While the well-worn adage states that men can’t multi-task, all of us it seems are doomed to limited cognitive capacity. That’s not to say we all aren’t very capable but there is a limit to the amount of information anyone can process at any one time.
To combat this social psychologists suggest we have become ‘motivated tacticians’. If the situation allows we can be thoughtful and thorough in processing information, however if it does not we resort to more economical tactics that use less cognitive resources – acting automatically without fully thinking through our decisions. These mental shortcuts we rely upon to help us make decisions and form judgements are called heuristics. By understanding heuristics we can explain how people, while complex, are incredibly predictable in their behaviour. By redesigning our environment to make good decisions easier or seem more appealing according to these shortcuts, we can encourage our audience to make better decisions for the good of their health and that of others.
An amazingly simple yet effective example by Dominic King and his colleagues (2014) is the suggested changes in the ‘choice architecture’ of hospital prescription charts. Prescribing errors are frequent in hospital inpatients, partially due to errors in legibility. By making simple changes to prescription charts such as using colour to direct attention to important areas, gridlines to encourage clear block capitals and utilising check boxes, they found physicians were significantly more likely to enter correct dose entries and specify the frequency of medication administration. In another example, a simple line of tape along the bottom of a shopping trolley, designating the area for fruit and vegetables, together with a sign prompting consumers to buy more fruit and vegetables, increased the amount purchased significantly (Payne, 2010). These simple non-intensive, cost-effective measures promote better decision-making, without restricting choice or imposing regulations.
By redesigning our environment, we can encourage our audience to make better decisions for the good of their health
While the previous examples utilise more traditional design features, behaviour can also be changed through design in the framing of information. This may utilise principles such as hyperbolic discounting, loss aversion and reciprocity. Hyperbolic discounting for instance suggests that people show greater motivation towards short-term rewards than long-term, partly due to difficulties in projecting the future. Consequently health goals are more effective when framed as immediate and concrete, an application thought to be especially useful in promoting healthy eating or the treatment of chronic diseases by focusing patients on short-term, positive habit formation (Voyer, 2015). Goal setting may also benefit from loss aversion, which suggests that individuals are more motivated to avoid a loss compared to achieving an equivalent gain. Loss aversion may also be applied to physician decision-making, while determining medication risk in relation to gains in quality of life, survival or disease-free progression etc, and when conveying options to their patients. The principle of reciprocity, alternatively suggests that messages are more influential when people feel that they owe something. For example the Behavioural Insights Team (2013) conducted one of the largest Randomised Controlled Trials performed in the UK into different messages to promote organ donation and found that a message based on reciprocity, ‘If you needed an organ transplant, would you have one? If so please help others’, was most effective. These are just a few of the principles one could utilise when considering behaviour design and demonstrate quite remarkably how small changes can result in large effects.
While creativity is vital in changing behaviour through design, it is also imperative to ground interventions in robust research evidence and psychological literature. For example, in another study attempting to increase organ donation the Behavioural Insights unit tested three messages. During trials, one message decreased the sign-up rate despite predictions that it would be highly influential through tapping into the unconscious motivation of normative behaviour, ie our need to be like everyone else. In this case, pre-testing saved thousands of potential donors, reminding all of its necessity.
It will be interesting to see how the government’s plan to state a medicines price, along with the statement ‘funded by the UK tax payer’ on all medication will fare in this light. While incentives and principles of reciprocity, eg ‘I must take this medication as I have paid for it’ may suggest this will decrease wastefulness, it could equally be that patients take medication less regularly than prescribed to, in their eyes, save money.
Behavioural design may not therefore be as simple as once proposed and an expert’s complete understanding of human behaviour is therefore required.
Utilising these principles, the Behavioural Insights team is thought to have saved British taxpayers millions of pounds and unsurprisingly, private companies are now rapidly adopting these methods. With the power of behavioural design to create large effects from simple changes, this is an opportunity the world can’t afford to miss.
At Hamell Ignyte we continue to fund such innovation as a priority, assessing persistent and recurring health issues, determining ways to challenge such harmful behaviours. With technological advancements increasing exponentially, it is vital to cast our eyes to mHealth as it continues to provide new opportunities in which we may utilise behavioural design to assist audiences, in a much broader context.
Fiona Hammond is managing director at Hamell, a full service behaviour change agency. Contact her on +44 (0)20 7978 5206, via Fiona@hamell.co.uk or visit www.hamell.co.uk
