Healthy behaviour change strategies

Behaviour change seems to have become embedded in brand marketing and public policy almost overnight. Both private and public sector organisations are seeking to engage behaviour change expertise in a way that we couldn’t have imagined ten years ago.

Behavioural science is particularly popular when it comes to improving public and personal health, no doubt because persuasion and prevention is far more cost effective than cure. And of course, effective communication around healthy behaviours is more important than ever in a world grappling with the Covid-19 pandemic.

But what exactly are the best healthy behaviour change strategies? Behavioural science promises seemingly simple solutions to health issues. Yet the drivers for health behaviours are complex, and effective behaviour change strategies necessitate a nuanced and intricate combination of elements.

A simple nudge?

The Behavioural Insights Team (BIT) set up by David Cameron’s government has achieved success with interventions from increasing organ donation to encouraging tax returns, using methods that appear deceptively simple.

Nicknamed the nudge unit, BIT has now evolved to become an international organisation, applying research-led interventions shaped by the key EAST framework globally. The framework – the acronym stands for easy, attractive, social and timely – is just one established model, with direct parallels with the COM-B Behaviour Change Wheel and the Fogg Behaviour Model.

In summary, it is based on the principles that people have to find the desired behaviour easy enough, it has to be more of an attraction than their current undesirable behaviour, it has it to be seen as the social norm, and inducements and encouragements have to come at the right time in an individual’s journey to change. These are all elements shared in one way or another with COM-B and Fogg.

It all sounds simple right? And resulting interventions often look simple too. But their execution invariably hides complexities and is informed by deep research to ensure that any healthy behaviour change strategy hits the mark for all drivers.

To this end, research and road testing is vital, especially when it reveals the unexpected. In its organ donation campaign, BIT found that a social norm in the form of a message on the registration website stating that thousands of people signed up to be donors every day increased registrations. But, surprisingly, when it was accompanied by an image of a group of people, the message performed worse than no social norm message at all.

Take too Thrive’s work on the mMitra campaign in India, and our research into why pregnant women were so reluctant to take iron pills despite anaemia being one of the main causes of maternal death. Health workers believed it was because the pills can cause constipation. It was only through focus group research that we discovered the real reason – a myth that iron discolours babies’ skin.

Messages were targeted towards dispelling that myth and positively focusing on how iron helps babies thrive, as well as including information on how to cope with constipation. By outlining the benefit of taking iron and making it easier (by including the constipation advice), more women in the programme now take supplements. But making this behaviour attractive and easy was only possible through focus group research.

Social change marketing

Social change marketing uses a combination of well-established brand marketing approaches and behavioural science insights to promote and encourage desired healthy behaviour. One of the most well-known examples is the UK’s Change4Life campaign. Using easily-understood and achievable messages, the campaign drew on the core principle of promoting social norms with audience targeting and a b brand identity borrowed directly from the commercial marketing playbook. Results include reaching 99 per cent of targeted families, with nearly half a million families joining and still interacting with the campaign after six months.

Social change marketing is a sophisticated approach that does require commercial insight, however, with specialist agencies set up to research, design, implement and evaluate the optimum combination of behaviour change approaches, married to brand marketing techniques.

Policy-level change

Occasionally a behaviour is so established and embedded as a societal norm that it requires a more radical approach to change. This was the case in 2006 and 2007 when Scotland, followed by the rest of the UK, banned smoking in indoor places, most notably pubs. Previous education campaigns to reduce smoking had largely failed and the controversial move was met with resistance from pro-smoking pressure groups.

But, not only did the ban have the immediate benefit of preventing exposure to second-hand smoke, a more subtle effect started taking place. Such a publicly visible change made non-smoking the social norm, prompting many smokers to give up completely. As the Centre for Public Impact reports, the number of adult smokers in the UK has shrunk by nearly a third, from 22 per cent in 2006 to less than 15 per cent in 2019. In just ten years, support for the ban also increased, from 78 per cent in 2007 to 83 per cent in 2017.

Similar cultural shifts have been seen with the legal requirement for car seatbelt wearing and the ban on mobile phone use while driving. It’s not just the chances of being caught that motivate people to comply, after all the risk is relatively low. Just as important is the fact that travelling without a seatbelt and using phones while driving have switched from being seen as social norms to deviating behaviours, contributing to cultural coercion to conform to the desired actions.

More recently, the UK government introduced the so called 'sugar tax' (officially, the Soft Drinks Industry Levy), which aims to reduce childhood obesity by imposing higher taxes on sugary drinks. This gives manufacturers the incentive to reduce sugar content in their products, and also makes sugary drinks less affordable for children.

Technology and behaviour change

In tandem with the increasing expertise in behavioural science, advancements in technology have made delivery of interventions easier, more achievable and more effective. Technology has enabled the rise not just of behaviour change interventions but, in healthcare, remote medicine too, and the two often go hand in hand. The mobile age allows for instant communication of messages at exactly the right time to exactly the right channel. Something as seemingly simple as a couple of text messages a week can improve weight loss outcomes in adolescents. Our own work helping mothers living with HIV in South Africa, including motivational text reminders to go to clinic appointments and take medication, improved health outcomes for both the women and their babies.

Mobile phone technology that detects where someone is, what they’re doing and even the state of their mental health through self-monitoring on wellbeing apps, can also refine targeting of messages to be even more effective. This level of interaction enables better gamification, increasing audience engagement especially in hard-to-reach younger audiences. The success of Fitbit and other wearables that use rewards systems to engage users is testament to this. Speaking to the Guardian, Thomas Hsu, social collaboration and gamification expert at Accenture, says: "Gamification is hot right now. We're in the golden age of scientific and neurological research. We understand the psychology, self-determination theory and intrinsic motivators that drive behaviour change."

As the complexities of behavioural science are better understood through further research and testing, and technology becomes even more advanced, the potential for behaviour change interventions to improve personal and public health is only set to become greater. Engaging expertise is imperative though to ensure that the seemingly simple is underpinned by solid research and experience to deliver truly effective and lasting change.

Here at Thrive, we work with brands, partner agencies, governments and charities who want to transform lives and societies for good.

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