In the initial days of COVID-19, towards the end of March 2020, India went into a lockdown. The number of daily new cases at that time was 87. But the fear of contracting the virus was very high. Now after five months, the number of daily new cases has crossed 75,000, but the fear of contracting the virus has reduced. Why do people misunderstand risk?
One reason is that the SARS-CoV-2 virus is not novel anymore. But more importantly, behavioural science studies show that numbers don’t move people. When we read that three million people in India have contracted COVID-19, most people can’t make much sense of it. But when someone close to us in proximity or relationship contracts COVID-19 or succumbs to it, the fear becomes tangible. People suddenly feel vulnerable. Otherwise, people feel invincible, even though the risk of contracting COVID-19 actually keeps increasing with daily cases increasing.
Guided by emotions
Emotions cause us to misunderstand risk. For example, flying is something that many people get scared of even though flying has become an extremely safe mode of transport. Zero people died in a plane crash last year in India, while over 1,50,000 people died in road accidents. Yet, people feel scared of flying, not of driving on Indian roads.
Flying evokes a powerful emotional response. You are literally up in the air, in the hands of a machine and two pilots. If something happens up there, there is nothing you can do about it. This makes flying feel unsafe even though it is among the safest modes of transport.
Likewise, some people believe that they should not step out of their homes because going out means that they will catch COVID-19. In reality, going for a walk in an uncrowded area with a mask on is relatively safe. Some of the same people believe that staying at home is far safer than stepping out. So, they have started keeping their househelps at home. This is relatively risky, because distancing may not be possible within a typical home in urban India and droplets exhaled, sneezed or coughed out tend to stay in the air indoors for longer.
The risk of contracting COVID-19 in any given situation can be categorised as ‘very high’, ‘high’, ‘medium’, ‘low’ or ‘very low’. Visiting a gym generally would fall under ‘very high’ risk, while playing tennis would generally fall under ‘very low’ risk, even though both activities are related to fitness.
However, since each situation demands assessing the risk of contracting COVID-19, it complicates people’s decision-making.
Colour-coding different tasks
To simplify decisions, people rely on short-cuts. For example, if you stay at home, you are safe. If you believe in god, you are safe. If you are healthy, you are safe. If you have a particular deity at home, you are safe. Such simplifications, using which people assess the risk, make COVID-19 a dangerous pandemic.
To help people get a better understanding of risk, the government needs to devise a simple behavioural design. Just like a traffic signal communicates ‘stop’, ‘ready’ and ‘go’ with ‘red’, ‘orange’ and ‘green’ colours respectively, our daily activities need to be categorised as ‘red’, ‘orange’ and ‘green’.
Having outsiders visit your home would be ‘red’, visiting retail stores would be ‘orange’ and meeting a friend at an uncrowded park while keeping a safe distance and wearing a mask would be ‘green’.
If people can’t judge risks accurately, COVID-19 is likely to continue to spread like a raging fire in a forest.
Ignaz Philipp Semmelweis, a Hungarian-born doctor came to Vienna in 1846 to work at the city’s General Hospital. Dr. Semmelweis noticed that women delivered by doctors had three times higher mortality rate than women delivered by midwives. He spotted a link between the lack of hygiene of the doctors and the mortality rate of the mothers. After he initiated a mandatory hand-washing policy, the mortality rate for women delivered by doctors fell from 18 percent to about 1 percent. Despite such a brilliant outcome, the idea of hand washing was rejected by the medical community. Doctors were offended by the suggestion that they could be causing infections. Semmelweis’s practice earned widespread acceptance only two decades after his death, when Louis Pasteur, of pasteurization fame, raised awareness of pathogens.
