“I'm going to talk about the science of habit and what it can tell us about human behaviour....”

This Keynote Speech by David T. Neal was presented at the First International SBCC (Social and Behaviour Change Communication) Summit in February 2016 in Addis Ababa, Ethiopia. The summit brought together over 700 practitioners representing 50 countries to advance SBCC as a domain of scholarship and practice and link SBCC to positive health outcomes and impact. David T. Neal, founder and managing partner at Catalyst Behavioral Sciences, LLC., was the first keynote speaker.

Neal outlined the specific desired behavioural outcomes that he garnered from the conference programme, noted the diversity, and suggested placing the behaviours on a continuum of habit strength, meaning that some behaviours are woven into everyday life, performed regularly in the same environment without thinking about them, and relatively frequently, thus falling into the category of habits. He creates an illustration of those behaviours that suggest habits, stronger to weaker, and at the far end of the scale a single, thus non-habitual, event, such as medical male circumcision (MMC). His message is that this dimension of habit strength really matters to those invested in changing human behaviours.

He poses the question: Why is the habit strength distinction important? Insights from behavioural science suggest that 45% of what people do falls into the range of habit. When people form habits, the brain connections underlying behavior change and procedural memory takes over. Actions that occur together become "chunked together as an action sequence". Once habits are formed, we "outsource control to the environment." Science can see resulting changes in the brain.

Neal cites examples, including a meta-analysis of behaviour intention and planning versus past history of habit strength. The study showed that things that we rarely do can be more influenced by intention - there is a correlation between intention and predicted behaviour, such as vaccinating a child. But things we do by habit, like condom use and seatbelt use, are not predicted by intention or planning, but rather by the past habit.

Taking an approach that is an influencing approach can work for the non-habitual or infrequent behaviours. However, knowledge of benefits does not correlate with change in habitual behaviour. Neal describes two systems of behaviour as: "system two: the economist," which is weighing value of behaviour through knowledge of results - a rational process, and "system one," which asks "what did I do last time in this environment?" Neal states that we are missing a set of technical principles on how to disrupt people's "bad habits" and help them form "good habits", with the notion of integrating how we approach system one and system two.

His case studies include smoking cessation, approached with: 1) the fear tactic that, according to studies sometimes led to more use, as in greater drug use; 2)then the point of purchase campaign, which didn't change the environment but added a posted message about dangers of smoking; and, finally, 3) the smoking substitute campaign that provided nicotine in other forms. None of these addressed system one. He demonstrated a video from a Thailand campaign in which children approach smokers and ask for a light for their cigarettes. Each smoker refuses and discourages the children. The children then give them a brochure with a message saying that they worry about the children, but why not about themselves. This caused smokers to throw away their cigarettes and showed that smokers had rational knowledge but hadn't changed behaviours until the communication disrupted the status quo and caused reflection on why smokers hadn't connected their knowledge to break their habit. Neal also cites using product substitutes that piggy back on existing habits, such as nicotine gum.

Additional ideas include:
People's changes of environment are an opportunity to change behaviour: moving to a different house and being offered public transportation vouchers to decrease private car use, or approaching seasonally migrating workers on open defecation habits when changing locations. Adding friction to old behaviours and removing friction from new behaviours can induce change, for example, smoking bans in buildings or providing pre-packaged doses of medication. Neal described the iron fish project in which Vietnamese can put an iron fish figure in their soup pots to slowly release iron, replacing iron supplements that people could not always remember to take.

Neal describes the use of ritual as habit that has taken on deeper meaning, a way of introducing and driving new behaviours. His example from the Philippines is one of placing religious figures on endangered coral reefs to prevent the behaviour of fishing by dynamiting coral reefs. Others are: inking a finger at voting places, or campaigning on marriage: when no toilet is available in the future home of the bride, "No Toilet, No Bride". Another is painting footsteps coming out of the latrine and going to the washing station or writing Arabic script near open defecation places so that people associate the spot with religious locations and change their practices. Neal concludes by suggesting folding habit thinking into the strategies already used for rational decisionmaking.