As social distancing and preventative measures are eased in the U.S., the CDC reports that 1 in 4 adults feel safe lifting these safeguards. While the majority of Americans remain more diligent in their adherence to coronavirus precautions, the remaining 25% of the population will pose an increasing threat to healthcare resources based on their behaviors. This dichotomy in behavior poses a familiar challenge to healthcare providers and leaders – non-compliance.
Healthcare providers have long struggled with issues related to compliance with medication usage, dietary and physical fitness goals, and early detection and treatment. The presence of a significant portion of the population that is non-compliant in their behaviors is not a new challenge.
As we seek to understand, and address, the 1 in 4 adults who have chosen to minimize their reliance on preventive measures in the midst of a pandemic, direction can be drawn from the science of persuasion that has been effectively deployed in changing attitudes toward smoking, exercise, nutrition and preventive care.
By applying the principles of social influence developed by Dr. Robert Cialdini in his book Influence, we see evidence and application of the 6 principles as they apply to social distancing, mask usage and other preventative measures recommended to curb the spread of the coronavirus.
Principles of Social Influence
Scarcity: In the face of scarcity, people tend to overvalue the scarce item. When lock-down orders and quarantines are in place over many months, we see an over-value placed on the ability to shop, dine and socialize. This overvalue tends to lessen the perceived risk level of these activities in exchange for the freedom of mobility.
Authority: Opinions and convictions are more firmly held by an individual when they share a belief with a person they perceive to be in authority. Whether or not an individual adheres to social distancing or will wear a mask is a reflection of the authority they grant to medical experts, politicians, celebrities or other influential leaders.
Social Proof: People tend to replicate the behavior of those they identify as similar to their own beliefs or circumstances. As neighbors begin to socialize, as families reunite, as the workplace opens, individuals will likely adopt the social distancing practices of those around them.
Liking: People tend to say “yes” more easily and adopt the practices of those people for which they have a natural fondness. Some individuals will find it difficult to say “no” to invitations to socialize with friends.
Reciprocity: People generally feel obligated to repay in kind. If a person is wearing a mask and engages in conversation with someone not wearing a mask, the mask-wearer may feel obligated to remove their mask as a sign of trust.
Consistency: Individuals feel compelled to maintain a strong stance that they previously established. If a person has been adamant that the pandemic is a hyper-inflated fear created by media reports, government officials, or medical experts, they will tend to maintain that stance even in the face of contradictory facts.
Application by Healthcare Leaders and Providers
By understanding these six principles of social influence, healthcare influencers can work toward lessening the non-compliance related to pandemic counter-measures. To achieve optimal levels of compliance, individuals must have the ability and motivation to adopt preventive measures.
The ability to adopt safeguards is certainly constrained when individuals suffer from socio-economic factors that restrict the availability of clean water, soap, face masks, adequate housing, workplace space, or other influences that restrict the ability of a person to adopt preventative measures. These factors are outside the scope of this article but are important to the overall preventative strategy.
The ability to influence the behavior of individuals who possess the ability to adopt preventative measures, but do not presently have the motivation to do so, may be positively influenced by making application of the six social principles.
The call-to-action for healthcare decision makers and providers is to consider the 6 principles of social influence when creating a strategic response in their local healthcare communities. The following applications are suggested:
Scarcity: The overvalue of mobility and personal interaction has caused individuals to minimize the risk. Communication and education that identifies the variability of risk between venues (i.e. attending a concert versus a neighbor’s backyard BBQ) can be helpful to offset the overvaluing of mobility and interaction. Additionally, education related to the treatment of the coronavirus (i.e. what is involved in ventilator treatment protocols) may balance the risk decisions.
Authority: When developing communication, marketing, and education strategies, use medical experts, recovering patients, and community influencers in the delivery of the message. Highlight the credentials of experts, the survival story of patients, and the identity of influencers to establish the authority of the messenger. Make time available for caretakers and providers, who are often seen in positions of authority, to reinforce compliance among patients.
Social Proof: Use identifiable role models to deliver positive messages of compliance to secure social comparability. Highlight positive examples of average people who were once skeptics and have now adopted compliant practices.
Liking: Train providers to leverage positive relationships to influence social compliance among their patients and their family. Well liked providers have the ability to ask patients and community members to take a position of compliance and support the compliance effort.
Reciprocity: Give recognition and affirmation to examples of compliance. Give community members alternative paradigms related to removing their mask in the presence of others or how to help their family and neighborhood demonstrate compliance. Equip compliant individuals to have meaningful discussions in their community that explains their actions.
Consistency: Communicate the permission that all individuals have to change their position from non-compliant to compliant behavior. Ask the non-compliant to become an opinion leader among others who are non-compliant to change their position. Provide the skeptics with accessible and understandable information to use to change the beliefs and behaviors in others.
With all of the current pressures on healthcare leaders and providers to address the clinical challenges of a pandemic, it is unfortunate that the burden of influencing compliance must also fall to them. As participants in the delivery of healthcare, we hold a special responsibility to our community. As part of the overall effort to flatten the curve, it is imperative that we employ creativity, dedication and resiliency in the pursuit of safe behaviors. By understanding the principles of social influence, we are able to understand the mindset from which compliance and non-compliance emerge and seek to influence our community.
Rod Brace, Ph.D. is a founding partner with Relia Healthcare Advisors.