Project context
About 1,500 people, predominantly men from Asian backgrounds, work as taxi drivers in Walsall. Research carried out for the project found that drivers faced a range of health and social problems. Drivers are often self-employed with extended family commitments. They tend to work long hours with busy periods over Christmas and Easter.
Meanwhile, the recession has caused financial problems and high levels of stress. Long hours spent ‘hanging about' waiting for customers mean that drivers struggle to eat regularly, find healthy food choices and take physical exercise. They can also feel bored and isolated. Entrusted with other people's lives, poor health could have devastating effects for themselves, their families, customers and other motorists.
Overview of the project
Taxi! was a one-year Health Inequalities Partnership Pilot project developed by the Walsall Council Creative Development team. The project used social marketing to encourage local taxi drivers to review their lifestyle and make positive changes.
The project used an in-car video diary of a taxi driver. The man reflects on the negative aspects of his job and describes the difference he has made to his life by turning ‘idle time' into ‘active time.' The film was screened at a celebration event and delivered to taxi firms to show in their waiting rooms.
The project worked on practical ways to help drivers improve their health. These included providing water dispensers and treadmills at the drivers' base, subsidising gym memberships and organising a football team. The project team visited each company twice to provide guidance and support. Health promotion workers from the Healthy Workplace scheme run by NHS Walsall agreed to follow up visits to support companies to sustain the approach.
The theory of change (what should happen)
An academic literature review identified that smoking, inappropriate eating habits and lack of physical activity are common among drivers. Social learning theory proposes that:
- although people do learn from their own trial and error, they also learn by watching other people
- letting someone else try out the behaviour, seeing if it looks sensible or has positive outcomes, rehearsing it in their own minds, and then trying it for themselves.
- The project encouraged drivers to make a personal connection with the character in the film to motivate them to make small lifestyle changes.
What will success look like?
A successful outcome would be that drivers make small, inexpensive and positive lifestyle changes within their working lives, such as:
- drinking more water
- swapping crisps and junk food for fruit and vegetables
- stretching and walking instead of sitting in the car
- spending more time with the family in an ‘active' way.
- The definition of ‘active time' was important to the project partners who were from health and arts backgrounds. There was a recognition that this wasn't just in traditional health terms, that is, increased levels of physical activity, but also in cultural terms. It would be equally as valid for drivers to spend time reading, learning another language or in some other cultural activity.
Measuring the difference
Walsall Creative Development team took an approach to evaluation that combined participatory methods with traditional forms of data collection and analysis. These included:
- telephone interviews, questionnaires, video diaries
- making a short film about possible small interventions for ‘healthier taxi driver lifestyle', based on secondary research, formal and informal group evaluation and follow-up phone calls.
Discussions with partners and taxi driver's managers were ongoing throughout the project. To understand the health pressures facing taxi drivers, a creative researcher interviewed:
- 20 drivers, directors or managers from 15 of the 29 taxi companies operating in Walsall
- officers from Trading Standards who are responsible for licensing taxi drivers.
The creative researcher also supported four drivers in filming a video diary of their working day.
Ten weeks after the first screening of the film, a community arts development worker visited 20 taxi companies in Walsall. They talked to company managers about the changes they had made as a result of participating in the project. If appropriate, the development worker signposted them to the Walsall Healthy Workplace initiative (NHS Walsall).
As the sample size was small, the results were indicative.
The challenges
There were problems with speaking to drivers attending the original screening. This was because of wrong phone numbers or a reluctance to talk on the phone. This was either because they were busy or didn't have the necessary language skills (for many drivers English is their second or third language).
One way of avoiding these issues would be to undertake one-to-one interviews with drivers in their cars. This could take place as they were driving, which would mean they would receive a fare and be reimbursed for their time.
As the project developed, a number of partners started to see the potential of the project and wanted to use the intervention to achieve a number of outcomes. Consequently, the questionnaire lost some of its focus and information became more difficult to get from phone interviews with drivers. In hindsight, focusing on one behavioural goal and gathering information to see if that had been achieved may have been more effective.
Results
Of 15 drivers interviewed by phone five weeks after viewing the film, 11 reported a significant change in their lifestyle including;
- increased levels of physical exercise and positive changes in diet
- dedicating more time to family activity.
Several local taxi companies regularly screen the film at their drivers' base and the local Licensing Department shows the film as part of their induction programme for new drivers.
Fourteen companies requested more information about the Healthy Workplace scheme.
Three companies have made significant changes to the drivers' base as a result of their involvement including:
- installing a water dispenser, pool table and treadmill
- paying half of gym fees
- starting a five-a-side league
- allowing the drivers to use an internet point while they wait for fares.
Reporting
Results were shared with local, regional and national stakeholders.
Walsall:
- Taxi companies
- Walsall Licensing Department
- Local Authority Service managers
- Walsall Health and Wellbeing Partnership
- NHS Walsall
- Walsall Community for Health Partnership Steering group.
Regional:
- West Midlands Communities for Health Steering group
- Strategic Health Authority
- Government Office West Midlands.
- National:
National Social Marketing Centre (NSMC)
- LGA
- Department of Health
- Department for Culture, Media and Sport (DCMS).
■ The NSMC features the case study on its website
Wider impact
The evaluation has led Walsall Communities for Health Steering group to look at health inequalities for men in Walsall on low income in factory settings.
West Midlands Communities for Health (C4H) evaluation will focus on ‘Taxi!' as a case study for the region and are exploring the potential for funding a wider Men's Health roll-out.
Walsall Communities for Health now has developed five projects taking a more in-depth approach to evaluation and will provide more accessible and relevant information for health partners. It has also informed the development of more ‘fit for purpose' projects that meet local health needs and ensure that limited resources are used effectively.
Personal learning
“I learned a new approach to evaluation and the terminology used for a wide variety of evaluation and impact assessment models. This was supported through Communities for Health evaluation action learning sets and through commissioning Social marketing support from NMSC.
“A well-evaluated project with a good case study can inform others well beyond the duration of the project. Time needs to be allocated for this as there are constant demands on us to deliver new work and quickly move on.
“I am now confident in developing, designing, managing and delivering impact assessment and evaluation projects and have managed many since starting on the learning set. I have been able to transfer learning form the action learning sets to staff who deliver and develop evaluation and impact assessments with the local authority and within the multi-partnership Communities for Health programme.”