www.strategic-social-marketing.

org

What we know about Designing Behaviour Change Programmes and Interventions

Professor Jeff French PhD, MBA, MSc, Dip HE, BA, Cert.Ed Strategic Social Marketing Ltd www.strategic-social-marketing.org jeff.French@strategic-social –marketing.org

www.strategic-social-marketing.org

Introduction
What we know about behaviour change 25 lessons from the evidence: Putting theory into practice Recent findings from a variety of fields of study have all helped to expand and enhance our understanding of how and why people behave as they do. This learning gives us a powerful set of principles, which can be used to help design more effective social change interventions. In particular, there is a much wider appreciation now that while behaviour can be ‘rationale’ and the result of conscious consideration, in practice many decisions flow from emotional engagement, social influence and environmental prompts. What we now know is that many of our choices and the decisions we make that influence our behaviour are not the result of active decision-making but can often also be unconscious and automatic in nature. These ‘decisions’ are influenced by our social and emotional contexts and by factors such as timing, and our physiological state. The following set of 25 principles summarises much of what we currently know about influencing behaviour drawn from fields of study that include but are not limited to management, psychology, policy development, economics, design, sociology, biology and communication studies

www.strategic-social-marketing.org

1. Change in behaviour is usually a process not an event, and often entails several attempts before success. When delivering intervention programmes there is a need to be persistent, sustain interventions over time and offer multiple paths to success. 2. A desire or at least an acceptance for change must be present in the target audience: Some people will want to change their behaviour; others will need to be persuaded to consider a change. 3. People need to feel involved and engaged. Participatory involvement often creates bigger behavioural change effects. Wherever possible, involve, consult and engage people in both designing and delivering interventions. 4. Active consideration often leads to more permanent change. If people have a chance to explore and consider issues, this soften helps them both reconsider attitudes and beliefs that help them change their behaviour or maintain a positive behaviour. 5. People can be taught critical thinking skills that can help them take more control over their behaviour and resist media, social and environmental influences on their behaviour. 6. People are often motivated to do the ‘right thing’ for the community as well as themselves and their families. Interventions that appeal to peoples sense of community togetherness and that the desired behaviour is a norm in the community and one that is valued by others tend to be more successful. 7. Social relationships, approval and social support have a strong and persistent influence on behaviour. Working with and through key influencers improves the impact of behaviour change programmes. Use the power of group norms and behaviour to inform and engage people in change, let them know that others are changing and use the power of group action. 8. People can be ‘locked into’ patterns of behaviour and need practical help to help them break or unfreeze current behaviour. Programmes that provide practical support to change are easy to access and require small steps tend to be more effective. 9. Beliefs and values influence how people behave. Programmes should start by understanding target audience beliefs and attitudes and use these to inform the development of behaviour change services and products. 10.Behavioural experience can influence beliefs and values. Programmes that move people to behaviour as quickly as possible i.e. give them a chance to try the thing that is being promoted work best. It is not always necessary to rely on shifting attitude first. Often behaving differently often leads to a shift in attitude. 11.Change is more likely if an undesired behaviour is not part of an individual’s coping strategy. Avoid ‘telling people off’ for ‘bad’ behaviour if they are using it to cope with life. Demonstrates an understanding of the reasons for their behaviour and offer realistic and attractive alternatives that give practical support to change.

