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Why pharma must trust the science of behaviour

With behaviour being the best weapon we currently have to combat coronavirus, Chris Ross explores why the application of behavioural science will be key to better health far beyond COVID-19

Behaviour change

Last month, as the world began to tiptoe its way out of lockdown, a Sky News anchor declared that COVID-19 had ‘exposed behavioural science’ as ‘a load of nonsense’.

The rationale? That behavioural scientists’ influence over the UK government’s COVID response caused a delay in lockdown that cost thousands of lives. The scientists’ logic was that if restrictions were imposed too early, ‘behavioural fatigue’ would soon set in and people might sleepwalk back into dangerous habits before the pandemic had peaked.

Increases in road traffic that began three weeks into lockdown suggest the thinking had some merit. But the subsequent death toll – and hindsight – tell a different story. Today, months into a crisis where we’re consistently told to ‘trust the science’, the science of behaviour is under the microscope.

However, to debate behavioural theory solely through the lens of the coronavirus – using death as the guiding metric – is to minimise its value. Human behaviour is complex, but understanding what drives it – and designing communications that encourage people to do things differently – is key to facilitating positive change.

Dismissing behavioural science as blather – a bitter irony in Sky News’ case, given the broadcaster’s mastery of conscious bias – betrays
a growing evidence base built up over decades. Behavioural science is now widely adopted. The FBI, for example, has been using it to profile
and snare criminals since the 1970s, with its Behavioural Analysis Unit playing a big part in capturing serial killers like Ted Bundy and George Metesky. Similarly, the UK government’s Behavioural Insight Team claims good successes in education, welfare and healthcare.

The application of behavioural science in health has never been more important. In the absence of a treatment or vaccine, behaviour change remains our best hope of thwarting COVID-19. But achieving it on a global scale was always going to test the science; if changing individual behaviour is difficult, reprogramming the habits of entire populations is practically impossible. Those challenges were evident as the world went into quarantine – and they’re at the heart of the battle as we slowly fight our way out.

Behavioural ‘nudges’ will be key to preventing a second spike, with everything from hand hygiene and haircuts to workplace safety and contact tracing all relying on the right behaviours. But evidence from past pandemics shows that, when the peak has passed, it doesn’t take long for people to return to their old ways. With COVID-19, short-term behaviour change won’t be enough.

Behavioural theory had a life BC – Before COVID – but its principles are currently centre stage as we journey through the pandemic. So what does the COVID experience tell us, and what can pharma learn from it to ensure interventions drive health improvements far beyond the crisis? I spoke to six experts in behavioural science in healthcare to find out more.

Complex science of human behaviour

“Getting people to change how they behave is notoriously difficult,” said Paul Tanner, Global Head, 90TEN. “This is because a large proportion of human behaviour and decision-making is driven by unconscious processes. As humans, we have evolved to employ mental shortcuts (heuristics) – simple, efficient rules that help us form judgments and make thousands of decisions every day. These rules work well under most circumstances, but can sometimes lead to irrational or counter-intuitive choices that prevent behaviour change. If we want to understand why people do what they do, we need to understand these cognitive biases and factor in that people don’t always weigh pros and cons objectively.”

Changing health-related behaviours, said Paul, is perhaps hardest of all. “Health is a strong driver of human behaviour, yet how we feel, think and act about our health is anything but simple. Unless we incorporate an understanding of the science of human behaviour into any planned intervention, we won’t successfully convince people to change.”

Global variation in complying with social distancing measures underlines the challenges of changing health behaviours – even when lives are at stake. In the UK, as many as one in four people in some age groups consistently refused to follow guidelines. The revelations are neither surprising nor new. “Evidence shows that major disasters – like the 2008 financial crash – typically cause short-term behaviour change, but only when people feel that a crisis affects them personally,” said Sally Bull, Senior Consultant, Consulting at McCann Health. “Research indicates that, whatever the situation, if changes we’re being asked to make don’t feel real or relevant, we simply won’t do them.

"In the current pandemic, people have generally responded well to the set of behaviours forced upon them because we’ve seen the threat and recognised the need. However, we don’t see the same kind of urgency in other health emergencies like diabetes and obesity. Driving improvements in these areas – and other chronic diseases – often requires significant, long-term lifestyle changes that are at odds with our ‘quick-fix culture’. There’s much that pharma can do to help, but it requires good application of behavioural theory.”

