Views on how to increase the awareness and uptake of Best Start Foods
This section includes views expressed directly in response to question 1, as well as views pertaining to awareness or uptake on Best Start Foods ( BSF) expressed in response to other questions (in particular questions 2, 4 and 5). Respondents raised the following points:
- The need for an awareness campaign
- The roles played by key stakeholders in raising awareness and uptake
- The role of retailers in promoting awareness and uptake
- Removing stigma
- The application process and eligibility criteria for BSF.
Each of these points is discussed in more detail below.
This chapter is concerned with awareness-raising about BSF and practical barriers to the uptake of the scheme, whereas Chapter 4 discusses possible initiatives to promote healthy eating habits. There is some overlap between the two areas, as education initiatives might also impact on the awareness and uptake of Best Start Foods. However, to avoid repetition, broader comments on education about healthy eating habits are covered in Chapter 4 only.
2.1 The need for an awareness campaign
A large majority of respondents saw a need to increase awareness of Best Start Foods amongst low income pregnant women and families, as well as those agencies and professionals with whom they engage regularly.
It was highlighted that direct awareness raising could be conducted through:
- Mainstream media
- Social media
- Visual marketing materials ( e.g. posters and leaflets) distributed at local community facilities, ELC and schools, healthcare facilities, social security services, retailers etc.
- Many respondents suggested including an information pack on Best Start Foods in the Baby Box that is sent to all pregnant women
- Some respondents suggested engaging a Scottish celebrity or chef in the campaign.
A partnership approach involving local authorities, the Department for Work and Pensions, the NHS, the Scottish Social Security Agency and Third Sector organisations, such as community food initiatives and welfare rights organisations, was suggested by some respondents as key to a successful awareness campaign. A few local authorities pointed to successful partnership working in their areas, which could be built upon to promote awareness and uptake of Best Start Foods.
Things to keep in mind for the campaign that were highlighted by respondents include the need for consistent branding and the provision of clear guidance, made available in a range of languages and in both digital and paper formats. Using positive messaging was suggested to partially address the stigma associated with the food vouchers. Many respondents pointed out that the awareness campaign should have a broader reach than just eligible pregnant women and families, which would also reduce stigma as well as increase general awareness and uptake.
2.2 The role of frontline staff in promoting awareness and uptake
The role of certain agencies and staff was seen by most respondents as key to raising awareness and uptake of Best Start Foods. The stakeholders most frequently noted were: healthcare professionals, early years providers and schools, local authority and third sector welfare rights advisers, and staff working in social care and community roles. Respondents thought that if these professionals were themselves made fully aware of the scheme, then information would 'cascade' through them and reach eligible families, although they did not think this eliminated the need for the broad public awareness campaign mentioned above.
The possibility to deliver training about Best Start Foods to frontline staff or include it as part of their core training and Continuous Professional Development events was also highlighted by some respondents.
Having 'Best Start Champions' or 'embedded workers' in each Local Authority of Health and Social Care Partnership, to promote the scheme to frontline staff, was also suggested. For example, a respondent commented that:
'In the current climate having a specific person available to offer information about income maximisation linked directly to other services for families and parents to be could be a useful step. This person could attend antenatal clinics, parent and toddler groups and nursery settings to offer information about the new system and other related benefits and support for families.' (Third sector/ community organisation)
The role of healthcare professionals, particularly midwives and health visitors, in making parents aware of their entitlement to the scheme was highlighted by most respondents. It was pointed out that all parents have contact with these health professionals during pregnancy and the early stages of a child's life. Supporting evidence was cited by the University of Bristol showing that 'most parents are introduced to Healthy Start by their midwife or health visitor  '. In addition, NHS Health Scotland pointed out that:
'the Scottish Maternal and Infant Nutrition Survey 2017 reports the most common routes for finding out about Healthy Start were the midwife, health visitor and Ready Steady Baby!. These would seem to be the most promising routes for increasing awareness'. ( NHS Health Scotland)
Specific ways in which health professionals could raise awareness and uptake of BSF that were mentioned by respondents were:
- Integrating the BSF scheme into the Health Visitor pathway. A NHS Board pointed out that:
'There are tick box sections for other schemes such as Childsmile but not one for Healthy Start [ BSF]. A health visitor has to remember a lot of information at each visit so having a box to tick would be a prompt to mention Healthy Start.' ( NHS Board)
- Completing the application to BSF within the initial midwifery appointment
- Include information on BSF in NHS resources for pregnant women, such as 'Ready Steady Baby!'.
It was also felt that Early Years providers, schools and childminders should be well informed about Best Start Foods, so that they can provide and support to parents and families. Suggestions for awareness raising included school/ ELC e-mails, newsletters and open days. Toddler and parent groups were also identified as possible targets for an awareness raising campaign.
