Don’t Knock the Nudge: Moving from online community engagement to real-life behaviour change in health
This is the third post of 4 in preparation of the #hccmty flipped panel by Robyn Sussel, Principal and Chief Strategist at Signals.ca.
All 4 panelists will be presenting their ideas and sparking conversations on this blog so that the on-stage event at the February 25 #hccmty meetup will be but one more link in the chain, not the start or end point. Read the first blog by Colin Hung and the second blog by Blair Ryan.
For more information on the #hccmty event.
We all know that when it comes to human beings and behaviour change, offering the carrot not the stick usually elicits a better response. Think about weight loss advice from your doctor. “I think you should eat more fruits and vegetables.” Okay, yeah I can do that. Versus, “You need to lose weight so eat less!” Uh….not so much.
Nudging us towards better behaviour is clearly a better option.
Richard H. Thaler and Cass R. Sunstein introduced “nudging” in their 2008 book, Nudge: Improving Decisions About Health, Wealth, and Happiness. Their theory was that it is helpful to “hide” behaviour change in positive experiences.
A good analog example of “nudging” is this Stockholm staircase that was made into a set of piano keys. When given the choice between an escalator or a fun staircase, the healthier option wins out. People were not informed, preached at or even reminded of the benefits of taking the stairs. The nudge was just a better experience and they changed their behaviour without admonishing or shaming.
Much like the piano in Stockholm, online technologies offer health providers a chance to engage with people in ways that elicit action. We also know that all digital audiences are seeking better and meaningful experiences online. In my day-to-day work, creating these experiences is especially important for our health and human rights clients who aren’t seeking a “business” endpoint, like a financial transaction. But rather they are looking to educate and hopefully prompt behaviour change to improve health — which is often the hardest sell of them all. (I’ve written more about online nudging techniques on the Signals blog).
Having created many digital campaigns that promote behaviour change, I can tell you that online communities are often central to creating this offline change. But like Colin Hung said in his blog post from last weekend, creating an online community may not be the necessary goal. A good place to start is to really understand the behaviour of your audience (as well as their attitudes towards the subject matter) and also understand what communities currently exist that could potentially access these audiences.
For example, we created a campaign to encourage young women (age 19-21) to take a healthy action — to go to their pharmacy for their HPV shot. This was a campaign that sought to interact with a group of people who already interacted in many online spaces. So our strategy was to reach them where they already spent time. We also put the “sharing” experience in their hands so they could share their action with their peers in the communities where they were actively established. This encouraged peer-to-peer prompts for behaviour change — the “nudge” from their friends (not public health officials) to get the vaccine.
But there are cases where the right online community does not exist, despite evidence that the target audience is active online. We ran across this when we created the Power to Push campaign which was targeting women in BC of reproductive age.
Due to unacceptably high rates of c-section in BC (and climbing), the goal of the campaign was to educate women who had already experienced one c-section, that they didn’t necessarily need another one. More than that, the action we wanted them to take was to call and visit the BC Women’s Hospital clinic where offline interventions could take place.
At the time, there was no online community for pregnant women in British Columbia, so our strategy was to create one and “work in” the Power to Push message. The “nudge” in this case was to provide women with an online support group that they lacked. Okay, contrary to nudging principles, we preached a bit, but it was mainly the community itself encouraging one another to consider alternatives to c-section.
The work involved in creating that community was huge (as my co-panelists have said) so this should not be taken lightly. But an economic case can be made — in this case our two year campaign was a drop in bucket compared to the savings to the healthcare system to avoid thousands of unnecessary surgical interventions. (Metrics for the campaign were presented at the first ever Evening Rounds in Vancouver back in 2012). Within a year it was (and still is) the largest online community for pregnant women in BC.
So here are some things to think about?
- How could “nudging” help your organization bridge the gap from just offering information to patients/public to eliciting a healthy action?
- How could “nudging” contribute to the sustainability of an online community?
- How could “nudging” techniques be used to transition online community connections to in-person connections?
- If you’re trying to make a health-related intervention, how can you best convince management that online discussion and to support to offline behaviour change is worth the investment (building a case)?
- Is an online community really the brass ring you are seeking? by Colin Hung
- Five key components to building an online community for physicians by Blair Ryan
- “Is anyone there?” – Is your online community a ghost town? by Colleen Young