www.strategic-social-marketing.org

12.People’s perception of their own ability to change can either enhance or detract from attempts to change. Develop services and support that will build people’s confidence knowledge and skills. 13.People’s perception of their vulnerability to a risk and its severity is key to understanding behaviour and developing effective interventions. Focus on understanding people’s perceptions and how they view the risks associated with the behaviour. Also focus interventions on people’s views and frame risks in ways that they can understand and are meaningful to them. 14.People’s perceptions of the effectiveness of the recommended behavioural change are key factors affecting decisions to act. This factor means that we need to set out in terms that people value the benefits and impact of the change that is being promoted. 15.People influence and are influenced by their physical, social and economic environments. There is a limit to a person’s capacity to change if the environment militates against the desired change. Deliver programmes that tackle the underlying environmental, social and economic barriers to change as well as personal factors. 16.People are loss averse. They will put more effort into retaining what they have than acquiring new assets or benefits. Stress potential losses associated with the behaviour as well as the positive gains that can be accrued from change. 17.People often use mental short cuts and trial-and-error approaches to make decisions, rather than ‘rational’ decision making. An understanding these short cuts or heuristics should be used to develop interventions and develop new ‘scripts’ associated with the behaviour you are trying to influence. 18.The more beneficial or rewarding an experience, the more likely it is to be repeated. Maintaining positive behaviour can be assisted by reinforcement. Behavioural interventions should seek to reward desired behaviours and when appropriate penalise inappropriate behaviour. Interventions should also seek to support positive behaviour by maintaining a relationship with people which affirms their new behaviour and encourages them to build on it. 19.Many people are often more concerned with short-term gains and costs, and tend to place less value on rewards or costs that might happen in the future. Programmes should emphasise short-term as well as long-term benefits and seek to reduce short-term costs. 20.People will usually change behaviour if they value what is being offered or in the case of a negative penalty that the penalty has meaning and real consequences for them. Offers and penalties need to be presented in a way that people find meaningful and understandable. 21.Change is more likely, if the actions that have to be taken are easy specific, simple and clear. Making the first step to change very easy also helps engage people in the start of a change process. Keep interventions

www.strategic-social-marketing.org

specific and promote them in a way that the target audience views as relevant and appealing. 22.People can be helped to change by designing services and environments in such a way that encourage people to act that does not involve complex choice decisions. Design services, environments that encourage ‘mindless choosing’ i.e. by removing the need for complex choices, for example making only low or nonalcoholic drinks available at social functions will encourage less people to get drunk. 23.Many people are bad at computation and risk assessment. Many of us do not understand numbers, risk ratios or odds. Test the use the understanding of numerical and risk based messages before using them. Convey risks and factual numeric information in ways that the target audience can understand and find compelling, for example the number of Olympic sized swimming pools full of water that can be saved by fitting a low volume flush toilet. 24.Communications and media including social media can have a powerful effect on people’s attitudes beliefs and consequently behaviour. However this effect is not mainly concerned with information transmission. The real impact of mass and social media on people is often less. Media can build up impressions of relationships between issues, set the agenda for public debate and create emotional responses as well as transmit information. 25.Behaviour is influenced by physiological and somatic state. If people are physically aroused this often wil have an impact on their behaviour, a sense of relaxation will also have an impact on behaviour. People’s somatic state, i.e. the shape of their body and how they perceive it will also have an impact on their behaviour. Genetics can also have influence on behaviour; there are some differences in the way men and women for example as populations if not individuals have a tendency to behave in specific instances.

Selection of supportive References
Andreasen A (1991) Marketing social change: Changing behaviour to promote health, social development, and the environment. San Francisco, CA: Jossey-Bass Ariely D, Predictably Irrational: The Hidden Forces That Shape Our Decisions. Harper Collins Australian Public Service Commission (2007) Changing Behaviour a public policy perspective. Australian Public service Commission. Barton, ACT: Australian Government Publishers Ltd. 2009. Australian Public service Commission (2007) Tackling Wicked problems, a public policy perspective. Australian Public service Commission. Barton, ACT: Australian Government Bagozzi R. (1975) Marketing as Exchange. Journal of Marketing, 39:32-3 Bate P, Bevan H, Robert G (2004) Towards a million change agents. Review of the social movement’s literature, implications for large scale change in the NHS. London: NHS Modernisation Agency. Brafman O, Brafman R. Sway. The irresistible pull of irrational behaviour. Virgin. London. 2009

