Behaviour Change…art or science?

Clive Bates

Director General, Sustainable Futures

Welsh Assembly Government

Contemporary challenges

Some relevant areas

Education/skills

Parenting

Post-16 participation

Adult literacy

Life skills (cooking etc)

Volunteering

Health

Teenage pregnancy

Drugs, alcohol, tobacco

Obesity

Keeping appointments

Organ donation

Prosperity

Service culture

Active job seeking

Entrepreneurship

Personal aspiration

Diversity

Environment

Transport choices

Energy efficiency

Reduce, reuse, recycle

Consumption choices

Fly-tipping

Community

Crime prevention

Anti-social behaviour

Terrorism

Social mobility

Litter / graffiti

Care / ageing

Self-care

Pension provision

Mental health

Active ageing

End-of-life choices

Behaviour change is big money

£154bn

£30bn

4

6

8

10

12

14

1977

-78

1982

-83

1987

-88

1992

-93

1997

-98

2002

-03

2007

-08

2012

-13

2017

-18

2022

-23

Projected UK health care spending

(% GDP public & private, annotations at 2002-3 prices)

£96bn 2007-8

US spent 14.6% GDP in 2002 (OECD)

% GDP

Source: Wanless, 2002 Securing Our Future Health: Taking A Long-Term View

About £220 bn over 15 years

Fully engaged

1. Use a simple model that people can remember

Encourage

Enable

Engage

Exemplify

Catalyse

1. The 4-E approach to behaviour changeTaxes & fiscal measures

Regulation & finesLeague tables

Targets / perf managementPrizes / rewards / bonuses

Preferential treatment Status recognition

Subsidies / discountsFeedback

Remove barriers to actSet defaults / opt-out vs opt-in

Form clubs / communitiesProvide information

Choose intervention timingPersonalise

Provide space / facilitiesBuild confidence

Ease/cost of access

Community/network actionDeliberative fora

Segmentation / focusSecure commitmentPersonal contacts

Role models / 'super-users'Paid/unpaid media campaignsPester power / Peer pressure

Workplace norms

Evidence baseWalk the talk & lead

Consistency across policiesSustained approach

Credibility / confidenceBenchmarking / evaluationLearning & improvement

Political consensus building

Encourage

Enable

Engage

Exemplify

Catalyse

4-E approach to behaviour changeTaxes & fiscal measures

Regulation & finesLeague tables

Targets / perf managementPrizes / rewards / bonuses

Preferential treatment Status recognition

Subsidies / discountsFeedback

Remove barriers to actSet defaults / opt-out vs opt-in

Form clubs / communitiesProvide information

Choose intervention timingPersonalise

Provide space / facilitiesBuild confidence

Ease/cost of access

Community/network actionDeliberative fora

Segmentation / focusSecure commitmentPersonal contacts

Role models / 'super-users'Paid/unpaid media campaignsPester power / Peer pressure

Workplace norms

Evidence baseWalk the talk & lead

Consistency across policiesSustained approach

Credibility / confidenceBenchmarking / evaluationLearning & improvement

Political consensus building

Some examples using the 4-E framework

• Smoking

• Drink driving

• Recycling

Smoking prevalence All > age 16 (Britain)

0

5

10

15

20

25

30

35

40

45

50

1975 1980 1985 1990 1995 2000 2005 2010

Encourage

Enable

Engage

Exemplify

Catalyse

Smoking and behaviour change

High excise taxesBan marketing practices

Address smuggling

(nb. Personal incentives)

NHS 'stop smoking' treatmentSmoke-free policies

Quit-linesPharmaceutical deregulation

Social marketing campaignsMore graphic warnings

Major news media assaultConstant revisiting evidence

“Denormalisation”

Smoke-free policiesClear messages from NHS

Consistent packageClear goals

Commercial arguments

A cigarette for the beginner is a symbolic act. I am no longer my mother’s child,

I’m tough, I am an adventurer, I’m not

square...

...as the force of the psychological symbolism

subsides, the pharmacological effects take over to sustain the

habit

But others forces are at work...

Dunn W. Vice President for Research and Development, Philip Norris. Why one smokes. 1968 Minnesota Trial Exhibit 3681.