From 1850s to 2020, hand washing has been advocated as a simple way of reducing the risk of infection. But even after 170 years, studies find that doctors still do not wash their hands often. A systematic review of studies on compliance with hand hygiene in hospitals, done by researchers Vicki Erasmus et al, found that only 32% of doctors and 48% of nurses wash their hands between seeing patients. Another study by researcher Didier Pittet, an infection control expert with the University of Geneva Hospitals, Switzerland found that compliance rates for hand washing amongst doctors and nurses was only 57 percent, and years of awareness programs urging doctors to wash up or use disinfectant gels have had little effect. A study of hand hygiene compliance amongst Indian doctors by researchers S. K. Ansari et al, found only 49% of doctors and 56% of nurses washed their hands with soap between patients.
If India needs to contain the spread of Covid-19, everybody ought to be washing our hands, especially doctors and nurses. But how can we change their hand washing behaviour?
The traditional approach of changing behaviour is to educate doctors and nurses on the importance of hand washing. It seems like the rational and logical thing to do, but even though doctors and nurses know that they should be washing their hands, they forget to do so. That’s why we need to apply behavioural design. Behavioural design is about creating subconscious nudges right at the moment where the desired action is to be performed, in our case where hand washing needs to happen.
Behavioural scientists piloted a low-cost experiment in rural schools in Bangladesh where behavioural design nudges were used to guide hand washing with soap after toilet use. Hand washing stations were built in visible and easy‐to‐reach locations, brightly colored paths were painted from toilets to the hand washing station, and footprints and handprints were painted on the path and at the hand washing station. Hand washing with soap after using the toilet went from 4% before these behavioural design nudges nudges were created, to 74% six weeks after they were introduced. No other hygiene education was communicated as part of the study.
Similarly, in hospitals where wash basins and hand sanitizers are placed, stickers of brightly colored footsteps should be placed so that doctors and nurses get attracted by them, which subconsciously directs them to the wash basin or the hand sanitizer. Such behavioural design nudges influence doctors and nurses to wash their hands with soap or sanitizer without making a conscious decision to do so. Hand washing is often done as a relatively subconscious habitual action, and can be easily triggered by contextual cues, so hand washing lends itself well to such behavioural design nudging. An experiment done at the Gentofte Hospital in Denmark has found that hand sanitizer usage increased from 3% to 67% when the hand sanitizer was placed in a prominent location with bright signage that caught people’s attention. Not bad for such a simple and low cost intervention.
Till a few weeks ago almost nobody in the world knew what social distancing meant. But since the spread of Covid-19, the term ‘social distancing’ has gone viral too. It implies steps that need to be taken to prevent the spread of coronavirus by maintaining a physical distance between people and reducing the number of times people come into close contact with each other. It involves keeping a distance of six feet from others and avoiding gathering together in large groups. It is critical in curbing the spread of the virus and must be followed as far as humanly possible.
But the
term ‘social distancing’ means to avoid being social. That’s unnatural for most
humans. Humans are a social and emotional beings. We survive and thrive being
social. Children are attached to their parents. Grandparents love spending time
with grandchildren. Siblings are emotionally close to each other. We all have
friends who are our life supports. In India, house helps are like extended
family. But now because of Covid-19 we suddenly need to follow social
distancing from the people who are always there for us precisely in times like
these. It goes against human nature. That makes using the term ‘social
distancing’ inappropriate.
Matthew
Liebermann, a social neuroscientist, has conducted several studies on how our brains processes social pain. He finds that to
the brain, social pain feels a lot like physical pain. The more rejected the
participant felt, the more activity there was in the part of the brain, that
processes the distress of physical pain. What’s surprising is that studies show
that drugs that treat physical pain, like paracetemol, can also reduce
emotional pain like social rejection, because similar brain circuitry is engaged when we feel
physical pain. That’s perhaps why we
express social pain in terms of physical pain, like “she broke my heart”, “he
hurt my feelings”. Social pain is real pain. Social pain is associated
with decreased cognitive functioning, increased aggression and engagement in
self-defeating behaviors, like excessive risk taking and procrastination. So its safe to assume that social
distancing in today’s times must be causing real pain too.
Over the
past few days we’ve been seeing people in various countries come out in their
balconies and sing songs, play music and cheer the people who have been dedicating
their time, risking their lives serving patients and delivering essential supplies.
