Behavioural scientists advise Ontario government on 'tailoring to the reality'

To get through the final stretch of COVID-19, officials need to understand how Ontarians actually think and act — not how politicians think they do.

That's the rationale behind a new group of experts, convened at the beginning of this year under the province's COVID-19 Science Table. They aim to guide officials on how to tailor pandemic messaging and policy to "the reality of the moment," according to Laura Desveaux, co-chair of the Behavioural Science Working Group.

For instance, a study led by Desveaux found only about 80 per cent of Ontario health-care workers plan to get the COVID vaccine.

The group's first brief, published last week, was on how best to urge the other 20 per cent to roll up their sleeves. It called on the government to tailor its vaccine messaging by categories like gender, age and ethnicity; to be empathetic and listen to concerns; and to make vaccines as easy as possible to get.

QP Briefing spoke with Desveaux about how Ontarians' shifting behaviours affect the pandemic, how the government can get people to come together, and why you might not actually want that Peloton.

This interview has been edited and condensed for clarity.

Could you give me an overview of what the working group has been up to?

Yeah, happy to.

We're currently working on enhancing public health measures and adherence to those measures in light of rapidly increasing variants of concern.

So on our radar are several topic areas, as I'm sure you could imagine. And each time we finish a brief, we sort of take a moment to reflect on the current situation and, of our topic list, which is the most pressing or relevant given what's happening.

When we finished the brief around vaccination among health-care workers, it was a reflection of, do we now transition to vaccination in the general population? Or is it more pressing to think about adherence to public health measures, given variants of concern? And we felt it was a more urgent topic to address adherence to public health measures.

And within those topic areas, at a high level, our job is not only leverage behavioural science, but in more accessible language, it's to help government and health system stakeholders think about tailoring communications and strategies and supports not for what we hope people will do, or how they will behave, but what we know about how they are behaving and what they do believe.

So it's not tailoring to the ideal. It's tailoring to the reality of the moment for Ontarians.

I was curious, why now? Why is this the moment for this working group to come together?

What a great question. So, I'm biased. It would have been great to see not only a behavioural science table at the beginning of the pandemic, but what I'm really hoping is that we are in a position to provide value to the system such that the value of behavioural science more broadly is recognized.

So behavioural science is a mechanism to ensure that what science and evidence tells us is the right thing to do is actually realized in practice. And nothing happens in health care without people, whether it's the average Ontarian, or the people that administer health care through the system.

And so if we don't adopt that lens, to try to translate things into practice and drive system transformation, then we're going to end up hitting our heads off the wall, wondering why there is a disconnect between evidence and practice. So I think it's just become even more pressing when the need to close that gap is as urgent as it is during a pandemic.

Do you think it might have been a missed opportunity to not have an expert table like this sooner?

It's hard to say. The benefit that our table has now is all of the evidence that was generated in the first six to nine months of the pandemic.

I actually don't think our evidence synthesis ability would have been as strong a year ago. It would have just been, here's our guidance, drawing from related fields and related concepts.

But the sort of bread and butter of behavioural science — I can't even believe I just used that analogy — is understanding how people react in context.

Let me give you an example. Before vaccines were approved, there were a lot of public opinion polls run on, will you get the vaccine when it's offered? But in the absence of a concrete vaccine to ask people about, there's a certain degree of speculation, right? We don't have the efficacy data. We don't know anything about the history of the vaccine.

So once you add context or specificity to that line of questioning, the way people think, and how they behave, shifts. You have to wait and see, with behavioural science, to be confident in the step you're going to take, versus, here's our best guess.

Could we have had a role sooner? Of course. Is the system firing on all cylinders and trying to do everything it can? From experience, definitely. I think people are overextended.

So it's not a criticism of what should have been, but hopefully, a recognition of the value that behavioural science can bring moving forward.

That's fascinating about vaccines and people's behaviour shifting.

It's just the way it goes. Right? Like, even if you think about yourself — those in my inner network probably get sick of me saying like, yeah, this conversation is great, but it's speculation, so can we just wait?

Here's a non-COVID example. When people are like, "Oh, should I get a Peloton? It's gonna be so great!" And I'm like, okay, well, until you have it, you don't know, right? You need exposure to something to have a behavioural reaction to it. And humans are notoriously terrible, myself included, at self-reporting their behaviour and predicting what they're going to do.

So it's all about understanding how people think. And then how that translates into what motivates them to do what they do. And then you take those insights and try to create supports and messaging that leverage what we know about how people think and why they do what they do, to help support them and making smart decisions that move the collective forward in the specific case of the pandemic.

So getting into the specifics a little bit: the health-care worker report — your table presented it to the Health Coordination Table, is that right?

We did.

And how did that go? How was it received?

It was received very well. It's not unlike your own reactions to what I'm describing. When you walk through the principles of behavioural science, they're very accessible principles. It's just not how we are trained to think.

But that's what that's part of what I love about it, is that it's so accessible. And so people can understand why this is relevant.

