Regulation of Cosmetic Interventions Research among the General Public and Practitioners Regulation of Cosmetic Interventions Research among the General Public and Practitioners 28 March 2013/ Job No. 618/ Version 3 Prepared for: Department of Health Creative Research Ltd Phone: 020 8567 6974 Email: [email protected] 43 Broadway, London W13 9BP Fax: 020 8567 6979 www.creativeresearch.co.uk Contents 1 MANAGEMENT SUMMARY 1 1.1 Introduction 1 1.2 Key findings 1 1.3 Conclusions 6 2 BACKGROUND AND RESEARCH METHOD 9 2.1 Background 9 2.2 Research objectives 9 2.3 Research method 11 2.4 Outline of the discussion content 13 2.5 Research timing and locations 15 2.6 Structure of the report 15 3 THE INFLUENCE OF ADVERTISING AND MEDIA COVERAGE OF THE COSMETIC INTERVENTION INDUSTRY 17 3.1 Introduction 17 3.2 Media coverage 17 3.3 Advertising 18 3.4 Issues with advertisements for the cosmetic intervention industry 20 3.5 Attitudes towards a ban on advertising and its regulation 23 4 OTHER SOURCES OF INFORMATION AND INFLUENCES ON CHOICE25 4.1 Introduction 25 4.2 The influence of peers 25 4.3 Other key sources of information 26 4.4 The influence and effect of access to cosmetic interventions 28 Regulation of Cosmetic Interventions: Research among the General Public and Practitioners 5 PERCEIVED MOTIVATION FOR COSMETIC INTERVENTIONS AND VULNERABILITY 31 5.1 Introduction 31 5.2 Attitudes and motivations for having cosmetic procedures 31 5.3 Vulnerable audiences 33 6 PERCEPTIONS OF THE RISKS OF COSMETIC INTERVENTIONS AND THE NEED FOR REGULATION 38 6.1 Introduction 38 6.2 Levels of perceived risk 38 6.3 Factors influencing perceptions of risk 41 6.4 The influence of perceptions of risk on attitudes to cosmetic interventions 43 6.5 Overview of attitudes towards the need for regulation 45 7 ATTITUDES TOWARDS REGULATION AND QUALITY STANDARDS FOR PRACTITIONERS 47 7.1 Introduction 47 7.2 Qualifications and training 47 7.3 Membership of professional bodies 50 7.4 Titles and other indicators of standards 52 8 ATTITUDES TOWARDS REGULATION AND QUALITY STANDARDS FOR DEVICES AND SETTINGS 56 8.1 Introduction 56 8.2 Attitudes towards regulation of devices 56 8.3 Attitudes towards the regulation of organisations 60 9 ATTITUDES TOWARDS SAFEGUARDING THE PROCESS OF UNDERGOING A COSMETIC INTERVENTION 62 9.1 Introduction 62 Regulation of Cosmetic Interventions: Research among the General Public and Practitioners 9.2 Information provision and informed consent 62 9.3 Assessment and counselling 64 9.4 Follow-up and aftercare 65 9.5 Responsibility when things go wrong 66 9.6 Seeking redress 67 9.7 Insurance and indemnity cover 68 10 PRACTITIONERS 69 10.1 Introduction 69 10.2 Current market for non-surgical interventions 69 10.3 Perceptions of current safeguards and regulation 80 10.4 Proposed Priorities for Regulation 87 11 APPENDICES 98 11.1 Patient/considerer depth profiles 99 11.2 Recruitment questionnaires 102 11.3 Discussion Guides 124 11.4 Stimulus for discussion 144 11.5 Instructions for follow-up interviews with selected workshop participants 154 Regulation of Cosmetic Interventions: Research among the General Public and Practitioners 1 Management Summary 1.1 Introduction This research was commissioned to inform the review of the regulations covering surgical and non-surgical cosmetic interventions and whether they provide adequate protection for those undergoing them. Its aim was to provide up to date and in-depth information about the public’s attitude to regulation in this area, including that of patients/clients. In a combination of workshops with the general public, depth interviews with patients/consumers who have undergone or have actively considered a cosmetic intervention, and paired depths with teenagers, a range of issues were explored to address the research objectives. These were the: • Regulations applying to surgical vs non-surgical cosmetic interventions • Risks of surgical and non-surgical procedures, and the safeguards required • Safety and quality standards offered in the private sector; qualifications, training, the experience of practitioners, membership of professional bodies • Information that is/should be accessible to patients/customers • Influence of advertising/media coverage, its impact on self-image, and opinions on the regulation of advertising • Funding of post-operative medical care and the responsibilities of the NHS in correcting adverse events • Need for psychological assessment/counselling prior to any cosmetic intervention • Establishment of registries of cosmetic implants. In addition, a series of depth interviews were conducted with practitioners with the focus of the discussion on the regulation of non-surgical cosmetic interventions and injectable procedures in particular. 