Slides from Webinar (Paul Webber Training) for WHO, February 2012. Topic: How to influence HCWs

1. 20-­‐04-­‐12
Psychological models & Healthcare
• ….
used
to
understand
and
predict
behavior,
but
(so
far)
hardly
used
in
healthcare
• Theory
of
Planned
Behavior
(TPB)
• Social
CogniDve
Theory
(SCT)
• Operant
Learning
Theory
(OLT)
• Common
Sense
Self-­‐regulaDon
Model
(CS-­‐SRM)
• Stage
Models
(SM)
• ImplementaDon
IntenDon
(II)
BoneK
et
al.
ImplementaDon
Science
2010;5:20
Influence
• While
we
wish
to
make
the
most
thoughRul,
fully
considered
decision
possible
…
we
frequently
resort
to
comply
on
basis
of
a
single
piece
of
informaDon
(trigger)
• “Click-­‐whirr”
(automaDc
response,
fixed
acDon
paXern)
– Mother
turkey
feeds
chicks
at
the
sound
of
cheep-­‐
cheep
• Stuffed
“pole
cat”
(natural
enemy)
à
rage
• Stuffed
pole
cat
with
cheep-­‐cheep
à
feeding
Triggers for compliance Commitments
• Commitments
• Shortcuts
–
judgmental
heurisDcs
• OpportuniDes
for
reciprocaDon
• Compliant
behavior
of
similar
others
• Contrast
principal
• Feelings
of
liking
&
friendship
• Authority
direcDves
• Consistency
• Scarcity
informaDon
Shortcuts-­‐
contrast
-­‐
consistency
1

2. 20-­‐04-­‐12
Shortcuts – judgmental heuristics Contrast principal
• “Expensive
=
good”
(and
opposite)
• Perceptual
contrast
• “If
an
expert
said
so,
it
must
be
true”
– Buying
suite
and
sweater
à
expensive
item
first
– Airline
industry
“captainiDs”
– Selling
the
car
first,
than
the
opDons
• “Because”
– Increase
compliance
even
if
no
reasoning
follows
(example
cuKng
lines)
– Possibly
based
on
“because”
…
“just
because”
of
parents
when
answering
their
children's
quesDons
Shortcuts-­‐
contrast
-­‐
consistency
Shortcuts-­‐
contrast
-­‐
consistency
Perceptual Contrast Consistency
• Most
people
have
a
strong
desire
to
look
consistent
within
their
words,
beliefs,
aKtudes
• Whenever
one
takes
a
stand
that
is
visible
to
others,
there
arises
a
drive
to
maintain
that
stand
in
order
to
look
like
a
consistent
person.
• Therefore,
wriXen-­‐down
and
publicly
made
commitments
can
be
used
to
influence
others
and
ourselves
Shortcuts-­‐
contrast
-­‐
consistency
Shortcuts-­‐
contrast
-­‐
consistency
Consistency Food-in-the-door (1)
• QuesDon
to
home
owners
–
place
large
billboard
• At
the
beach
“Drive
Carefully”
in
your
lawn
– Leaving
a
blanket
with
valuables
–
pretended
thec
• Two
groups:
A)
17%
complied
–
4/20
people
in
the
area
reacted
B)
76%
complied
– Saying
“watch
my
things”
first
à
19/20
reacted
• Why
the
difference
between
A
+
B
?
?
B
was
asked
a
few
weeks
before
to
display
a
small
If
I
can
get
someone
to
commit
(take
a
stand
or
go
on
record)
3x3in
sign
in
window
“Be
a
safe
driver”
I
can
set
the
stage
for
automaDc
consistency
!
Shortcuts-­‐
contrast
-­‐
consistency
2

