People often intend to take beneficial actions, such as reviewing their credit reports or going to the doctor for a check-up, but fail to follow through. The lack of action can be linked to procrastination and memory failures, such as the tendency to process information in a shallow way or to lose information as time passes.
In recent years, numerous studies have established that defaults can have a powerful effect on saving behavior. Relatively less is known about whether more a modest "nudge" can affect behavior, including behavior outside the realm of saving. In Following Through on Good Intentions: The Power of Planning Prompts (NBER Working Paper 17995), researchers Katherine Milkman, John Beshears, James Choi, David Laibson, and Brigitte Madrian explore the effect of an intervention designed to help people form and follow through on a plan - a simple sticky note.
The study focuses on the decision to receive a colonoscopy. One study estimates that for every 1,000 additional individuals who follow a schedule of one colonoscopy every ten years between the ages of 50 and 75, 250 life-years would be gained.
The study involved four employers who sent mailings to nearly 12,000 employees due for a colonoscopy. All employees received a mailing providing information about why and how to obtain a colonoscopy and describing how sticky notes can be used to help people remember to do important things. For those employees randomly assigned to the treatment group, the mailing included a sticky note that urged "Don't forget!" and provided a space to write the location and date of the appointment. Employees in the control group received a blank sticky note instead.
During the seven-month follow-up period, 7.2 percent of treatment employees received a colonoscopy, compared to 6.2 percent of control employees. This statistically significant difference was comparable to the increase in compliance associated with a 10 percent increase in the fraction of the procedure's cost covered by insurance. The authors also find that the treatment effect was largest for demographic groups judged to be at the highest risk of failing to receive a colonoscopy due to forgetfulness.
"This paper provides evidence from the field that planning prompts have the power to help people overcome forgetfulness and follow through on their plans even when that follow-through is in the distant future, requires multiple steps, and involves a costly, unpleasant action," the authors write in their conclusion. Interventions such as the one they study "may be able to save many lives at much lower cost than price mechanisms that are often suggested for promoting behavior change."
The researchers gratefully acknowledge financial support from the National Institute on Aging (grants P01AG005842 and P30AG034532). At least one co-author has disclosed a financial relationship of potential relevance for this research; further information is available at http://www.nber.org/papers/w17995.ack.