BACKGROUND AND AIMS Public perceptions of alcohol and its related harms and policies are shaped by multiple discourses and can influence behaviour and policy support. As part of a FrameWorks-informed project to test framing approaches to improve public understanding and support for evidence-based alcohol policies in the UK, this research aimed to (i) summarise relevant evidence; (ii) compare how public understanding of alcohol harms differs from those of academic and charity experts; and (iii) develop novel framing approaches.

METHODS (1) a literature review including systematic, scoping and targeted components to understand previous evidence on effective framing from behaviour change, UK alcohol policy and FrameWorks literatures; (2) comparison of public views of alcohol harms and policies from four focus groups (n = 20) with those of public health experts; (3) an iterative process involving workshops and stakeholder consultation to develop 12 novel framing approaches.

RESULTS We found no previous study that directly tested framing approaches for alcohol policy advocacy. Our narrative summary of 35 studies found that explaining diverse harms may be important, whereas framing that engenders empathy, emphasises dependence or invokes a sense of crisis may be less effective. In focus groups, the public linked alcohol to pleasure/socialising, whilst understandings of harm focused on severe alcohol problems and individual deficits of biology or personality, with policy proposals focused mainly on treatment/support services. Public health experts highlighted more diverse harms and solutions, emphasising environmental and commercial causes. Comparison of public and expert views yielded six tasks for novel framing approaches to deepen public understanding. The team co-developed initial framing ideas (n = 31), before finalising 12 narrative framing approaches based on values (n = 5), metaphors (n = 3) and explanation (n = 4).

CONCLUSIONS In the United Kingdom, public and expert understandings of alcohol related harms, causes and solutions differ. Along with prior evidence, these differences can inform novel framing approaches designed to deepen public understanding.