Creating a step
change in
behaviour using BE
to tackle obesity

Helen Nuki and Alexa
Arrowsmith
Monkey See
#MRSlive
May 2012 - NHS London asked for ideas based on BE
thinking for how to innovatively tackle obesity or
alcohol abuse
It’s clear that a persuasion based intervention would
not be enough ….

79%

of people think they should do more
exercise
...
So we turned to Behavioural Economics Theories
And a bit of inspiration from the mind of a young person
How did research help in
the process of Idea to
Business?
Designing the logo and poster – 4 options & 3 key
objectives
1.Which is the most
instantly understandable?

2. Which is th...
And some tweaks to traditional methodologies
Man was the strongest on all key measures
Action

Understanding

Salience

Appeal
56
76
56
54

Diagnostics

Top 3
Is clear...
We tested over 30 messages under 8 themes – all
designed using Behavioural thinking
Weight Loss:
Burning calories and fat....
But will the idea actually
help tackle obesity?
A holistic methodology combining behavioural and
attitudinal data
Poster Trial
3 buildings
2 weeks baseline
4 weeks interv...
A few methodological challenges along the way
Technology

Human Beings
29% of people across the 3 building were influenced by the
posters . Almost all say they will continue this behaviour
% Sa...
A significant increase in stair use in all buildings

% Change in stair use (avg over 4 weeks)
P=<
0.0000
29

P=<
0.0000

...
80% of smart card users changed their stair climbing
habits – twice the norm in the same building

% saying used the stair...
Smart card users recorded an extra 4.4 journeys on the
stairs per day. incentivised users recorded 6.8

Avg no. of
journey...
Taking the results and forecasting calorie burn forward
Building

extra stair
journeys per
day

per week

per month

per y...
Overall observations on human behaviour
•

Salience & Message
•
•

•

Incentives worked
•

•

In the case of stair climbin...
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Members Evening October

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Helen Nuki and Alexa Arrowsmith presented one of the latest ideas to tackle obesity in London developed by Monkey See for NHS. Attendees experienced the idea in action and saw how behavioural economics theories were used in its development.

Published in: Technology, Health & Medicine
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Transcript of "Members Evening October"

