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Behavioural Science: Nudging in health promotion

May 13, 2024
Nudge
Achieve sustainable healthy behaviour with the right impulses
Nudging in health promotion - Topic overview

What is nudging?

Why is nudging useful?

Nudging addresses key challenges in health promotion

How to introduce nudging in health promotion

Examples - How nudging can be implemented in health promotion

Nudging in health promotion

Our health is largely determined by our behaviour. Many of these behaviours are shaped by unconscious decisions and behavioural patterns and are therefore difficult to change. In this article, we describe how you can use behavioural science findings through nudging in the workplace health promotion to improve the health of your company.

What is nudging?

Nudging is derived from the English word "to nudge" and refers to methods of targeted behavioural change without the use of regulations and incentives. This practice was significantly influenced by the two scientists Richard Thaler and Cass Sunstein and their 2008 book "Nudging: Improving Decisions About Health, Wealth and Happiness", published in 2008.

Why is nudging useful?

We often assume that we humans are rational beings and that our actions are subject to a certain logic. In classical economics, for example, most theories are based on homo oeconomicus, a model of man as a purely rational being who has all information in view and always acts in the interests of maximising his own benefit.

It has long been known that this image of human beings does not correspond to reality. In fact, we only make 20 % of our decisions consciously and often against all logic. For example, we all know that we should sit ergonomically and move more, but we still sit hunched over in front of the computer and prefer to take the lift rather than the stairs. This is not because we are self-destructive or lazy. It's because we are confronted with thousands of decisions every day, most of which we (fortunately) make unconsciously. The aim of nudging is therefore to adapt our physical and immaterial environment so that we unconsciously make the "right" decision.

Nudging addresses key challenges in health promotion

One of the main problems faced by many practitioners in the field of health promotion is the limited reach of OHM measures. These usually reach the same employees who are already very concerned about their health. One way to increase the number of participants in OHM & OHF measures is to optimise the type of communication. Read our article "Successfully organising BGM communication". Another option is to change the behaviour of employees beyond the classic measures by changing the physical and immaterial environment, i.e. through nudges. The advantage of nudging is that it is based on the "programming of our brain" and thus on automatic patterns and therefore works largely independently of intra-individual differences. Educational programmes based on the transfer of information and knowledge require conscious perception and must be processed with limited cognitive resources. This results in social selection, which manifests itself, for example, in a lower participation rate among lower social classes. In addition, cognitive resources are generally focused on things that are relevant to the fulfilment of the work objective, which reduces the impact of educational opportunities in everyday working life.

How to introduce nudging in health promotion?

Two models have become established: the MINDSPACE model and its later development, the EAST model. Both concepts were developed by the Behavioural Insights Team (BIT) for the practical application of behavioural science measures. EAST is an acronym and stands for Easy, Attractive, Social and Timely. It describes that interventions should be simple, low-threshold, attractive, social and well-timed in order to change people's behaviour. You can find out more about the MINDSPACE and EAST model and download a manual here.

AEIOU model

The AEIOU model is essentially the German-language counterpart to the aforementioned models, but refers explicitly to nudging in health promotion. It was developed by Mathias Krisam and Eva Kuhn.

A - Address:

  • Visual elements
  • Personalisation
  • Emotion-based communication
  • Attractive naming

E - Simplicity:

  • Simple language
  • Simple and convenient
  • Timely fitting
  • Positioning
  • Standard option

I - Incentivisation:

  • Reward / Sanction
  • Playful elements and competitions
  • Praise

O - Orientation:

  • Social norms & comparisons
  • Social support & role models
  • Liability

U - Immediacy:

  • Memories
  • Prompting
  • Action guidance
  • Subdivide planning support and goals
  • Short-term advantages

Examples - How nudging can be implemented in health promotion

 Visual elements:

  • Images, especially moving images, attract our attention and are understood more quickly than text.
  • If, for example, you want to draw attention to new yoga courses in an e-mail, a corresponding image should be included for each offer so that it is clear what is on offer just by looking at it.

Personalisation:

  • Addressing the recipient personally and clearly naming the sender increase the likelihood that a message will be read.
  • For example, try to personalise emails from company health management (BGM) (Dear Ms Müller; Hello Sabine) and send emails via an email address assigned to a person and not via a general address such as gesundheitsförderung@unternehmen.de.

Emotion-based communication:

  • As in traditional advertising, the approach works best when it arouses emotions and addresses the needs of the recipient.
  • Read our article on successfully organising BGM communication.

