Regulatory compliance in Scotland's tattooing and cosmetic body piercing industry: A concurrent mixed methods study

The objective of any regulation is to realise the goal(s) that justified its intervention. One means of demonstrating this is to determine the extent of regulatory compliance. This study intended to determine the extent of regulatory compliance with the Civic Government (Scotland) Act 1982 (Licensing of skin piercing and tattooing) Order 2006 in Scotland’s tattooing and cosmetic body piercing industry. Implemented in Scotland in 2006, its aim was to minimise risk to health from skin piercing and tattooing. Philosophically underpinned by pragmatism, a concurrent mixed methods study was undertaken. All 220 practitioners and 78 enforcers engaging with this regulation across Scotland were invited to participate. Through analysis and interpretation of data from semi-structured questionnaires (n=107, 36%), qualitative focused interviews (n=35) and non-participant observations (n=8), users’ experiences of regulatory implementation were explored and explained, to more fully understand regulatory compliance. Integrative analysis and interpretation of this study’s mixed methods data determined neither substantive compliance (compliance with the collective goals of regulation) nor rule compliance (compliance with the regulatory standards) had been achieved following implementation of this new regulation. The existence of a significant level of shared activity between practitioners and enforcers during regulatory implementation was however established, where partnership working had derived from the ‘specialist’ nature of industry practice. Consequently, it was deduced that ‘compliance’ (defined in this context as ‘doing what was asked to conform to the law’) poorly reflected the events of regulatory implementation. Instead, ‘concordance’ has been discerned as the primary activity. The concept of concordance as ‘working towards agreement’ more accurately depicted the experiences of practitioners and enforcers during the process of regulatory implementation. Subsequently, the extent of ‘concordance’ was determined: The divergent attitudes/ experiences on the consistency of regulatory implementation and its ability to achieve its aim, coupled with the ambiguous understanding of ‘risk to health’ and converse working perspectives of practitioners and enforcers led to the conclusion that goal concordance (agreement on the collective goal(s) of the regulation) had not been achieved. On the other hand, despite evidence of apparent inadequacies and omissions in industry practices, practitioner and enforcer confidence in industry infection control practices led to the conclusion that rule concordance (agreement on the regulatory standards to be met) had been achieved. From these collective findings, a ‘Specialist Industry Concordance-Compliance Model’ was developed to explain the achievements of practitioners and enforcers as a result of implementing new regulation/ meeting regulatory requirements within a specialist industry. Complementing rather than conflicting with existing literature, this study offers ‘concordance’ as an alternative and/or intermediate output of regulatory implementation, explaining the process by which practitioners and enforcers implement new regulation/meet regulatory requirements within a specialist industry. Moreover, the study findings provide a framework to support better understanding of the potential output from implementation, monitoring and review of regulatory interventions, frequently associated with sub-optimal compliance. In turn, through combined understanding of concordance and compliance, the design of good regulation can be promoted, thereby facilitating maximum reduction in risk/ risk to health through regulatory intervention.