MODULE 5: HEALTH
BEHAVIOR CHANGE
THEORIES: NEW
DEVELOPMENTS AND
APPROACHES
ABRAHAM T GIZAW (PHD)
CONTENTS
• NUDGE THEORY AND BEHAVIORAL ECONOMICS
• HUMAN-CENTERED APPROACH TO BEHAVIOR CHANGE
NARRATIVE-BASED AND STORYTELLING APPROACH TO
BEHAVIOR CHANGE
LITERAL MEANING OF NUDGE (OED)
VERB FORM
NUDGE SOMEBODY/SOMETHING TO PUSH SOMEBODY GENTLY,
ESPECIALLY WITH YOUR ELBOW, IN ORDER TO GET THEIR ATTENTION.
HE NUDGED ME AND WHISPERED, ‘LOOK WHO'S JUST COME IN.’
NUDGE SOMEBODY/SOMETHING + ADV./PREP. TO PUSH
SOMEBODY/SOMETHING GENTLY OR GRADUALLY IN A PARTICULAR
DIRECTION. (FIGURATIVE) SHE TRIED TO NUDGE HIM INTO CHANGING
HIS MIND (= PERSUADE HIM TO DO IT).
04/10/2026 3
CONT…
CONT…
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SOURCES : HTTPS://[Link]/@NUDGEIN/NUDGING-
MEN-TO-STOP-PUBLIC-URINATION-5880EB183646
CONT.…
When I was studying BS at L.S.E, my Colleague, Simon, asked
during a class, “Can BS solve real problems, like how do we stop
indian men from urinating in public?”
My Reaction — Dig My Head Down In Shame!
The issue of men urinating in public is so prevalent in India that
most of us Indians, cover our nose and walk away. we have
accepted this behavior; but for Simon, who spent a lot of time
travelling across India by train, it must have been perplexing.
CONT…
• One part of this issue was the availability of public toilets and as
such an infrastructure issue. the government has put in efforts to
build public toilets under the Swachh Bharat mission —
urban program. last i read, the number was 490,000 additional
public and community toilets built in urban India since 2014.
• Aashish Gupta, research fellow at rice, in a financial express article
says — “mere construction of toilets does little to change the
mindset of people”.
• It can’t be said in simpler terms — infrastructure has a role in
availability heuristics, to make use and access easy, but availability
and making access easy alone can’t change mindsets. changing
ingrained mindsets needs time and a multi-scope effort.
CONT.…
NORMS
• Decisions are an outcome of several factors. some of these
factors are often conflicting with each other.
• following factors drive our decisions , cognitive ability to make
a choice: we struggle with cognitive overload, heuristics and
biases and our preference towards pain or pleasure
• context which we are in : we take cues from our environment,
availability or non-availability of tools/infrastructure
• social factors such as norms, beliefs etc.
CONT.…
• Therefore despite having the availability of infrastructure,
people continue to urinate in public.
• When more people who practice such acts think they are
conforming with rest, it becomes a socially accepted norm.
• Norms will continue to go on (status quo bias) until an
intervention challenges them. changing ‘norms’ is a
gradual process, and this process can’t be achieved
overnight.
NUDGING TO STOP PUBLIC URINATION
• GERMANY AND SAN FRANCISCO
Changing context or choice architecture can also include
‘restricting choice’, while not taking it entirely away.
policymakers use sanctions to change behaviour.
interventions are qualified as nudges if they do not take
the choice away. designing choice architecture such that
the choice is only restricted but not taken away can still be
an option. Using a bit of innovation and imagination might
come handy at this point.
CONT…
• Car manufacturer Nissan first used dirt-reflecting paint to
protect cars from any liquid form of dirt. this reflector paint
was used to paint walls and street corners in Germany and
San Francisco where public urination was a problem. the
“pee-back” walls didn’t take away the choice from a user; it
only created context to restrict the use. government created a
context which was not by way of imposing a fine, but by
giving men a splash of their own leak.
CONT…
Posters warning about “Pee-back” walls were displayed to warn
people. This reduced public urination, at least where the warning
signs were displayed.
This new context (which wasn’t monetary sanction) nudged people toward a
desired outcome, it created awareness and eventually changed the habit of
NUDGE THEORY
• NT is a behavioral economics concept that proposes individuals
can be encouraged to make better choices by simplifying the
decision-making process.
• This approach allows people to maintain their freedom of
choice while nudging them towards specific actions that are
believed to benefit their wellbeing, such as healthier eating or
saving for retirement.
