Earlier this month, Behavioral Scientist teamed up with Knowable Magazine to host a discussion about the science of behavior change during COVID-19. I had the privilege of moderating the conversation with our guests, behavioral scientist Katy Milkman and social neuroscientist Jay Van Bavel.
The two shared their insights on a range of topics—vaccine uptake, how political identity and polarization have impacted public health, their behavior-change bright spots from an otherwise challenging year, and more.
Below are four of the most thought-provoking things I learned about behavior change during the pandemic from Katy and Jay.
Why understanding the root causes of political identity and polarization are key for public health
For months we’ve watched political leaders debate measures like mask wearing and social distancing while discrediting scientific and medical experts. For me, it was particularly chilling to hear Jay’s explanation of the root causes of our polarized public health response and what some of the long-term consequences might be. It’s much deeper than any one behavior, like mask-wearing. [Jump to this part of the conversation, 22:08]
“Getting at the root-causes element of behavior change is fundamental to understanding what’s going on,” he said. “Because if vaccines weren’t the issue, and it was some kind of medicine and that was polarized by our political leaders, then you’d see the same problem there.
“So it’s not a problem with masking per se, it’s not a problem with distancing. Individuals might say I don’t trust the masks, but those same individuals are not trusting anything, because of this polarization and the way the media landscape is set up.
“So it’s not a problem with masking per se, it’s not a problem with distancing. Individuals might say I don’t trust the masks, but those same individuals are not trusting anything, because of this polarization and the way the media landscape is set up.”
“I think that’s why it’s important to understand it at that level, these root causes, and figure out how we can address those, because this is an issue that’s not going away in the U.S.”
But it didn’t have to be this way. As Jay explained, “I’m Canadian. Canada has a conservative and a liberal party, and they’ve been increasing in polarization, but their leaders there decided to all come together.”
He referenced a study that found that the political leaders from different parties were speaking about the pandemic with similar levels of seriousness, and that Canadian citizens, regardless of their political leanings, were also taking it seriously.
Jay concluded: “If leaders … get on the same page about the seriousness of this, you’re going to have much more effective behavior change, even in a polarized environment.”
The power of megastudies to help us understand how to boost vaccine uptake
Megastudies are massive randomized controlled trials that allow researchers to test multiple hypotheses at once. This allows researchers to better understand which interventions work best, and make comparisons across populations to understand what works for whom. Katy is currently leading two megastudies investigating behavior related to flu vaccine uptake. I asked her to tell us about what insights they provide about the current COVID-19 vaccine rollout. [Jump to this part of the conversation, 11:28]
Katy explained: “We set up two megastudies. One was with two large hospital systems … We wanted to test different ideas around messages that could be pushed to patients in text messages leading up to a healthy visit, encouraging a flu shot. The other study was with Walmart and their pharmacy team with hundreds of thousands of customers…. About 700,000 [customers] were randomized to get different messages encouraging them to come and get a flu shot this year.”
“It’s really important to send messages that are clear, simple, professional. One of the big winners was also highlighting for someone, this is reserved for you.”
They focused on understanding follow through, rather than persuasion. “Estimates suggest it’s anywhere between 30 to 70 percent of us who will say I am going to get this colonoscopy, I’m going to get this flu shot, I am going to vote, and then don’t actually show up.” The goal was to “bridge that follow-through gap,” Katy said.
Katy and her team were able to bring together about 130 scientists to test dozens of ideas. At this point, only the data from the first megastudy with the two hospitals systems is in. The key takeaways for Katy so far are that “it’s really important to send messages that are clear, simple, professional,” she explained. “One of the big winners … was also highlighting for someone, this is reserved for you. Almost implying there’s a default that we expect you to get this.
“A lot of the behavioral science that we would expect to work well did. But things that were clever, cute, or surprising actually didn’t perform as well as I might have expected,” she concluded.
Are people more likely to change their behavior if they have personal experience with COVID-19? It’s complicated.
A viewer asked a terrific question: What is the impact on your behavior if you have personal experience with COVID-19?