Prime Minister Narendra Modi has addressed the nation twice requesting we all
stand in solidarity. It may not mean much for people who can easily take care
of themselves during these times. But for the rest of us, his aim is to boost
morale, because levels of stress and anxiety are rising. We humans don’t like
uncertainty. We don’t know how long it may take for the vaccine to be made
available for most of our population. We don’t like being caged in our little
homes away from our social bonds. These times call for social bonding, not
social distancing. Thankfully social bonding is possible today because of being
able to stay connected over voice and video calling. We can talk to each other about
how we are feeling, what we cooked, the jokes our children are cracking, the
dreams we’re getting at night and details about the quarrels between couples.
On March 20, the World Health Organization officially changed its language. “We’re changing to say ‘physical distancing,’ and that’s on purpose because we want people to still remain connected,” said WHO epidemiologist Maria Van Kerkhove. Language matters. Just like how ‘climate change’ is now refered to as ‘climate crisis’ by media, ‘social distancing’ needs to be refered to as ‘physical distancing’. So start exercising physical distancing and social bonding, because this pandemic is going to last quite some time.
Let’s explore few ways in which
one could reduce littering:
1. You could fine people for
littering.
2. You could place CCTVs in the
area.
3. You could incentivize people for using garbage bins.
4. You could create a social stigma for people who litter.
5. You could make throwing stuff in bins fun.
6. You could use social proof to indicate that a high percentage of people use the bin.
But behavioural scientists did something better in the 2011 Copenhagen study that reduced littering by 46%.
They placed green footprints on
the ground, pointing the way to the nearest garbage bin. Simple, low cost,
effective Behavioural Design.
India, though is a different story. Usually there are no trash bins in public places, because the trash bins get stolen by people who sell it to make some money, even though they are fixed to the ground with screws. Everything in India has re-sale value.
So Briefcase has created a Behavioural Design solution in the form of non-stealable, waste-segregated, long-lasting, low cost, low maintenance, all weather, endorsable trash bins. But unfortunately, the local government authorities here in Mumbai – the officers from BMC, aren’t interested because of apathy. How can we change their behaviour? Can you help us?
We were happy to be invited to speak at Milano Arch Week 2019 on applying Behavioural Design to urban planning or as they liked to refer to it ‘Urban Regeneration’. We are happy that architects are opening up to our practice of Behavioural Design to build cities that work for people living in it and to use architecture to modify public behaviour.
Our talk included Behavioural Design examples from my Instagram feed. Some of the examples we referred to were the Ballot Bin that gets cigarette smokers to stub their cigarette buds at the Ballot Bin because they are motivated to vote for their choice, whether the choice is about your favourite football player or some other topical question. We were asked about Bleep horn reduction system as a Behavioural Design nudge to reduce drivers’ honking. We spoke about how the Bureau of Energy Efficiency (BEE) in India has made it mandatory for appliances to come with star ratings and how it’s nudging people to choose higher star rated appliances so that people can save money and in doing so also consume lower power and contribute towards climate crisis in a positive manner. Some of the other examples we spoke about were Behavioural Design nudges to reduce overspeeding, getting people to – use trash bins in the outdoor, use sanitizers in hospitals, use stairs instead of escalators, and many more. If you’re curious to know more, click here.
It was fun speaking on applying Behavioural Design to improve employee engagement at Nasscom Technology & Leadership Forum on 21st Feb 2019 at Grand Hyatt, Mumbai. I spoke about few high-impact low-cost Behavioural Design nudges, based on experiments in behavioural science, that demonstrate how employee engagement and experience can be improved at the workplace. Given that employee engagement is at abysmally low levels at a lot of companies, it’s high time to apply behavioural science to transform processes like appraisals, feedback, learning, rewards, recognition, productivity, collaboration amongst other experiences to improve employees’ performance and happiness. The Behavioural Design nudges shared raised a good amount of smiles and curiosity. There were inquiries to deliver talks at different companies and do projects to change employee behaviour. Let’s see which of them happen. After all Behavioural Design is about improving conversions.
