A presentation on the 4E (encourage, enable, engage, exemplify) framework for behaviour change initiatives.

1. Behaviour Change
…art or science?
Clive Bates
Director General, Sustainable Futures
Welsh Assembly Government

2. Contemporary challenges

3. Some relevant areas
Post-16 participation Energy efficiency
Parenting Transport choices
Education/skills Adult literacy Environment Reduce, reuse, recycle
Life skills (cooking etc) Consumption choices
Volunteering Fly-tipping
Drugs, alcohol, tobacco Anti-social behaviour
Teenage pregnancy Crime prevention
Health Obesity Community Terrorism
Keeping appointments Social mobility
Organ donation Litter / graffiti
Active job seeking Pension provision
Service culture Self-care
Prosperity Entrepreneurship Care / ageing Mental health
Personal aspiration Active ageing
Diversity End-of-life choices

4. Behaviour change is big money
Projected UK health care spending
(% GDP public & private, annotations at 2002-3 prices)
% GDP
14
US spent About £220 bn
14.6% GDP in over 15 years
2002 (OECD)
12 ke
ta £30bn
up
ow
Sl
10 Fully engaged
8
£154bn
£96bn
2007-8
6
4
19 78
19 83
19 88
19 93
20 98
20 03
20 13
20 18
20 08
3
-2
-
-
-
-
-
-
-
-
-
17
77
82
87
92
97
02
07
12
22
19
Source: Wanless, 2002 Securing Our Future Health: Taking A Long-Term View

5. 1. Use a simple model that
people can remember

6. 1. The 4-E approach to behaviour change
Taxes & fiscal measures Remove barriers to act
Regulation & fines Set defaults / opt-out vs opt-in
League tables Form clubs / communities
Targets / perf management Provide information
Prizes / rewards / bonuses Enable Choose intervention timing
Preferential treatment Personalise
Status recognition Provide space / facilities
Subsidies / discounts Build confidence
Feedback Ease/cost of access
Encourage Catalyse Engage
Community/network action
Evidence base
Deliberative fora
Walk the talk & lead
Segmentation / focus
Consistency across policies
Exemplify Secure commitment
Sustained approach
Personal contacts
Credibility / confidence
Role models / 'super-users'
Benchmarking / evaluation
Paid/unpaid media campaigns
Learning & improvement
Pester power / Peer pressure
Political consensus building
Workplace norms

7. 4-E approach to behaviour change
Taxes & fiscal measures Remove barriers to act
Regulation & fines Set defaults / opt-out vs opt-in
League tables Form clubs / communities
Targets / perf management Provide information
Prizes / rewards / bonuses Enable Choose intervention timing
Preferential treatment Personalise
Status recognition Provide space / facilities
Subsidies / discounts Build confidence
Feedback Ease/cost of access
Encourage Catalyse Engage
Community/network action
Evidence base
Deliberative fora
Walk the talk & lead
Segmentation / focus
Consistency across policies
Exemplify Secure commitment
Sustained approach
Personal contacts
Credibility / confidence
Role models / 'super-users'
Benchmarking / evaluation
Paid/unpaid media campaigns
Learning & improvement
Pester power / Peer pressure
Political consensus building
Workplace norms

8. Some examples using the 4-E framework
• Smoking
• Drink driving
• Recycling

9. Smoking prevalence
All > age 16 (Britain)
50
45
40
35
30
25
20
15
10
5
0
1975 1980 1985 1990 1995 2000 2005 2010

10. Smoking and behaviour change
High excise taxes
Ban marketing practices NHS 'stop smoking' treatment
Address smuggling Smoke-free policies
Enable Quit-lines
(nb. Personal incentives) Pharmaceutical deregulation
Encourage Catalyse Engage
Smoke-free policies Social marketing campaigns
Clear messages from NHS Exemplify More graphic warnings
Consistent package Major news media assault
Clear goals Constant revisiting evidence
Commercial arguments “Denormalisation”

11. But others forces are at work...
...as
the force of the
A cigarette for the beginner
psychological symbolism
is a symbolic act. I am no
subsides, the
longer my mother’s child,
pharmacological effects
I’m tough, I am an
take over to sustain the
adventurer, I’m not
habit
square...
Dunn W. Vice President for Research and Development, Philip Norris. Why one smokes. 1968 Minnesota Trial Exhibit 3681.

