Taxi! was commissioned by Walsall Council as part of the Department of Health’s Communities for Health Programme and builds on a successful partnership between NHS Walsall and Walsall Council Creative Development Team. The project explored the links between community arts practice and social marketing principles, developing a project which maximises the benefits of each approach with a focus on encouraging local taxi drivers to review their lifestyle and make positive changes.

Men’s health has been one of the ‘themed’ areas of work that has taken an innovative and targeted approach to engage local people in consulting around health needs, addressing barriers to accessing health services, informing service delivery and raising awareness to health and wellbeing messages. The project sought to build on good practice around engaging men in health promotion interventions. A key driver for the project was the Choosing Health White Paper (2004) that not only championed the approach of addressing workplace health but also priorities around tackling inequalities in men’s health. NHS Walsall’s Men’s Health Steering Group selected taxi drivers as a way of accessing men at work. This provided a clear segmentation for the project and further data about the group was gained from the Licensing Department at Walsall Council.  Since only 6 of the 1500 taxi drivers in Walsall are women, the project focused on men’s health. 87% of taxi drivers in Walsall are private hire drivers working as part of a taxi company. The project was devised to meet the needs of these drivers and work with the taxi companies to support their drivers in making healthy lifestyle changes.

TAXI also aimed to pilot the National Social Marketing Centre’s ‘benchmark criteria’ within it’s project delivery and planning.

The project report is now online as a case study on the national social marketing centre website

http://www.nsmcentre.org.uk/resources/showcase/taxi

http://thensmc.com/sites/default/files/Taxi%21%20FULL%20case%20study.pdf

Taxi! was a one year pilot project using a social marketing approach, to encourage local taxi drivers to review their lifestyle and make positive changes. WCDT worked with the National Social Marketing Centre (NSMC), NHS Walsall and creativityteam to fully explore the links between community arts practice and social marketing through this commissioned project and successfully incorporated each of the NCMC’s benchmark criteria in its development and delivery as outlined below:

To provide customer orientation a review of policy and academic research on the health of professional drivers was undertaken at the start of the project by a PHD student from Wolverhampton University. Lifestyle factors such as smoking, inappropriate eating habits and lack of physical activity are commonly reported in professional drivers (Raanaas & Anderson, 2008; Whitelegg, 1995). Stress levels and conflict with customers have also been highlighted as issues (Whitelegg 1995; Machin & De Souza, 2004).

With approximately 1500 people working as taxi drivers in Walsall, drivers are either employed by a taxi company driving their own private hire cars, or are Hackney drivers driving traditional black cabs. The majority of them are men from Asian backgrounds. Through consultation with the drivers the documentary/drama film was developed and an Asian actor was employed to play the taxi driver in the film in order to represent the Walsall taxi drivers and act as a positive role model. In order to help understand the day-to-day working lives of taxi drivers, the pressures they face, and whether there have any specific health issues, a creative researcher interviewed 20 drivers individually and in small groups, directors or managers from 15 of the 29 taxi companies operating in Walsall and Officers from Trading Standards who are responsible for licensing taxi drivers.  In addition, the creative researcher supported four drivers in filming a video diary of their working day.

Insights gained concluded that amongst other criteria: drivers work long unsociable hours, often juggle multiple jobs to earn a living (with most drivers being self employed and the majority earner) as such, drivers need to set their own income targets/ work a long number of hours to meet their financial needs. Through the research interviews and video diary’s local driver told us that they find it difficult to make individual health changes with them spending long periods of time “hanging out” waiting for a fare which involves either them sitting by themselves in their car or waiting in a room provided by their company.  Health issues affected include: food and healthy eating; lack of opportunities to take regular physical exercise; stress – particularly financial concern during the on-set of the economic recession – with a lack of customers leading to boredom and isolation. This initial research aimed to find out what moved and motivated them to make small steps to improve their health and clearly the biggest motivator was the need to keep working to meet their financial responsibilities.

The behavioural goal of the project was to encourage Walsall taxi drivers to make small, inexpensive, positive lifestyle changes, i.e.: drink more water , swap crisps and junk food for fruit and vegetables, stretch and walk instead of sitting in the car and spend more time with the family in an ‘active’ way. The project steering group didn’t require any measurable targets to be set, but requested information about the changes drivers made to their lifestyle as a result of participating in the project.

The key barrier to achieving positive lifestyle changes was the perception that being healthy costs money and takes time, both of which are very valuable commodities for drivers. Drivers perceived that taking time to be healthy would reduce the amount of time they had to work. Taxi! encouraged drivers to see that small, inexpensive changes can be made when they are waiting for fares.The major competition facing drivers wanting to make healthy changes is the need to make money and support their family. Taxi drivers work long, unsociable hours and many juggle a number of jobs. The project focused on encouraging drivers to incorporate health changes into their working lives, such as eating fresh fruit rather than snacking on crisps. These small changes can help drivers stay healthy, feel better and continue working.

The project utilised Social learning theory – Akers & Ronald 1973 which looks at how people learn behaviour. An essential aspect of the project was to encourage drivers to make a personal connection with the character in the film so that they would be motivated to make small lifestyle changes. The film was scripted using interviews and the video diaries created by Walsall taxi drivers and filmed in Walsall at local venues frequented by taxi drivers themselves.

Through a Methods mix approach the primary intervention delivered by the project was a 20 minute film, ‘Have you been busy?’, scripted by taxi drivers in Walsall and performed by an actor. The film is an ‘in-car’ video diary of a taxi driver, who 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 is being used as a training resource and promotional advert as well as being launched at the New Art Gallery Walsall. Additionally each taxi company has been provided with a set of custom-made scatter cushions and car seat covers containing key project messages and copies of a Men’s Health manual were also left in each waiting area for drivers. Taxi companies have also been supported and encouraged to develop practical and structural ways of helping their drivers improve their health.