Amongst the Third Sector, organisations providing advice on welfare rights and financial inclusion, as well as organisations distributing food, e.g. food banks, were mentioned by many respondents as additional points of contact with families. It was suggested that Best Start Foods were aligned to the 'Menu for Change' initiative, which aims to tackle food insecurity in Scotland.
2.3 The role of retailers in promoting awareness and uptake
Most respondents agreed that a partnership with retailers was crucial to raise awareness and promote uptake of Best Start Foods, as shops are the most immediate point of contact with users.
Many respondents thought that retailers should actively promote the Best Start Foods scheme. Many respondents also identified ways in which retailers could contribute more broadly to a public education campaign on healthy eating – this is discussed in Chapter 4. It was suggested that retailers could promote awareness and uptake of Best Start Foods by:
- Clearly indicating that they accept Best Start Foods payments
- Visually identifying eligible foods – e.g. through a Best Start Foods logo
- Displaying and distributing Best Starts Foods marketing and educational resources – e.g. posters, leaflets, recipe cards, and information packs
- Sharing information on Best Starts Foods on their websites or social media accounts
- Having discounts and promotions on Best Start Foods products
- Having 'bundles' of eligible foods to the value of a weekly payment
- Having a stand or section of the shop with all the products eligible through Best Start Foods
- Larger retailers could have 'Best Start Foods champions' in the shop that promoted the scheme
- Engaging customers in a wider range of educational activities (see Chapter 4).
However, respondents felt that in order to maximise the potential of retailers promoting the scheme, they need to themselves be made aware of it and trained to promote it to customers (see Chapter 3 on the smartcard system). Moreover, retailers argued they needed to be supplied with resources for promotion. One retailer indicated they wanted:
'More promotion materials so we can make it clear we accept the vouchers, as it not only raises awareness of us as a place to spend the vouchers, but of the scheme as a whole, and we are in the heart of a low - income area, where take up is low.' (Retailer)
2.4 Removing stigma
Creating a positive image around Best Start Foods and removing any stigma associated with it was seen by many respondents as important to promote uptake of the scheme. In this vein, most respondents welcomed the shift from paper vouchers to smartcards, which they believe carry less stigma. For the same reason, a few respondents also welcomed the change in terminology from 'Welfare' Foods to 'Best Start' Foods.
To further create a positive perception of Best Start Foods, some respondents emphasised the need for a broad public education and awareness campaign that was aimed at the whole population, rather than at eligible families only. The implicit rationale appeared to be that healthy eating should not be portrayed as an issue relevant only to low income families. Many respondents also highlighted that the design of the new smartcard could further contribute to removing stigma (see Chapter 3).
2.5 The application process and eligibility criteria for Best Start Foods
A majority of respondents commented on the suggested application process and/or eligibility criteria for Best Start Foods when discussing how uptake could be promoted. Regarding the application process, there was a consensus amongst respondents that the process needs to be as simple and streamlined as possible. Therefore, the proposal to combine the administrative processes for Best Start Foods and Best Start Grant was welcomed by respondents.
Respondents suggested additional ways in which barriers to uptake could be removed from the application process. Many respondents pointed out that consideration needs to be taken of literacy and language barriers: wording should be clear; forms should be available in a range of formats (face-to-face, online, paper and by phone); and it should be possible to access forms in languages other than English.
A majority of respondents were of the view that uptake of Best Start Foods would be increased if eligible parents were automatically enrolled onto the scheme upon confirmation of pregnancy by healthcare staff, without the need for a separate application. For example, it was suggested that:
'there could be a notification from Health to the Social Security Agency ( SSA) with the parents' consent […]. The SSA could then automatically begin payment to eligible parents.' (Clackmannanshire Council – a focus group comprising local authority staff and third sector partners).
Many respondents also felt that the range of staff who can sign off the application form should be extended beyond health professionals to include allied health professionals, social workers, early years providers and community workers. It was argued that there may be a delay in seeing health professionals, whereas other staff might be in regular contact with the expectant mother or family. As such, they could raise awareness of the scheme and support them in their application.
Some respondents highlighted that the need to re-apply for Healthy Start Vouchers after the baby is born is a barrier for parents and families, leading to delays in receipt of the vouchers and, overall, in lower uptake. These respondents argued that the need to re-apply should be removed, leading to a continuous receipt of payments from the moment the pregnancy is confirmed.
Some respondents welcomed the enhanced eligibility criteria for Best Start Foods outlined in the consultation document but felt that eligibility could be enhanced further. Groups suggested for inclusion within the scheme were:
- women with insecure immigration status (such as asylum seekers)
- women aged under 20
- single women in receipt of Maternity Allowance
- families in receipt of Council Tax reduction (but not Universal Credit or Housing Benefit)
- low-income families who only marginally exceed the income limit or who have fluctuating incomes.
A few respondents argued that the eligibility criteria for Best Start Foods should be fully harmonised with those for Best Start Grant.