Understanding developments in conceptualisation and measurement of gambling harms

About the study 

Gambling is increasingly framed from a public health perspective, aligning it with trends for tobacco, drugs, and alcohol. As an approach that emphasises reduction or prevention of harms right across the population, it requires a strong understanding of how harms arise and who they affect.

The National Centre for Social Research and the University of Plymouth received funding from GambleAware to conduct a short scoping study to understand developments in the understanding and measurement of gambling related harms. The aim was to review existing approaches and inform future research, prevention, and intervention strategies. 

The approach involved a rapid structured literature review, alongside Subject Matter Expert workshops, supporting the appraisal of the literature by incorporating a variety of lived experience and stakeholder perspectives. 

Findings

The last decade has been seen substantial developments in the conceptualisation and measurement of gambling related harm, providing new perspectives that move beyond clinically-derived definitions for gambling.  A continued move towards a public health approach will require continued development of underlying tools and expertise. The report identified a number of frameworks for gambling harm which categorise harm according to several domains (such as financial, relationship, physical and social harm). The study found similarities between different frameworks and concluded that existing frameworks were largely understandable and comprehensive, with some areas for further development including greater UK lived experience input.

Established gambling measures such as the Problem Gambling Severity Index (PGSI) and South Oaks Gambling Screen have several shortcomings. Developed several decades ago, they lack any robust underlying theoretical frameworks of harm and are largely predicated on clinically-derived notions of ‘pathological’ versus ‘non-pathological gambling’. The report recommends that new modes of gambling related harms measurement should be used, which are based on robust frameworks of harm, such as the Short Gambling Harms Screen or newly designed harms items which are being deployed in the upcoming Gambling Survey for Great Britain. 

When concepts shift, measurement approaches need updating. By building future measurements upon robust conceptualisations of harm, and then linking these to reductions in quality of life, gambling related harm will be integrated with other public health initiatives. It will enable the field to pivot away from historic definitions of ‘problem gamblers’, where notions of individual responsibility risk being a stigmatising driver of harm.

Methodology 

This project involved a scoping review integrated with targeted Subject Matter Expert engagement. Scoping reviews deploy systematic approaches to efficiently appraise diverse literature, identify knowledge gaps, and help inform future research strategies. The scoping review was conducted using a rapid review methodology. 

Both academic and grey literature were included, and papers were screened at two stages: (1) title and abstract and (2) full-text. The screening was conducted via the online platform Covidence, designed for systematic reviews. Following the scoring, 34 of the highest rating papers were selected for data extraction. A data extraction tool was developed to enable narrative synthesis and critical appraisal of existing frameworks and measures of harm.

The core approach of this work was the scoping review, outlined above. However, to enable synthesis, discussion, and recommendations to reflect the perspectives of multiple stakeholders, we also conducted a brief and pragmatic expert engagement exercise. These Subject Matter Experts served as key respondents who represented the perspectives of various organisations, communities, and expertise, thus appraising our preliminary findings from these multiple perspectives. Expert engagement primarily involved two 2-hour workshops. During the workshops, overall findings from the scoping review and analysis were presented and discussed, with group discussions focusing on (A) identified frameworks of harm and (B) identified measurement approaches for harm. Participants were invited to discuss gaps and omissions; utility and applicability for their context; and “next steps”.