1. Adapted from the Nudge Toolkit created by© IIT Institute of Design and KTPH Design Innovation Team and EAST: Four Simple Ways to Apply Behavioural Insights © Behavioural Insights Team  D EFAULTS Go with the flow of the pre-set option  R EDUCE THE ‘H ASSLE F ACTOR ’ Reduce the effort required to undertake a task  S IMPLIFY MESSAGES Break the goal down into simple actions  A TTRACT A TTENTION People can be drawn towards the desired behaviour  D ESIGN R EWARDS AND SANCTIONS FOR MAXIMUM EFFECT Use effective incentive designs e.g. lotteries ☺ P ERSONALISE MESSAGES Tailor messages to the individual  N ORMS Show that most people perform the desired behaviour  N ETWORKS Behaviour can be spread peer to peer  M AKE A COMMITMENT TO OTHERS Public promises ‘lock-ourselves’ into doing something  P ROMPTS Prompt people when they are most likely to be receptive  I MMEDIATE COSTS AND BENEFITS We are more influenced by immediate costs and benefits than those delivered later  M AKE A P LAN Help people plan their response to events

2. Ideas: By… How might we get ……………………………… (Target Group) To…. Nudge Sheet Describe target behaviour  Adapted from the Nudge Toolkit by the Design Incubation Centre :: National University of Singapore. More information on the EAST framework developed by the Behavioural Insights Team can be found at: http://www.behaviouralinsights.co.uk/publications/east-four-simple-ways-apply-behavioural-insights Strategy card

3. © IIT Institute of Design and KTPH Design Innovation Team Reduce the ‘hassle factor’ of performing an action The effort required to perform an action often puts people off. Reducing the effort required can increase uptake.  To reduce the ‘hassle factor’… ask yourself How might we bring attributes of existing routines into the experience of doing the new behaviour? e.g. Taking a pill at an arbitrary time each day is more challenging than taking one every time you brush your teeth or eat a meal. Simplify messages To simplify messages… ask yourself How might we eliminate unnecessary information? Can information be broken down or revealed progressively to identify how a complex goal can be broken down into simpler, easier actions. e.g. A prescription form that was simplified to allow doctors to circle micrograms/milligrams reduced medical errors significantly. King et al. (2014) Redesigning the ‘choice architecture’ of hospital prescription charts. BMJ Open 2014 Making the message clear often results in a significant increase in response rates to communications.

4. © IIT Institute of Design and KTPH Design Innovation Team Attract attention We are more likely to do something that our attention is drawn towards. Ways of doing this include use of images, colour or personalisation  To attract attention… ask yourself Can you make the costs or benefits of the behaviour more salient? Can we use images or colours to create associations? Is there a way of increasing emotional impact? e.g. … Consider the immediate costs and benefits  To help people see the immediate costs and benefits… ask yourself How can we make the future implications more evident in the present? How might we help the user recall actions in the past that affect them in the present? e.g. Simply telling doctors he cost of an optional lab test reduced use of that test by a third. At scale this could save the NHS £3m per year. Fogarty et al (2013) Hospital Clinicians’ Responsiveness to Assay Cost Feedback: JAMA Intern Med 2013;173:1654–5. People have a hard time drawing connections between actions and future consequences. They are also more motivated by costs and benefits which take place over the short term.

5. © IIT Institute of Design and KTPH Design Innovation Team Use a compelling messenger  To use a compelling messenger… ask yourself Who has the authority/ knowledge that these people respond to? What current stories already exist that messengers can promote? e.g. A request for social care providers to complete an information update were more effective when from the CQC rather than a minister. DH Behavioural Insights Team People respond differently depending on who gives them a message.

6. © IIT Institute of Design and KTPH Design Innovation Team Encourage people to make a commitment to others  To make the most of commitment devices… ask yourself Can the commitment be made in public or to another person whose opinion will be valued? Can social media be used as a way of recording the commitment? Can the commitment be strengthened by making the outcome clearer? e.g. ??? We often use commitment devices to ‘lock ourselves’ into doing something in advance. The social nature of these commitments is crucial. Make messages personal to the individual Tailored messages make it easier for people to imagine ‘what this means for me’.  To personalise the message to the individual… ask yourself What are the specific costs and benefits to the individual? What information do you have available to tailor the message? Can you include the persons name? e.g. …

7. EAST Framework, © Behavioural Insights Team Make the desired behaviour the default People regularly ‘go with the flow’ and stick with defaults, rather than actively choosing an option.  To make the desired behaviour the default… ask yourself Are there options for how to behave in your scenario? Is there the opportunity to change the default option? e.g. Wales has recently changed to an opt- out organ donor registration system (the ‘do nothing option’ results in being on the register) whereas England has an opt-in system. Prompt people when they are at their most receptive  To prompt people when they are at their most receptive… ask yourself Can we coordinate the introduction of this change with other episodes of change in peoples’ lives? Are there certain points in a process when people are more amenable to change than others? e.g. Encouraging people to walk or cycle to work, rather than drive, is easier when aligned with a major lifestyle change such as a new job or moving house. Smarter choices, smarter places. Scottish Government 2013 The same offer made at different times can have drastically different levels of success. Behaviour is easier to change when habits are already disrupted, such as around major life events.

8. Help people to make a plan There is a substantial gap between intentions and actions. If people develop a specific plan, they are more likely to follow it through. Use the power of networks  To … ask yourself Can you use people’s strong instincts for reciprocity and mutual support? Can you encourage people to perform the desired behaviour collectively? e.g. A trial to encourage people to join the organ donor register after they have renewed their car tax on line found the most successful message tested used reciprocity to encourage people to donate. Add reference We are all embedded in a network of social relationships which shape our actions.  To provide opportunities for people to make a plan.. ask yourself Can we break the desired behaviour down into simple actions? Can we ask people to write down or record their plan? Can we get people to commit to undertaking the action? e.g. A letter inviting people to attend the NHS Health Checks included a place for patients to themselves record their appointment time and date. This, boosting attendance by 13%. DH Behavioural Insights Team: Increasing Uptake of the NHS Health Check. Report of research with Medway Council. 2013.

9. © IIT Institute of Design and KTPH Design Innovation Team Design rewards and sanctions for maximum effect Financial incentives are highly effective, but alternative designs also work well and can cost less  To go beyond simple incentives… ask yourself Could this incentive be structured as a lottery? Could you draw attention to the scarcity of your product or service? How might you draw attention to a positive self image? e.g. … Show that most people perform the desired behaviour Group and societal norms can be strong motivators. People tend to align their choices with those of a group they are part of.  To draw upon or introduce social norms ask yourself How might we take advantage of existing positive social or group norms or introduce new ones? Are there any norms which will undermine the intervention? Is displaying the number or proportion of individuals undertaking the desired behaviour more effective? e.g. GPs were sent letters which compared their practices antibiotic prescribing rates to near by practices with the aim of reducing over prescribing PHE/DH Behavioural Insights Team