How often have we heard that we must take the stairs especially if we
need to go to Floor nos. 1/2/3, yet how many times do we take it? It’s an
exercise that can be so easily incorporated into everyday life, but awareness
yet again doesn’t translate into action.
So a few behavioral scientists put a sign at the bottom of the stairs
telling us that walking up the stairs burns about five times as many calories
as taking the lift. Sixteen
studies analyzed this intervention
and found that on average, stair use increased by 50%. Sure this is from a low
baseline, because not many people generally use the stairs in the first place,
but it does demonstrate that a small nudge can do more than any big-budget-ad-campaign
to change behavior. Few stations in Tokyo, Japan like Tamachi station have
implemented it by mentioning the number calories burned with each step. And a
friend of ours says he feels better while walking up the stairs because he can
see how many calories he’s burning with each step.
Of course there’s a way of making climbing stairs fun like the Volkswagen piano staircase, but putting signs is probably a thousand times cheaper.
Source: R.E. Soler, K.D. Leeks, L.R. Buchanan, R.C. Brownson, G.W. Heath and D.H. Hopkins – Point-of-decision prompts to increase stair use: A systematic review update – American Journal of Preventive Medicine 38, no.2 (2010): S 292 – S 300
Recently it was reported that a 9W 697 Mumbai-Jaipur flight was turned back to Mumbai after take off as, during the climb the crew forgot to select the bleed switch to maintain cabin pressure. This resulted in the oxygen masks dropping. Thirty out of 166 passengers experienced nose and ear bleeding, some also complained of headache.
Aviation safety experts say such an incident was “extremely rare” as turning on the bleed switch is part of a check-list that pilots are expected to mandatorily adhere to. If turning on a switch that regulated cabin pressure is part of standard protocol, how could the pilots make such a simple, common-sensical error. And more importantly how can such errors be avoided in the future?
Traditional thinking suggests increasing the training of the pilots so that it makes them better and thereby avoid such errors. But training is not a full-proof method of ensuring human errors don’t get repeated. That’s because as long as humans need to rely on their memory to ensure the cabin pressure switch is turned on, errors are bound to happen. Sure check lists work. But that’s still a manual method of ensuring that the switch is turned on. And after repeatedly performing the tasks on the checklists over multiple flights, checklists themselves become routine habitual tasks done without much thinking. Also given that there are multiple tasks pilots need to perform in the 3-4 minutes after taking off, the chance of errors happening during those critical moments becomes high.
So instead of the pilot having to rely on their memory or routine check-lists, the answer to avoid such human errors lies in implementing simple behavioural design nudges. For example, if there was a continuous audio-visual reminder that the bleed switch had not been turned on, it would draw the pilot’s attention and it would be highly likely they would have turned it on. Such an audio-visual reminder was not present in this kind of an older generation of aircraft, and therefore the chance of human error increased.
The Japanese have a term for such error-proofing – poka yoke. This Japanese word means mistake proofing of equipment or processes to make them safe and reliable. These are simple, yet effective behavioural design features that make it almost impossible for errors to occur. The aim of error-proofing is to remove the need for people to think about the products or processes they are using. Some examples of behaviourally designed products used in everyday life are the microwave oven that doesn’t work until the door is shut or washing machines that start only when the door is shut and remains shut till the cycle is over. Elevator doors now have sensors that cause them to not close when there is an obstruction. This prevents injury to someone trying to enter as the doors are closing.
Human behaviour cannot be trusted to be as reliable as a machine. In fact, human behaviour is far from perfect. Yes, the people who operate expensive and complicated machines may be the best trained, but human errors in the form of simple error, lapse of judgment or failure to exercise due diligence are inevitable. According to Boeing, in the early days of flight, approximately 80 percent of accidents were caused by the machine and 20 percent were caused by human error. Today that statistic has reversed. Approximately 80 percent of airplane accidents are due to human error (pilots, air traffic controllers, mechanics, etc.) and 20 percent are due to machine (equipment) failures.
