_Midlands.pdf