Learning from 25 years of preventative interventions in Scotland

8. Targeting Preventative Interventions

The majority of the case studies (10 out of 15) highlight interventions which have either been targeted at particular groups, or are a mix of targeted and universal support (e.g. Childsmile, Access to Welfare in Schools and BFNL). Examples of particular groups targeted in the case studies include; homeless people with complex needs (HFP), young first-time mothers (FNP), domestic abuse perpetrators and their (ex-) partners and children (the Caledonian Programme), and pregnant women living in deprived communities (smoking cessation in pregnancy).

A recent Scottish Government review set out the key attributes of person-centred approaches, which are: holistic; ethical; relational; strengths/ assets based and intensive.^[20] There were a number of examples of holistic support, meaning that they ‘start from a holistic understanding of the person and their needs, acknowledging the complexity and individuality of people’s lives.’^[21] Examples include the HFP - a holistic intervention that not only addresses housing needs but also the complex wider needs that drive homelessness, and FNP – which provides support services for families with very young children at risk of poor outcomes.

Many of the case studies describe examples of person-centred or family-centred interventions (family-centred interventions fall under the umbrella term of person-centred interventions ‘views the family as a whole, understanding the dynamics between its members, and the influence of this on their experiences). Examples of these include the FNP, the HFP, FSS, the Caledonian System and Access to Welfare in Schools). BFNL emphasised person-centred care by focusing on the individual needs of breastfeeding mothers and their families.

8.1 Prevention as a means of addressing inequalities

Several of the case studies illustrate how both targeted and universal programmes have been successful at reducing socio-economic inequalities. Examples include:

• The Childsmile programme which has supported a reduction in socio-economic health inequalities by reducing the gap in oral health inequalities between the most and least deprived quintiles of primary one aged children.
• The MUP case study which showed that the greatest reduction in deaths wholly attributable to alcohol was seen amongst men and those living in the 40% most socio-economically deprived areas in Scotland, indicating a strong potential to address health inequality.
• Financial incentives for smoking cessation - smoking in pregnancy is highly concentrated in more deprived communities, and the incentives for smoking cessation during pregnancy were found to be effective for women living in these communities.

8.2 Behaviour change

A number of the interventions described in the case studies were informed by behavioural research, or were designed to lead to changes in attitudes and behaviours. For example:

1. The delivery of the Childsmile programme was informed by behavioural science, used to introduce changes to incentivise dentists to apply fluoride varnishes and improve training and guidance for people working with disadvantaged families.

2. The BFNL case study shows how the model was designed to enable changes to attitudes to breastfeeding at the community level and over time, working with the youngest generation to build that knowledge from the start, develop, design and build local facilities to accommodate breastfeeding mothers and promote breastfeeding wherever possible.

3. Project PRIME is a collaborative intervention which brought together behavioural research, engineering design and government policy to improve motorcycle rider behaviour and prevent them being killed or seriously injured.

Examples of preventative case studies that are either informed by behavioural research or have demonstrated changes in behaviour span across legislation and regulation (MUP, 20 mph limits, Smokefree legislation), financial incentives (smoking cessation in pregnancy), examples of changes to the physical environment (e.g. safeguarding vulnerable road users) and holistic and intensive support programmes (e.g. BFNL, FNP).

Many of the case studies also highlight attitudinal changes, illustrated by some of the following quotes:

‘While the ultimate aim of the Caledonian Men’s Programme is behaviour change, given the relationship between behaviour, feelings and values, it also works intensively around men’s beliefs and attitudes.’ ^[22]

‘One of the teachers spoke about the need for young people to have the confidence to overcome the generational poverty that existed in the community and to see that employment could provide both a source of income and a sense of achievement and fulfilment. This was echoed by several parents who said that their attitude to employment had changed and they felt more comfortable in considering opportunities beyond the zero hours contacts they had been offered.’ ^[23]