Stuck on repeat

Take healthcare for example: an industry constantly faced with significant non-adherence challenges. Research shows that roughly 50% of us do not take our medications as directed which has a dramatic impact on the sector as a whole, not to mention our short and long-term health as individuals.

Mainstream interventions to improve adherence such as reading a simple set of instructions and prompts from others seldom result in nudging our behaviour. What’s required is fundamental behaviour change that focuses on forming new habits and actively encourages taking medication as directed.

Habits underpin every aspect of adherence behaviour and in order for behaviours to change we often have to break previous habits and develop entirely new ones. This is no easy feat, but the formation of new habits is critical to behaviour change success and is something we must strive for in order to achieve a positive outcome.

Forming new habits

According to Professor Jane Wardle and Dr Phillippa Lally at the University College London, habits take approximately 66 days to form. This means that if we were to adopt a new behaviour – let’s say eating more healthily as a New Year’s Resolution – it would take until March the 6th for this behaviour to become both effortless and second nature. The best way to reach this 66 day mark is to ensure the new behaviour coincides with a standard daily routine.

It’s in our nature to want things to go with the flow, so if we can’t find a way to fit a new behaviour into our daily routines then it’s unlikely to stick. Take healthy eating for example: we need to link the act of say, eating an apple a day, with another daily activity like having a glass of water after a meal. Professor Wardle and Dr Lally call this finding a ‘situational cue’ that will trigger the new formed habit automatically.

When it comes to the challenge of medication non-adherence, the healthcare industry could see marked improvements in adherence rates simply by helping patients to integrate their treatment into their existing routine by identifying suitable cues. Taking medication with a morning coffee, for example, is one way to work medication into a routine. Similarly, some physicians suggest linking taking medication with teeth brushing; which is especially apt for medicine taken twice a day as there are few habits we already have that occur both in the morning and the evening.

Once taking mediation is linked to an already established routine, it is equally important to set the right visual reminders so that the new habit can be properly formed. That is, keep the medication next to the coffee pot or your toothbrush to ensure it isn’t missed!

More complex regimens, however, will demand more carefully thought out strategies and cues so that the right doses are taken at the right time. Mapping out your strategy for this at the beginning and sticking with it will ensure a better chance of habit formation in the long run rather than hoping to develop as strategy as you go along.

(Editor’s note: for more on the challenge of medical adherence, and ways of encouraging it, see Crawford Hollingworth’s article from June, ‘More than a spoonful of sugar’)

Changing behaviour by breaking habits

Understanding habitual behaviour is just as important in other sectors and can shed light on some key challenges that marketers face. One such challenge is how to break the cycle of habitual purchasing. This is a particular issue for FMCG brands, where consumers regularly make a purchase in a category and move from active consideration of options to auto-pilot purchasing of their usual brand. In fact, in many cases, consumers can undertake an entire supermarket shop on auto-pilot.

This behaviour has not gone unnoticed by grocery retailers and has led to a number of interventions to break the habitual cycle. One such intervention has been to re-arrange the store layout so that shoppers can no longer take their usual route. While this is effective in breaking consumers out of their habitual cycle, it doesn’t necessarily ‘go with the flow’ of their routine and therefore can lead to frustration and even negative feelings towards the retailer.

A different intervention, such as placing promotional items at end of aisle that are unrelated to those in the rest of the aisle, can arguably be just as effective. The salience of the promotion and the fact that the item seems out of place brings it to the shopper’s attention. It also allows them to pick up something new and different on their usual route – without having to make a detour.

In essence, the new behaviour (buying item x) has been introduced through a habitual cue (buying item y). But end of aisle promotions can’t last for 66 days and consumers don’t do daily supermarket shopping, so to encourage individuals to re-purchase or ‘adhere’ to a new purchasing behaviour requires a different tactic; loyalty points, coupons or similar CRM-style activities for example.

What’s in store?

The role of habit formation is set to become even more pertinent in intervention planning and marketing activities, both in terms of interrupting existing habits and encouraging new habits to form. The key is to remember that in many cases, these two go hand in hand.

If you want a behaviour changed to an entirely new one, simply interrupting the existing habit will not suffice. A new behaviour must be easy to integrate into daily routines using existing cues. If we can achieve this, then any additional activity around supporting and reinforcing new behaviours is likely to have much more success.

Helen Donald is an associate at Incite