Many ‘nudge’ based interventions have proved successful over recent years. From increasing vaccination rates (1) – to boosting organ donations (2) – careful design of the way choices are presented to people has been shown to significantly influence their judgment and decision-making.

However, the examples where nudges have been most successful typically comprise one-off decisions, such as those above. Unfortunately, many behavioural challenges are more difficult – particularly those requiring new behaviours to be repeated over time.

In such scenarios, despite best intentions it can be very difficult to maintain motivation. This article summarises three common interventions which can help both patients and physicians maintain motivation for new behaviours:

1. ENCOURAGE GOAL SETTING: Goal setting helps direct attention and effort. Goals may relate to behaviours or outcomes, and can be set with minimal instructions delivered in print or verbally. It has been shown to be particularly efficacious (3) in younger people, males, and Asians; evidence also suggests group goals are more effective than individual goals (3).

2. FACILITATE ACTION PLANNING: Action planning is a technique to prompt planning performance of an activity at a particular time. It is a skill which can be acquired, and which helps to both assist in preventing lapses in memory and attention, as well as in organising and regulating motivation. Strategies are versatile and can take many forms, such as prompts or instructions provided by a practitioner – or even as a written or online print communication.

3. ENABLE FEEDBACK AND MONITORING: Feedback and monitoring interventions help maintain motivation for goals which require repeated efforts by prompting comparison of the current situation with stated goals. Methods include written or electronic diaries, mobile apps, or medical records; monitoring can be active or passive and may be done by oneself or others. This type of intervention has successfully helped people with weight, blood pressure, and blood glucose goals (4).

Despite best intentions, our motivation to do new behaviours can fluctuate over time. The approaches described above have been proven to help overcome cognitive challenges such as lapses in memory and attention, as well as helping to organise and regulate effort. Indeed, strategies which encompass two or even all three of the above will generate an even greater chance of success.

Chris Harvey
Founder, Activate Research

References:
1. Dai, H. et al. (2021). Behavioural nudges increase COVID-19 vaccinations. Nature, 597, 404-409.
2. Johnson, E.J., & Goldstein, D. (2003). Do defaults save lives? Science, 302, 1338-1339.
3. Epton, T., Currie, S., & Armitage, C.J. (2017). Unique effects of setting goals on behaviour change: Systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85, 1182-1198.
4. Harkin, B. et al. (2016). Does monitoring goal progress promote goal attainment? A meta-analysis. Psychological Bulletin, 142, 198-229.