Encourage

Enable

Engage

Exemplify

Catalyse

Smoking: from the dark side

AdvertisingRole models

Adult product definitionDuty Free

Orchestrating smugglingLightsFilters

Wide availabilityFighting smoke-free places

Aspirational sell to poor Coupons and catalogues

Coaching argumentsDistracting PRBogus science

Product placement in filmsSponsorshipNormalisation

Drink drivingReported drink drive accidents and fatalities: GB 1980-2008

1980=100

0

20

40

60

80

100

120

1980 1985 1990 1995 2000 2005 2010

Fatalities

Accidents

DFT: Reported Road Casualties Great Britain 2008: Annual Report

Encourage

Enable

Engage

Exemplify

Catalyse

Drink driving

More severe penaltiesPolice enforcement

BreathalyserSoft drinks normalisation

Taxi services & other innovations

Driver training as part of penalty

Strong sustained media campaign

Clever segmentation

30 year campaignVilification of politicians

No 'nod and wink'

Drink drivingReported drink drive accidents and fatalities: GB 1980-2008

1980=100

0

20

40

60

80

100

120

1980 1985 1990 1995 2000 2005 2010

Fatalities

Accidents

DFT: Reported Road Casualties Great Britain 2008: Annual Report

SeatbeltsCompulsory

1983

1992

1994

1996

1998

2000

2002

2004

2006

0

10

20

30

40

50

60Rise of Alcopops

ml/w

eek

per

pers

on

Drink drivingReported drink drive accidents and fatalities: GB 1980-2008

1980=100

0

20

40

60

80

100

120

1980 1985 1990 1995 2000 2005 2010

Fatalities

Accidents

DFT: Reported Road Casualties Great Britain 2008: Annual Report

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

300

400

500

600

700

800

900Decline of breath tests

Num

ber

of b

reat

h te

sts

(tho

usan

d)

Eng

land

and

Wal

es

Recycling and behaviour change

1991

-92

1992

-93

1993

-94

1994

-95

1995

-96

1996

-97

1997

-98

1998

-99

1999

-00

2000

-01

2001

-02

2002

-03

2003

-04

2004

-05

2005

-06

2006

-07

2007

-08

0

20

40

60

80

100

120

140

160

180

200

UK recycling rateKg per person

Encourage

Enable

Engage

Exemplify

Catalyse

Recycling and behaviour change

Landfill taxLandfill diversion targets

Infraction

Local authorities incentive structure changed

Collection servicesContainers / bags

Sorting

(difficulties remain)

Common endeavourNo free-riding

Waste Awareness

But... controversy and sensitivity

Government targetsMoney committed

SD indicatorsLong-term view (to 2025)

Organ donation

Johnson, E. J. and Goldstein, D. (2003). Do defaults save lives? Science, 302:1338–1339.

Encourage

Enable

Engage

Exemplify

Catalyse

Blood / organ donation

Payment? Default (opt out)

Blood money

Developed Transition Developing0

10

20

30

40

50

38.1

7.1

2.3

Donors per thousand population

World Health Organisation: Blood Transfusion Safety Unit 2007 data.

Paying for blood creates poor incentives

Percentage of voluntary unpaid blood donations, 2007

Contracts for exercise

Contract No contract0

20

40

60

80

100

81

31

Participation in walking programme

Williams BR, Bezner J, Chesbro SB, Leavitt R. The effect of a behavioral contract on adherence to a walking program in postmenopausal African American women. Top Geriatr Rehab.2005;21(4):332- 342.

Encourage

Enable

Engage

Exemplify

Catalyse

Contracts to create reciprocity

Solidarity with othersPeer pressure

Contract & reciprocity

Teachers Expectations affect Student Outcome

Randomly selected but labelled "High achievers"

Control group0

5

10

15

20

25

30

21

5

Proportion pupils achieving 30 point grade increase

Rosenthal, Robert & Jacobson, Lenore. Pygmalion in the classroom (1992). Expanded edition. New York: IrvingtonQuote: attributed to George W Bush

“The soft bigotry of low expectations”

Encourage

Enable

Engage

Exemplify

Catalyse

The Pygmalion Effect

Expectation setting and belief

4-E behaviour change model in use

2. Think of people as ‘human’

2. Understand human behaviourRational

all-knowing individualised

long-term utility

maximisation

MINDSPACE

MINDSPACE

Messenger: We are influenced by who communicates information

Incentives: Our responses are shaped by biases and shortcuts

Norms: We tend to do what those around us are already doing

Defaults: We ‘go with the flow’ of pre-set options

MINDSPACE

Salience: Our attention is drawn to what is novel and seems relevant to us

Priming: Our acts are often influenced by sub-conscious cues

Affect: Emotional associations can powerfully shape our actions

Commitment: We seek to be consistent with our public promises, and reciprocate acts

Ego: We act in ways that make us feel better about ourselves

The Science of Persuasion

6 weapons of influence

1.Reciprocation: You did something for me and now I owe you

2.Consistency: One thing I do or think leads to another

3.Social proof: 9 out of 10 cats prefer...

