Nudging Healthy Behaviour

How insights from behavioural economics, like defaults, reminders and commitment, are used to encourage vaccination, handwashing and medication adherence.

Knowing what is healthy is not always enough. People often intend to get vaccinated, exercise or take medicines regularly, but fail to follow through. Behavioural economics offers tools to help.

Common health nudges

Reminders: text messages reminding people about vaccinations, appointments or medication have been found to improve follow-through in many studies.
Defaults: automatically scheduling appointments, which people can change, increases attendance. Research found that giving people a default appointment time for flu vaccination increased vaccination rates.
Making it easy: bringing services closer, simplifying forms and reducing waiting times.
Small incentives: modest rewards can have large effects.
Commitment devices: helping people commit in advance to healthy behaviours.
Social norms: telling people how many others are taking healthy actions.

Immunisation incentives in India

A study in Rajasthan by Abhijit Banerjee, Esther Duflo, Rachel Glennerster and Dhruva Kothari found that holding regular, reliable immunisation camps raised full immunisation rates, and adding a small incentive, a bag of lentils per vaccination plus a set of plates for completing the schedule, raised full immunisation much further. The incentives made the programme more cost-effective per child immunised because staff were used more fully.

Handwashing

Handwashing with soap prevents diarrhoea and respiratory infections, but many people do not wash hands at key times. Programmes combining reminders, making soap and water convenient, and social cues have improved handwashing in several settings.

Medication adherence

Patients with chronic conditions or TB often stop taking medicines. Digital adherence technologies, such as pill boxes that record openings or phone check-ins, aim to help, though results have been mixed.

Limits

Nudges work best as complements to good services. A reminder does not help if the clinic has no vaccines or staff. Some nudges have smaller effects than first reported.

The lentils that worked

In rural Rajasthan, many children started but did not complete their vaccinations. When immunisation camps offered a kilogram of lentils for each vaccination, completion rates rose sharply. A small, immediate reward helped busy parents follow through on something they already wanted for their children.

Thinking information alone changes behaviour

People often know what is healthy but struggle to act on it. Making healthy choices easier, more convenient and more immediately rewarding often works better than information alone.

Key takeaways

Behavioural tools help people follow through on healthy intentions.
Reminders, defaults, convenience, small incentives and social norms can work.
In Rajasthan, reliable camps plus lentils raised full immunisation sharply.
Nudges complement, but cannot replace, good health services.