Three ways nudging can improve health outcomes

There is no panacea for the huge challenges facing the NHS. The COVID-19 pandemic, arriving after a decade of austerity, stretched services like never before.

This has been exacerbated by a crisis in social care and a shortage of doctors and nurses.

Curing these ills requires major policy change and investment.

In the meantime, behavioural science can be an invaluable tool, encouraging medics, managers, and patients to make manageable and cost-effective changes.

Here are three ways nudges can support better outcomes, drawn from our policy briefs.

1 Using behavioural science for public health protection

The COVID-19 pandemic shone a spotlight on the challenges that policymakers face in mobilising the population to protect public health.

This was particularly apparent with the reluctance of many people to have the COVID-19 vaccine.

By better understanding their reasons for hesitating, we could make several recommendations to increase uptake.

To boost confidence, information about the safety and effectiveness of the vaccine needed to be widely accessible, branded by the NHS, and personalised by people’s local GP where possible.

The vaccine-booking system had to be user-friendly, offer information about how the jab was delivered, and emphasise that it was free.

It was also important to tap into people's desires, such as protecting those close to them, rather than themselves, and easing lockdown restrictions to return to normal life.

2 How can nudges encourage healthy behaviour?

We all know that obesity, sedentary lifestyle, and excess alcohol consumption are key contributors to ill health and lost years of life.

But many of us struggle to convert that into a healthy lifestyle.

This is fertile ground for carefully constructed nudges to deliver better outcomes and significant savings for the NHS and society more generally.

Take alcohol, for example. We sent 101 students, all of whom drank excessively, four different text messages over four weeks and found the framing had a significant affect on its impact.

When their drinking was compared to the recommended limits, just five per cent requested links to alcohol education websites.

This rose to 45 per cent when it was compared to what others drank.

Messages about healthy diet could deliver similar benefits. Losing weight through diet and exercise is only half the battle. Most people regain half of what they have lost within a year and 80 per cent return to – or exceed – their pre-diet size.

But teenagers who were sent texts encouraging them to commit to healthy behaviours, such as eating a bowl of cereal each morning or fruit for dessert, and checking on their progress, were more successful at keeping the weight off.

Even something as simple as changing the order that items appear on a menu can help. Our research with McDonald’s showed that moving Coke Zero to the top of the menu on its touchscreen kiosks, and Coca-Cola to the bottom, increased sales of sugar-free drinks by up to 30 per cent.

3 How nudges can promote sustainable practices in healthcare

There is also potential to nudge patients and practitioners towards behaviours that reduce waste and improve the performance within the NHS.

We found that well-worded text messages, warning patients that each missed appointment costs £160, could prevent 400,000 missed hospital appointments each year, saving the NHS an estimated £64 million (or more if the NHS had mobile numbers for more than 20 per cent of patients).

Text message reminders can also increase the number of women who attend cervical screening.

NHS leaders can also use behavioural science to encourage healthcare practitioners to implement guidance on prescribing antibiotics or sedatives and making referrals.

Targeting practitioners with personal letters is a low-cost intervention. Our findings suggest that it can significantly enhance decision-making.

Again, framing is key. Letters that highlighted characteristics that the sender and the recipient shared, appealed to social norms, and supported a positive self-image were more effective.

So were those providing clear instructions for the recipient and explaining the consequences for their patients.

Further reading:

Mastering your unconscious biases for better decisions

How to help people to reduce their alcohol consumption

Why organisations should help those experiencing a midlife crisis

Ivo Vlaev is Professor of Behavioural Science and Advisor for the NHS COVID-19 Behaviour Change Unit. He teaches Behavioural Sciences for the Manager on the Executive MBA and Full-time MBA plus Judgement and Decision Making on the MSc Finance.

Learn more about using behavioural science on the four-day Executive Education course Behavioural Science in Consumers and Markets.

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