4.Liking: I will buy Tupperware from you because I like you

5.Authority: More doctors smoke Lucky Strike

6.Scarcity: Get it now, or I’ll be sorry when it’s gone 

Robert Cialdini, The science of persuasion, Scientific American, 284, 76-81.

Some “biases” in real behaviour

• Loss aversion

• Recency

• Peak experience

• Herding

• Heuristics

• Omission

• Habit

• Confirmation

• Hyperbolic discounting

It's illogical Captain...

List of cognitive human “biases”Behaviour & Decision-making

Probability & belief Social

Bandwagon effectBase rate fallacyBias blind spotChoice-supportive biasConfirmation biasCongruence biasContrast effectDéformation professionnelleDenomination effectDistinction biasEndowment effectExperimenter's Extraordinarity biasFocusing effectFramingHyperbolic discountingIllusion of controlImpact biasInformation biasInterloper effectIrrational escalationJust-world phenomenonLoss aversionMere exposure effectMoney illusionMoral credential effectNeed for ClosureNegativity biasNeglect of probabilityNormalcy biasNot Invented HereOmission biasOutcome biasPlanning fallacyPost-purchase rationalizationPseudocertainty effectReactanceRestraint biasSelective perceptionSemmelweis reflexStatus quo biasVon Restorff effectWishful thinkingZero-risk bias

Ambiguity effectAnchoring effectAttentional biasAuthority biasAvailability heuristicAvailability cascadeBelief biasClustering illusionCapability biasConjunction fallacyDisposition effectGambler's fallacyHawthorne effectHindsight biasIllusory correlationLudic fallacyNeglect of prior base rates effectObserver-expectancy effectOptimism biasOstrich effectOverconfidence effectPositive outcome biasPareidoliaPrimacy effectRecency effectDisregard of regression toward the mean.Selection biasStereotypingSubadditivity effectSubjective validationTelescoping effectTexas sharpshooter fallacyWell travelled road effectConsistency biasCryptomnesiaEgocentric biasFalse memoryHindsight biasReminiscence bumpRosy retrospectionSelf-serving biasSuggestibility

Actor-observer biasEgocentric biasForer effectFalse consensus effectFundamental attribution errorHalo effectHerd instinctIllusion of asymmetric insightIllusion of transparencyIllusory superiorityIngroup biasJust-world phenomenonNotational biasOutgroup homogeneity biasProjection biasSelf-serving biasSelf-fulfilling prophecySystem justificationTrait ascription biasUltimate attribution error

For more information Wikipedia search:

“List of cognitive biases”

3. Understand the population

3. Understand the population

Use segmentation

Able to act

5: Cautious participants I do a couple of things to help the environment. I’d really like to do more, well as long as I saw others were. 14%

2: Waste watchers‘Waste not, want not’ that’s important, you should live life thinking about what you are doing and using. 12%

1: Positive greensI think it’s important that I do as much as I can to limit my impact on the environment. 18%

3: Concerned consumersI think I do more than a lot of people. Still, going away is important, I’d find that hard to give up..well I wouldn’t, so carbon off-setting would make me feel better. 14%

4: Sideline supportersI think climate change is a big problem for us. I know I don’t think much about how much water or electricity I use, and I forget to turn things off..I’d like to do a bit more. 14%

7: Honestly disengagedMaybe there’ll be an environmental disaster, maybe not. Makes no difference to me, I’m just living life the way I want to. 18%

6: Stalled startersI don’t know much about climate change. I can’t afford a car so I use public transport.. I’d like a car though. 10%

Willing to act

4. Be careful with the relationship between citizen and state

4: Establish the case for intervention

“The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant”.

But… Children? Addiction? Influence of background? Mental illness? Collective costs? Regret...?

From soft paternalism to regulation

Health impacts

Unregulated addiction

Hooking kids

Passive smoking - public

Passive smoking - workers

Private impacts

Public (external) impacts

5. Adopt a learning approach

4+2 Es approach to behaviour change

Encourage

Enable

Engage

Exemplify

CatalyseExplore Evaluate

5. Culture change: self-sustaining behaviour

Summary

1. Four-E behaviour-change modelEncourageEnableEngageExemplify

2. Understand real behaviour

3. Segment and personalise

4. Judge public acceptability (which changes)

5. Experiment and evaluate

Reading up...

Thaler & Sustein Mark Earls Robert Cialdini Dan Ariely

Reading up...

Government communications

Government Social Research

Institute for Government

& Cabinet Office

Cabinet Office