And part of our job as behavioural scientists, and through the working group, is giving people a systematic approach to applying those principles, which is what we tried to do in that brief. And I think when you can provide what I hope is a clear framing and road map, then I actually can't even think of any situation I've seen in health care, whether it's behavioural science or otherwise, where people don't buy into that.

Slide from the Behavioural Science Working Group's presentation to Ontario's Health Coordination Table.

So we try to avoid, where possible, overly technical language. Because if we're overly technical, then there's no point producing a brief. No one's going to be able to digest it. And that's not going to do anything.

Yeah, reading it over, it was very digestible, as a layperson.

Happy to hear it. And then, just to more explicitly answer your question, most of the conversation after our presentation at the health coordination table was, like, "How do we message this?" So, you know, "Can you give us an example of how we might frame this communication?" Or, "Can we follow up with you to review our specific communications?"

And that's exactly what we would have hoped for, is supporting people in thinking through how they communicate complex topics, in a way that delivers the outcome that they're hoping to.

So you will be following up with them about more specific communication strategies?

Yeah, it's ongoing. So one of the things Justin [Presseau, co-chair of the working group] and I are trying to juggle is, in addition to the topics that the group approaches, is managing the ongoing requests to review communication documents, consent forms, key messages, or what have you.

So we try to sort of on-the-fly provide feedback to people around how to frame things, which is challenging at a time when there's so many different channels of communication and so many different messengers, but we're happy to provide whatever insight we can. Because any incremental step towards alignment with behavioural science principles is better than no step at all.

I noticed one part of that brief said that a key part of this was making it as easy as possible to get vaccinated. Obviously, there's been a ton of discussion around paid sick days and paid time off to get vaccinated. Do you think that's something that Ontario is missing right now?

A hundred per cent, I do. I think one of the messages is that behavioural science is not just about communication principles, in fact, there are different levers that you can act on.

And when we think about paid sick leave, there's policies and regulations that are arguably, in some cases, more effective than any communication could be.

So one of the ways to think about it is that any behaviour, whether it's at an individual or population level, is a product of three constructs that interact with each other. Those three constructs are:

An individual's capability — so can they physically do something? Do they understand how to do it? And do they have the skills that are needed?

The second is opportunity. Is there social opportunity to do something? Is there physical opportunity to do something?

And then motivation — do they care about doing it? And that's both our conscious motivation and our unconscious motivation.

And so, policy levers, regulation levers, communication, incentives, all of those things influence our behaviour. So our job as part of the working group is to help the system understand what levers would be effective, and then leave it to them to decide which of those to operationalize.

I was curious if there's anything that you can think of that's important to know about the general population's behaviour around COVID, or vaccines, that's not being talked about, either in the media or among politicians.

I'll try to keep this as simple and neutral as I can. What I wish was more broadly recognized is that, on average, the majority of Ontarians are adhering to public health measures in a way in the way that they understand them.

Not that I've collected population-level data on this, but I don't think people are wilfully ignoring recommendations and are defying public health measures. I think that people are just confused about how to enact those public health measures in a wide range of different scenarios, right? Like, it's different at the grocery store, versus if your kids are in school right now, versus you going to work.

So it's behaviourally complex. And I wish that there was a little bit more positive framing around how much people are doing, versus a focus on what we think they are doing and really being critical about, if something's not happening, what's actually driving that.

I know you said you wanted to be neutral, and we can leave it there if you want. But this brings to mind [Chief Medical Officer of Health] Dr. David Williams pretty frequently saying that if people only did what they were supposed to do, things would be a lot better right now. Is that disheartening for you to hear from the top doctor?

I think it's more so that no matter what behaviour we're talking about, whether it's people getting vaccinated or people adhering to public health measures, it requires capability, opportunity and motivation to enact any behaviour.

The onus isn't entirely on individuals. There's a wide range of activities or behaviours that are within my control as an Ontarian. But there are also a pretty considerable amount of determinant factors that are outside of my control.

For example, if I didn't have a car, and had an essential job that required me to go in person, then I have to get on public transit. And can I afford to get a different disposable mask every day? Or can I afford to do laundry every day to wash my mask, if it's a cloth mask?

So there's all of those sort of structural things that, if the ultimate goal was, how do we support the population in doing what needs to be done to end the pandemic, then, if it were me, I would say, what's within my control, and how much can I drive that forward? And then, how can I help people understand what's in their control and show them what's being done to support them, sort of in line with the we're-all-in-this-together mentality of the pandemic.

Is there anything else you'd like to add?

The only thing that I would recognize is that, whether it's behavioural science or otherwise — I don't know if this is just me trying to reassure myself, but it is literally impossible to tackle everything that needs to be tackled right now.

It is a question of prioritization. Like, what is the next critical thing that needs to be addressed, with a view to supporting the entire population.

And hopefully, when things start to return back to normal, we can reflect on not only behavioural science but just how science, in general, can help support responding to things in the way we want to, moving forward.