Motivation and emotion/Book/2023/Nudge theory and sedentary behaviour

Overview
Case study 1: Imagine walking into the men’s bathroom only to find a fly-shaped sticker at the base of the urinal. This would probably strike you as odd or unexpected, right? Well this is exactly what Schiphol International Airport did. The airport employed this questionable campaign in the hopes that it would reduce the volume of spillages around the urinals and incredibly, it worked! The airport saw an 80% reduction in spillages, simply by giving the men using their urinals something to aim for (see Figure 1.) There are plenty of other examples of how changing a small detail in someone’s environment can incentivise them to change their behaviour. But how do these seemingly insignificant campaigns work? Well it can all be attributed to nudge theory.

Nudge theory was developed by two academics, Richard H Thaler and Cass R Sunstein (2008). They found that you do not have to remove someone’s choice or force them into making the decision you want them to, you can simply change the framing of their environment so that the preferred choice becomes the most obvious one to them. The theory relies on the fact that people make a lot of their daily decisions instinctively and perhaps irrationally, and that human behaviour is quite often predictable. Whilst reducing the spillages in the men's bathroom is great (see case study 1), nudge theory can also be applied to motivate other prosocial behaviours, such as recycling, eating healthily or becoming more active. This chapter will focus on how nudge theory can reduce sedentary behaviour.

Sedentary behaviour has been a major concern for governing bodies across the world for many years now. It reportedly costs the Australia government $13.8 billion annually in response to health conditions caused by the population's inactivity. In an attempt to combat sedentary behaviour, organisations and governments across all levels have run different campaigns to get people moving (For example, the Sit Less, Move More intervention). Nudge theory techniques can be seen in some of these campaigns and have assisted in helping people to become more active. Techniques include modelling desired behaviours, reminding people of the benefits of being active and designing spaces to make it easy to get moving. The different nudge theory techniques and how well they can be applied to reduce sedentary behaviour will be critically analysed, by answering the following focus questions.

Focus questions:
 * What is nudge theory and how does it work?
 * What is sedentary behaviour?
 * How can nudge theory be applied to sedentary behaviour?
 * And, how effective is nudge theory in changing the choices people make?

How does nudge theory work?
Nudge theory involves making changes to ones environment, which is known as choice architecture. These changes are used to influence ones decisions. Nudges do not force people to chose a particular option, they simply influence people to make the predictable, preferential decision. Adapted from the transtheoretical model of change implementing a change to ones environment involves seven stages :
 * 1) Precontemplation - The process begins with defining the change you would like to make,
 * 2) Contemplation - A stakeholder analysis should then be run to ensure you understand the recipients behaviour and the likelihood of them making certain decisions,
 * 3) Preparation - Gather evidence for the best change option,
 * 4) Action - Present the change as a choice to the recipients,
 * 5) Maintenance - Listen to feedback,
 * 6) Adjust or remove obstacles for the change to better suit environment,
 * 7) Maintain momentum with short term wins for the recipients.

By following these stages the nudge, or change to the environment, will have the greatest chance of success.

Other theories and psychological phenomenon's that should be considered include:

Test yourself: Choose your answers and click "Submit": {We use heuristics to make quick and easy decisions: + True - False
 * type=""}

{Defining the change is part of the contemplation stage: - True + False
 * type=""}

What is sedentary behaviour?


Sedentary behaviour is defined as any waking activity that is done sitting or lying down, that uses ≤1.5 metabolic equivalents (METs). This can include driving, sitting at your desk at work or school and watching TV. Sedentary behaviour is becoming more and more prominent in societies all over the world due to the increase of sedentary office jobs and technological advancements. Sedentary behaviour has been shown to exacerbate serious health problems, including cardiovascular diseases, diabetes, and obesity. It has also been linked to increasing the risk of certain cancers, and depression and anxiety. Due to the physical and mental health risks associated with sedentary behaviour, governmental agencies along with global organisations have been encouraging people to reduce their sedentary behaviour by implementing different policies and campaigns.

The Australian government recommends "150–300 minutes of moderate-intensity aerobic physical activity; or at least 75–150 minutes of vigorous-intensity aerobic physical activity" per week. But only 27.2% of people aged 15 years and over are meeting these recommendations (see Figure 2) and due to the lack of space in urban areas it is becoming increasingly difficult for a lot of people to meet these recommendations. van der Ploeg & Hillsdon (2017) study suggests that, instead of trying to achieve a certain amount of high METs activity, simply replacing sitting with standing could be enough to reduce the health risks of sedentary behaviour. People can replace their seated desks with standing desks, pick up an active hobby to keep themselves entertained rather than watching TV or perhaps cycle to work or use public transport rather than drive. Although there hasn't been extensive research in this area, skeletal pains and muscular weakness in the hips and legs will be counteracted at the very least.

How can nudge theory be applied to sedentary behaviour?
Case study 2: A recent graduate of the University of Canberra launched the UC30 project. Alice Martin encouraged students in Physiotherapy classes to stand and stretch once every 30 minutes. Reminders were placed into the lecturers PowerPoint slides and posters were hung up near where the students were expected to view them frequently. This resulted in less sedentary behaviour for the students and due to this success there now are plans to roll the program out across the rest of the university.

How can nudge theory be used?
Nudge theory has been implemented in multiple different ways. The table below includes a few examples of the different nudge techniques.

How has nudge theory been applied in research?


