Using behavioural science to improve healthcare

Last week Ben Cox, Tom Grant and I attended the Royal Society of Medicine’s ‘Behaviour Science for Better Outcomes in Health and Care Services’ event. Bringing together leading researchers of behaviour science and health practitioners, the event aimed to share knowledge of research techniques, behavioural intervention design, and strategies for evidence-based change in healthcare.

We heard from a range of speakers on how behaviour science was being adopted within their organisations to inform policy and improve the effectiveness of interventions. Here are our key take-aways:

A notion that came up repeatedly during the event; the factors that influence decision-making are crucial to consider when creating policies or interventions to change behaviour. If we are aware of the factors that determine behaviour, we are far better placed to consider what interventions might be successful in changing it.

Hugo Harper from the Behavioural Insight Team spoke on their ‘EAST’ framework. According to their research, if we want to encourage a behaviour, we need to make it Easy, Attractive, Social and Timely for people to engage with. Hugo recalled the success of an NHS campaign which reduced the number of missed healthcare appointments by 23%, using text message reminders. The wording and structure of these mobile phone reminders can be carefully engineered to appeal to our subconscious and trigger a desired behaviour; for example, reminding people of the specific cost to the NHS when they miss an appointment.

Some speakers referred to the COM-B model, which asserts that it is our capability, motivation and opportunity to do things, which determines our actions. These three broader factors can be broken down and analysed to help us consider all the individual determinants of behaviour.

Nicole Stingelin-Giles covered the topic of Nudging, whereby subtle changes to processes or environments are used to encourage people towards a certain behaviour, without direct instruction. Simple examples include placing fruit at eye-level to encourage healthier snack choices. On a greater scale, however, she spoke of how moving from an opt-in to an opt-out model of organ donation – as the NHS will in Spring 2020 – has a significant effect on the numbers of available organs for transplant.

Interestingly, there was also discussion surrounding the ethics of ‘nudging’. If we are subtly engineering people’s choices, who is to say what the ‘right’ behaviour is?

It was interesting to hear from Sarah Mullane, who spoke on J&J’s approach to behaviour science. They are combining Behaviour Science, Data Science and technology to personalise BCTs for individuals and sub groups; understanding what improves engagement from non-responders through a rapid iterative approach. The Data Science and technology now available to us is significantly speeding up learning on Behaviour Change Techniques and their success.

Dr Claire Garnett (UCL) and Dr Sarah Mullane (J&J) wrapped up the day with a joint presentation on the design and testing of digital solutions for healthcare. They discussed the importance of engagement (the ‘Little E’) and effectiveness (the ‘Big E’); our main aim is effective behaviour change intervention, but this is reliant on the engagement of users with our methodology.

They emphasised the fact that well designed user experience – and rigorous user testing and revision throughout development – is crucial in securing user engagement. Linking back to the EAST model, through good design and testing we can ensure that our method of behaviour change intervention – whether an app, poster or process – is easy and attractive to use: good design means greater engagement.

“Behaviour change is all about making things you want to happen easier, and making things you don’t more difficult.”

Importantly, this engagement is the door to effective change. If we can’t get users engaging with our platform, then we won’t achieve the ‘Big E’ goal as there will be limited exposure to our behaviour change interventions, which will thus be less effective.

To summarise

Behaviour change is all about making things you want to happen easier, and making things you don’t more difficult. Understanding human behaviour, and predicting the effectiveness of interventions, is far from simple. However, the technology now available to us, as well as modern research and understanding, is developing rapidly.

We saw a great range of examples of how behavioural design is being adopted to significantly improve efficiency, but also to make huge costs savings in healthcare. Not only can these interventions achieve great cost savings, but in themselves can be relatively low cost to implement. It’s exciting to see how these interventions are being used, and might be able to be used in future, to improve our health services and quality of care for all.

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