Another instance of how systems could be made safe by applying behavioural design is of airplane emergency evacuations. During the emergency landing of the Emirates flight EK521 at the Dubai airport in 2016, passengers were running to get their bags from the overhead cabins, instead of evacuating the plane. Only when the airplane staff began yelling at them to leave their bags and run, did the passengers finally pay heed to their calls and evacuate. Just a few minutes after the evacuation, the plane caught fire. It was a near miss situation. Had even a few passengers waited to get their bags from the overhead cabins, many of them would have got engulfed in fire. Again the natural instinct to correct such a situation would be to train people to evacuate and get them to listen to the flight’s safety instructions. But behavioural science studies have proven that such efforts are time-consuming, money-draining, unscalable and most importantly ineffective at changing human behaviour. In such an emergency situation, if the overhead cabins were automatically locked, with a label “Locked due to emergency”, passengers would not waste time trying to open them. That would in turn get passengers to behave in the desired manner and evacuate faster.
Sometimes behavioural design nudges are intuitive. Other times they are counter-intuitive. In a fire-drill experiment by behavioural scientist Daniel Pink, he found that placing an obstacle like pillar in the middle of a doorway got people to exit a hall 18% faster than without the pillar. The pillar was an obstacle but it split up people into two streams at the exit. That got people to use each side of the door, which in turn made the flow of people exiting the hall a lot smoother and faster. When the pillar wasn’t there to separate them at the exit, people bottle-necked at the door making the exit slower. Likewise, behavioural design could go a long way to design safer buildings, machines and systems and reduce human errors.
Drinking water is essential to human health. The amount one should drink varies from person to person based on gender, age, height, weight, physical activity, sweat levels, metabolism level, body temperature, humidity levels, external temperature, altitude, quantity and quality of food intake, quantity and quality of other fluids’ intake and host of other details. When you don’t get enough water, every cell of your body is affected. You lose a lot of electrolytes, including sodium, potassium and chloride, which are essential to your body’s functions. Pretty much all of your cellular communications revolve around sodium and potassium, including muscle contractions and action potentials. Fatigue, lethargy, headaches, inability to focus, dizziness and lack of strength are all signs of dehydration. Nature has given us a powerful alert system – thirst. But in our busy chaotic lives we often ignore it and forget to drink water.
Behavioural Design vs awareness
There is enough information about why we should drink more water, yet most people feel they don’t drink enough. Education doesn’t change behaviour.
Behavioural change requires a different approach. Drinking water regularly is a good habit. Habits are essentially automatic in nature, where one does not consciously think about the action. In other words, habits are auto-pilot behaviours. For a behaviour to become a habit, it requires three things to come together – trigger, action and reward. When the loop gets completed, the habit sets into place. For example, over a period of time we have gotten used to waking up in the morning (trigger), brushing our teeth (action) and feeling fresh (reward). To create good habits, initially conscious effort is required. However, we humans are lazy, so the lesser the effort to get the habit started, the better. Eg. We forget to drink water during the day. So if there’s a trigger like a reminder from the water bottle, we’re likely to drink water. Over time the action of opening the water bottle because of the reminder can become auto-pilot i.e. become a habit. This approach led us to create a water bottle that glowed and beeped that gently nudged people to drink water 16% more.
The Experiment
We chose to do an experiment in an office of one of our corporate clients. The administration department of that company would keep filled-water-bottles on the desk of each employee every morning and refill it once every evening. So we bought the same type of water bottles for our experiment so as to not draw any suspicion amongst participants. And we created two versions of caps. In the first version of the cap, we fitted a chip which recorded the number of times the water bottle was opened. In the second version of the cap, we fitted a chip which recorded the number of times the water bottle was opened and in addition, the cap now glowed and beeped once after every two hours of the water bottle being opened. If the bottle wasn’t opened, then the cap would glow and beep after an hour. When the water bottle was opened, the cap would sense it and stop glowing. In both versions the chip was hidden inside the caps.