Taxi! provided an opportunity to explore how the two approaches – social marketing and community arts practice complemented each other. In summary by following a social marketing framework it helped ensure the creative approach taken by community artists and creative team is rigorous and robust. Previously work has focused on using the arts as a tool to consult or scope work but by following a social marketing framework it enabled us to see ways of developing creative interventions which can result in sustainable behaviour changes.

In turn, the creative approaches used within the project have helped to ensure the scoping stage of a project isn’t just one which extracts information from people, but involves them in a creative dialogue. For example the use of video diaries was key in gaining an insight into the day to day lives of taxi drivers and in turn provided clear direction for developing appropriate and targeted interventions.

The TAXI! project is now being used as a model of good practice to develop further work to tackle local health inequality targets around men’s health within a manual labour industry. The next project ‘Breaking the Mould’ will look to work at a local Foundry in Walsall and deliver a creative project with employers and employees of the company.

The project report is now online as a case study on the national social marketing centre website

http://www.nsmcentre.org.uk/resources/showcase/taxi

The Taxi! video can also be found on The National Social Marketing Centre: http://thensmc.com/resources/showcase/taxi?view=development

Due to budget restraints, a mix of quantitative and qualitative methods were used to evaluate the outcomes and impact of the project. Overall the project has been successful in supporting local taxi drivers to make meaningful lifestyle changes as well as supporting local taxi companies to make practical and structural changes to the organisation to help encourage and sustain health promotion messages and interventions.

In summary:

15 taxi drivers were interviewed over the phone five weeks after viewing the film. Of these, 11 reported a significant change in their lifestyle, which focused on increased levels of physical exercise and positive changes in diet, as well as dedicating more time to family activity.

Increased levels of physical exercise

“Since that night (watching the film at the gallery) I’ve joined a health club and I have to say I’m feeling much better. I’d recommend that film to all drivers.”

“Since I saw that movie I’ve joined a gym and I’m running a couple of miles a week. It really did change my life and made me look after myself a lot more.”

“I’ve started to walk to the base every morning, which is about a mile, and I’ve started playing cricket with my sons.”

“When I finish my shift now I try and play in the garden with my sons – I’m really enjoying it, and so are they.”

“I’ve started jogging and doing a bit of running because it’s become important to me now to keep fit and active.”

“I’ve joined a gym and I go out for a walk on my own occasionally. I’d never have thought about it before, but it’s great to spend a bit of time for myself. The funny thing is, I’m spending more time with my family as well, taking my kids out and playing a game with them. I’ve never heard them laugh so much. My family are noticing a difference so it must be working.”

Positive changes in diet

“I eat less rubbish at the base because I’m thinking more now about what I eat.”

“I’m eating much better than I was before and feeling much better for it. I’ve dropped the junk food.”

“I’m definitely walking more after seeing that film, and I’ve started eating salad and drinking more water. It’s making me feel better and I’m feeling happier than I have for a long time. A few of the drivers have noticed a change in me and I’ve talked about it with them. If it can work for me it can work for them too.”

“I’m eating a lot more fruit now and drinking more water, which I wasn’t doing before.”

“I drink a lot of water now (and do a bit of exercise like stretches and sit ups). I even eat fruit! I do feel better”

One driver talked about the benefits of socialising:

“ I thought the film and the meeting were good. We (taxi drivers) should get together regularly, because we need to socialise more and understand each others’ problems.”

A small number of people who engaged in conversation with the researchers talked about the barriers still facing them.

“There were some really good messages in that film and I’ve decided I’m going to join a gym straight after Ramadan. It’s not a good time to start while we fast, but seriously I’m joining up after.”

One driver highlighted the personal and economic cost of making positive lifestyle changes but did offer a possible solution:

“The meeting at the Gallery has made me think but to be honest I haven’t done anything about it yet. I feel like I’m too tired all the time, and eating at such funny hours doesn’t help. I can’t really afford to join a gym or leisure club. It would be good if a company could give us cheap membership around tea-time when we’re not too busy.”

Positive outcomes for the local Taxi Companies

Several local taxi companies regularly screen the film at their drivers’ waiting room base and the local Licensing Department shows the film as part of their training and induction programme for new drivers. To date approx 450 taxi drivers have seen the film.

14 companies have expressed more information about the local Healthy Workplace Scheme delivered by NHS Walsall Community Health to help sustain health promotion interventions into the workplace.

3 companies have made significant structural and practical changes to the driver’s base as a result of their involvement in the project such as providing internet access, water dispensers and treadmills at the drivers’ base, subsiding gym memberships, and organising a football team.

Reflections from project partners:

The Council’s Trading Standards team, responsible for licensing taxi drivers, has also reported positive changes:

“I have been involved with Taxi! from its early days and have been very impressed by the enthusiasm shown, not only by the team of arts workers but importantly by those taxi drivers and base operators involved.

The project has already started to make a difference and has also laid down firm foundations on which to build a healthier future for our hackney carriage and private hire operators.” Trading Standards Manager

Project resources produced as a result of TAXI included:

• On line case study on the national social marketing centre website http://www.nsmcentre.org.uk/resources/showcase/taxi

          http://thensmc.com/sites/default/files/Taxi%21%20FULL%20case%20study.pdf

• The Taxi! video can also be found on The National Social Marketing Centre website: http://thensmc.com/resources/showcase/taxi?view=development
• Project report outlining process and findings
• TAXI! DVD ‘Have you been Busy?’ including promotional talking heads style film and local taxi driver video cam diary extracts
• Bespoke project scatter cushions and seat covers with health promotion messages