Exchange in Behavior Change

Making consumers feel, instead of do

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One of the most often expressed grievances related to the COVID-19 pandemic has been around wearing face masks. Everyone is made aware of its importance when stepping out. We can thank the hundreds of videos, posters (digital and offline), social media content, and articles on the subject. Not wearing a face mask outside today could mean instant scrutiny, even mockery or humiliation. Sometimes I wonder how many wear face masks to protect their health and that of others, and how many wear face masks because ‘everybody else is doing it’ or it is ‘cool’ or ‘popular’ or ‘this one is branded and oh so pretty’. Of course, this is not to say there is only one motivation at play here, or that one is better than the other. It just is an excellent example of how simple awareness-raising of the health benefits is not enough – motivation comes from a combination of individual and social factors as well as knowledge.  

Social marketing’s impact

In the context of social marketing, we briefly discussed the idea of ‘exchange’ in our blog post by social marketing expert Rowena Merritt, “It Makes Me Smile,” posted a fortnight back. We explained how, if the goal is to change a behavior, offer something in return. While most of us might think of cash incentives or gift vouchers as rewards, the exchange is often non-monetary, such as making someone feel unique, or creating a sense of control or ownership. At Sight and Life, we think about whom we are serving and what could be a compelling exchange for our target audience. 

Research is important

Let us look at the Eat More, Eat Better campaign* launched in Rajasthan – a state in Northern India – in 2018. The project aimed to improve food access and food choices for pregnant and lactating women (PLW), whose calorie intake was 40% below doctors’ recommendations. However, we quickly realized that we needed to do more than raise awareness; we needed to offer an exchange that our audience valued. To help us do this, we used social marketing techniques and tools and conducted in-depth formative research. 

The findings helped identify critical insights to develop a behavior change strategy, the most notable being:
  A. The kitchen was generally the mother-in-law’s domain, and she associated eating more with being indulgent, greedy or lazy. This perception was not relaxed even for her pregnant or lactating daughter-in-law!
  B. The husband tried to balance patriarchal norms with being more emotionally available to his wife. For instance, he would occasionally smuggle in goodies or fruits for his wife to eat.
  C. Snacking, rather than the three meals, carried greater permission for the PLW as it did not lead to territorial clashes in the kitchen and was also something that was not frowned upon by the mother-in-law.

Based on these findings, the social marketing project focused on introducing a new behavior – nutritive snacking for PLW. The habit of snacking was accepted and already practiced, making it a more natural behavior to change. PLW were provided a specially designed snack box that she could use when away from the kitchen and a small treat pouch that she could use to carry snacks in her sari.  The baby was dubbed a ‘Champion’ that would fill both the mother and father with pride and parents were encouraged to do what is best for their ‘Champion’. Fathers were also asked to sign a pledge to support the nutritional needs of their wives and babies actively. And the exchange? The PLW felt special and cared for by her husband and empowered when it came to looking after herself and her baby. 

This is a graphic for the Eat More, Eat Better campaign paying a tribute to the region’s unique Rajput painting style. It shows a husband urging his wife to eat more and calling her the mother of the ‘Champion’.

Another good example is our work in the 2017 Karnataka WASH (Water, Sanitation and Hygiene) behavior change project. As part of the larger objective to improve nutritional status among school-going children, Sight and Life worked with PATH and Karuna Trust on a strategy to prevent loss of nutrients among children by aiming to influence motivations regarding several behaviors:
  A. Washing hands with soap at key times, including before meals, after using the toilet, after play, and after handling garbage
  B. Drinking water from safe sources only
  C. Rejecting open defecation or urination
  D. Flushing the toilet with water after use
  E. Keeping their school tidy and free of garbage
  F. Eating vegetables and healthy snacks

The formative research delved into the physical, social-normative, and biological factors that drove eating and hygiene practices in school. The team conducted a combination of ethnographic interviews and focus group discussions exploring codes related to hygiene, sanitation, and social influence. Based on this information, the team designed a phased strategy where they tried to make the behavior changes as fun, easy, and as popular (the social norm) as they could by deploying the following:
  A. Physical cues – for example, rhymes and short messages, relevant signboards, installing a tippy tap, soap for handwashing and buckets and jugs made available in toilets (making it easy)
  B. Games – specially crafted games and someone entrusted with the responsibility of owning these games (making it fun)
  C. Role modeling – each class elected a role model, who would then encourage his/her classmates to adopt health behaviors (making it popular) 
  D. Helper crews – specifically created to ensure all tasks were fulfilled (making it fun, easy and popular!) 

In 2017 Sight and Life’s intern, Shannon King, worked in India to research the implementation of these school-based nutrition and WASH intervention strategies to develop healthy eating habits while improving hygiene and sanitation behaviors.

