Bursting the bubble

One thing I often focus on when thinking about behaviour change is the bubble. So much of our behaviour is driven by the people and things that surround us – our physical environment and culture, our friends and colleagues, and the wider community. All of this contributes to a type of bubble that informs our world. We each have a bubble, and it creates a special type of social norm that drives and reinforces much of our behaviour. So unless we find ways to crack open this bubble and reveal other, often larger bubbles, people will continue to feel supported in their behaviour – whether, for example, we’re talking about smoking, binge drinking, mob riots, or immunization.

One project I worked on in 2011 was the 15andfalling anti-smoking campaign. The bubble we focused on cracking was the one that told kids that smoking was popular – in fact, they believed that 50% of young people smoked. The actual smoking rate was far different – 15%, so we set about breaking this bubble, and building a greater sense of resiliency for young kids to resist.

The people around us

I’ve talked about it here before, but when I first get involved in any behaviour change or health promotion challenge, I like to start by looking up and out. For me, this means looking up beyond the individual and out toward the social or surrounding influences that contribute to our behaviour. Our attitudes aren’t fixed, but move around depending on the context in which we make decisions. As we bump into these other influences, they can reinforce or challenge our behaviour.

When we think beyond the individual, it can open us up to some really interesting and powerful influences on behaviour. Take this effort to tackle domestic violence that launched in India, and has since gone global. Bell Baiao or “Ring the Bell” seeks to bring violence against women to a halt by calling on men and boys to ring a door bell to speak out.

Or this effort from Kenya focused on reducing reckless driving, particularly with local bus drivers. The idea focused not on the driver, but on the passengers – encouraging them to complain when they felt endangered. Results of the trial, called Heckle and Chide are here.

Ultimately these efforts focused on the same end goal of behaviour change. But they re-framed the issue and attacked the challenge from another angle.

It’s easy to think about the ways this might inspire other behaviour change approaches. For example, how might we take on the issue of people talking on their cell phone while driving? Instead of focusing on the individual driver/ talker, we could engage the people around them. For example, it’s fairly easy to tell when chatting with someone on their cell whether they are driving. So messaging could encourage people who “receive” calls from people driving to ask them to pull over, or call back when off the road.

What about other health promotion challenges – including obesity, binge drinking or smoking? How might we look at the surrounding influences and the power of the social to change behaviour?

The Cameraman

I stumbled across this lovely little animated story from This American Life. While it closes with a wonderful moral lesson,  it also does a great job of demonstrating how things spread. Because so much of what we do is the result of our environment and those around us, it’s easy to see why many things can feel like a great idea – or acceptable – at the time. Even the idea of making pretend little cameras and filming others can seem normal.

Being aware of how the environment and those around us impact what we do is a great first step when considering how to change behaviour for the better.

Hat Tip to TheMadeShop

The red vest

One of the behaviour change examples I’ve referenced a lot when talking about the need to consider the wider environment comes from Switch. In it, the Heath Brothers describe the efforts used by Becky Richards, the Adult Clinical Services Director at Kaiser South San Francisco hospital.

Nurses who were distributing medication had a higher then average error rate. Rather then assuming this was a training or attitude issue with the nurses (it wasn’t), Richards observed that during the administration of medication, nurses were being distracted by doctors and others who would ask for their help.

So her solution focused not on the nurses, but those around them. In a pilot project, nurses administering the drugs were asked to wear a red vest, while at the same time, others within the hospital were instructed not to interrupt nurses when they were wearing the vest. At the end of the 6 month trial, error rates had dropped by 47%. It was adopted as a permanent process across the entire hospital – and in the 1st month, error rates dropped by 20% overall.

It’s a simple yet inspiring story that drove real behaviour change. To me, it’s a great reminder of how clearing a path to change can come from looking up and out, rather than simply at the individual.