12. Smoking: from the dark side
Advertising Orchestrating smuggling
Role models Lights
Adult product definition Enable Filters
Duty Free Wide availability
Fighting smoke-free places
Encourage Catalyse Engage
Aspirational sell to poor
Product placement in films Exemplify Coupons and catalogues
Sponsorship Coaching arguments
Normalisation Distracting PR
Bogus science

13. Drink driving
Reported drink drive accidents and fatalities: GB 1980-2008
1980=100
120
100
80
60
40 Accidents
Fatalities
20
0
1980 1985 1990 1995 2000 2005 2010
DFT: Reported Road Casualties Great Britain 2008: Annual Report

14. Drink driving
Breathalyser
Soft drinks normalisation
More severe penalties Taxi services &
Police enforcement Enable other innovations
Driver training
as part of penalty
Encourage Catalyse Engage
Strong sustained
30 year campaign Exemplify media campaign
Vilification of politicians
No 'nod and wink'
Clever segmentation

15. Drink driving
Reported drink drive accidents and fatalities: GB 1980-2008
1980=100
Rise of Alcopops
60
50
120
40
ml/week per person
30
100 20
10
80 0
1992 1994 1996 1998 2000 2002 2004 2006
60
Seatbelts
40 Compulsory Accidents
1983
Fatalities
20
0
1980 1985 1990 1995 2000 2005 2010
DFT: Reported Road Casualties Great Britain 2008: Annual Report

16. Drink driving
Reported drink drive accidents and fatalities: GB 1980-2008
1980=100
Decline of breath tests
900
800
120
Number of breath tests (thousand)
700
England and Wales
600
100 500
400
80 300
1992 1994 1996 1998 2000 2002 2004 2006
60
40 Accidents
Fatalities
20
0
1980 1985 1990 1995 2000 2005 2010
DFT: Reported Road Casualties Great Britain 2008: Annual Report

17. Recycling and behaviour change
UK recycling rate
Kg per person
200
180
160
140
120
100
80
60
40
20
0
1991-92 1993-94 1995-96 1997-98 1999-00 2001-02 2003-04 2005-06 2007-08

18. Recycling and behaviour change
Landfill tax
Collection services
Landfill diversion targets
Containers / bags
Infraction
Enable Sorting
Local authorities
(difficulties remain)
incentive structure changed
Encourage Catalyse Engage
Common endeavour
Government targets No free-riding
Money committed Exemplify Waste Awareness
SD indicators
Long-term view (to 2025) But... controversy and
sensitivity

19. Organ donation
J o h n s o n , E . J . a n d G o l d s t e i n , D . ( 2 0 0 3 ) . D o d e f a u l t s s a v e l i v e s ? S c i e n c e , 3 0 2 : 1 3 3 8– 1 3 3 9 .

20. Blood / organ donation
Payment? Enable Default (opt out)
Encourage Catalyse Engage
Exemplify

21. Blood money
Donors per thousand population
50
40 38.1
30
20
10
7.1
2.3
0
Developed Transition Developing
World Health Organisation: Blood Transfusion Safety Unit 2007 data.

22. Paying for blood creates poor incentives
Percentage of voluntary unpaid blood donations, 2007

23. Contracts for exercise
Participation in walking programme
100
81
80
60
40
31
20
0
Contract No contract
Williams BR, Bezner J, Chesbro SB, Leavitt R. The effect of a behavioral contract on adherence to a walking program in postmenopausal
African American women. Top Geriatr Rehab.2005;21(4):332- 342.

24. Contracts to create reciprocity
Solidarity with others
Peer pressure Enable
Encourage Catalyse Engage
Exemplify
Contract & reciprocity

25. Teachers Expectations affect Student Outcome
Proportion pupils achieving 30 point grade increase
30
25
20
21 “The soft bigotry of
low expectations”
15
10
5
5
0
Randomly selected but labelled Control group
"High achievers"
Rosenthal, Robert & Jacobson, Lenore. Pygmalion in the classroom (1992). Expanded edition. New York: Irvington
Quote: attributed to George W Bush

26. The Pygmalion Effect
Enable
Encourage Catalyse Engage
Exemplify
Expectation setting and belief

27. 4-E behaviour change model in use

28. 2. Think of people as ‘human’

29. 2. Understand human behaviour
Rational
all-knowing
individualised
long-term
utility
maximisation

30. MINDSPACE

31. MINDSPACE
Messenger: We are influenced by who communicates information
Incentives: Our responses are shaped by biases and shortcuts
Norms: We tend to do what those around us are already doing
Defaults: We ‘go with the flow’ of pre-set options

32. MINDSPACE
Salience: Our attention is drawn to what is novel and seems
relevant to us
Priming: Our acts are often influenced by sub-conscious cues
Affect: Emotional associations can powerfully shape our actions
Commitment: We seek to be consistent with our public promises,
and reciprocate acts
Ego: We act in ways that make us feel better about ourselves

33. The Science of Persuasion
6 weapons of influence
•Reciprocation: You did something for me and now I owe you
•Consistency: One thing I do or think leads to another
•Social proof: 9 out of 10 cats prefer...
•Liking: I will buy Tupperware from you because I like you
•Authority: More doctors smoke Lucky Strike
•Scarcity: Get it now, or I’ll be sorry when it’s gone
Robert Cialdini, The science of persuasion, Scientific American, 284, 76-81.