It is interesting to see how the ‘fun’ element was given great importance, and rightly so since the target audience was young children. The rhymes and games helped children identify ideal WASH behaviors; watching role models encourage the same outside of playtime helped build good habits. Rhymes and games acted as an essential feel-good factor and led to a higher recall for a topic that runs the risk of being regarded as boring and irrelevant by many children. 

Knowledge is key

Figuring out the exchange is an engaging journey, one which requires exploring the individual and society, the motivations at play, and the broader environment they are all delicately balanced within. This summer, Sight and Life is holding a three-day online course with the SSPH Lugano Summer School, “Generating Demand for better public health goods and services: A systems and consumer-centered approach”. The course will look at how to create demand for healthy products and healthy behaviors (and we will also talk about exchange). Further details regarding enrollment can be found here. We look forward to (virtually) meeting you there!

* The formative research for the Eat More, Eat Better campaign was completed by Eva Monterrosa, former Sight and Life Senior Research Manager.

It Makes Me Smile 

How can behavioral insights for unhealthy foods help create demand for healthy food?

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I had convinced my son that “fizzy” drinks were disgusting. I told him they were bad for him, that they are full of teeth rotting sugar and that they did not taste nice. He believed me and never wanted to try one. However, eventually, children reach an age where their friends become authorities on seemingly everything, and they start to listen more to their mates than their mum.

On the school run yesterday, my 8-year old son: “Oliver says, mixing red and blue makes green.”
Me: “No, I am sure that makes purple.”
My son: “No, Oliver knows Mummy.”*

Then later

Me: “Why are you digging a massive hole in our lawn?”
My son: “Freddy said we could find diamonds in our gardens.” 
Me: “Err no, darling, we don’t have diamond mining in the UK.” 
My son: “Yes, we do. Freddy told me so (as he carries on digging).”

When Oliver and Freddy told my son that he should try a “fizzy” drink as they were “fun”, he no longer listened to me and my warnings. He used his pocket money to buy a can of Cola-Cola. The result – he loved it! Why do you love it? I asked him.

“It makes me smile Mummy,” he replied simply.

For me, this uncomplicated response summed up everything – unless healthy and nutritious drinks such as milk and water make my eight-year-old “smile”, he will keep wanting Coca-Cola. And although I can use a metaphorical “stick” and ban him from drinking such drinks now, without the “carrot”, I will not win the battle in the long run. As soon as he is old enough to walk to school and go out by himself, he will just choose to buy unhealthy drinks with his pocket money.

Apart from my son’s questionable trust in his friend’s advice (and their questionable art and geological knowledge), what can we learn from his Coke experience? And how can we use such insights to create demand for nutritious food and drinks?

For me, the key is this

LISTEN. Listen to your target audience – the people whose behavior you want to change. Whatever people do, even if it seems foolish to you, they will have their reasons. These reasons might not be rational (as my son’s experience demonstrates), but then we are driven by emotion, and our decisions and actions are rarely logical.

Many of you might have focused on educational interventions in the past, believing that people simply need to know what is good for them and what is not. However, do not be fooled; education does not always work.

If we always made rational decisions, none of us would overeat, smoke, salute three times to magpie birds (which I do due to a silly old English superstition), or drive like lunatics. But rest assured, when you ask and listen, your target audience will have their reasons.

When I worked at the Department of Health England, they ran the 5-a-day campaign, trying to encourage people to eat more fruit and vegetables. However, during the campaign run, consumption went down. Why? They made the incorrect assumption that knowledge and changes in attitudes are sufficient, and ignored beliefs or benefits gained from eating unhealthy foods (do carrots and broccoli make my 8-year-old smile? You can guess the answer).

The whole social marketing discipline is based on the idea of exchange, and if you want people to change their behavior, you have to offer them something in return. Often this is non-monetary – a feeling of belonging, sophistication, or security. Or, an alternative product that gives them the same or greater benefits as the product they are currently using. These benefits must be immediate, as we value these more than longer-term ones.

You only can work out what the exchange should be by listening to your target audience and understanding the benefits they derive from the negative behavior, such as consuming high-sugar soft drinks. Coke gave my son immediate happiness; how can we create that same feeling with a healthy drink? 

For deeper insight on formative research, take a look at our Action in Brief on “Eat More, Eat Better”, a behavior change strategy to support improved food access and food choices for women in the northern Indian state of Rajasthan. 

Further Learnings

This summer Sight and Life are running a three-day course as part of the Swiss Lugano Summer School. The session “Generating demand for better public health goods and services: A systems and consumer-centered approach” and will explore how social marketing, behavioral insights, and innovations in behavioral science can be used to create demand for healthy products and behaviors. The course will also explore how public-private partnerships can make healthy products more attractive to consumers and develop sustainable business models. Further details and where you can enroll click here

I hope to “see” some of you there.

*In case you are wondering, mixing yellow and blue make green.