The Coronavirus Behavior Change Opportunity

The Coronavirus Behavior Change Opportunity: Creating Better Healthier Habits for the Long-Term by Neale Martin, PhD

The coronavirus (COVID-19) is disrupting the lives of billions around the world. Likely most of you have cancelled travel, postponed or cancelled in-person events, and are conducting most of your business meetings virtually. Many of us have kids at home for the next two weeks and are trying to solve a host of novel challenges, ranging from navigating impromptu on-line home schooling to finding toilet paper. For many, COVID-19 is far more than an inconvenience.

Those who have contracted the disease often have severe, even life-threatening symptoms, and face mandatory quarantine. Others who are not infected face financial hardships as their livelihoods have been put on hold or cancelled for the foreseeable future. Entire industries have been paralyzed, including the hotel, tourism and restaurant businesses.

While the world periodically suffers new viruses, the response to the COVID-19 has galvanized health workers around the globe. The experience in Italy serves as a dire warning to the rest of the world. Its health care infrastructure rapidly became overwhelmed as the virus spread, forcing the country to ration care as it curtailed nearly all public gatherings.

For all of COVID-19’s virulence, every year the world faces a similar but far less publicized scourge, flu season. In the US alone, deaths from the flu ranges from 12,000 to as many as 60,000 annually. Hundreds of millions of people contract the flu every year and hundreds of thousands die from it. Hopefully, our efforts to constrain COVID-19 will also reduce the spread of this year’s flu. But what about next year?

As experts in habit and behavioral change, we see an opportunity to learn from the current crisis to make long-term changes in health and hygiene practices that can reduce the spread of disease — not only this year but every year. This will not happen automatically even in the wake of COVID-19. Habit change is hard and even momentous disruptions are often not enough to prevent past habitual behaviors from resuming.

Our extensive work studying habits in healthcare has confirmed what the CDC discovered repeatedly—education doesn’t change behavior. After multiple attempts, the CDC discovered that even compelling, public health education has little effect in getting the 50% of out-of-compliance patients to follow their doctors’ treatment recommendations. This feels counterintuitive. How could explaining to people the negative effects of their behavior not change what they are doing?

Our original insights into this came from working with alcohol and drug patients. Simply educating patients through information and data was not sufficient to overcome their addictive behavior. And anyone who has ever tried unsuccessfully to lose weight can attest to the fact that knowing what to eat and what not to eat is not enough to modify decades-old behavior. There’s wisdom to the saying, “Old habits die hard.”

Based upon our research, the first step in behavior change is disruption: some significant event that elevates a day-to-day behavior out of our unconscious, ‘habitual mind,’ to our conscious ‘executive mind’ awareness. COVID-19 has done that. Hundreds of millions of people are now consciously focused on behaviors to avoid contracting the disease; and not to spread it if they have already been exposed. However, essential to getting that new behavior to become a habit is reinforcement and punishment. And this is where efforts to change habitual behavior falter.

Take one recommended hygiene related behavior: washing your hands after sneezing or coughing. Now that we are cognizant and mindful about the potential spread of disease, we are aware of what we are doing and think about washing our hands. But it is often inconvenient to stop what we are doing to wash our hands, and even if we do, how do we know that doing so made a difference? There is no feedback that indicates that we have done something good. The absence of feedback, in fact, jeopardizes a behavior from being repeated.

In the behavior change model developed by ThinkGen, we define this type of challenge as requiring a new “Behavioral Belief”—a mental model that bridges the gap between action and feedback when there is no tangible evidence. An example of this is taking vitamins. Vitamins typically do not provide any feedback they are working, yet many of us take them (or give them to our children) daily. The need for a behavioral belief is essential in reliably getting people to change their behavior around hygiene.

We saw this firsthand while working for a client who had recently launched a hand sanitizer in India, but who saw lackluster uptake. We were asked to find out why the product was underperforming. After spending a few days talking with people in Mumbai it became apparent that most lacked a clear Behavioral Belief around germs, and cleanliness was powerfully (even spiritually) connected to washing with water. The idea of putting something on their hands that felt and smelled of chemicals made no sense when one does not have a ‘belief’ in germs.

The present effort of the US government is a strong attempt to instill a behavioral belief: that through separation, we will slow the spread of the virus, and that by slowing the spread, we will protect the most vulnerable in our population and not overwhelm our health care system. The mental model proposed by Dr. Anthony Fauci is that of ‘flattening the curve,’ preventing a mass of infections occurring over a short period of time. It is too soon to tell whether this behavioral belief will be strong enough to instill a new behavioral pattern.

Hopefully COVID-19 will crest soon and begin to wane, but if we are to take something positive away from this experience it should be the development of new, more hygienic and healthier habits that will prevent the spread of disease in communities around the world for years to come. To do this requires health organizations to think like marketers and create powerful beliefs using metaphors and narratives that draw heavily on existing cultural themes. For all of us, a good way to start is examining our own behaviors and seeing where we are out of compliance and to look hard for what is reinforcing our old behavior or punishing the new and what behavior beliefs we need to develop in response. We can pass these on to our families and communities, and that is something that should reinforce all of us.

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