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We had a great time at #Commscampnorth, so much cake, coffee and conversation.

Kirstie, our managing director held a session on Nudge Theory. Lots of interesting ideas were shared around and these are some notes that came from the session.

The following resources were suggested and have been used for these notes too:

Inside the Nudge Unit

Applying Behavioural Insights, Simple ways to improve health outcomes

The Idiot Brain

The Easy, Attractive, Social and Timely (EAST) framework is a simple way of applying behavioural insights to make behaviour change more likely:

Easy. We want to avoid expending effort wherever possible. For example, because we often avoid making an active choice, we often end up with the ‘default’ option. Therefore, making the default option the healthy one is likely to be effective: if the default option is to receive an HIV test, then testing will be much more frequent than if the default is to not receive one. Requiring even small amounts of effort (’friction costs’) can make it much less likely that a behaviour will happen. For example, making it just slightly more difficult to obtain large amounts of over-the-counter drugs has been shown to greatly reduce overdoses. Other examples: Pensions, millions more saving as a result of auto-enrolment; University entry, 25% more poor students go when forms pre-filled.

Things to think about:

  • Simplify
  • Friction: remove or add to inhibit
  • Defaults: set the easy path as the healthiest safest option

Reduce even very small barriers to make a healthy behaviour more likely

Attractive. Our attention is limited and so we need new ways of attracting it. One way of doing this is to identify the messages that work best. For example, a study found that missed hospital appointments could be cut by a quarter if a reminder stated the specific cost of a missed appointment to the health system. Another way is to attract attention through visual or spatial design: accidental deaths on railways in India were cut by painting reference lines on railway tracks to make it easier for people to judge the speed of trains. Clear visual representations can also attract attention to the way diseases are trans- mitted. For example, one Ebola prevention technique showed a man with clean hands shaking hands with another man who had blue powder on his hands representing the Ebola virus. After the handshaking, the colour blue appeared in the palm of the man, implying he had come into contact with the virus. Without washing his hands, the man picked up a loaf of bread and immediately the colour appeared on the bread. Other examples: Tax, 10 times more doctors declared income with salient letter; Giving, 2 x more donations to emergency appeals with story of one child versus statistics of millions affected; Courts, 3x more likely to pay fines with personalised text.

Things to think about:

  • Personalise: use recipients name; make relevant
  • Salience: make key point stand out
  • Messenger: experts and named individuals beat anonymous or distributed sources. The doctor, the mum, the child..
  • Lotteries: make incentives more attractive
  • Emotion: as important as reason

Create simple and clear messages, or new design features, to attract our limited attention.

Social. Humans are social beings who are strongly influenced by what others do – ’social norms’. Making healthy behaviours more visible can make them seem more prevalent and easier to copy. For example, the ‘Ebola handshake’ that was introduced in Nigeria to reduce physical contact (and thus the spread of disease) acted as a highly visible replacement greeting. Even simply telling people what others do in the same situation is effective – doctors prescribed antibiotics at a lower rate when told that most of their peers were doing this. Other examples: Litter, 8x more likely to drop flyer if others already on the ground; Tax, 16 % more likely to pay if informed that most people ‘pay on time’; Giving, 7x more likely to give when learning that a colleague already gave.

Things to think about:

  • Norms: what are others doing
  • Networks: a friend or colleague recommends
  • Reciprocity and active commitments: promises
  • Reminders of others: eyes and faces

Show or tell people that others are performing a healthy behaviour.

Timely. People are more receptive to changes at some times than others. Therefore, some moments will be more effective times for intervention, such as religious or cultural holidays, the start of the year or significant life events. For example, a successful diabetes screening program in Qatar timed the intervention (which required fasting) to coincide with Ramadan, when many people were fasting anyway. Other examples: Health, 3x more workers choose healthy options a week ahead than on day; Tax, 2x more less likely to respond to nudge if late paying previous year; Sunday morning is a timely point for getting people to donate after Saturday night out.

Things to think about:

  • Habits: intervene before they become established
  • Key moments: when behaviour is disrupted
  • Priming and anchoring: the power of what just came before
  • Time inconsistency: discounting of the future (much more likely to choose a health snack for next wee, than on the day)

Launch interventions at times when people are most receptive to change. 

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