Recent research on sedentary behaviour has looked at how different nudge theory techniques can increase health promoting behaviours. Included in this research, Cooley et al. (2022) study sent out electronic reminders for employees of a company to take movement breaks every 45 minutes. The employee's were able to snooze the reminder for 15 minutes before the prompt would return (prompting people to think before deciding.) The employee's who participated benefited from the prompts, to move every hour (much like the students who are taking part in the UC30 project; see case study 2.) The employees reported positive affect from their experience and were hopeful that they were able to influence others in their team to also take regular breaks (social modelling.)

Welbot is a similar type of software that was used by a different company for two weeks. Welbot reminded staff to take a movement breaks every 30 minutes however this software had some gamification aspects to it too, as it asked the individuals to either stretch, complete a mindfulness exercise or make a cup of tea, rather than simply prompting them to take a screen break. The participants received positive feedback from their involvement in the study due to their reduced levels of stress, depression and anxiety. This meant they were able to fulfil their need for competence. And although this study did not follow up with the participants, it did include participants self-reports that they had become more aware of their unhealthy work behaviours, so those who continued to take screen breaks would be able to fulfil their need for autonomy (cognitive evaluative theory.)

Sudholz et al. (2016) provided students at a Melbourne high school with height adjustable desks, making the option to stand up easier to access (and the bad choice difficult to access; see figure 3.) The students were 25% less sedentary by the end of the study. They also found students were more likely to choose to stand during morning classes, compared to afternoon classes. Similar findings were seen in a meta-analysis run by Torbeyns et al. (2014). The analysis included different types of active workstations which resulted in less sitting time and more energy expenditure across the workplaces. The type of active workstation which is implemented and the time of day participants are encouraged to use the apparatus, can affect the likelihood of uptake and therefore the amount of time spent sedentary.

A default physical well-being education program was trialled at a university in North America. They found only 15% of students unenrolled from the default physical activity well-being course compared to the 47.5% of students who did not enrol in the course in the free choice condition. They found students who completed the course were more likely to continue to partake in physical activity post graduation, compared to those who did not enrol. The study shows that when people do not have strong preference or a full understanding of the choices available they will stick to the default or easiest, sufficient option (bounded rationality.) Theory Y can also to be seen by the students who continued to exercise after the study had finished. The self-direction and self-control shown by these students will be hugely beneficial to their health. Although this study does not look at sedentary behaviour specifically, those with an active lifestyle spend less time sedentary and they are less likely to be affected by negative health outcomes.

Shaw et al., (2019) looked at the demographical characteristics of a neighbourhood and the influence that had on sedentary behaviour (social influence.) The study focused on those 65 years of age and above. The researchers found people who lived in areas with increased crime rate or areas they perceived to have a lack of shops and services, spent more time sedentary. Those who spent time caring for others (such as a partner or grandchildren) and participants who were members of a gym, church or voluntary organisation were less sedentary. The study points those who are less active, get involved in their community less, leading them to perceive the services available to them to be limited (heuristics.) Although nudging all elderly people to take up helping roles or join a social club, may seem like the perfect solution, for some people it would be too physically and psychologically demanding and would cause them more harm. From the data collected in this study, we learn that changes should be implemented early. To reduce the amount of time people spend sedentary, in retirement, they should be encouraged to stay active rather than become active - so that movement is not overly stressful to them.

Will nudge theory actually work?
Time to reflect: How do you think nudge theory could apply to your life? Would you implement any of the techniques to reduce the amount of time you spend sedentary?

Although the research on nudge theory and sedentary behaviour has had mostly positive outcomes, there are also some limitations. Cooley et al. (2022) study identified that some participants reported negative affect, due to the movement breaks dissenting from workplace norms. The participants felt a loss of control and reported the constant disruption broke their workflow. Similar results were found during a 'Sit Less, Move More' intervention in New South Wales emergency call centres. Participants of this study reported enjoying the program but found the disruptions were incompatible with the stressful nature of their work, and that it would not be sufficient on its own to break their deeply entrenched sedentary habits. Therefore workplaces which intend to implement movement breaks need to consider the workplace norms and the characteristics of the recipients job roles thoroughly.

There are also concerns for the efficiency, long-term effectiveness, and ethical consideration of the different nudge theory techniques. The effects of nudge theory can be difficult to measure, especially when applying the techniques on a large scale. Compounding variables could be causing the change in behaviour or an unexpected change could appear. When governments or large organisations are trying to implement change, what they consider to be the preferred choice can be subjective and not always something that can be generalised. Although reducing the time we spend sedentary is beneficial to our health, how different organisations go about changing peoples behaviour could have negative affects. As Shaw et al. (2020) highlights, nudging all elderly people to take up helping roles or join a social club would be overwhelming and could cause them more harm. Accountability and transparency are two things that need to be taken into consideration, so as to not cause undue stress or harm. As suggested in the seven stages of change a thorough stakeholder analysis should be run.

Conclusion
Nudge theory can be used to reduce sedentary behaviour. Reminders or prompts can be sent out with simple positive messaging or designed in a gaming format. Behavioural modelling and social influence can be structured to sway peoples opinions and perceptions, or simply making the 'bad' choice harder to access, people become more active. When implementing different programs, the architect needs to be considerate of the ethical implications, compatibility with current norms, and the long term effects. Active workstations and reminders to take regular screen breaks are popular techniques which have been applied to the schooling and working environments. The recent research on reducing sedentary behaviour has not been without its limitations but there has been a reduction in stress, depression, and anxiety. Future research should to include longitudinal studies to see if nudge theory has longer term effects, and if the behavioural change is resistant to new nudges.