Just in case you are thinking ‘What is nudge theory?’ Nudge theory – the science behind subtly leading people into the ‘right’ decision. My own take on this is ‘using indirect and subtle suggestions to get people to behave in a way that is beneficial to them’.

The aim of using Nudge Theory is to persuade people towards better choices rather than mandating behaviours, some of which may be self-destructive. Studies have shown that it’s possible to create lasting change in everything from wellbeing and safety to pension take-up, as well as empowering employees.

There are many aspects to Nudge Theory but I want to concentrate on just one: following the herd, often referred to as conforming, mob instinct and behaving like sheep. This tendency is caused by people’s need for affirmation, avoiding risk/embarrassment, strength in numbers, fear of isolation, etc. Mass media, and authorities and institutions with vested interests in certain beliefs, commonly help build and maintain false group-beliefs.

There are many cultural factors which enhance these effects, especially when enabled and magnified by modern internet/computer/communications technologies.

The common human urge (conscious or unconscious) to conform to the behaviours of others, or to social norms, expectations and customs, has many different causes, for example, the need for affirmation (being like others, which produces feelings of affirmation)

Here are two examples I have recently encountered:

Example of a ‘following the herd’ nudge in a renewal reminder from the UK Data Commissioner:

‘How to pay

Did you know that 89% of fee payers pay on time? You can pay in any of these ways:’

Example of a ‘following the herd’ nudge in a payment request from the UK Government’s tax collection department:

‘95% of people in your area have already paid their tax.’

Of course, I have no evidence that these figures are accurate but I have no reason to believe that these Government departments would use false information to persuade me to settle these bills.

Many experts would also say that conforming in one way or another has also been a necessary survival instinct throughout human history so that the tendency may actually be to a degree ‘hard-wired’ or genetically inherited by each of us. Whatever the causes of conformity, it’s immensely powerful.

From my clinical experience, these are the areas where people’s decisions can cause them harm in terms of eye care (or lack of it):

• Contact lens wearing compliance (not swimming in lenses, changing them according to the recommended wearing regime.
• Contact lens cleaning compliance.
• Keeping appointments.
• Warnings about retinal detachment signs and symptoms and what to do.
• Warning about sight changes and what to do.
• Warning about coming back for further testing e.g. visual fields.

You could use information from research studies, your own clinical experience or just a gut feeling in your letters and patient information leaflets. My preference is to use a nudge in written material and if you do use it verbally then back that up in writing.

For example:

95% of people in this practice always clean their contact lenses with fresh solutions.

89% of people in this practice change their contact lens case every three months.

98% of people in this practice wear their daily disposable contact lenses for one day only.

95% of people in this practice make an appointment within two weeks of receiving a reminder.

95% of patients requiring further tests return within one week.

95% of patients experiencing flashes and floaters in their vision make an appointment on the same day.

You can think of your own examples along these lines.

Best of all, the best nudge interventions are easy and cheap.