How Social Norms Drive Health Behaviour Change: Lessons From Frome 

Health behaviour isn’t shaped by clinical advice alone – it’s shaped by the people around us and what they treat as normal. Social norms drive health behaviour change because social contact, and the norms that encourage or discourage it, have a real, measurable impact on health outcomes. In Frome, England, making community connection a normal part of care coincided with a 14% fall in emergency admissions. 

Key takeaways 

• Social connection – and the norms around it – measurably affects health outcomes. 

• In Frome, unplanned admissions fell by 14% while they rose by 28.5% across the rest of Somerset. 

• Patient support should treat social connection as part of the prescription, not an afterthought. 

What Are Social Norms in Health Behaviour Change? 

Social norms are the shared, often unspoken expectations about what people around us do and approve of – and in health, they decide whether seeking support, staying connected or joining a community group feel normal. Human beings are social creatures by nature, so the norms around social contact shape health behaviour as much as any clinical protocol. 

When the norm of connection erodes, support erodes too. In the United States, the proportion of people who say they have no one to confide in about important matters nearly tripled, from around 10% in 1985 to around 25% in 2004⁷. For more on how norms spread, see how social proofing drives behaviour. 

Why Does Social Isolation Harm Health? 

Isolation affects the body as well as the mind. Cytokines – chemical messengers of the immune system – trigger inflammation that can encourage people to withdraw from social contact precisely when they need it most³. That same inflammatory response is now understood to be a contributing factor in depression⁸. 

The clinical evidence runs deep. People living with HIV who report stronger social support achieve better viral load suppression⁴, and women with breast cancer who have strong social networks face roughly half the risk of dying from the disease compared with those who are socially isolated⁵. 

How Did the Frome Model Use Community to Change Health Behaviour? 

The Frome Model made community connection a normal part of primary care – and emergency admissions fell as a result. 

• Context: in 2013, GP Dr Helen Kingston launched what is now known as the Frome Model in Frome, Somerset. 

• Intervention: the practice built a directory of community groups – lunch clubs, exercise groups and social activities – and trained ‘Health Connectors’ to link isolated patients to them, alongside regular ‘Talking Cafés’. 

• Result: between April 2013 and December 2017, unplanned hospital admissions in Frome fell by 14%, while admissions across the rest of Somerset rose by 28.5%¹. Abel and Clarke noted that “no other interventions on record have reduced emergency admissions across a population”². 

• Lesson for practice: the change came not from a new drug or device, but from rebuilding patients’ ordinary social connections. 

Does It Work in Asia-Pacific? Social Prescribing in Singapore 

Yes – Asia-Pacific health systems are building their own versions, and Singapore is one of the clearest examples. Since July 2019, SingHealth’s community hospitals have trained dedicated ‘Wellbeing Coordinators’ to connect discharged patients – mostly older adults – to community resources rather than just clinical follow-up⁶. See also how DeltaMV used behavioural science for community empowerment in Vietnam. 

Designing a patient support programme? DeltaMV’s Healthcare Behavioural Strategy team can help you build social connection into it from the start. 

How to Build Social Norms Into Patient Support: 4 Steps 

1. Map trusted community resources. Like Frome’s directory, list the groups and peer networks patients can join. 

2. Appoint people to make the connection. Health Connectors and Wellbeing Coordinators turn a list into real relationships. 

3. Make participation visible and normal. Open activities like Talking Cafés signal that seeking support is what people here do – the same ‘herd’ effect seen in everyday trends. 

4. Measure what matters. Track wellbeing, loneliness and caregiver burden with validated tools, as Singapore does. 

What Are the Limitations of the Evidence? 

• Comparison, not a trial: Frome is compared with the rest of Somerset, so other factors may have played a part. 

• Association, not causation: the HIV and breast cancer studies show links rather than proving cause. 

Frequently Asked Questions 

What is the Frome Model? 

A community-based model of primary care, launched in 2013, that links isolated patients to community groups. 

Next Steps: Build Social Norms Into Your Patient Support Strategy 

If the patient is truly at the heart of everything we do, care needs to move beyond medication – treating social connection as a genuine part of the prescription. DeltaMV’s “Make it Social” lever turns insight like Frome and Singapore into a deliberate intervention rather than a one-off pilot. 

Want to build social norms into your next patient support or adoption strategy? Get in touch with DeltaMV’s Healthcare Behavioural Strategy team. 

References 

1. Abel, J., Kingston, H., Scally, A., Hartnoll, J., Hannam, G., Thomson-Moore, A., & Kellehear, A. (2018). Reducing emergency hospital admissions: A population health complex intervention of an enhanced model of primary care and compassionate communities. British Journal of General Practice, 68(676), e803–e810. https://bjgp.org/content/68/676/e803 

2. Abel, J., & Clarke, L. (2018). Compassion is the best medicine. Resurgence & Ecologist, (307). https://www.resurgence.org/magazine/article5050-compassion-is-the-best-medicine.html 

3. Dantzer, R., O’Connor, J. C., Freund, G. G., Johnson, R. W., & Kelley, K. W. (2008). From inflammation to sickness and depression: When the immune system subjugates the brain. Nature Reviews Neuroscience, 9(1), 46–56. https://doi.org/10.1038/nrn2297 

4. Friedman, M. R., Coulter, R. W. S., Silvestre, A. J., Stall, R., Teplin, L., Shoptaw, S., Surkan, P. J., & Plankey, M. W. (2017). Someone to count on: Social support as an effect modifier of viral load suppression in a prospective cohort study. AIDS Care, 29(4), 469–480. https://doi.org/10.1080/09540121.2016.1211614 

5. Kroenke, C. H., Kubzansky, L. D., Schernhammer, E. S., Holmes, M. D., & Kawachi, I. (2006). Social networks, social support, and survival after breast cancer diagnosis. Journal of Clinical Oncology, 24(7), 1105–1111. https://doi.org/10.1200/JCO.2005.04.2846 

6. Lee, K. H., Low, L. L., Lu, S. Y., & Lee, C. E. (2023). Implementation of social prescribing: Lessons learnt from contextualising an intervention in a community hospital in Singapore. The Lancet Regional Health – Western Pacific, 35, Article 100561. https://doi.org/10.1016/j.lanwpc.2022.100561 

7. McPherson, M., Smith-Lovin, L., & Brashears, M. E. (2006). Social isolation in America: Changes in core discussion networks over two decades. American Sociological Review, 71(3), 353–375. https://doi.org/10.1177/000312240607100301 

8. Miller, A. H., & Raison, C. L. (2016). The role of inflammation in depression: From evolutionary imperative to modern treatment target. Nature Reviews Immunology, 16(1), 22–34. https://doi.org/10.1038/nri.2015.5