“Future of health” rings the same bells for most people: a much more efficient and personalized health care sector that is enabled by technology and data. It is true that data and technology has the power to transform how we maintain our health and receive health care. The real transformative potential, however, is a function of how we use technology and data to understand and change the “behaviour”. This is mainly because human behaviour is still and will be the most critical determinant of public health.
Behavioural aspects in healthcare have long been discussed and studied, now ever stronger with the COVID-19 pandemic, where human behaviour is at the centre of spread and thus protection measures. From handwashing to social distancing and wearing masks, COVID-19 measures are purely behavioural and rely on how individuals are able to prioritize these actions and find motivation to act. Majority of the chronic diseases are known to be preventable through well-being activities such as healthy eating, exercising and lifestyle habits. Traumas -to some extent- are preventable through managing risky behaviours. Yet behaviour is not something easy to change- at least if left alone.
Yes, as humans we act in irrational ways to undermine our health and future well-being and yes, this irrationality is perfectly predictable thanks to the large collection of research and literature on how human decision making and behaviour can be flawed. Knowing the mechanisms behind the irrational behaviour, behavioural scientists also developed ways to induce desired behaviours through well designed “nudges”.
Health sector is one of the areas that behavioural nudges are applicable for enhancing the wellbeing of the individuals and optimizing healthcare. Today, understanding the psychological-social barriers that lead the unhealthy behaviours and how to change them through data science and technology is in the focus of many technology companies. Combination of data -facilitated by technology- and behavioural insights make a power couple to pave the way to future of health where precision and more personalized health care experience is at the core.
Go EAST: Make it Easy, Attractive, Social and Timely
Behavioural Insights Unit has introduced EAST framework as a hand toolbox for encouraging behaviour. EAST framework (Easy, Attractive Social, Timely) has been popular in the context of healthcare sector. Let’s see how it is combined and strengthened with technology:
Easy: People tend to go with the most convenient, hassle-free, less energy consuming option, avoiding extra effort where possible. Knowing this, making the healthier choice the “default” one and making the unhealthy one more demanding in terms of effort, pays off. For example, adding a step of bureaucracy in the purchasing of large quantities of over-the-counter drugs reduces the “overdose” cases. In USA, deaths from paracetamol poisoning were reduced by 43% after a legislative change on the maximum number of pills allowed in a pack. One stop shops, easily accessible healthy food, instant and effortless feedback mechanisms are other ways to make things “easy”. Technology has the power to make things further easy: Wearables and mobile apps allow for more instant nudges without the hassle of searching for information, such as calorie intake, exercise level, oxygen saturation, or even being in the proximity of an infected person, as in COVID-19 tracing examples…
Attractive: As humans, we have quite a limited attention span. Messages need to be interesting, eye-catching, memorable, relatable, etc. to capture our attention. Take COVID-19 measure booklets or posters in public areas for example: many of them are methodical, well-structured, so everywhere and so uniform that after a while people do not even notice them. And yes, although the golden rules are written everywhere, people do tend to forget to wash their hands before touching their face and do tend to leave their noses uncovered while wearing their masks. Making it attractive calls for some creativity, and technology does help, especially through tailoring the message to be more personalized by making use of advanced data analytics and AI. Sensors further provide a strong enabler for personalized nudges. Take patients of chronic diseases whose health and well-being data is constantly collected via sensors, recorded, and managed by expert internet of things (IOT) platforms. It is possible to nudge the patients for managing their risks through the right channel and with the personalized message.
Social: Humans are social creatures and tend to do what others are doing. Saying “everyone is doing this” has a strong impact on motivating people to do the same. New Zealand’s “Unite Against Covid-19” campaign is a recent example of this. “People in your age start to consume 30% less animal based protein to maintain their cardiovascular health” is a stronger message than saying “now that you are 50, you should cut animal based proteins”. Or “%50 of people with diabetes are not aware of their conditions. Are you one of them?” could capture the attention of a pre-diabetes person and motivate to act on. In UK, prescription of excessive antibiotics was managed by nudging doctors with the information: “you are prescribing 30% more antibiotics than the average”. Designing socially strong nudges call for having right behavioural insights, where data analytics play a crucial role in collecting and analysing the data. Gamification is also a strong means of employing social nudges: People loved to post the screenshots of their workout apps showing the parkour they covered and distance they run.
Timely: Timing is everything. People are more receptive to changes at certain times than others, meaning, some moments are more effective for intervention. Often a good time to nudge a person for a certain behaviour is right before s/he makes a decision or right on spot. Technology helps here as well. There are wearable devices to help people with posture problems to train themselves to correct their posture using on the spot biofeedback. Telehealth is a good example of timely interventions. Now with COVID-19 restrictions, people typically stay home, do less exercise and order in. A good time to nudge for healthy lifestyle: right before ordering in a pizza.
Consumer driven-health care: calling the power couple!
Behavioural insights are now ever easier to gather with the available technologies: sensor data from wearables and other devices, data from social media, mobile apps, data analytics platforms and analytic tools all are providing a rich foundation for drawing valuable insights into personalized and -also collective- behaviour. With some creativity and making use of available technologies, it is possible to design personalized nudges for healthy behaviour. Micro interventions tailored to individual needs has a strong potential to change behaviour. Further we believe, this is not a one-way relationship where the patient is the passive recipient: we expect the patients to own their data more, know why and how to selectively share it with third party analytical solutions service providers and use it to both their and society’s advantages for decision making purposes.
 Behavioural Economics literature has grown fast during the past 4 decades and the literature brought home 3 Nobel prizes: Herbert Simon (1954) for his theory on bounded rationality of humans, Kahneman and Tversky (2003) for their work on how human mind is prone to misjudgements, and Richard Thaler (2017) for his work on how to nudge people for desired behaviours, by making use of behavioural insights.
 Behavioural Insights Unit, aka “Nudge Unit”, is a social purpose organisation that generates and applies behavioural insights, officially to inform policy and improve public services. www.bi.team