How many health economists does it take to change a lightbulb?
One, but it has to want to change.
Behind every insight generated from expert analysis needs to be people willing to make change happen, and that is where behavioural science comes in. In healthcare behavioural science focuses on understanding and influencing human behaviour to improve health outcomes, from encouraging people to take up effective interventions, to discouraging patients from expecting unnecessary antibiotic prescriptions.
The Health Economics Unit (HEU) was asked by UNICEF to share their experience and insights with Polish healthcare leaders looking to set up Poland’s first behavioural science unit.
The HEU’s Lisa Cummins and Gayathri Kumar presented outstanding examples of effective behavioural science from the NHS.
Making Every Contact Count (MECC) supports NHS staff to have brief, opportunistic conversations with patients about behaviours like smoking, alcohol, diet, and physical activity, using structured, theory-based techniques. An example in practice is the Royal Free London’s Healthy Conversations programme, which equips staff with the skills and resources to support behaviour change and direct patients to local services – the HEU is leading the economic evaluation of this programme.
The NHS Health Check is a national prevention initiative targeting cardiovascular disease. While not primarily a behaviour change programme, it uses behavioural science to increase uptake, communicate risk effectively, and support lifestyle change.
Both programmes show measurable health benefits and are cost-effective, with brief interventions often costing less than £2,000 per QALY gained. However, challenges remain, particularly around staff capacity, follow-up, and sustaining long-term behaviour change. Continued application of behavioural science is vital to overcoming these barriers and maximising the impact of prevention programmes across the NHS.
Overprescribing of antibiotics is a key contributor to antimicrobial resistance, a major global health threat. To address this, several behavioural interventions were trialled targeting both general practitioners (GPs) and patients. One such intervention involved sending letters to the top 20% of antibiotic-prescribing GP practices, highlighting that 80% of practices in their local area had lower prescribing rates. Another intervention targeted patients through posters and leaflets, with accompanying information sent to GPs. These strategies were underpinned by behavioural principles including social norms, the messenger effect, and clear behavioural instructions.
The GP feedback intervention led to a statistically significant reduction in antibiotic prescribing over six months, whereas the patient-focused materials resulted in a slight, non-significant increase. The findings suggest that interventions are most effective when targeting a meaningful proportion of high prescribers, while maintaining a credible social norm reference point. Emphasis on balance is crucial: targeting too few may backfire, while overextending the norm may weaken its impact.
Missed hospital appointments lead to inefficiencies in the healthcare system by lengthening waiting lists and wasting staff time. To address this, SMS appointment reminders were trialled, incorporating behavioural insights to improve attendance. These reminders used principles such as timeliness, ease of action, social norms, and a sense of commitment to others.
The most effective message was the one that specified the financial cost of the missed appointment, which reduced non-attendance by three percentage points compared to other messages. Interestingly, messages based on social norms did not perform better than the control, suggesting that the success of the cost-based message was not due to social pressure or increased ease of contact.
The findings underscore that specifying the monetary value of a missed appointment has a tangible impact on behaviour. However, broader behavioural factors, captured within the COM-B framework, must also be considered. Notably, structural inequalities play a role in missed appointments. In response, initiatives in areas like Sheffield and Birmingham have supported families with transport assistance, such as free parking, travel passes, and taxis, to help ensure attendance.
For successful implementation and evaluation of prevention programmes like MECC and NHS Health Checks, Lisa advised that Poland’s health service should invest in building staff capacity through training, embed behavioural science into programme design, and ensure systems are in place for follow-up and referral. Evaluation should focus not only on uptake and short-term outcomes but also on long-term behaviour change and cost-effectiveness, using routine data where possible to support continuous improvement.
Gayathri shared a four-step approach to implementing behaviour change interventions in the NHS, an overview of the COM-B and EAST frameworks and risks to watch out for in implementations.
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