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Novel Science Addresses Novel Virus

Lessons learned from applying behavioral insights to COVID-19 lockdown measures

by Fadi Makki

Applying behavioral strategies that utilize insights from psychology and behavioral economics while maintaining freedom of choice -otherwise known as ‘nudges’- have the potential to gently steer people towards greater adherence with COVID-19 lockdown measures. The overreliance on classical policy levers such as rewards and penalties has yielded suboptimal compliance rates because it assumes that people are rational. However, with limited success in enforcing lockdown measures, the pandemic has revealed deep behavioral roots underlying the lack of compliance which requires alternative policy tools.

A regional study that looked at the policy responses of 13 Middle Eastern countries in order to assess the effectiveness of stringency measures in managing the spread of the virus found risk perceptions to play a central role in compliance. The study used the stringency index from the Oxford COVID-19 Government Response Tracker, which is an aggregate of eight indicators on specific government responses, and the number of cases per day, which was used to measure each country’s enforcement capacity and the compliance of the public.  

It was recorded that in Lebanon there were significantly more violations by the end of May 2020, despite a lower stringency index, than in the beginning of May. The increase in violations began just as the government announced a reimposition of preventative measures following a resurgence of cases. However, the number of daily cases went up even more drastically after the period of renewed stringency which highlights the behavioral challenges to lockdown measures.

Behavioral economics challenges human “rationality” to help design interventions based on realistic understandings of human behavior and the behavioral barriers they face during COVID-19 lockdown measures. Several cognitive biases – systematic errors in judgements – prevent people from complying with rules mandating people not to leave their homes.

In the presence of such biases, risk perceptions can falter and change over time, which diminishes compliance with lockdown measures. Travel restrictions and enforced penalties do not address these cognitive shortcomings nor do they address inter-temporal risk perceptions which can influence adherence to stay-at-home orders. In addition, while conventional communication campaigns may be informative, they only add to the noise and do little to change behaviors.

These biases include “present bias”, whereby individuals place greater value on the “today,” but less so on the distant future.  This leads people to miss out on lucrative long-term benefits as they focus on myopic short-term ones which put them at risk. Individuals who do not adhere to strict lockdown measures focus on the immediate benefits of visiting families and friends while not appreciating the long-term health benefits of staying at home.

Another bias is “optimism bias” where individuals underestimate the probability of a negative event happening to them in the future. For example, people not adhering to lockdown measures may be aware of the risks of contracting COVID-19 but will underestimate the probability of being exposed to it.

In addition, human beings have “limited cognitive bandwidth” which affects their ability to objectively assess risks, particularly in high stress environments. Individuals who are experiencing financial hardships for example will be prioritizing food security and employment, leaving little mental bandwidth to assess the risks of not complying. In addition, the information overload people are bombarded with daily via social media and news outlets can have an additional strain on risk perceptions and decision making.

Integrating behavioral tools to counter the systematic errors in judgment is a viable alternative to the standard command and control regulations, which fail to address many of the cognitive barriers. Over the past few years, an increasing number of behavioral insights initiatives, also known as “Nudge Units”, were launched around the Middle East and have been employing behavioral techniques or “nudges” with astounding success.

Results from the stringency study indicate that people with higher risk perceptions tend to have a higher likelihood to comply with preventive behaviors, which suggests the importance of having individuals properly assess the risks of contracting COVID-19. This highlights the need to address the limited cognitive bandwidth people experience by finding ways to properly communicate these risks through behaviorally informed messages.

The study also found that people become less compliant the longer they spend undertaking compliance behaviors, which demonstrates the role of present bias and optimism bias as compliance measures drag on, and as behavioral fatigue sets in. 

In addition, a pilot survey that measured respondents’ rate of compliance over time and relative to their risk perceptions on COVID-19 found that participants were more compliant when their risk perceptions were higher. However, participants were less compliant the longer they spent undertaking these behaviors. These results suggest that people are less likely to comply to restrictions such as leaving their house and having access to public spaces. Data from Lebanon shows that cases can rise, even during lockdowns, the longer people are required to comply and get habituated to the disease which may also diminish risk perceptions.(Makki et al., 2020)

Thus stringency measures are more effective in lowering the number of daily infections if imposed for shorter periods. This is especially problematic overtime as people are less likely to comply the longer lockdown measures are enforced. Thus, quick and hard-line government lockdown measures are more effective in lowering the number of daily recorded cases, compared to more delayed, gradual responses.

So what are nudges that can work to overcome the cognitive biases inherent in people and improve risk perceptions in order to increase compliance?

A pilot study in Lebanon designed to increase self-reported compliance measures randomized participants into a control group, which received a generic survey, and a treatment group which included additional behaviorally informed survey messages. Participants in the treatment group received a nudge text in the survey describing how adhering to strict social distancing would help save the economy, which decreased the amount of times they left their homes by 41 percent compared to the control group. There are several reasons why this intervention had an impact on compliance rates which include the appeal of economic benefits for those who report higher self-interest and because it encourages feelings of collaboration, which can equally prompt individuals to adhere to lockdown restrictions.

Other nudges have also been employed during a large study which sampled UK and US participants to measure their impact on compliance and preventive behaviors in order to reduce the spread of COVID-19. Since these nudges worked for a specific demographic, they would have to be adapted and tested to see if they work in the Lebanese context. A letter condition was delivered to participants asking them to think about a person vulnerable to COVID-19 they know and who means a lot to them, and to write a letter to that person explaining that they will do everything that is necessary to stop the spread of the virus and to ensure this person survives the crisis. This nudge decreased the number of hours participants spent outside by 12.6 percent compared to the control condition. This nudge demonstrates that having individuals engage in an immersive exercise to think about a loved one, and inducing greater empathy and concern for others can change behavior.

An additional informational nudge presented hypothetical scenarios on violations with behavioral recommendations to prevent the spread of COVID-19, after which participants had to assess the appropriateness of the hypothetical violations and were then immediately provided with feedback on the accuracy of their answers to debunk some of the misconceptions they had regarding COVID-19. This informational nudge made participants less likely to allow their family members, friends or other people to visit them, which was statistically significant. Underlying the success of this nudge is inoculation theory that postulates an individual’s beliefs can be ‘psychologically vaccinated’ against persuasion or influence by exposing them to misinformation that is subsequently refuted. Thus the feedback participants received regarding the accuracy of their answers helped them develop the ability to debunk some of the misconceptions regarding the virus. An additional reason why this intervention may have been effective was because it helped mitigate optimism bias which reduces risk perceptions. 

Consistent with previous findings, these nudges are effective for people who start practicing social distancing recently and make them go outside less, however, they can have undesirable effects for those that have been complying for longer periods. This underscores the fact that a blanket approach to implementing behavioral interventions in a situation where many people already comply may not be meaningful and that delivering targeted nudges to subgroups of individuals, particularly to those that have only recently started to comply may have the greatest impact.

With many behavioral challenges underlying this pandemic, behavioral insights can bring small but measurable improvements to lockdown measures. This is particularly important given the diminishing authority of the state and their incapacity to enforce rules and regulations. With limited institutional capacity, additional nudges and behavioral policy levers will be required to address the cognitive biases affecting citizens to nudge them towards greater adherence. As the political crisis drags on and the country struggles to encourage citizens to get vaccinated, nudging can be particularly useful in addressing some of the cognitive biases and their overall hesitancy to get inoculated.

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Fadi Makki

Founder of Nudge Lebanon and Director of B4Development

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