Is it Free?

Posted: 8th November 2010

Up and down the country millions of pounds of money and the time of thousands of professionals are being invested to reduce "health inequalities", the unacceptable gap in quality of life, health outcomes and life expectancy experienced by those in lower socio-economic communities compared to their more affluent neighbours.

In public health we are in the business of persuasion. We are trying to encourage the wider public to buy a new kind of lifestyle. I say "buy" because the process is actually the same as the one you would go through when, for example, deciding to buy a new sofa. There is a cost/benefit exchange and the point at which the decision to purchase is made is the point at which the expected benefits exceed the expected costs. The "costs" here can be money, but they also include the effort, the convenience and the time it will take to get it. We are trying to persuade people that the benefits for making healthier lifestyle choices far outweigh the effort it will take to make those changes.

All across the country you will find teams of people working furiously on ways to lower the cost and remove the barriers to behaviour change to help speed up the decision process... Doorstep activities, free transport, child care provided and the big hit... free activities and free support. You'd think these programmes would be full to bursting yet amazingly many struggle to achieve even modest attendances. The very fact that most interventions have a performance indicator for having people simply show up tells the story for itself.

The problem is that when it comes to services "FREE" sometimes comes with hidden subtext that says "this is a little bit rubbish". If it's free, then it has no value. If people are used to paying £5 for a fitness class and then get offered one for free they can jump to the very wrong conculsion that it will be many times lower standard than the class they could have paid for, even if it is with the same instructors and at the same venue!

If someone signs up for a free activity there is no penalty for not turning up. They would be in no worse off place for deciding not to go. The often overlooked factor here is 'time' and people really value their time. If they think the quality of the service is low (because it's free) then they are unlikely to want to swap their time for it. There's the consumer angle too; when we pay for services we become customers which gives us a certain sense of power. If we are receiving stuff for free, we don't get to call the shots.

I'm not a great fan of offering everything for free and with public money and available grants dimishing rapidly the case for making projects self-sustaining is becoming ever more important. We simply can't keep offering it all for nothing. I believe that if people want something enough they will find a way to be able to afford at least a contribution towards the cost of attending. This has the added upside of the sense of "investing in yourself", feeling good about choosing to take part.

So far we've only explored one half of the cost/benefit exchange and that's lowering the costs but I think the key is held in the other half of the transaction. If we can help our target audiences to realise that the expected benefits are so overwhelmingly wonderful they will turn the earth over to get them. And if you do have to offer your service for free, make sure your service users know the value of what you are offering. Here are some examples of raising the value of your programmes:

"" "12 weeks free weight management programme WORTH £150."
"" "Get support from the MOST highly skilled and highly trained fitness instructors."
"" "We care so much about you that we want to offer you the chance to have THE BEST healthy lifestyle support available and it won't even cost you a penny."
"" "WANTED: seriously motivated people looking for a new lease of life. You bring your motivation along and we'll provide everything else."
"" "Healthy glowing skin, sparkling eyes, the best sleep you've had in ages, bags of energy, feel better in your clothes, ooze confidence... you think you couldn't bottle something this good... well we have and we'd like you to have some."


So, in summary, keep on making it easier for people to access your services but spend equal amount of time helping your target audience understand the value of what you are offering them. Whether they have to pay for it or not, you can speed up the purchasing decision more positively by making the benefits seem too good to miss.



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