Insight is everything

“Lifestyle changes have to fit into people’s everyday lives if they’re to be sustainable,” said Sally. “Insight is key. Whether you’re trying to change HCPs’ prescribing behaviours or encourage patients to take their medicines, success comes from truly understanding the barriers to change and designing solutions to help overcome them.

"It’s only by talking to people and working through the belief shift pathway that you’ll get to that light-bulb moment. However, education alone isn’t enough – people need to be given the tools to incorporate changes into their everyday life. For example, patients know they need to adhere to treatments, but when the real world gets in the way, it’s easy to lapse.

"Good communications will explain the consequences of non-adherence, but they’ll also provide the triggers that help patients build taking their medicine into their daily routine. It’s all about making sure messages resonate with target audiences – and that hinges on deep insight.”

The shock of COVID-19 has thrust human behaviour into the spotlight and forced people to become more amenable to change. Could this inadvertently present an opportunity for pharma?

Dan Coffin, Director, the Research Partnership, thinks so. “Generally, human beings don’t like  change. However, the current environment
has – through necessity – driven a widespread openness to change that marketers must maximise. There’s a real opportunity to use behavioural thinking to help patients achieve better outcomes. Fundamentally, if marketers can understand why people are behaving the way they do, they’re better-placed to design insight- driven solutions that motivate target behaviours.

"Behaviour science breaks that insight down into bite-sized chunks to identify the beliefs, values and biases that influence individual behaviour. By understanding those unconscious processes, it’s easier to develop marketing initiatives that resonate with customers and help to change behaviour.

“There are hundreds of different biases and heuristics that we tap into to make decisions. Through interaction with customers, good market research can deploy behavioural techniques to understand which of these biases are at play,” said Dan. “For example, we might observe how someone interacts with a device, or listen to how they describe one product versus another. If one description is convoluted and the other is nailed with clarity, it indicates a ‘cognitive load bias’ that wouldn’t respond well to complex messaging.

Similarly, if interaction reveals a customer is more comfortable mirroring peer behaviours – ie, social norms bias – messaging that suggests ‘everyone’s doing this’ is likely to be effective. Behavioural research deploys a range of techniques, observations styles and analysis – across a variety of personal and digital channels– to uncover the biases and heuristics driving behaviour. Historically, pharma companies have relied heavily on scientific/clinical data to inform their marketing. However, with society currently more amenable to change, tomorrow’s leaders will be those who embrace behavioural science and use it as a lever for insight-driven marketing.”

A nudge and a think

So how should pharma proceed? “If we’re to truly embrace behaviour change, we need to start by looking at beliefs and motivations,” said Louise Sharp, Founder and Managing Director, Makara Health Communications. “For a change to be sustained we need to consider ‘towards’ and ‘away from’ motivators. Using the example of a new health regime, improving overall health, boosting mood and living longer would all be classed as ‘towards’ motivators. Spending time away from a computer and working fewer hours could be considered ‘away from’ motivators. The problem is that we’re moving away from things that are habitual, easy and familiar. The motivation we feel when we first start making a change often isn’t enough. We need to develop strategies to maintain motivation over time. Evidence suggests it takes between 21 and 66 days to change a habit, so the motivation to keep going is the key factor. We need to regularly remind ourselves why we are making the change and truly believe in it.”

When programmes aim to change behaviour without addressing the underlying beliefs of that behaviour, they are bound for failure, said Louise. “We behave in certain ways because it supports something that we believe or need. Look at what happens when we seek comfort; some might turn to a good book, others might choose cake. If your choice of comfort is cake but your desired change is for a healthier diet, you need to replace the cake with something that will be just as comforting, otherwise the ingrained habit of eating cake may be too strong a pull.”

One area of behavioural science that can be readily transferred into the healthcare arena is nudge theory. “Nudge theory focuses on highlighting the importance of something without imposing rules or bans,” said Louise. “Nudging breaks down behaviour change into small, incremental, specific and achievable goals, making the change easier to achieve. For pharma, developing disease awareness campaigns, patient support programmes and public health initiatives with nudge theory in mind can offer an effective approach.”

Follow the evidence

Once again, such programmes rely on deep insight right from the start. “The fundamentals of behaviour change theory require us to understand our audience’s current behaviour – what is it, where does it occur and who is involved? – and identify exactly what needs to change,” said Sarah Savage, Director, Pharma & Life Sciences, Pegasus.