  1. 1. Creating a step change in behaviour using BE to tackle obesity Helen Nuki and Alexa Arrowsmith Monkey See #MRSlive
  2. 2. May 2012 - NHS London asked for ideas based on BE thinking for how to innovatively tackle obesity or alcohol abuse
  3. 3. It’s clear that a persuasion based intervention would not be enough …. 79% of people think they should do more exercise 50% of people think they are overweight or obese It is the behavioural barriers that need targeting
  4. 4. So we turned to Behavioural Economics Theories
  5. 5. And a bit of inspiration from the mind of a young person
  6. 6. How did research help in the process of Idea to Business?
  7. 7. Designing the logo and poster – 4 options & 3 key objectives 1.Which is the most instantly understandable? 2. Which is the one that is most directive? 3. Which is most salient? 4. Which has the most appeal? 5. Which conveys the right feel and tone?
  8. 8. And some tweaks to traditional methodologies
  9. 9. Man was the strongest on all key measures Action Understanding Salience Appeal 56 76 56 54 Diagnostics Top 3 Is clear climbing stairs is good for you – 76% Easy to understand – 60% Clean & Modern Style - 47% 50 69 49 43 51 73 55 46 51 72 47 42 Bottom 3 Stylish looking – 20% Approachable – 19% Warn & Friendly – 17%
  10. 10. We tested over 30 messages under 8 themes – all designed using Behavioural thinking Weight Loss: Burning calories and fat. “watching your weight?” Health: Protecting heart, reducing risk of heart attack & stroke, lowering cholesterol Exercise Gentle: Calorie burn vs jogging, number of calories, frame against gym and exercise quota Exercise Aggressive: Endurance challenge, cardio fitness, muscle tone, aerobic capacity, vertical rush Vanity: Tone and firm legs, muscles, bums Top Influencers Regular stair climbers have stronger hearts Green: Cutting carbon footprint, saving the planet, Herd: Lots of people are getting fitter, toning up using the stairs Nudge: 62 Burns 7x more calories than taking the lift 62 Regular stair climbing protects your heart 61 Burns more calories than jogging 61 Regular stair climbing can half the risk of a heart attack 60 Watching your weight? Stair climbing burns calories & fat 60 No time for the gym? Get your daily workout on the stairs 58
  11. 11. But will the idea actually help tackle obesity?
  12. 12. A holistic methodology combining behavioural and attitudinal data Poster Trial 3 buildings 2 weeks baseline 4 weeks intervention 261,062 journeys Recording stairs and lift journeys Among 370 in buildings (100+ per building) Questionnaire 2 focus groups among building workers: influenced & not People counters Smart card readers Holistic Evaluation Programme Focus groups Focus groups Smart Card Trial 50 people 2 sub-groups, 1 incentivised 2 weeks Recording all stair journeys Questionnaire To all participants 2 focus groups among trialists: incentivised & not
  13. 13. A few methodological challenges along the way Technology Human Beings
  14. 14. 29% of people across the 3 building were influenced by the posters . Almost all say they will continue this behaviour % Saying used stairs more County Hall Farnham House Elizabeth House Those most influenced were 16% Women 25-34 Exercise less than once a week Overweight 31% 40%
  15. 15. A significant increase in stair use in all buildings % Change in stair use (avg over 4 weeks) P=< 0.0000 29 P=< 0.0000 P=< 0.0001 P=< P=< 0.0001 0.0001 P=>. 025 2 2 1 County Hall 8 P=< 0.0000 9 Total Change 14 16 P=< 0.0000 Down Change Up change P=<. 028 5 Elizabeth House Farnham House Base: Total recorded journeys (County Hall 70,432, Elizabeth House 126,151, Farnham House, 64,479)
  16. 16. 80% of smart card users changed their stair climbing habits – twice the norm in the same building % saying used the stairs a lot or little more) County Hall Farnham House Elizabeth House 16% 31% 40% Smart Card Group* Q5.Do you think the posters made you change the amount you used the stairs? Base: CH 126, FH 122, EH 122, smart card 35 * NB Low Base 80% * NB Low Base
  17. 17. Smart card users recorded an extra 4.4 journeys on the stairs per day. incentivised users recorded 6.8 Avg no. of journeys on stairs per day baseline No. of stair journeys per day among sub groups Additional journeys per day Smart Card Only 0.97 5.4 4.43 Smart Card & Incentive 0.97 7.8 6.83 I found I’d go up a couple of floors to go to the toilet instead of the nearest one (smartcard nonincentivised, female) At lunchtime I’d go up and down the stairs a few times to clock up some journeys (smartcard incentivised, female)
  18. 18. Taking the results and forecasting calorie burn forward Building extra stair journeys per day per week per month per year Calorie equivalent per year County Hall 49 244 1225 10780 75,891 Elizabeth House 114 569 2850 25080 144,461 Farnham House 80 400 2000 17600 61,952 SC Trial only 6350 31,750 158,750 1,397,000 4,023,360 SC Trial Incentive 9173 45,865 229,325 2,018,060 5,812,012 * We have assumed a company of 1200 took part i.e. the same number of employees as in Elizabeth House ** We have assumed of the 1200, 1176 would take part (i.e. same drop out rate as in the smart card test)
  19. 19. Overall observations on human behaviour • Salience & Message • • • Incentives worked • • In the case of stair climbing, behaviour change over the course of 4 weeks may well be sufficient time to change habits. 92% believed they would continue stair climbing Challenge & Commitment help to stick to the change • • 22% believed their stair climbing influenced others and 16% believed they had been influenced by others. Defaults & Habits set in after 4 weeks • • While in focus groups people say the incentive is not important, but in real life it sparked greater behaviour change (increasing daily stair use from 5.4 journeys to 7.8) The Herd Effect was evident • • Signs in places designed to disrupt daily routines can cut-through. By deploying signs next to lifts, inside lifts, on stair walls and runners led to 95% of people in a building noticing them. A simple direct message (almost order) works to affect a change, the health benefit is simply used as the rational (to themselves & others) to justify the action Upward journeys were more affected, the competition was a strong driver of behaviour change and people wanted to set themselves targets to track themselves against. Ego came to the fore and leads to greater behaviour change • Once people had made this small change they had the desire to continue to act positively and consistently – a third of people had started taking the stairs in other places.

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