Behavioural Nudges for better health and hygiene practices in rural Bangladesh (Part 2)

BACK OF THE ENVELOPE

In this second part of our blog series, Behavioural Nudges for better health and hygienic practices in rural Bangladesh, we discuss the methodology and results for two of our successful prototypes.

For small purchases, as is usually the case for the majority of transactions in rural medicine shops, the pharmacist/shopkeeper generally hands out the items in a small paper envelope/packet. During the design phase, we assumed based on our own experience, that this envelope receives a person’s attention at two points in time- firstly on receiving the envelope and secondly on extracting the items from the envelope (usually at home). Two of our nudge designs leveraged these existing consumer behaviours to try and provide relevant, timely messages. The results for both of these prototypes were quite positive.

Prototype 1: Hand over masks in an envelope with instructions on the proper use of masks

When selling masks (less than a full box), pharmacies were instructed to place masks in an envelope/packet with instructions printed on their backs on proper use of masks.

On a separate form, the pharmacist/shopkeeper was asked to record whether (a) the customer noticed the instructions and (b) followed the instructions

For the instructions on proper mask usage, a total of 459 masks were sold to 202 customers across 11 pharmacies during the intervention period. Of these 202 customers, 28 did not wear the masks at the shop- they simply made the purchase and left. The remaining 174 naturally split into two groups- those who read the message and those who did not. The table below illustrates the differences between these two groups.

Prototype 2: Custom packets/envelopes for customers (to carry home purchased items)

For small purchases, pharmacies were asked to hand the items over in custom envelopes that we designed with hygiene messaging regarding hand-washing, mask use, and social distancing.

They were also given a product (Nivea cream) and were told that as a market research activity, someone would call them to ask about the benefits of the cream. In this way, their phone number was collected. Pharmacies noted the color of the envelope that was handed out to the customer.

After 1–3 weeks, we called these customers to gauge recall and self-reported compliance.

In total, we were able to collect phone numbers for 186 customers. Of these, we could reach and complete the survey with 171 respondents over the phone. Surveyors asked if (a)the respondent could recall the message on the envelopes (b) the respondents complied with the message and (c) showed the envelope to anyone else.. Overall, 77% of responders were able to successfully recall the message on the envelope 1–3 weeks after having received it.

The chart on the right shows the results of the phone survey. As you can see, message recall is quite high (greater than 86%) and compliance and share-ability are at 30%-35% for mask use and social distancing.

Interestingly, the compliance for hand-washing is the lowest, which brings into question our assumption that people pay attention to the envelope once they’ve entered their homes and are retrieving the items from the packet. On the other hand, the compliance for social distancing is unexpectedly high, leading us to posit that perhaps people are most likely to pay attention to the messaging on receiving the envelope and perhaps during their commute (given that the design is interesting and the novel.)

*It should be mentioned here that our surveyors reported that the self-reported results for compliance and share-ability were most likely inflated (judging by tone of voice). The chart above shows is already adjusted for that issue and only considers the reports that our surveyors felt were genuine.

Conclusion

It is important to bear in mind that neither of these results have been tested for statistical significance. The goal of rapid prototyping is not rigour- it is to test out ideas as quickly as possible so as to learn and iterate one’s way to success. Unfortunately, we were not able to make many meaningful iterations in the timeframe that we had. As such, it is necessary to test these ideas out at a larger scale, and design a more rigorous evaluation procedure to gauge compliance.

However, based on the results of these prototypes, we do believe that medicine envelopes are a great way to disseminate important information and nudge desired behaviours through pharmacies, medicine shops, and shops in general. In this regard, we also strongly suggest the use of clever message formats (analogies, limericks, etc) that are likely to be memorable, and bold artwork that draws the eye ensures that the messaging does not go unnoticed.

In the next and final part of our blog series, Behavioural Nudges for better health and hygienic practices in rural Bangladesh, we will discuss one of our failed prototypes