COVID-19: Past and Present
Think back to the reactions when the COVID-19 crisis first emerged. Governments in disarray, toilet paper nowhere to be found, conspiracy theories flying everywhere. Everybody was in their panic stations, and nobody had a clear idea on what was to come.
At the beginning of the pandemic, to encourage COVID-safe behaviours, behavioural nudges were the preferred policy by governments in the UK, USA, and Australia. Nudges are a set of policy tools which utilize psychological insights to attempt to motivate people to adopt certain desired actions/behaviours, without having to enforce strict laws, bans, or punishments. The beauty of nudges is that they can motivate people into making responsible decisions, while preserving individual liberty – and that’s exactly what made them so attractive of a policy tool for governments at the beginning of the pandemic.
However, with the rapid spread of COVID-19, it quickly became clear that nudges were not enough to get everyone to fully comply with COVID-safe protocols. For example, consider mask-wearing: signs were placed in public spaces to nudge people to wear masks (a tactic still employed today). While some complied, the impact of this nudge was largely insufficient at slowing the rapid spread, forcing the hand of governments to implement stricter laws. This change in strategy highlights the limitations of nudges: While popular, nudges will never be as effective at ensuring population-level behaviour change as a law or a disincentive (e.g., tax, fine, arrest).
The Role of Behavioural Science
As we learn to live in a world alongside the virus, the need for laws to enforce compliant behaviours appears to be lessening. However, this next stage of the pandemic will bring a new set of challenges. More than two years have passed since the start of the pandemic, which has led to people feeling fatigued over complying with COVID-safe protocols. How can we ensure that people continue to wear masks without the need for laws? How can we motivate people to get annual boosters for their COVID vaccine?
This makes the role of nudges and behavioural science ever more crucial. As mandates relax, a greater reliance on individual compliance is required if we are to prevent mass-outbreaks in the future.
In other words, the time for nudge theory to take centre-stage is now. In what follows, I highlight a few key areas where nudges will likely play a key role in the near future:
While the benefits of mask wearing are well-known at this stage, one challenge moving forward will be to encourage mask wearing despite no legal obligations to do so.
One potential nudge for mask wearing involves designing masks so that they can be more fashionable and personalized. Studies have found that personalized masks or masks with unique designs are more desirable to wear. Having personalized masks takes advantage of our innate desire to perform behaviours which showcase our own identity and display the social groups we belong to, because our self-esteem is largely derived from feeling belonging to the social groups we associate with (known as social identity theory). Just like how our clothing often reflect our self-identity, masks can also be tailored to be a new part of our everyday wardrobe.
We’ve even seen identity as a factor amongst our work at HRW with healthcare professionals and COVID-19, where we have recommended non-specialists to receive personalized messages to convince them to take a role in treating the virus, as non-specialists tend to believe that treating COVID-19 is a role for specialists in hospitals, so they typically refrain from treating patients.
The most important motivator for mask wearing, however, will involve observing others wearing masks. One of the most robust findings in decision psychology is that we are heavily influenced by what we see others are doing, even without realizing it. Mask wearing laws have made it commonplace to see people wearing masks on the street, and even though laws have been relaxed, this has been impactful as it has created a social norm of mask wearing: by observing that most others are wearing masks, this can motivate our own behaviour to adhere to the norm.
Vaccinations and Boosters
As vaccines become widespread and available all over the globe, the next step in public policy will be ensuring that people attain an annual booster to limit the spread of the virus.
Studies on nudges and flu vaccinations can prove useful in this setting, as getting yearly COVID boosters will be a very similar challenge to encouraging people to get their annual flu shot. For instance, one potential nudge involves the role of defaults, whereby people are automatically enrolled to receive a booster and must deliberately cancel the scheduled appointment if they do not wish to receive it. Defaults are often found to be the most powerful nudge because they take advantage of status-quo bias: our tendency to heavily prefer our current state of affairs and unwillingness to switch to alternatives (even if they may be better). By requiring people to put in effort to opt-out of the default, attendance at a scheduled vaccination increases.
Other strategies have included text-based reminders where vaccinations were tied onto scheduled doctor’s appointments. One large-scale study on patients who had existing doctor’s appointments scheduled found that texting them to book their booster while they were at the doctor’s was an effective nudge to boost booster appointments. This takes advantage of piggybacking: we often find it easier to adopt a new behaviour if it is tied to an already existing behaviour. Interestingly, piggybacking can work on several levels for COVID-19 booster uptake, as we at HRW have seen in our work in COVID-19 that linking the timing of boosters relative to flu or other vaccinations, or other routine health behaviours, can help make them more memorable.
In terms of the content of text reminders, the researchers in the flu vaccine study referenced above also found that the best-performing message framed the flu shot as a ‘Flu shot reserved for you’. This utilizes egocentric bias, our tendency to consider our needs and opinions more important than others. Despite the text being a generic one that is sent out to all patients, by mentioning that the flu shot is ‘reserved for you’ makes it feel like it is specially dedicated to the individual themselves.
While mandates were likely the most impactful strategy at the start of the pandemic, moving forward is where the role of nudges will be the most critical. After continuous lockdowns and economic shocks, nudges offer an attractive option to support people in following common-sense mitigation measures as we adapt to living with the virus.
By Tony Jiang