Understanding Behaviour Change in Context. the Role of Sociology in Social Marketing Health Programmes

Background: Social marketing health approaches centred on behaviour change, choice and self-management have been criticised for limited power to effectively engage the populations most affected by inequalities and understanding and altering the structural barriers to health. One of the criticisms of current practices in behaviour change interventions is the focus on individual beliefs and attitudes which poses the danger of neglecting peoples’ practices and strategies in the wider social context. Objectives: The paper examines how interactions with a collaborative service-driven social marketing programme may lead to change in both the practices of the individual service user (smoke outside) and of staff. In doing so, this research explores sociology theory as an alternative perspective to the traditional psychology lens used in social marketing health programmes to understand the social and institutional processes underlying behaviour and social change. Methods: The paper builds upon Bourdieu’s treatment of habitus, capital and field and Hays (1994) concept of transformative agency, qualitative data collected through observation notes and interviews with members of the public and community services workers engaged in a Smokefree homes and cars initiative in a city in England. Findings: The findings indicate that despite structural barriers, transformative agency leading to incremental change of practices and habits emerges from conflicts between the habitus associated with the community work and the home field and resource interactions between staff and members of the public. Conflicts between the habitus and the field driven by the changes to health professions and public services challenge both staff and service user to be creative and may lead to reflexivity, transformation of capital to adjust to the new field and change of rules, practices and habits. Conclusions: The study highlights the value of sociological frameworks for understanding how change occurs in open-systems and individuals’ embeddedness to inform customised health programmes.