3. 20-­‐04-­‐12
Contrast & consistency principle applied in
infection control ?
Promise
of
publicity
• Key-­‐person
as
role-­‐models
• Published
list
of
supporters/let
them
sign
a
pledge
Self
generated
support
• Pre-­‐prime
your
customer
– Would
you
(theoreDcally)
be
supporDng
our
goals?
Followed
by
a
visit
to
commit
them
to
IC
New
self-­‐image
Shortcuts-­‐
contrast
-­‐
consistency
Opportunities for reciprocation Examples of reciprocation
• “we
are
obligated
to
future
repayment”
• Mailing
a
$5
gic
along
with
a
survey
was
twice
• Regan
et
al.
“Coke
experiment”
as
effecDve
as
a
$50
payment
for
sending
it
– Joe
gave
others
(unasked
for)
a
drink.
Later
asked
them
to
back
(James
&
Bolstein
1992)
buy
raffle
Dckets
from
him
à
those
who
got
a
Coke
bought
more
Dckets
• à
a
small
iniDal
favor
can
produce
a
sense
of
à
those
you
“liked”
Joe
bought
more
Dckets
obligaDon
to
agree
to
a
larger
return
favor,
– but
….
relaDonship
between
“liking”
and
compliance
since
most
of
us
find
it
highly
disagreeablte
to
wiped
out
in
those
that
received
a
Coke
!
be
in
a
state
of
obligaDon
“a
feeling
of
indebtedness
by
doing
us
an
uninvited
favor”
ReciprocaDon
ReciprocaDon
Reciprocation techniques Benefactor-before-beggar-startegy
• Reciprocal
concessions
Disguised
Krishna
– Boy
scout
selling
$5
Dckets
for
Saturday
night
event,
when
arrested
for
soliciDng
rejected
offering
$0,50
candies
(buyer
feels
that
second
request
is
a
concession
to
him)
without
a
license
when
pressing
candy
• Rejec1on-­‐then-­‐retreat
strategy
canes
on
shoppers
and
– Over
ask
first,
than
come
with
intended
amount
than
asking
for
donaDons
– Ask
volunteers
for
1
week
of
community
service
than
offer
1
hour
à
reciprocity
rule
– Rejected-­‐than
retreat
group
has
a
higher
compliance
to
actually
do
that
service
(85%
vs.
50%)
• Benefactor-­‐before-­‐beggar-­‐strategy
ReciprocaDon
3

4. 20-­‐04-­‐12
Benefactor-before-beggar-startegy Compliant behavior of similar others
• Principle
of
Social
Proof
– Important
means
that
people
use
to
decide
what
A
nice
Christmas
gic
for
to
believe
or
how
to
act
is
to
look
what
other
your
HCWs
–
believe
or
do
shortly
before
launching
• Social
proof
is
most
influenDal
under
two
condiDons
your
HH
campaign
– Uncertainty
– Similarity
ReciprocaDon
Similar
others/social
proof
Principle of Social Proof 50 million can’t be wrong
• “We
view
behavior
as
correct
to
the
degree
“people
want
to
be
part
of
the
majority”
we
see
other
performing
it”
– When
lots
of
people
do
it
–
it
must
be
right
Similar
others/social
proof
Social proof - examples What is going to happen?
• Laughing
tracks
– Others
laugh
=
it
must
be
funny
• we
react
to
the
sound
(even
if
fake)
–
not
the
content
• works
even
if
the
sound
is
arDficial
• Church
usher
salDng
collecDon
baskets
Similar
others/social
proof
Similar
others/social
proof
4

5. 20-­‐04-­‐12
Using principles of social proof in
Pluralistic ignorance infection control?
• Never
again
start
a
lecture
with
only
40%
disinfect
Uncertainty
their
hands
…
Hart
aXack
or
drunk?
– “all
HCW
agree
that
HH
is
the
most
important
…”
Other
bystanders
reduce
• Pay
people
to
be
the
good
example
(role
models)
personal
responsibility
• Movies
with
correct
behavior
around
the
hospital
• Campaign
logo/IC-­‐logo
worn
by
all
KOLs
Similar
others/social
proof
Similar
others/social
proof
Feelings of liking & friendship Halo effects
• “
We
most
prefer
to
say
YES
to
the
request
of
• Occurs
when
a
posiDve
characterisDc
of
a
people
we
know
and
like”
person
dominates
the
way
a
person
is
viewed
• Factors
leading
to
liking:
– Good-­‐looking
=
talent,
kind,
honest,
intelligent
– physical
aXracDveness
(halo
effect)
– similarity
– Works
in
many
situaDons:
even
judicial
process
– familiarity
à
handsome
men
lighter
sentences
– praise
– associaDon
Liking
Liking
Similarity Compliments
• “We
like
people
that
are
similar
to
us”
– more
likely
to
help
those
that
dress
like
us
• “We
are
phenomenal
suckers
for
flaXery”
– PosiDve
comments
produce
just
as
much
liking
for
the
flaXerer
independent
if
they
were
untrue
or
true
Liking
Liking
5

