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Behavioural design - it's a no-brainer

Directions in behaviour change: From translating the theory into practice to looking at its design implications and beyond, we put behavioural change under the spotlight.

There has been plenty written about how insight-based communication is key to driving behaviour change. And there's easily as much data to back it up. But what if we need behaviour change to come in under the radar without the giveaway label of marketing attached? Don't we need a subtler approach? Step forward behavioural design.

Behavioural design can support behaviour change communications by offering a choice architecture that leads us towards a desired behaviour. And it achieves this by tapping into our automatic, unconscious decision-making. Typically behavioural design influences the decision-making process in order to guide us towards making good choices by making them easier. Or it can constrain our behaviour in order to make certain actions or decisions more difficult. There are examples of behavioural design everywhere. In his book 'The Hidden Forces That Shape Our Decisions' Dan Ariely cites the microwave that won't start unless the door is closed and the cash machine that won't dispense cash until you've taken your card.

That's all good, but where does behavioural design belong in the healthcare arena? Let's start with rheumatoid arthritis. Fatal medication errors relating to a disease-modifying medication for RA prompted an investigation into patient behaviour. It revealed patients were unable to open their medication packaging because of pain, weakness and loss of function in their hands. In other words they couldn't apply enough pressure to open childproof medicine bottles or they didn't have enough strength in their thumbs to pop tablets through blister packs. They were forced to ask carers to open the bottles and decant the medication into other containers such as teacups and bottles that contained other medication. Something clearly had to be done and observing this behaviour led to the design of seven different prototype containers for medication. Patients then tested all the prototypes and the most successful design went into production.

Behavioural design offers a choice architecture that leads us towards a desired behaviour
Moving from hands to noses, it seems certain olfactory cues can have a significant effect on hand hygiene behaviour. In a simulated hospital environment, groups testing a non-scented soap had a hygiene compliance rate of 51% whereas participants in the fresh scent group had a hand hygiene compliance rate of 80%.

Behavioural design has also had a significant impact on reducing violent behaviour in A&E. In a project backed by the Design Council, substantial reductions in hostility and aggression were seen in two NHS emergency departments following the introduction of large signs explaining where you are in the queue, as well as live information on digital screens.

So it seems behavioural design can be a powerful tool for behavioural change in its own right, and can significantly enhance the effectiveness of behaviour change communications. At the very least it should be an equal consideration with more overt communication strategies if we want to achieve long-term behaviour change.

Fiona Hammond is managing director at Hamell, a full service behaviour change agency. Contact her on +44 (0)20 7978 5206, via or visit 

24th February 2017