Influencing Social & Community Context through Social Norms & Reference Networks

PART OF A BEHAVIORAL SCIENCE LENS ON SOCIAL DETERMINANTS OF HEALTH

Key Terms

01.

Social Norms

Social Norms are perceived, unwritten "rules" that define acceptable actions or behavior within a network or community. People will likely adhere to a social norm given they believe that most people in their referencenetwork conform to it (descriptive norm) and that most people in their reference network
believe they should to conform to it (normative expectation) ”.

02.

Descriptive Norms

Descriptive norms (also referred to as empirical expectations) refer to our expectations of how others will people behave. These perceptions can influence behavior significantly, particularly among the elderly, who may rely more heavily on social cues to make decisions.

03.

Normative expectations

Normative expectations refer to what we think others should do. It is distinct from what we believe others will do in reality but is a guiding factor in a social norm.

04.

Reference Network

Reference networks refer to the actions and opinions of people we care about.. For example, an elder individual living with his daughter's family making a decision may not refer the the people in his closest vicinity (who he lives with) but rather his reference network of other seniors he identifies with.

Strategies to Empower Seniors & Boost Digital Engagement

Digital health solutions have the potential to be a transformative force in engaging patients during their health care journey. Specifically for elderly populations managing multiple health conditions, it enables seamless coordination between providers and ultimately better healthcare delivery and outcomes. With the convenience of managing healthcare anytime and anywhere via smartphones—devices most patients already possess—the possibilities are immense. Existing resources include patient portals, personal emergency response systems (PERS), medication adherence apps, and smart wearable devices. These technologies are also crucial to managing medical costs for patients in the U.S. where those aged 65+ accounted for 37% of healthcare expenditure in 2020 .

In the US, the 65+ population representing 17% of the population, accounts for 37% of healthcare spending. This is over 5x the spending per child and almost 2.5x that of the working-age population .

Now more than ever, it is vital to engage elderly patients through digital engagement. These tools not only help seniors maintain their independence but also streamline their healthcare experiences. It ensures they receive precise and efficient care when needed.

Unfortunately elderly patients often miss out on these advantages. This phenomenon exemplifies the “digital health paradox”, where certain social groups, particularly populations like the elderly, do not take advantage of digital tools despite the widespread availability and potential benefits. Recent studies explore reasons why the senior population have lower adoption rates with digital health tools and found the common barriers to be changes in the body associated with aging, general cognitive decline, not knowing the extent of functionality available and confidence (self-efficacy) with using technology . Even if older patients understand the distinct benefits of using digital health tools and think they should be using it (as part of their normative expectations), that belief alone will likely not lead to sustainable behavior change.

Oftentimes we only attribute behavior to a person’s will or volition. Many industries design systems and programs with the assumption that people are always conscious of their decision making and behavior. However, that assumption significantly underestimates the impact of all other factors that could be influencing our behavior.

To drive behavior change in the senior population requires a more nuanced approach than solely appealing to the logical or analytical parts of the brain. Exploring the impact of social norms within this key demographic can powerfully boost the adoption of digital solutions.

Social norms are an often unexamined, yet huge driver of behavior. Social Norms are perceived, unwritten "rules" that define acceptable actions or behavior within a network or community .The influence of social norms not only stems from our inclination to imitate others, but also from our deep-seated desire to belong to our community. Ultimately, it can be a powerful mechanism to sway behavior.

Recent findings from the National University of Singapore reveal that elderly patients are significantly more inclined to use digital health services when they see peers in their reference networks engaging with these technologies . The heuristic underpinning this phenomenon can be attributed to the "bandwagon effect," where individuals assume a health action is valuable because others believe so. Using social norms to influence behavior can be particularly powerful with this population because cognitive decision-making tends to slow and become less efficient with aging. Older adults often shift from deliberate decision making to relying more on heuristics and social cues. Therefore, automatic processes like observing the actions of others and having a belief that other elderly patients are digitally engaged in their care (descriptive norms) can play a significant role in driving positive health behaviors.

Leveraging social norms effectively can powerfully motivate the elderly to embrace digital health tools, fostering a culture that enhances their independence and well-being. Join Banyan Consulting Co to begin crafting strategies bolstered by behavioral science today.

Interventions

Incorporate Familiar Faces in Marketing Materials: Use images and stories of actual elderly users in marketing materials to show them successfully navigating digital health tools. Using imagery of patients in their reference network as a proxy can help patients visualize themselves using the technology.

Initiate a Recognition Program: Develop a program that recognizes and rewards elderly patients who effectively use their digital health tools. Recognition could be in the form of badges, certificates, or special mentions in community newsletters, further motivating others by showcasing achievable success. Additionally, encouraging elderly patients to share their fitness trackers and status within their networks reinforces descriptive norms that other older patients are digitally engaged.

Offer Contextual Demonstrations During Healthcare Visits: Integrate demonstrations of digital tools during regular healthcare visits, where healthcare providers can personally show how to use various features. This immediate, context-specific guidance can make the learning process more intuitive and relevant. This influences behavior through social cues and also provides patients education by making the behavior more salient.***

***Tune in next week for an exploration on augmenting patient education through salience and self-efficacy.

Sources

1. Hlobil, Ulf. 2017. “A Handbook for Social Change.” Metascience 26 (3): 459–62. https://doi.org/10.1007/s11016-017-0209-7.

2. “Spending by Age and Sex 2020 Highlights.” n.d. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/AgeandGenderHighlights.pdf.

3. Kebede, Abraham Sahilemichael, Lise-Lotte Ozolins, Hanna Holst, and Kathleen Galvin. 2022. “Digital Engagement of Older Adults: Scoping Review.” Journal of Medical Internet Research 24 (12): e40192. https://doi.org/10.2196/40192.

4. Wu, Qiaofei, Annabel Ngien, and Shaohai Jiang. 2023. “Descriptive Norms and EHealth Use among Older Adults: A Cross-Country Comparative Study.” Health Communication, December, 1–12. https://doi.org/10.1080/10410236.2023.2297120.

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