Creating prototypes of both versions of water bottle caps took longer and was costlier than we expected (planning fallacy). We could only produce a total of 70 water bottle caps over more than a year. Thirty-five pieces of each version – first version with recording chip without glow and beep and second version with recording chip with glow and beep. Because of being able to produce 70 water bottle caps we chose to randomly select thirty-five participants from the office employees who wished to participate in our experiment.
In week 1 we gave them our similar looking water bottles with the first version of the cap with recording chip hidden in it. In week 2 we replaced the caps with the second version of the cap with the recording chip with the glow and beep. We accounted for data from Monday morning to Friday night in both weeks. We then compared the data of how many times the water bottle was opened with the numbers of hours the employees had spent in office on each day of Week 1 (no glow and beep) and Week 2 (glow and beep). Had we been able to conduct the experiment amongst a larger set of sample, we would have chosen the typical control group and treatment group, but due to the above mentioned capacity, time and money constraints we did a before-and-after format for this experiment.
The Results
In week 2 employees opened the water bottles 16% more than in week 1. It means the employees were not sufficiently hydrated with regular water bottles even though they were kept on their desk right in front of their eyes. The simple Behavioural Design of glow and beep water bottle caps got employees to drink 16% more frequently than without the Behavioural Design nudge.
Frequently asked questions
Q. How much water does one need?
A. Scientific studies are inconclusive on the amount of water required by an adult. Some say its 3 litres. Some say 2.5 litres. Some (Mayo clinic) say for men its 3 litres and for women its 2.2 litres. But fact is that calculating how much water you need depends upon your gender, age, height, weight, physical activity, sweat levels, metabolism level, body temperature, humidity levels, temperature, altitude, quantity and quality of food intake, quantity and quality of other fluids intake and host of other reasons. It’s extremely difficult to calculate real time hydration levels accurately.
Q. Why didn’t we create a bottle that could calculate how much water each individual person needed?
A. To do that we’d need to know people’s gender, age, height, weight, physical activity, sweat levels, metabolism level, body temperature, humidity levels, temperature, altitude, quantity and quality of food intake, quantity and quality of other fluids intake and host of other details. It’s extremely difficult to calculate real time hydration levels accurately. Sensors and software that can capture all of the above seamlessly are very expensive as of date. Measuring only some of the inputs would lead to an inaccurate result that would be misleading. So we used a simple rule of thumb of drinking water every two hours to stay hydrated.
Q. What’s the best way to judge whether you are hydrated or dehydrated?
A. The most scientific and simplest way to judge whether you are hydrated or dehydrated is to look at the colour of your urine. If your urine is crystal clear it means you’re probably drinking too much water. If its light or mild yellow it means your drinking an adequate amount of water. If its proper yellow or darker it means you need to drink more water. If its brown you need to visit a doctor.
Sources:
Mild Dehydration Affects Mood in Healthy Young Women – Lawrence E. Armstrong, Matthew S. Ganio, Douglas J. Casa, Elaine C. Lee, Brendon P. McDermott, Jennifer F. Klau, Liliana Jimenez, Laurent Le Bellego, Emmanuel Chevillotte and Harris R. Lieberman – The Journal of Nutrition – 21 December, 2011.
Mild dehydration impairs cognitive performance and mood of men – Matthew S. Ganioa, Lawrence E. Armstronga, Douglas J. Casaa, Brendon P. McDermotta, Elaine C. Lee, Linda M. Yamamotoa, Stefania Marzano, Rebecca M. Lopez, Liliana Jimenez, Laurent Le Bellego, Emmanuel Chevillotte and Harris R. Lieberman – British Journal of Nutrition – Volume 106 / Issue 10 / November 2011, pp 1535-1543
Lawrence E. Armstrong – an international expert on hydration who has conducted research in the field for more than 20 years (professor of physiology in UConn’s Department of Kinesiology in the Neag School of Education)
