Coauthors John Beshears, Stanford Graduate School of Business; James Choi, Yale School of Management; David Laibson, Harvard University; Katherine Milkman, University of Pennsylvania
Public health officials often struggle with how to motivate people to engage in more healthful behavior. Millions of dollars and thousands of hours are spent on multimedia campaigns designed to capture people’s attention and prompt them to take action.
As it turns out, one solution may be found in a small product invented by 3m that costs a fraction of a penny apiece. The benefits in a health campaign of displaying a message on a simple sticky note are highlighted in a new paper coauthored by Brigitte Madrian, Aetna Professor of Public Policy and Corporate Management, which focuses on how the right prompt can drive people to take even an action many of them dread. Called “Following Through on Good Intentions: The Power of Planning Prompts,” the paper describes a study in which nearly 12,000 employees of four U.S. companies received the same mailer urging them to get a colonoscopy (all the subjects were due for the colorectal cancer screening). The only difference: About half the mailers had a blank sticky note attached, which recipients could use to write down an appointment for the procedure; the other half also included sticky notes, but on them was written “Don’t forget! Colonoscopy appointment with _____ on _____.”
People who received the sticky note with the message ended up getting colonoscopies at a rate 16 percent higher than those whose notes were blank — a statistically significant difference. According to the authors, such planning prompts “have the power to help people overcome forgetfulness and follow through on their plans even when that follow-through is in the distant future, requires advance planning, and involves a costly, unpleasant action.” They write that the sticky note with the message may have triggered in people an “implementation intention” while offering a visual reminder of this plan. In addition, they conclude that people who were perceived as more likely to forget had an even stronger response to the planning prompt.
“The theory is that the planning prompt is making it less likely that you’ll forget to do something that you know you ought to do,” Madrian said in an interview. Although the paper does not include reactions from the subjects of the study, there is reason to believe that the prompts influenced their actions, as the authors note. The experiment involved no effort to influence people other than the written sticky notes; the subjects weren’t aware they were part of an experiment; and reliable data, based on insurance claims, indicated who actually underwent colonoscopies. Thus, the study shows the potential for the wider use of similar techniques, particularly given how simple they are to employ.
“Public health interventions based on the intervention studied in this paper may be able to save many lives at much lower cost than the price mechanisms that are often suggested for promoting behavior change,” the authors write.
Identifying ways to change behavior is nothing new to Madrian, who has long studied the factors that influence people to save and invest money, particularly for retirement. Much of her research has been funded by the National Institute on Aging, which is also involved in studying health outcomes. She recently began focusing on health behavior, and wrote a previous paper that found increased rates of compliance when people were given prompts to get a flu shot.
When it comes to taking care of their health, most people probably have the best of intentions, Madrian said. But people also have limited attention. For her part, Madrian acknowledged that it was hard to focus on the fact that her daughter needed a tetanus shot when she entered seventh grade this year — because that instruction came with 20 other items in a school mailing. A reminder to take that one important action certainly would have helped, she said.
“Anything that makes it more likely that you’ll remember to do something makes it more likely that it will happen,” said Madrian.
— by Lewis Rice