You might assume that if someone wasn’t following mask or distancing guidelines and a family member became severely ill or even died, their behavior would change. That might be the case, but the rather large wrinkle here is the opposite experience—what if someone knows a number of people who’ve had COVID-19 but had no symptoms? Would they be more likely to relax their behavior? [Jump to this part of the conversation, 36:44]
Katy: “There’s this really great research by Ido Erev, who studied the way we react to described versus experienced risk. And when we have a risk described for us, we tend to be really risk averse. We’re very nervous. We’re very cautious. And I think that’s where we were in March. None of us had experienced this scary disease but we’d read about it in the papers and heard that it could kill a huge portion of the population, we were terrified and a lot of people took drastic measures.
“But then the pandemic actually hit, you start reading about it, but maybe no one you know has gotten sick or been affected…. When we experience risk we’re much less likely actually to behave in a risk-averse way. We’re more risk seeking, and part of that is that we don’t experience the rare negative events and so we underweight their likelihood.
“So when we know someone or something really bad happens to someone in our network, that shock can actually be helpful in reminding us that risk is very real even though you hadn’t experienced it before.”
Jay: “That was my prediction last March…. But I have to say, and I think that works in almost every domain, and it probably works in other places, but I’m just going to tell you the data from the U.S. looks terrifying on this. And in fact, I had to write in a paper that I was wrong about this.
“What we found in our data is that as the pandemic spread into [politically conservative] areas, it didn’t have any impact on their social distancing, almost at all. In fact, the partisan gap between Democrats and Republicans grew bigger, the more the pandemic spread. So this was a horrifying piece of evidence—that being exposed to risk in your neighborhood, your environment, your county, your city, your town isn’t necessarily going to be good evidence for you to change your behavior. That was probably the most disheartening piece of data I’ve ever had in any of my research.
“This was a horrifying piece of evidence—that being exposed to risk in your neighborhood, your environment, your county, your city, your town isn’t necessarily going to be good evidence for you to change your behavior.”
“I do think there’s trickiness—for the average person in most cases that actually is a really good principle and likely true. In this particular case, I think it was wrong, at least over the time frame we looked at it.”
Katy: “Do you think that’s a decent proxy for having someone have a negative experience? Because, at least for me, when I talk to some of my friends … they know people who’ve gotten COVID and been fine. So having it spread in their community actually didn’t give them the really negative perception, which I would predict, it rather gave them exposure to the nonrare events. So I’m just curious what’s driving that? If someone you know dies, I would still make a prediction that that might change your behavior.
Jay: “I think that that’s right. But the death rate is like less than one percent of people who get it, so I think if you could hone in on those one percent of people and people around them, that might change their behavior.
“But 99 percent of people—Donald Trump embodied this. He was in the hospital on oxygen and it didn’t change any of his behavior. He just kept holding giant rallies with people who knew that he had been hospitalized from it. So it’s one of those things, it might require mortality. But again, he hosted an event and it led to Herman Cain, a former Republican presidential candidate, to die from it, it looks like, and he didn’t seem to change his behavior either. When identity is involved, you get things that just look nonrational, I think, in the classic sense of the word.”
Despite challenges, science (and scientists) shone brightly this year
Last year was a tough one. But there were also reasons for hope. We concluded our conversation with Katy and Jay sharing their behavior change bright spots from the past year. Here’s what they picked. [Jump to this part of the conversation, 53:50]
Katy: “This whole year has been an extraordinary success in terms of behavior change. Obviously, we would have liked it to go even smoother and even farther and even faster. But it is remarkable the collective change in behavior that we have seen to save lives. And, if you run the numbers, we have saved huge numbers of lives, by not having concerts and staying at home and working from home and all of the sacrifices we’ve made.
“Another bright spot to me scientifically actually has been how incredibly willing scientists have been to pivot and help whenever asked…. You know, a governor’s office called and wanted help, and we just put up a Google Sheet and asked [scientists] to write in their suggestions. Nobel laureates are writing in, within five minutes, and it’s amazing to see how committed everyone is to helping.”
Jay: “This pandemic has changed the way I do science—to be much more cooperative and collaborative, and I think I’m never going to go back. I hope we don’t. The other thing I think that is important to me is to think about what are the silver linings, what habits can we keep… We’ve reduced travel. The next big crisis we’re going to face as humanity is the climate-change crisis, and we’re going to change a lot of behavior and policies around that.”
With the New Year, we have the opportunity to reflect on how our lives changed in 2020 and set out a plan for 2021. If we want to put the pandemic in the rearview mirror sooner rather than later, we’ll have to reduce the divisions that emerged during the last year and embrace the collaborative energy that has helped us get through it.