How to nudge people into getting tested for coronavirus

After having her temperature checked and scanning a bar code on her phone, she would carefully swab the inside of her nose. Within a day or two, an email would arrive with her results. Week after week, her results came back negative. She continued to participate in the testing program even after being vaccinated, and she continued to test negative. And then, two weeks ago, an email landed in her inbox that stunned her: Her sample was positive for the coronavirus. The result — which turned out to be a false positive — briefly threw her life into chaos. “Our whole family was turned upside-down for an afternoon trying to figure out how to separate ourselves in our small house, trying to figure out who’s going to take care of the kids and who else did we expose,” Dr. May said.

“The reality is that people are going to have to wake up and decide whether this is something they intend to do on any given day or any given week,” said Harsha Thirumurthy, associate director of the Center for Health Incentives and Behavioural Economics at the University of Pennsylvania. “And we know — from lots of examples of people’s decisions to seek testing for other health conditions, or even people’s decisions to engage in other health-related behaviours — that people are constantly weighing the costs and benefits of engaging in these services.” Here are ways that health officials say can help shift the calculus.

Humans have a bias toward the status quo, a tendency to want to keep things as they are rather than shake them up. Many studies have shown that people are more likely to engage in various behaviours, from becoming an organ donor to enrolling in a 401(k) plan, when those behaviours are presented as the default choice. Similarly, coronavirus screening programs are more likely to see wider participation if they are opt-out rather than opt-in. “The more you ask people to put in their own cognitive efforts and behavioural efforts into this, the less likely they’re going to do it,” said Derek Reed, who directs the applied behavioural economics laboratory at the University of Kansas.

Experts also suggested asking people to think through the logistics of when and how they plan to get tested. Studies show that people who clearly formulate a plan for how they intend to accomplish something — whether it’s voting in an upcoming election or getting a flu vaccine — are more likely to follow-through. One possibility, Dr. Reed said, would be to text people reminders of their testing appointments, and ask them to reply with, say, a 1 if they plan to walk to the appointment, a 2 if they plan to drive or a 3 if they plan to take the bus. “And then depending on the response, you just automatically ping back Google map directions or a link to campus or community bus system maps or timetables,” he said.

These kinds of nudges are likely to be most effective for people who are already motivated to get tested but may have trouble following through. “Often you need to nudge them a little bit by just removing frictions to get rid of these small costs,” said Sebastian Linnemayr, a behavioural economist at the RAND Corporation, a think tank in California. — NYT