www.strategic-social-marketing.org

Cabinet Office Research Project (2002) OPM. The effectiveness of different mechanisms for spreading Good Practice. London: Cabinet Office Cabinet Office (2008) Cultural Change. A policy Framework. London: Cabinet Office Cabinet Office. Mind Space. The Cabinet Office.London 2010. Ciladidi R. Influence. The psychology of persuasion. Collins.1994. COI a. Payback and return on marketing investment (ROMI) in the public sector. GNC. London 2009. COI b. Communications and behavior change. COI GCN. London. 2009 COI c. Lannon J (Ed) How public service advertising works. IPA London 2008. Cottam, H. Leadbeater, C. Red Paper No1 health: Co-creating Services. The Design Council. London. 2004. Cavill, N, Bauman, A. Changing the way people think about health-enhancing physical activity: do mass media campaigns have a role? J Sports Sci 2004 22 (8) CDCYNEGY planning tool for social marketing (2005) Atlanta, GA: Centres for Disease Control. Craig, C. L., Cragg, S. E. Tudor-Locke, C. Bauman, A. Proximal impact of Canada on the Move: the relationship of campaign awareness to pedometer ownership and use. Can J Public Health 2006 97 Suppl 1 Dawney E.Shah H. Behavioural economics, seven principles for policy makers. London: New Economics Foundation. 2005. Department of Health (2003) Tackling Health Inequalities. A Programme for Action. London: Department of Health Department of Health (2007) Health Challenge England. London: Department of Health Department of Health and Human Services (2003) Making Health Communication programmes work. Washington, DC: National Institute of health National Cancer Institute. Dixon M ( 2006) Rethinking financial capability, lessons form economic and behavioural finance. IPPR London. Donovan R and Henely N (2003) Social Marketing: Principles and Practice. East Hawthorn, VIC: IP Communications Du Plessis E. The advertised mind. Milward Brown Koran Page London. 2005 Earls, M. Herd: How to Change Mass Behaviour by Harnessing Our True Nature John Wiley & Sons (2007) Elliot B (1988) The development and assessment of successful campaigns’. Education coordinators’ workshop on media skills. Brisbane: Public Opinion Quarterly, vol.37, pp.50-61 French J (2004) 9 steps for effective practice Jan. CPHVA Journal. London French J and Mayo E (2006) It’s Our Health! London: National Consumer Council French J. The Big Pocket Guide to Social Marketing 1st Edition. National Social Marketing Centre. NSMC. The National Consumer Council. London. 2005.

www.strategic-social-marketing.org

French J. (a) The Value / Cost Exchange Matrix. Presentation given at the 20th University of South Florida social Marketing Conference June 2010. Down load at: www.strategic-socialmarketing.org French J. ( b) The Social Marketing Intervention Mix Matric. Presentation given at the Open University November 2010. Download at: www.strategic-social-marketing.org French J, Blair-Stevens C. Improving Lives Together. The de-Cides© Framework. Westminster City Council. London. 2010. French J. Blair- Stevens C. Merritt R. McVey D. Social Marketing and Public health, theory and practice. Oxford University Press 2010. Futerra (2006) New Rules of the game Communications tactics for climate change. The game is changing behaviours; the rules will help us win it. London: Futerra Grilli R, R. C. M. S. Mass media interventions: effects on health services utilisation. Cochrane Database of Systematic Reviews: Reviews 2002 Issue 1 2002 Goldberg M, Fishbein M, Middlestat S (1997) Social marketing: Theoretical and practical perspectives. Washington, DC: The Academy for Educational Development Goldstein N Martin S, Cialdini R Yes . fifty secrets form the science of persuasion. Profile Books. London 2007. Government Social Research Unit (2008) Knowledge review. Practical guide: An overview of behaviour change models and their uses. London: Government Social Research Unit. HM Treasury Government Social Research Unit. Knowledge review. Practical guide: An overview of behaviour change models and their uses. London: Government Social Research Unit. HM Treasury. 2008 Grist M. Steer. Mastering our behaviour through instinct, environment and reason. Royal Society of Arts. London. 2010. Halpen D, et al. (2004) Personal Responsibility and Changing Behaviour: the state of knowledge and its implications for public policy. London: Prime Minister’s Strategy Unit Health Care Commission and the Audit Commission (2008) Are we choosing health? The impact of policy on the delivery of health improvement programmes and services. London: Health Care Commission Health Development Agency. The effectiveness of public health campaigns (2004) London: Health Development Agency Herron DB (1999) Marketing nonprofits programs and services: Proven and practical strategies to get more customers, members, and donors. San Francisco: Jossey-Bass Hills D (2004) Evaluation of community – level interventions for health improvement: a review of experience in the UK. London: Health Development Agency. Hornick RC (ED) Public Health Communication Evidence for Behaviour Change. New Jersey LEA. 2002. Hyland, A. M., Wakefield, M., Higbee, C., Szczypka, G., Cummings, K. M. Anti-tobacco television advertising and indicators of smoking cessation in adults: a cohort study. Health Educ Res 2006 21 (3) Iles V, Sutherland K. (2001) Organisational change. A review for health care managers, professionals and researchers. London: National Coordinating Centre for NHS Service Delivery and organisation R&D