• Developed by Richard Thaler and cases R. Sunstein in their
2008 book “Nudge: improving decisions about health, wealth,
and happiness," the theory draws on earlier psychological
insights regarding human decision-making.
NT & BE …
“Putting fruits at eye level counts as a nudge. banning junk
food does not….”
why?
What is NT?
• The NT is a flexible and modern concept in BS to understand how People
think ,
• Make decisions and behave.
• The concept helps people to improve their thinking and decisions,
• Manage all kind of Changes, and
• Identify and change existing influences.
ORIGIN OF NUDGE
• NT was named and popularized by the 2008 book , ‘nudge : improving
decision about health , wealth and happiness’ written by American
academics Richard H Thaler and Cass R Sunstein.
• Thaler was the 2017 Recipient Of The
Nobel Memorial Prize In Economics For "Incorporat[ing] psychologically
realistic assumptions into analyses of economic decision-making.
• By exploring the consequences of limited rationality, social preferences,
and lack of self-control,
• He has shown how these human traits systematically affect individual
decisions as well as market outcomes.
NT…
NT…
NT…
NT…
Understanding Nudge
NT is flexible and modern concept for:
Understanding of how people think, make decisions and
behave
Helping people improve their thinking and decisions,
Manage changes of all sorts and
Identifying and modifying existing unhelpful influences
on people.
Explaining NT
• NT Accepts that People have certain Attitudes,
Knowledge, Capabilities ..Etc and allows for
these factors (Whereas autocratic methods
ignore them).
• NT is based on understanding and allowing for
the reality of situation and human tendencies
(unlike traditional forcible instruction, which
often ignores or discounts the reality of situation
and people).
Intervie
OBSERVATION ws
COGNITIVE BIAS NEEDS NEED
B/r are like iceberg, they are mostly
beneath the surface
NT at a Glance
CONT.…
NUDGE EX
Get started with the Nudge
• To create Nudges, it’s important to
observe people’s current behavior before
determining which behavior has to be
altered.
• You can then design your Nudges, which
generally fall into three categories:
Perception Nudge
• Focus on the underlining perceptions of organizational B/R for
change of understanding, leading to change of B/R.
• Example: everyone, responses differently to the same
information depending on how it is interpreted. Food that is
describe as 99% fat free is seen as better for you that food that’s
described as 1% fat.
Motivational Nudges
• These are necessary if you want people to care
about change. One way to achieve that is to
refer to other people’s behavior to emphasize
what is acceptable and desired.
Ability and Simplicity Nudges
• These are needed when people feel it is very difficulty to
behave as desired. It is important to tell people that
changing and changes are simple. The easier it is , the
higher the likelihood that people will implement changes.
Designing Nudges
• The Following Steps Are Important In Designing Nudges
1. Identify each B/R that you have to change.
2. Establish what people’s current behavior is;
3. Determine which Nudges you wish to employ;
4. Test and evaluate.
Human-Centered Approach to BC
• Is HCD a Mindset or a Approach?
Why?
CONT.…
• There are debates about whether HCD is a Mindset or an
approach. Well, It Can Be Both.
• As a mindset, HCD takes the position that problems are best
identified and defined by the people who face them in the
first place and that solutions are best developed directly
with these people.
• Furthermore, a human-centred mindset believes that
community voices and perspectives must be involved
systematically from beginning to end, from programme
inception and design through to evaluation.
• As an approach, HCD is a methodical means to uncover
insights, discover solutions, and iteratively test and adjust
them in context.
WHEN SHOULD YOU APPLY HCD?
• Communities know their own needs best but may lack the
tools to turn their insights into action. This is where HCD Is
most useful.
• The most effective way to put HCD into practice is when
the community members themselves define their needs
and design their own solutions.
Reading Articles
REFRENCES
• HTTPS://[Link]/CREATE/USING-HUMAN-CE
NTRED-DESIGN
• ACQUISTI A, GROSSKLAGS J. WHAT CAN BEHAVIORAL
ECONOMICS TEACH US ABOUT PRIVACY?. INDIGITAL PRIVACY
2007 DEC 22 (PP. 363-378). AUERBACH PUBLICATIONS.
• THALER RH, SUNSTEIN CR. NUDGE: IMPROVING DECISIONS
ABOUT HEALTH, WEALTH, AND HAPPINESS. PENGUIN; 2009
FEB 24.
• POSNER RA. RATIONAL CHOICE, BEHAVIORAL ECONOMICS,
AND THE LAW. STAN. L. REV.. 1997;50:1551.
THANK YOU!