Monday, 15 August 2011

There's a nudge coming your way very soon!

How would you respond if you were told that an aspect of your behaviour was different from that of most people, for example that most people were taking more physical activity than you each day, buying more fruit and vegetables each week, or even paying their tax bill more quickly than you? 

This may or may not concern you, but whether it does or not, you will be seeing more of these kinds of messages in supermarkets, letters from the tax office or at work very soon, because these ‘nudges’ are firmly built into health and social policy ideas for the next few years.

Where does nudge come from?
The idea of behavioural nudges was developed by two American professors and published in a book, unsurprisingly called ‘Nudge’. It describes how we might be prompted to change our behaviour by our environment, but without restricting our right to choose. And the UK Government has taken up this message in a very big way. One of its first actions when coming into office was to set up a ‘behavioural insight group’ to look at ways health and social behaviour could be influenced, and the authors of Nudge are said to be advisors to the group. 

So far, the group have raised several nudges that will come into regular use in the near future. These include a change to the wording of an overdue tax letter and an automatic opt-in to pension schemes. Other ideas being discussed are working with supermarkets to reorganise products and messages on their shelves to make it easier to buy healthier products, and inviting you to make a charity donation when you are withdrawing cash from a hole in the wall.

How do nudges work?
The theory is quite straightforward. As humans, we behave in certain ways, for example:
1.   It’s known that our choices are influenced by what’s immediately available in the environment
2.   We tend not to opt in to something, but once in, we tend not to opt out
3.   We respond to rewards
4.   We like to feel similar to other people, rather than different

So, putting this evidence into practice may result in strategies that help us successfully change our behaviour.

If you’re thinking ‘so what’s new?’, you are not alone. We already know the effect of peer pressure, and in recent years we have all seen desirable or special offer products being positioned near checkouts to tempt us. We have also all got a purse or wallet full of reward cards. So in commercial terms, we are often ‘nudged’. However, nudge theory has not yet been applied to creating national health related policies.

In pursuit of this, the aforementioned behavioural insight group have recently published a document discussing how nudging could be applied to health, using examples from many areas, including diabetes. It cites one pharmaceutical company’s blood glucose testing product, which offers points on popular computer games for each test completed. Apparently, as a result, more tests are done because the user feels less pain and forgets about the experience more quickly when it is coupled with playing the game, which is a distracting and enjoyable activity.

Is nudging a good thing?
Although it’s important for people to make choices that are right for them personally, nudging could be a useful way to make people aware of options they hadn’t yet thought of, and so there would definitely be some value in ‘moderate nudges’. There’s no doubt that there’s a big need for change in some areas of our lives, particularly health related – you only need to look at the growing size of the nation (literally!), concerns over the livers of teenagers, and the lack of physical activity in the population to know that. We also know that conventional ‘telling people what to do’ doesn’t work in the long term, and many of our good and healthy intentions only last a few months before we relapse back into our old ways. Anyone who’s tried to lose weight more than once will know this so well! So maybe a well-placed reminder or two to do the right thing will really help and there’s a fair bit of evidence for that.  Also, nudging focuses on providing only choices that result in a positive outcome.  Applied to health, where often only the negative aspects of taking certain actions are presented, nudges could be a particularly welcome development.

On the other hand, what about our right to choose and not to have our behaviour psychologically manipulated? Where will it end? The cash machine telling me to spend my money on attending Weight Watchers instead of buying wine? My driving licence only being issued if I agree to donate my organs if I die in a car crash? My doctor’s surgery restricting my appointments because I haven’t performed as well as other people with the same condition as me? Obviously these are extreme examples, but then nudge is based on the fact that human behaviour is somewhat irrational, and also that we tend not to opt out if we are automatically opted in… so perhaps we need to be aware of these possibilities and be alert for that ‘nudge too far’?

A more intriguing question for us and one which is consistent with our philosophy of enabling people to make the right choices for themselves, is ‘could people nudge themselves?’ Knowing a bit more about nudging and knowing what our priorities for change are, could we arrange things in our own lives to make it easier for us to make different choices? For example, making ourselves more aware of our unhealthy behaviours by counting the number of our friends who don’t smoke, or who do eat 5 a day, or who have successfully lost weight? Setting a mobile device to regularly ask us about the amount of physical activity we have undertaken? Even reorganising the shelves in our cupboards or fridge so the healthy options are easier to reach? Then again, if it was that easy, perhaps we would already be doing these things - so perhaps we DO need the bony elbow of the health ministry to help us!

What’s your view about nudging? What would ‘nudge’ you - or are you un-nudgeable? This topic is now open for discussion…

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