34. Some “biases” in real behaviour
• Loss aversion
• Recency It's illogical
• Peak experience Captain...
• Herding
• Heuristics
• Omission
• Habit
• Confirmation
• Hyperbolic discounting

35. List of cognitive human “biases”
Behaviour & Decision-
Probability & belief Social
making
Bandwagon effect Ambiguity effect Actor-observer bias
Base rate fallacy Anchoring effect Egocentric bias
Bias blind spot Attentional bias Forer effect
Choice-supportive bias Authority bias False consensus effect
Confirmation bias Availability heuristic Fundamental attribution error
Congruence bias Availability cascade Halo effect
Contrast effect Belief bias Herd instinct
Déformation professionnelle Clustering illusion Illusion of asymmetric insight
Denomination effect Capability bias Illusion of transparency
Distinction bias Conjunction fallacy Illusory superiority
Endowment effect Disposition effect Ingroup bias
Experimenter's Gambler's fallacy Just-world phenomenon
Extraordinarity bias Hawthorne effect Notational bias
Focusing effect Hindsight bias Outgroup homogeneity bias
Framing Illusory correlation Projection bias
Hyperbolic discounting Ludic fallacy Self-serving bias
Illusion of control Neglect of prior base rates effect Self-fulfilling prophecy
Impact bias Observer-expectancy effect System justification
Information bias Optimism bias Trait ascription bias
Interloper effect Ostrich effect Ultimate attribution error
Irrational escalation Overconfidence effect
Just-world phenomenon Positive outcome bias
Loss aversion Pareidolia
Mere exposure effect Primacy effect
Money illusion Recency effect
Moral credential effect Disregard of regression toward the mean.
Need for Closure Selection bias
Negativity bias Stereotyping
Neglect of probability Subadditivity effect
Normalcy bias Subjective validation
Not Invented Here Telescoping effect
Omission bias Texas sharpshooter fallacy
Outcome bias Well travelled road effect
Planning fallacy Consistency bias
Post-purchase rationalization Cryptomnesia
Pseudocertainty effect Egocentric bias
Reactance
Restraint bias
False memory
Hindsight bias
For more information
Selective perception
Semmelweis reflex
Reminiscence bump
Rosy retrospection Wikipedia search:
Status quo bias
Von Restorff effect
Self-serving bias
Suggestibility “List of cognitive biases”
Wishful thinking
Zero-risk bias

36. 3. Understand the population

37. 3. Understand the population

38. Use segmentation
Willing to act
1: Positive greens
I think it’s important that I do
as much as I can to limit my
2: Waste watchers impact on the environment.
‘Waste not, want not’ that’s 18%
important, you should live life
thinking about what you are 3: Concerned consumers
doing and using. 12% I think I do more than a lot of
people. Still, going away is
important, I’d find that hard to
give up..well I wouldn’t, so
7: Honestly disengaged carbon off-setting would make
Maybe there’ll be an me feel better. 14%
environmental disaster, maybe
not. Makes no difference to
me, I’m just living life the way I 5: Cautious participants
want to. 18% I do a couple of things to help
the environment. I’d really like to
do more, well as long as I saw
others were. 14%
4: Sideline supporters
6: Stalled starters I think climate change is a big
I don’t know much about problem for us. I know I don’t
climate change. I can’t afford think much about how much
a car so I use public water or electricity I use, and I
transport.. I’d like a car forget to turn things off..I’d like to
though. 10% do a bit more. 14%
Able to act

39. 4. Be careful with the relationship
between citizen and state

40. 4: Establish the case for intervention
“The only purpose for which power can
be rightfully exercised over any
member of a civilised community,
against his will, is to prevent harm to
others. His own good, either physical or
moral, is not a sufficient warrant”.
But… Children? Addiction? Influence of background?
Mental illness? Collective costs? Regret...?

41. From soft paternalism to regulation
Public (external) impacts
Passive smoking - workers
Passive smoking - public
Hooking kids
Unregulated addiction
Health impacts
Private impacts

42. 5. Adopt a learning approach

43. 4+2 Es approach to behaviour change
Enable
Explore Encourage Catalyse Engage Evaluate
Exemplify

44. 5. Culture change: self-sustaining behaviour

45. Summary
1. Four-E behaviour-change model
 Encourage
 Enable
 Engage
 Exemplify
2. Understand real behaviour
3. Segment and personalise
4. Judge public acceptability (which changes)
5. Experiment and evaluate

46. Reading up...
Thaler & Sustein Mark Earls Robert Cialdini Dan Ariely

47. Reading up...
Government Government Institute for Cabinet Office
communications Social Research Government
&
Cabinet Office