www.strategic-social-marketing.org

Institute of Government and Cabinet Office. Mindspace, Influencing behaviour through public policy. London 2009 International Union for health promotion and education (2000) The evidence of health promotion effectiveness. International Union for health promotion and education. Brussels: European Commission. 2nd Ed. Jackson T (2005) Motivating Sustainable Consumption Sustainable Development Research Network. University of Surrey: Centre for Environmental Strategy Jorm, A. F., Christensen, H., Griffiths, K. M. The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments. Aust N Z J Psychiatry 2005 39 (4 Kelly G, Mulgan G, Muers S (2002) Creating Public Value. An analytical framework for public sector reform. London: Prime Ministers Strategy Unit, Cabinet Office Kahneman D ‘A Psychological Perspective on Economics’ by, American Economic Review, Vol. 93 No.2 , pp. 162-168. 2003. Kotler P and Roberto W (1989) Social marketing: Strategies for changing public behaviour. New York: The Free Press Kotler P, Roberto W and Lee N, Second Ed (2002) Social Marketing - Improving the quality of life. Thousand Oaks, CA: Sage Publications. P. Kotler and G. Zaltman, ‘Social Marketing: an approach to planned social change’, Journal of Marketing, 35 3-12.1971. Kotler P and Roberto W. Social marketing: Strategies for changing public behaviour. New York: The Free Press. 1989. Manoff RK (1985) Social marketing: New imperative for public health. New York: Praeger McGuire WJ (1986) The myth of massive media impact: savings and salvagings’ Public communications and behaviour. vol 1 pp173-220 Miller M & Ware J (1989) Mass media alcohol and drug campaigns; consideration of relevant issues. Monograph Series No. 9, AGPS, Canberra Michie S Jochelson K, Markham W, Bridle C. (2008) Low income groups and behaviour change interventions. A review of intervention content and effectiveness. London: King’s Fund Ministry of Health Planning. Prevention that works. A Review of the Evidence Regarding the Causation and Prevention of Chronic Disease. Chronic Disease Prevention Initiative: Paper 2. Prevention and Wellness Planning. Population Health and Wellness. Ministry of Health Planning. Victoria BC. November 2003 MMWR Effect of ending an ant tobacco youth campaign on adolescent susceptibility to cigarette smoking--Minnesota, 2002-2003. MMWR Morb Mortal Wkly Rep 2004 53 (14) Modernisation Agency (2001) Managing Change in the NHS. Making informed decisions on change. NCCSDO. Improvement Leaders Guide to sustainability and spread. London: The Modernisation Agency. London Moodie R (2000) Infrastructures to promote health: the art of the possible. Victoria: Health Promotion Foundation. Moor M (1995) Creating Public Value: Strategic management in government. Cambridge, MA: Harvard University Press

