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Abstract
Objectives To understand the influences and decisions of vulnerable older people in relation to keeping warm in winter.
Design A qualitative study incorporating in-depth, semi-structured individual and group interviews, framework analysis and social marketing segmentation techniques.
Setting Rotherham, South Yorkshire, UK.
Participants 50 older people (>55) and 25 health and social care staff underwent individual interview. The older people also had household temperature measurements. 24 older people and 19 health and social care staff participated in one of the six group interviews.
Results Multiple complex factors emerged to explain whether vulnerable older people were able to keep warm. These influences combined in various ways that meant older people were not able to or preferred not to access help or change home heating behaviour. Factors influencing behaviours and decisions relating to use of heating, spending money, accessing cheaper tariffs, accessing benefits or asking for help fell into three main categories. These were situational and contextual factors, attitudes and values, and barriers. Barriers included poor knowledge and awareness, technology, disjointed systems and the invisibility of fuel and fuel payment. Findings formed the basis of a social marketing segmentation model used to develop six pen portraits that illustrated how factors that conspire against older people being able to keep warm.
Conclusions The findings illustrate how and why vulnerable older people may be at risk of a cold home. The pen portraits provide an accessible vehicle and reflective tool to raise the capacity of the NHS in responding to their needs in line with the Cold Weather Plan.
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
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Footnotes
Data integrity All authors, external and internal, had full access to all the data (including data reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.
To cite: Tod AM, Lusambili A, Homer C, et al. Understanding factors influencing vulnerable older people keeping warm and well in winter: a qualitative study using social marketing techniques. BMJ Open 2012;2:e000922. doi:10.1136/bmjopen-2012-000922
Contributors AMT and TR had the idea for the study. AMT was principal investigator, participated in data collection and analysis, and wrote drafts of the manuscript. AL took the lead for the data collection. AL, JMC, JA, KAM and AJS helped design the study, develop the methods, collected and analysed the data, and helped with interpretation. All authors have seen and approved the final version of the manuscript. AMT is the guarantor.
Funding This paper presents independent research commissioned by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RFPB) Programme (grant reference number PB-PG-0408-16041). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The study sponsor was NHS Rotherham. They hosted the study and held the NIHR RFPB grant. JA was a member of the research team and a co-author of this paper. She is the research lead for the sponsor organisation. The organisation itself employed AL, the main researcher on the project. AMT, the principal investigator, held an honorary contract with the sponsor organisation. The NHS Rotherham has supported the collection, analysis and interpretation of data but has taken no active role outside of members of the team. They have supported the decision to submit the article for publication. Provision of funding alone.
Competing interests None.
Ethics approval The KWILLT study obtained ethics approval from the Leeds East NHS Research Ethics Committee. (REC reference 09/H1306/90) and Research Governance approval from the NHS Rotherham (reference 28 841/54 078/14/727). All participants gave informed consent before taking part.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data available.
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