“We use the COM-B model which states that capability, opportunity and motivation influence behaviour. For behaviour change to take place, any barriers in these categories need to be understood and addressed. COM-B allows us to capture a holistic view of the behaviour of patients and healthcare professionals; it looks at the full ecosystem of target behaviours that are needed to achieve a given outcome, and then identifies the key barriers from which we can build HCP or patient-facing campaigns and programmes.

“To sustain behaviour, programmes must be based on evidence, not assumptions. It’s therefore important to invest time and resource to insight gathering; what are the truths when it comes to a brand, market/therapy area and audience? Without identifying these, it’s unlikely you’ll correctly diagnose the behaviour problem or indeed uncover new perspectives. Some of our most impactful behaviour change programmes have hinged on an unexpected finding at the research stage.”

It’s also important, said Sarah, to ensure that creativity and behavioural science meet in the middle. “Tactical execution is a key component
in how the intervention lands with an audience and how successfully a patient or HCP adopts the behaviour change,” she said. “Finally, agility is crucial. Behaviour change is a process, so programmes must be ready to respond. Test-learn- adjust are vital steps in ensuring that behaviour change is not only achieved but also maintained. The capability to do must be built-in upfront.”

Consumption models

Another important model concerns consumption; even the most creative communications will only work if they meet target audiences ‘where they live’ and deliver resonant personalised experiences. Technology, said Michelle Kelly, Marketing Director, EPG Health, inevitably has a huge role to play.

“There are many theories for behavioural change and each comes with its own set of challenges. But an effective model of consumption is one of the most important and challenging components to get right. Different personas, behaviours, demands and preferences all need to be taken into account. A one-size-fits- all approach is never going to be as effective as supporting behaviour change with a personalised approach.”

Digital channels have become the dominant choice for consumption by both HCPs and patients. “With advances in technology, it’s now possible to support behaviour change online in a more personalised way,” said Michelle.

“Multichannel integrations allow information to be delivered in the right format, time and place, while AI-enabled platforms support personalised notifications and journeys – reinforcing messaging and providing relevant content.

“However, while pharma is sharpening its focus on behavioural science, its adoption of digital consumption models as a vehicle to support behaviour change has been slow. There are three key steps to driving effective consumption. Firstly, make it easy for audiences to find and consume information by providing intuitive navigation, a choice of formats and options to consume more or less. The better the experience, the more likely someone is to continue their journey and take action.

"Secondly, focus on key educational messages by presenting them front and centre, and architecting different journeys for each persona. Time-poor HCPs are less likely to abandon their journey – and more likely to adopt change – if they reach the salient points quickly. Finally, make it relevant and personalised by using technology that can monitor customers’ journeys, using behavioural data to guide them to relevant content. This will enable you to gain insights into those journeys as an indicator of behaviour change.”

Behavioural metrics

Finally, the importance of measurement cannot be overstated, with metrics established from the outset. “The first thing pharma should be doing is focusing on behavioural measures wherever possible (not perceptions, claims or attitudes),” said Paul Tanner.

“In the same way that double blind studies are used for testing drugs because people’s perceptions aren’t reliable indicators of efficacy, people saying they’ll act differently shouldn’t be relied upon. Behavioural science tells us that context is key. Since each context is different, it’s not possible to predict accurately how any given ‘nudge’ will impact people. So, the ultimate goal has to be testing alternative interventions through randomised controlled trials.”

Fundamentally, said Paul, it all comes back to understanding that behaviour is driven by unconscious mental processes. “Any project targeting behaviour change needs to identify and understand what’s driving current behaviour. From there, we’re in a better position to create interventions that have a chance of success. But it’s important we continue to track behavioural outcomes so we can learn what’s worked well, and what hasn’t.”

As the world continues its journey through the pandemic, behaviours will undoubtedly be subjected to further twists and turns. However, while we await a vaccine, those behaviours are currently the best weapon we have. It’s important we do all that we can to understand them. There’s never been a more important time to embrace behavioural science. It will play a huge role in getting us through COVID-19 and it holds the key to better health far beyond it. It’s time to trust the science.

Chris Ross is a freelance journalist specialising in the pharmaceutical and healthcare industries

24th July 2020

Chris Ross is a freelance journalist specialising in the pharmaceutical and healthcare industries

24th July 2020

From: Marketing

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