www.strategic-social-marketing.org

Mulgan G, Aldridge S, Beales G, Heathfield A, Halpen D, Bates C Personal Responsibility and Changing Behaviour: the state of knowledge and its implications for public policy. Prime Minister’s Strategy Unit. February 2004. Mulgan G. Influencing Public Behaviour to Improve Health and Wellbeing An independent report. DH London. 2010. National Institute for Health and Clinical Excellence (2007) Behaviour change at population, community and individual levels. Reference Guide. London: NICE National Social Marketing Centre. (2008) The total process planning framework for social marketing. London: National Social Marketing Centre New Economics Foundation. (2005) Behavioural economics: seven principles for policymakers. London: New Economics Foundation NESTA (2001) Selling Sustainability. Seven lessons from advertising and marketing to sell low-carbon living . Report Supplement 01 London: NESTA NHS Centre for Reviews and Dissemination (1999) Getting evidence into practice. Effective Health Care. Vol 5 Number 1. York, UK: NHS Centre for Reviews and Dissemination Ogden L, Shepherd M, Smith WA (1996) Applying prevention marketing. Atlanta, GA: Centres for Disease Control and Prevention, Public Health Service Prime Ministers Strategy Unit (2003) Review of Area based initiatives. London: Prime Ministers strategy Unit. Regional Coordination Unit Roe L, Hunt P, Bradshaw H et al. (1997) Health Promotion Effectiveness Reviews 6: Health Promotion Interventions to Promote Healthy Eating in the General Population: a review. London: Health Education Authority Rothschild M L. Carrots,(1998). Sticks and promises: A conceptual framework for the management of public health and social behaviours. Journal of Marketing. Oct . Vol 63. 24-37 Rogers EM & Storey JD (1987) Communication campaigns, in Berget, CR & Chattee, SH (eds), Handbook of Communication Science San Francisco, CA: Sage Publications Ryan M (2001) Overview of practice collections relevant to tackling health inequality. October. London: Health Development Agency Schade, C. P., McCombs, M. Do mass media affect Medicare beneficiaries' use of diabetes services? Am J Prev Med 2005 29 (1) Social Market Foundation (2008) Creatures of Habit. The art of behaviour change. London: Social Market Foundation Solomon DS (1982) Mass media campaigns in health promotion, Prevention in Human Services, vol. 2, nos 1 and 2, pp. 115-23 Solomon DS (1984) Social marketing and community health promotion: the Stanford heart disease prevention program. In Frederiksen L, Solomon L & Brehony K (eds), Marketing Health Behaviour. New York: Plennum Press Schorr LB (2003) Determining “What works” in social programs and social policies: Towards a more inclusive knowledge base. The Brookings Institution

www.strategic-social-marketing.org

Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J., Fleming-Milici, F., Proctor, D. A meta-analysis of the effect of mediated health communication campaigns on behavior change in the United States. J Health Communication 2004 9 Suppl 1 Thaler R and Sunstein C. Nudge. Improving decisions about health, wealth and happiness. New Haven & London: Yale University Press. 2008. Thomas M, Brain D Crowd Surfing. A &C Black London 2008. Turning Point. The managers Guide to Social Marketing. The National Social Marketing Excellence Collaborative. Seattle, CA: Turning Point. 2004. Turning Point (2004) The managers Guide to Social Marketing. The National Social Marketing Excellence Collaborative. Seattle, CA: Turning Point Vargo, S. L. & Lusch, R. F. Evolving to a new dominant logic for marketing. Journal of Marketing, 68: 1- Vargo, S. L. & Lusch R. F. (2006). Service Dominant Logic: What it is, What it is not, What it might be. In Lusch S. L. & Vargo, S. L. (eds). The Service Dominant Logic of Marketing: Dialog, Debate & Directions. New York: M. E. Sharpe. 2004 Whitehead M, Tones K (1991) Avoiding the Pitfalls. London: HEA World Health Organization (1977) Jakarta Declaration. Geneva: World Health Organization World Health Organization (2008) Closing the Gap in a generation. Geneva: World Health Organization

Professor Jeff French PhD, MBA, MSc, Dip HE, BA, Cert.Ed Strategic Social Marketing Ltd www.strategic-social-marketing.org jeff.French@strategic-social –marketing.org

Sign up to vote on this title
UsefulNot useful