Among the buzzwords on the tip of every healthcare marketer’s tongue these days is behavioral design. For years, we’ve known that one of the keys to creating greater value for our clients is to change their customers’ behaviors. And for years, the best way to do that has remained elusive. With behavioral design, I believe we’ve found the way forward and that good medical stories will be key in charting that path toward greater value. 

Behavioral Design—A Primer 

What is behavioral design? It’s the intersection of two academic fields: behavioral science and impact evaluation. Behavioral science encompasses a wide swath of research in various fields including psychology, marketing, neuroscience, and behavioral economics. These sciences explore human cognitive processes and how different conditions affect human behavior. From behavioral science, we’ve learned about implicit bias, that most people choose instant payouts over greater rewards over the long term, and that given too many choices many people will choose nothing, among another novel, counterintuitive insights.  

Impact evaluation measures both the intentional and unintentional changes that can be attributed to a certain intervention, such as a program, project, or policy. Unlike outcome monitoring—which measures whether intended targets have been achieved—impact evaluation uses counterfactual analysis to compare what happened to what might have happened in the absence of an intervention. Counterfactual analysis enables observers to assign cause and effect between interventions and outcomes.

Behavioral design then is a measurable method for designing spaces and objects to influence behaviors. Let’s take Disney World for example. If you’ve ever been there, you’ve probably noticed how clean it is. Not only does Disney World have a massive crew to keep the parks magical, but there are also trash cans every 30 feet all throughout the parks. Years ago, Walt Disney determined that 30 feet was the most the average person would walk before throwing their trash on the ground—and he was right. Another great example is Facebook. Behavioral design informs nearly everything they do—from the infinite scroll to the like button, to the calculated mixture of advertisements, news stories, and peer content—and it’s all designed to keep users engaged and using Facebook.  

Medical Storytelling and Behavioral Design 

Just like websites and physical spaces, stories can benefit from the use of behavioral design. For 100,000 years human beings have relied on storytelling to pass on news, values, attitudes, history, and cultural heritage, and in 4th century BC, the philosopher Aristotle identified three modes of persuasion: pathos (emotion), ethos (ideals), and logos (reason). The modes formed the foundation of rhetoric—the art of persuasive speaking, also known as, storytelling designed to change the behaviors of an audience. For medical storytellers today, it is pathos that is perhaps the most effective rhetorical mode for changing behavior—and we now have the science to prove it.  

The Neuroscience of Stories 

Paul J. Zak, one of the first scientists to integrate neuroscience and economics, observed that compelling stories cause an increase in the hormone oxytocin—a small peptide synthesized in the hypothalamus and known as the bonding molecule, most commonly associated with breastfeeding mothers. Zak and his team conducted numerous studies and found that oxytocin increases prosocial behaviors—it’s the “neurologic substrate for the Golden Rule: If you treat me well, in most cases my brain will synthesize oxytocin and this will motivate me to treat you well in return.”  

In one study, they measured the neurological effect of two different video narratives: one with a classic dramatic arc featuring a father and a son with terminal brain cancer and another with a father and son where the son is depicted as bald and referred to as “miracle boy” but the specifics of his disease go unstated. Zak and his team found that the dramatic arc narrative caused an increase in cortisol and oxytocin, which had a positive correlation with the participant’s feeling of empathy for the subjects. The researchers also found that this heightened empathy motivated participants to offer money to a stranger who was in the experiment. In his study, Zak stated that these findings “suggest that emotionally engaging narratives inspire post-narrative action.”  

Applying Zak’s research, along with the COM-B System and behavioral economics, will help you identify what you are truly trying to achieve, and thus enable you to craft a compelling, compliant, and balanced medical story that appeals to your audience, sticks in their memory, and most importantly, inspires them to think and act differently.

Behavioral Design—A way forward?

Given Zak’s robust research, we know that good stories can spur action and that some types of stories are better at this than others. The big question is: how do we measure this? That’s where behavioral design comes in. I propose that the future of medical storytelling is measuring not only the outcomes of our medical stories but the design of the stories themselves. Can AI assist us? Perhaps. It wasn’t too long ago that an AI-written short story made it through the first round of a literary contest in Japan. No matter how we get there, tomorrow’s medical stories will be informed by the principles of behavioral design.