Changing behaviours – in others, or in ourselves – is a difficult thing to do. But it is something all of us must contend with at various points in our lives. To encourage people to take the medicines they need, or switch to a healthier lifestyle, we must first implement some behavioural psychology.
What better way to explain this than with an analogy? So, let’s consider the ‘behaviour-change buffet’. What do you habitually reach for? A carrot? A stick (of celery)? A leg-up of lamb? A large helping of cold reality soup? Resorts and cruise ships love buffets because they simultaneously cater for hundreds of different tastes and the same is true for influencing behaviour – one person’s leg of lamb is another’s celery stick.
And yet, in health, behaviour change initiatives are always very similar, often developed in silos and usually only catering for a few patients.
This is due partly to resource availability, but also to the desire for an evidence-based, cost-effective solution – especially in pharma. The right mindset for good health behaviour is to focus on patient outcomes, not just brand outcomes. It requires a longer-term view – over five to ten years, not six to 12 months, and more financial commitment – but it’s worth it.
Why ‘nudging’ doesn’t work
The ‘go to’ theory is the simple act of ‘nudging’ – where freedom of choice isn’t restricted, but certain choices are encouraged. Nudging draws on concrete ideas from psychology and economics, and promises fairly quick results from small but precisely targeted interventions – which makes it very appealing.
However, following an evaluation into behavioural change for the UK government in 2011, the UK House of Lords Science and Technology Committee concluded: ‘Our central finding is that non-regulatory measures used in isolation, including “nudges”, are less likely to be effective. Effective policies often use a range of interventions.’
In plain English, to really change the outcome of certain health behaviours – such as obesity levels or eating your five a day – you need a range of ideas and initiatives. This is not to say that nudging doesn’t work at all, but it needs to be part of a wider initiative.
Preparing your buffet
If nudging is to be served as a side dish, what else can you prepare? The behavioural change dietary staples need to be:
* Desire
* Ability
* Opportunity.
At a bare minimum, the buffet table should feature all of these – and they must be easily digestible by everyone.
Desire to change
Most people recognise the need to improve their lifestyle for health reasons – but this knowledge alone is not enough to inspire change.
This is when the carrot, the stick, the scare tactic, the support, the cajoling and even the nudge can also be used. But first, you need to decide which method each patient needs at any given time. Ideally you do this up front, through individualised medicine. But when that’s not available, put the options on a buffet table and help them find what they’re hungry for.
Ability to change
This is the area where drug companies and HCPs alike feel most comfortable. We like to provide tangible ‘things’ such as educational tools, apps and leaflets. But these ‘things’ have to be consistent. HCPs, for example, may already have the education required to get the best results for their patients – but they may be missing the ‘framing’ of behaviour change that will help achieve those results.
Opportunity to change
Let’s say you want to take your medication and you’re able to do so. What’s holding you back from actually taking it?
Perhaps it needs to be refrigerated and you travel for a living. Perhaps you live too far from a hospital to regularly commute. Perhaps you have a young family and time for yourself is non-existent.
Some of these are societal issues, but pharma can still do its part to boost access and convenience. Considerate product design can help, as can health service partnership to provide home delivery or streamline pathways.
Building the buffet
Even when discussing the same diseases or conditions, it is impossible to say what behavioural interventions will be appropriate to treat or manage them. Individual needs vary too much. But the common denominator is that almost all patients want practical, simple, everyday ideas that make their lives easier.
The key to behavioural change is to take more time to find out what will work and what motivates them. Simple ideas that will make a difference in any given situation – as long as they’re plural, diverse and designed for real life. That way, everyone will feel catered for and satisfied.
Kirsty Mead is Account Director at Purple Agency
