Strength messaging insight report

Exploratory research

We started working with BritainThinks in January 2020. We gathered insight from published research, stakeholders, our member survey and focus groups to understand more about our members’ experiences of talking about strength.

We sought crucial perspectives from people living with LTCs through online diaries, in depth interviews and focus groups to understand more about their experiences, what motivates them and their barriers.

Key insights and motivations

Key insights from people with LTCs

1. There is no ‘typical’ inactive person with a long-term condition: this is a highly diverse audience both in terms of the nature and impact of health condition and also in terms of mindset, experiences of physical activity, demographics and lifestyle.
2. The concept of strengthening activity is much less front-of-mind than cardiovascular exercise / physical activity more broadly, while baseline awareness and understanding of strengthening guidance is very limited.
3. There is considerable potential for confusion when providing strengthening guidance and a risk of conflation with moderate physical activity more broadly, with the CMO/NHS guidelines perceived to be vague and unhelpful.
4. There is some underlying desire to do more general physical activity and interest in understanding more about strengthening activity – suggesting some potential motivation to change behaviour for the CSP initiative to tap into.
5. Short-term benefits of strengthening related to ‘doing more’ (e.g. ability to complete daily activities) and ‘feeling better’ (e.g. managing the condition, improved mood or self-esteem) tend to be more motivating than longer-term medical benefits.
6. In addition to low awareness and understanding of strengthening activity, a perception that their condition inhibits activity or would deteriorate as a result is widespread – though there is a wide range of additional barriers faced by this audience.

Motivations for people with LTCs

• There is only a vague awareness of the benefits of strengthening
• Initially, most simply articulate the benefits of strengthening simply as “exercise is good for you” but on deeper consideration, many can think of more specific benefits – but these are generally applicable to any physical activity:
  • “Getting stronger”
  • “Feeling a sense of accomplishment”
  • “Cheering you up”

Key insights from physiotherapy staff

1. Physio staff all strongly believe strengthening to be important, have a detailed understanding of the benefits and claim to frequently provide strengthening advice to patients. They are likely to be willing messengers for the initiative.
2. Knowledge of the CMO strengthening guidelines is only mixed and there is considerable criticism of them in terms of how useful, clear and instructive they are. This means that they are rarely used in practice when providing guidance.
3. Instead, the strengthening advice that physio staff provide varies considerably. Some of this is due to a requirement to be patient-specific – but there is also significant inconsistency in terms of motivating message and supplementary resources.
4. Physio staff – particularly NHS staff – perceive a number of challenges to providing strengthening advice, including low patient understanding and motivation, lack of time in patient contact, lack of resources and contradictory advice from other HCPs.
5. Most physio staff have a good understanding of the motivations and barriers faced by the target group – but can underestimate softer, more emotional motivators (e.g. body image, self-esteem) and barriers (e.g. embarrassment, low mood).
6. Physio staff are often narrowly associated with short-term treatment of injury and recovery, with patients not looking to them for longer-term health, lifestyle and behavioural advice.

Recommendations

1. Make messaging relatable
2. Provide tailored guidance
3. Set a specific, memorable target
4. Raise widespread awareness
5. Ensure inclusivity and accessibility
6. HCPs, friends and family, and informal online networks are viewed as key sources of advice on health and lifestyle.

Pre-creative testing 

As the Covid-19 pandemic developedwe recognised the need to explore the impact of lockdown on our target audience and, to help enhance the findings from the insight, test some ‘rough’ draft stimulus. This included testing of visuals, tone and narrative.

In May 2020 we carried out this ‘pre-creative testing’ phase,using online methods and telephone interviews to ensure the project remained on track and on time.

Key considerations

1. Make inclusivity and relevance explicit
2. Avoid negatives and focus on positives
3. Remind of the (future) benefits
4. Avoid references to ‘pain’ or ‘tiredness’
5. Use the notion of starting small and improving
6. Offer a range of options for strengthening
7. Avoid use of ‘technical’ language
8. Use a target but ensure it is realistic and flexible

Creative development

Five possible creative routes were developed with different conceptual approaches to support the initiative.

Creative routes

Recommendations

1. Choose between ‘Better with strength’ and ‘Stronger My Way’ to take forward – but incorporate the best of both.
2. Select the lead visual very carefully to ensure it is engaging, relevant and clear.
3. Balance the need for tailoring with a lack of expertise and confidence.
4. Explain how strengthening activity can be done.
5. Reassure physiotherapy staff that they will have control over the process.
6. Signpost to further resources to achieve behaviour change.

Strength messaging dos and don'ts

Do…

• Say ‘gradually increase’
• Say both ‘maintaining’ and ‘improving’ strength
• Use everyday, simple language (e.g. raising your leg)
• Convey that strengthening is easy
• Provide a target and show strengthening is accessible (i.e. at home, with everyday items)
• Talk about choosing from ‘approved’ exercises
• Refer explicitly to strengthening and to the audience having health conditions

Don’t…

• Say ‘gently increase’
• Only say ‘maintaining’ or ‘improving’ strength
• Use words seen as jargon/technical (e.g. calf raises)
• Explicitly say strengthening is easy
• Use unnecessarily patronising terms (e.g. lifting ‘small’ bottles)
• Ask the audience to ‘design’ a programme of strengthening
• Be vague about the target audience or message

Concept development

We tested tested two concepts:

1. A tailored, progressive strengthening programme that builds towards achieving a meaningful, quality-of-life goal set by the patient and supported by physiotherapy staff.
2. A communications campaign to encourage strengthening that’s based around informative, inspiring resources that physiotherapy staff can use to support their conversations with patients.

Resources

We asked which resources would be most useful to support physios personally in encouraging people with long-term conditions to undertake strengthening activity more regularly. Their answers are below:

The most popular resources were training for physios and tools that patients could engage withindependently.

Key insights

Putting it into practice

In December 2020, we allocated budget to support the development of the leading concept, Stronger My Way.

MOVE Consulting, specialists in behaviour change, are working with a steering group of physiotherapy staff from all parts of the profession to understand the real world application of the project’s learning.

This partnership will identify and test products and tools that support engagement and adherence in strength-based activities for their patients.

Outcomes

The outcomes sought from this phase are:

• Identify design characteristics for a strength-based behaviour change product/tool.​
• Highlight good practice / tools utilised in existing programmes and campaigns. ​
• Co-design strength advice, targeting physiotherapy staff across multiple settings.​
• Identify, co-develop and test resources and tools to support delivery of strength advice.​
• Provide a project report, detailing ‘proof of concept’ for influencing practitioner behaviour.​
• Create ‘Phase Two’ recommendations to support scalability of the project.​

The findings of this phase will be presented in late April.