Attractiveness of the naming:

  • Existing offers that are poorly perceived can be renamed. A new, target group-orientated name for an offer can increase the attractiveness of the offer.

Simple language:

  • According to the Kiss principle: "Keep it short and simple". We are exposed to a multitude of stimuli every day and information is often skimmed over and perceived selectively. The more concise the message, the better.
  • Emails are a good example. We receive a lot of them every day, and many are irrelevant. What is not immediately categorised as relevant is generally not read.

Simple and convenient:

  • The simpler a behaviour is, the more likely it is to be carried out.
  • The digital health coach ISA follows exactly this principle of low-threshold, for example by suggesting a series of exercises that can be done in less than 2 minutes at the desk.

Timely fitting:

  • There are good and bad moments for health programmes that should be taken into account when planning. Pay attention to the schedule of those involved.
  • For example, the time before the summer holidays is less suitable, as most people have a lot to do there.

Positioning:

  • Supermarkets use this method and place expensive branded products at eye level where they are clearly visible. Utilise the visibility through good positioning.
  • For example, if you want to motivate your employees to use the stairs more often, label the stairs with stickers indicating the additional calories burned per step.

Standard option:

  • Switch from opt-in to opt-out! If employees have the choice between a healthy and unhealthy option, make the healthy option the default option, which applies if no decision is made.
  • If you want employees to eat more fruit in the canteen, you could, for example, include an apple as standard in the menus so that employees have to actively opt out if they don't want fruit.

Rewards:

  • Incentives associated with a certain behaviour increase the likelihood that this behaviour will occur.
  • Participant certificates, financial incentives or health points, which can be exchanged for benefits.

Gamification:

  • Especially at the beginning, healthy behaviour is often not characterised by joy. Playful elements provide the necessary fun factor and stimulate our competitive behaviour.
  • If points are awarded for participation in health programmes, anonymous lists can be kept, e.g. by means of a group score.

Praise:

  • Social reinforcement in the form of praise causes dopamine to be released in our brain and therefore acts as a natural reinforcer for praised behaviour. The temporal proximity to the praised behaviour is important
  • For example, put up a poster on each floor of the stairwell with a positive message for those who have used the stairs.

Social norms / social comparisons:

  • Individual behaviour is strongly influenced by the environment, i.e. people compare their own behaviour with that of others. As a rule, behaviour patterns are adopted that are exhibited by the majority of a social group. We therefore orientate ourselves to social norms.
  • One way to capitalise on this is to include figures in the communication material, e.g. "more than 1000 office workers are already using this offer".

Social support and role models:

  • The more we identify with a person and the higher their social status, the more they influence our behaviour. Use opinion leaders, role models and leaders.
  • You can address such key figures and involve them in your campaigns by having them publicly speak out in favour of offers, sign up for them or promote them.

Commitment:

  • (Public) commitments to goals increase the likelihood that we will remain true to them.
  • Offer participants in health programmes the opportunity to set goals and write them down or share them with others.

Memories:

  • As mentioned at the beginning, we make most of our decisions unconsciously, so that many behaviours are automatic. Memories can break through this and help to create new routines.
  • Remind people of healthy behaviours and offers with flyers, emails or push messages in health apps. The digital health coach ISA For example, it regularly reminds you to drink enough water or to use a high table.

Prompting:

  • Prompts are a special type of reminder that is played out precisely when a certain decision is to be made or a certain behaviour is to be shown.
  • Digital services such as health apps usually utilise this type of reminder. The digital health coach ISA, for example, recognises poor posture and reminds you in real time to change your posture.

Lead to the action:

  • In order to learn new behaviours, "a certain amount of guidance from outside" is required
  • Support employees by catering to their individual preferences.

Divide planning support / goals into intermediate goals:

  • It is important to set intermediate goals and plan the steps to achieve them, especially for complex behaviours. Achieving intermediate goals increases self-efficacy and can also be reinforced by rewards.
  • For example, if the goal is to increase physical activity, intermediate goals such as not using the lift can be defined and rewarded.

(short-term) advantages:

  • Long-term goals such as avoiding health problems in old age often pay off late. In order not to lose motivation, short-term benefits should be created and emphasised.
  • As part of an information campaign, for example, immediate benefits can be mentioned in addition to future health benefits (e.g. mood enhancement through dopamine during sport or better performance after sport).
 
Sources and further articles

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