Five behavior change lessons from a recent public health experiment

Credit: Lorenzo Cafaro

Great news came out of Colorado last week: the wildly successful Colorado Family Planning Initiative is being copied by other states. The program, which provides free IUDs and birth control implants to women in Colorado, has reduced the rate of unintended pregnancies, teen pregnancies and abortions by nearly 50% since its inception in 2009. It’s estimated that every dollar spent on the program saved nearly six dollars for the state government over the following three years.

What’s really interesting about this is not that contraception works- because of course it does- but rather that this particular program has worked so much better than others. Other government programs which aimed to provide access to condoms, birth control pills and family planning services have spent far more money, and gotten far less to show for it.

There are four big reasons why the Colorado Family Planning Initiative has been so successful- here’s what they can teach us about how to make behavior changes that stick.

If you want people to do something, make it free and easy

The CFPI provided long-acting forms of contraception, which can normally cost around $800, absolutely free of charge. Moreover, there were very few administrative hurdles that women had to pass to get access. They didn’t need to prove financial need, pass strict medical qualifications, or even wait for very long. Because it was free and easy, more women took advantage of the program.

If you’re an organization that wants to change the behavior of your employees, think about how you can make the desired behavior easier and cost-free for them. Can you provide them with gym memberships, healthy food at the office, or standing desks? Is there a low-cost perk you can give to employees that would improve their productivity, and be easy to use?

Now think about how you could use this principle to change your own behavior. Perhaps you can make yourself eat healthier by having healthy food ready to eat in your fridge. Perhaps you can become more productive by removing barriers to productivity, making it easier.

Another note: you may think that the “free” part of this doesn’t apply to personal behavior change, but that’s only half true. You may not be able to get stuff for free, but you can pay the cost of something up front, so that using it has no marginal cost. For instance, if you buy a two-year gym membership, going to the gym becomes “free” for two years.

One big decision is easier than a lot of small ones

Most government-sponsored birth control programs offer condoms, birth control pills, and/or family planning services. By contrast, the CFPI offered long-acting forms of birth control, including IUDs and implants.

Although these forms of birth control are more expensive, they’re more effective because they only require a single decision to be made, whose effects then last for a long time. Condoms and pills, on the other hand, require a small decision to be made consistently, either every day or whenever someone has sex.

Think about ways in which you can take one big action that will prevent the need for smaller actions. You could remove all the beer and junk food from your home, so that you don’t need to continually choose not to consume them. You could organize your workspace once, so that you don’t need to fumble around for stuff you need every day.

Taking action once is many times easier than taking action many times, on a consistent basis. Look for opportunities to do one big thing that makes many other good behaviors unnecessary, or makes bad behaviors impossible.

Make decisions when you’re at your best

Your willpower and decision-making ability are higher at some times than others. Condoms have the disadvantage that the decision to use them needs to be made when you’re horny and about to get laid. Birth control pills can have a similar problem, as women often need to take them when they’re busy, in a hurry, or simply tired.

In addition to being one big decision, long-acting forms of birth control have the added advantage of allowing that one decision to be made at the easiest time for the user.

Aside from changing the nature or frequency at which decisions are made, there’s a lot to be said for changing when they’re made. If there’s a behavior that you want to change, might you be able to shift the timing? Perhaps you can work out, or work on your side business, at a time of day when your energy is higher. Perhaps it would be better if you shopped for groceries immediately after eating, when hunger won’t influence your decisions.

Make the right decision the default decision

When presented with a choice, people are most likely to make no choice at all. As the authors of Nudge famously pointed out, people are many times more likely to sign up as organ donors when that’s presented as the default decision. Long-acting forms of birth control benefit from this same dynamic- once they’re implanted, it takes a separate decision to remove them. Staying on birth control thus becomes the new default.

If you join a weekly fitness class, going to that class is your default option. If you subscribe to a healthy meal delivery service, eating that healthy food becomes your default option. If there’s a website that your work requires you to utilize, you can make it your home page.

Behavior changes are more likely to stick when it takes a significant amount of effort to reverse them, or when sticking with them is the default option. Make your default option the best thing you can possibly do.

Make positive behavior more enjoyable

I know people don’t like to admit this, but- sex feels better without condoms. Also, I hear a lot of women kind of feel like shit on hormonal birth control. So there’s another advantage to the IUD: it doesn’t get in the way of having great sex, nor does it feel uncomfortable beyond the initial insertion procedure.

Any behavior is more likely to happen if it’s enjoyable, so think about ways to make good behaviors more enjoyable, or undesired behaviors less enjoyable. Maybe taking a cooking class would allow you make healthy food that tastes better than unhealthy food. Maybe playing recreational sports is more fun for you than lifting weights.

The whole idea of gamification is based on this- think about ways to turn behavior change into a game. You could come up with a system for scoring your productivity, or turn your behavior change into a contest with friends.

Or, perhaps you could pair something you need to do with something you enjoy- work on a project while snacking on your favorite (healthy) food, or listening to your favorite music.

Get started now

Making positive behavior changes that stick can be tough, especially when you’ve tried and failed before. That’s why I created the Habit Change Cheat Sheet- to show people exactly how to change their behavior and make it stick, without constant effort. Click here to download the Habit Change Cheat Sheet.

And before you go…

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