6. 20-­‐04-­‐12
Association Association
• An
innocent
associaDon
with
either
bad
or
• SALE
good
things
will
influence
how
people
feel
– Buying
becomes
more
likely
because
it
is
about
us
or
a
product
associated
with
good
experience
in
the
past
– The
good
looking
models
next
to
the
car
• RaDng
of
idenDcal
car
changed
with
and
without
model
• CelebriDes
and
adverDsement
• Men
didn’t
believe
that
their
judgment
was
influenced
– Establish
a
connecDon;
it
doesn’t
have
to
be
a
logical
one,
just
a
posiDve
one
Liking
Liking
Can you think about a situation in which
you could use this ? Authority directives
• Power
of
authority
(Milgram
study,
1974)
• Praise
instead
of
criDcize
!
• Let
others
report
about
the
outbreak
&
extra
• Symbols
of
authority
measures
– Titles
• InfecDon
Control
luncheon
– Clothing
• Use
a
(local)
celebrity
(non-­‐medical)
to
adverDze
for
– Automobiles
InfecDon
Control
Liking
(aXracDveness,
praise,
familiarity,
similarity,
associaDon)
Authority
Power of authority (Milgram study, 1974) Symbols of authority
• Appearance
of
authority
is
enough
to
get
is
into
the
click,whirr
mode
Expert/Authority • Symbols
of
authority
– Titles
– Clothes
– Trappings
Authority
Authority
6

7. 20-­‐04-­‐12
Titles Clothes
• PresDgious
Dtles
lead
to
height
distorDon
• Request
by
well-­‐dressed
person
is
more
frequently
obeyed
• Visitor
to
college
presented
as
“Student”
– Man
walking
crosses
red-­‐traffic
light:
in
suit
to
“Professor”
at
5
different
levels,
college
versus
shirt
&
trousers
students
than
asked
to
esDmate
length:
Δ
– 3.5
x
as
many
people
followed
suited
0.5
per
category
or
2.5
in
overall
jaywalker
• Size
and
status
is
related
Authority
Authority
Can you think about a situation in which
you could use this ? Scarcity information
• People
assign
more
value
to
opportuniDes
• Start
wearing
a
De?
when
they
are
less
available
• Get
an
impressive
office
– “limited
number”
and
“deadline”
• Meet
and
be
seen
with
senior
clinicians
and
– Difficult
to
get
=
valuable
CEO
– Loosing
freedom
of
choiceà
increases
wish
• Use
your
Porsche
to
work
à
would
achieve
• Psychological
reactance
the
opposite
in
the
NL
• Scarcity
and
informaDon
Authority
(obedience,
Dtle,clothing,
cars)
scarcity,
censorship,
reactance
Psychological reactance Censorship
• “Things
that
are
difficult
to
get
are
beXer”
• Response
to
“banned”
informaDon
– Want
the
informaDon
even
more
• When
free
choice
is
limited
or
threatened
the
– Believe
the
informaDon
more
even
though
it
need
to
retain
our
freedom
makes
us
want
wasn’t
received
them
significantly
more
– “Terrible
two
and
equally
desirable
toys
of
which
one
behind
a
Plexiglas
barrier
– Parental
interference
with
young
love
Reactance,
an
emoDonal
reacDon
to
pressure
or
persuasion
that
results
in
the
strengthening
or
adopDon
of
a
contrary
belief
scarcity,
censorship,
reactance
7

8. 20-­‐04-­‐12
Commodity theory ‘Feeding frenzy”
Humans
and
animals
alike
lose
perspecDve
on
what
they
• Sale
of
product
want
and
begin
striking
at
whatever
is
contested
– Standard
info
– Standard
info
+
upcoming
scarce
x
2
• School
of
fish
when
loose
bait
in
water
will
– Standard
info
+
scarce
exclusive
source
x
6
snap
on
bare
hook
• Overspending
during
aucDons
• $145.000
for
John
T.
Saturday
Night
Fever
polyester
suit,
because
two
bidders
became
looked
into
a
compeDDve
bidding
scarcity,
censorship,
reactance
Can you think about a situation in which
you could use this ?
Summary
• This
were
just
a
few
examples
of
one
book
• IntroducDon
of
new
hand-­‐rub
or
catheters
in
your
hospital
• In
order
to
effecDvely
implement
infecDon
– Present
&
announce,
restrict
it
to
ICU
and
those
units
that
control
we
need
more
knowledge
in
first
order
behavioral
science
• Announce
a
limiDon
of
hand-­‐rub
and
than
find
a
“new
source
of
supply
• Behavioral
science
furthermore
offers
explanaDons
we
see
in
healthcare
seKngs
scarcity,
censorship,
reactance
The Spreading of Disorder
• when
people
observe
inappropriate
behavior,
this
weakens
their
concern
for
appropriateness
§
Orderly
alley:
§
Orderly
alley
33%
liXering
§
No
graffiD
sign
§
Flyer
on
handlebar
§
GraffiD
alley:
§
69%
liXering
§
avoid
liXering
We
need
“order”
in
our
hospitals
and
people
showing
appropriate
behavior
!
www.sciencexpress.org
/
20
November
2008
/
Page
1
/
10.1126/science.1161405
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