Building a more caring world

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How might we build and maintain a more caring, responsive world? In her work, researcher Brené Brown shines a light on a powerful behavioural insight – how empathy can motivate us to respond to others’ needs and behave more prosocially. Prosocial behaviour is defined as voluntary behaviour that benefits others and may involve a cost to oneself. If it does involve personal cost, it is more narrowly thought of as altruism. It can range from charitable donations to giving away fruit and vegetables from your garden, lending money, getting your child vaccinated or, during the current era, physical distancing and handwashing.

Prosocial behaviour can be driven by various factors, including eliciting empathy, cooperation or moral values. It may even be driven by a sense of social responsibility. Not surprisingly, initiatives to motivate people to go beyond their personal preferences and think more prosocially are currently very topical.

Studies on how to encourage behaviour change with broad societal benefits often focus on reducing friction, or communicating social norms or personal benefits, to encourage take-up. For example, efforts to encourage more people to have an annual flu vaccine have focused on making it easy, by opting people into appointments, or by framing the personal benefits. While these types of intervention have had some effect, it is only in the past few years that researchers have begun exploring whether initiatives drawing on prosocial behaviour can also encourage vaccination.

A 2016 study (Li, Taylor, Atkins, Chapman and Galvani) showed three differently framed messages highlighting victims of flu to almost 4,000 participants from eight countries (China, Japan, Brazil, UK, US, France, Israel and South Africa):

• An elderly victim scenario described a 76-year-old man who contracted flu and eventually died because others had neglected to vaccinate
• A young victim scenario described a five-month-old boy
• An unidentified victim message simply described how neglecting to vaccinate can cause the flu to spread to others, who might die of complications
• A fourth control group saw no message.

The first three messages use framing to help us to take another person’s perspective and empathise with their situation, making the potential consequences of our actions salient. The first two messages also have an identifiable victim. We know from research that being able to imagine the plight of one person can help us to take action, because we can more easily empathise with how they are feeling than with the suffering of a mass of people.

All three messages increased people’s stated intention to get vaccinated, particularly those who didn’t usually get their yearly flu vaccination: 31% of non-vaccinators said they now intended to get a vaccination, as opposed to 24% in the control-message group – a 30% increase. When participants were shown a message with an identified victim, either young or old, intentions increased slightly further, to 32%. Across all eight countries, the researchers found no cross-country differences in prosocial motivations or intentions to be vaccinated.

While this study did not track whether people followed through with their intentions to get vaccinated (it is likely there will be some drop out), it did increase people’s willingness – not easy in this era of anti-vaxxers. If this approach was combined with other intervention techniques, such as automatic appointments, it could have a significant impact on vaccination take-up rates. In the US, the CDC estimates that if vaccination rates improved by just 5%, it would have a significant and valuable medical and societal impact.

Another study – very relevant to the era in which we are now living – looked at whether salient signs using prosocial framing could increase rates of handwashing by healthcare workers in a hospital. You might think that healthcare workers are one of the best groups at washing their hands, given their clinical environment. Yet, compliance is far from 100%, particularly among doctors, and research has found that a key barrier to prosocial behaviour is that they think first of the risk of infection to themselves. Second, they discount this risk as they, like the rest of us, are susceptible to overconfidence, believing that they are less vulnerable to germs and disease.

So Adam Grant and David Hofmann tested whether poster messages, framed in different ways and placed next to 66 hand-sanitiser dispensers, could drive up rates of use. A poster framing the handwashing message as a personal risk read:

“Hand hygiene prevents you from catching diseases.” The prosocial frame read: “Hand hygiene prevents patients from catching diseases”, while the control poster, developed by hospital managers, simply instructed healthcare workers: “Gel in, wash out.”

While the personal-risk frame led to no change in the use of hand sanitiser, the prosocial frame led to a significant uplift. Healthcare workers cleaned their hands 11% more often and used 45% more soap and gel.

A further experiment across eight hospital wards placed posters with either a personal-risk frame or prosocial frame by patients’ beds and asked observers to record whether healthcare workers washed their hands at times when they should, such as before and after patient contact. Again, clinicians did not change their behaviour when the personal-risk frame was used, but did better when the poster with a prosocial frame was displayed by the ward beds. Healthcare workers washed their hands at 89% of all opportunities, compared with just 80% before the intervention or with the personal-risk message displayed.

Highlighting how hand hygiene can improve patient outcomes when the patients are in their field of vision helped to drive more frequent handwashing among doctors and nurses. Perhaps it’s harder to ignore or dismiss the message while standing directly in front of a patient.

These findings begin to shape a new empathy-based framing tool in the behaviour-change toolkit – a frame to help us remember that our behaviour often impacts on others. Making salient another’s perspective in life and eliciting genuine emotion can be an effective mechanism to drive social change and for creating a more caring and less selfish world.

In the context of Covid-19, former US president George W Bush recently said: “Empathy and simple kindness are essential, powerful tools of national recovery.” Prosocial framing could be a very valuable tool over the next few years.

This article was first published in the July 2020 issue of Impact.