1.2 Key findings Despite their very different perspectives, there was a high level of agreement in the views of members of the public (including patients and those considering an Regulation of Cosmetic Interventions: Research among the General Public and Practitioners 1 intervention) and those of practitioners in terms of the regulation of the industry for cosmetic interventions. 1.2.1 Influences on the market for cosmetic interventions This research suggests that a wide range of influences, including media coverage of celebrities and their cosmetic interventions, reality TV programmes and the wider broadcasting of cosmetic procedures, alongside the increasing availability of and access to cosmetic interventions, are coming together to create a climate in which having a cosmetic procedure is increasingly regarded as normal and the associated risks are often underestimated. These factors also result in changing aspirations and ideals regarding body image, with some evidence that this results in greater salience for cosmetic intervention among the young. While advertising is seen as widespread and therefore as adding to the impression of everydayness, individual advertisements seem to make little impact in terms of choice of supplier. However, mainstream advertising and marketing propositions such as discounting by third party operators, have clearly commoditised some non-surgical procedures. While there is no appetite for a wholesale ban on advertising, the hazards of time-limited offers are widely recognised and there is greater support for a ban/control of these. It is felt that more should be done to ensure the reliability of advertising in this area, to give the public a basis on which to filter potential suppliers and to protect the unwary prospective patient. In making decisions about whether to proceed with an intervention and who to do this with, one’s peer group and in particular, those within it who have already had such an intervention, are key sources of information about, and referrals to, practitioners. Indeed, their influence may override all other considerations. For those looking for information and guidance, there is no single ‘go to’ place for impartial information about interventions, practitioners, risks, questions to ask/things to look for; instead, those seeking to find out more are often driven to commercial sites by search engines. This often means that the practitioners are telling prospective patients what they want them to know and the patient is left unaware of the questions that he/she should ask and the answers that they should seek. Regulation of Cosmetic Interventions: Research among the General Public and Practitioners 2 It was widely recognised that in the current climate for cosmetic interventions, certain groups of people may be vulnerable to messages of an easily accessible solution to dissatisfaction with their appearance including young people, those at risk of getting into debt and those with psychological problems. However, because many people are not fully informed when they undergo procedures and do not currently have the means to ensure that they can inform themselves, it would seem that a high proportion of those having interventions are at risk. 1.2.2 Perceptions of risk and the need for regulation Even without being informed about current levels of regulation within the cosmetic intervention industry, over half of the public sample felt that it should be more tightly regulated, along with nearly all practitioners. While surgical interventions were seen as riskier, safeguards were assumed to be in place, and it was suspected that non-surgical interventions were where greater safeguards were needed. Among non-surgical interventions, it was anticipated that the greatest risk and need for enhanced protection was among the more invasive and potentially damaging procedures of injectables and chemical peels. Once members of the public had been shown information about the current state of regulation, there was an overwhelming call for greater regulation based on real concerns about the lack of safeguards across many interventions. Both surgical and non-surgical interventions were felt to need sufficient regulation to ensure patient safety, although it was recognised that the level and nature of the safeguards required would differ. 1.2.3 Safety and quality standards for practitioners There was an expectation by the public that practitioners offering cosmetic interventions are trained and experienced in that intervention and currently, much is taken on trust that this is the case. At present, the prospective patient has no base of knowledge on which to judge the calibre of the practitioner; titles, qualifications/letters after the name, membership of professional bodies are all unfamiliar and