Decoding behavior change: A strategic communications framework for healthcare 

OCTOBER 19, 2024

Key Takeaways

• Most healthcare decisions are made by System 1, the fast emotional brain, not System 2 
• Three heuristics consistently undermine behavior change: recency bias, anchoring, and loss aversion 
• The COM-B framework diagnoses the real barrier before any communication is designed 
• Communication goals should be defined across three dimensions: what audiences think, do, and feel 
• Psychographic segmentation surfaces motivational differences that demographics cannot reach 

We design campaigns for the rational mind, loading them with clinical data, risk statistics, and evidence-based guidelines, and then wonder why uptake remains low. The answer lies not in the quality of the information, but in a fundamental misunderstanding of how human beings make decisions. Any effective behavior change communication strategy must incorporate the human decision-making process.  

The rider and the elephant 

Psychologist Daniel Kahneman described the brain as operating across two systems. System 1 is fast, automatic, and emotionally driven, i.e. the part that handles instinct, habit, and gut feeling. System 2 is slower, deliberate, and analytical, i.e. the part we use when consciously weighing up options. Most healthcare communication is designed for System 2. Most decisions are made by System 1. 

The metaphor

Jonathan Haidt’s metaphor captures the dynamic that every communications strategy must contend with. 

This has profound implications for healthcare communicators designing patient journeys, campaign plans, or strategic communications strategies. The gap between evidence and action is almost always an elephant problem, not a rider problem. 

Why we take shortcuts

 To manage the extraordinary cognitive load of processing 11 million pieces of information every second, we rely on heuristics, mental shortcuts that allow us to make decisions quickly and with less effort. These shortcuts are enormously useful. They are also the source of some of our most predictable irrationalities. Understanding them is the foundation of effective audience segmentation and messaging strategy. 

Three biases every healthcare communicator must understand 

A framework for closing the gap 

Understanding these biases is one thing. Systematically applying that understanding to a communication challenge is another. The COM-B framework, developed by Professor Susan Michie at University College London, provides a structured approach to both and should sit at the heart of any rigorous communications strategy framework for healthcare. 

COM-B: A behavior change communications framework

The value of this framework is that it prevents the most common error in behavior change communication: diagnosing a capability problem when the real barrier is motivational, or designing an emotional campaign when what is actually needed is clearer information and easier access. Each component requires a different intervention; applying the wrong solution to the right problem produces little result. 

From framework to communication goals

Once the COM-B analysis is complete, communication goals can be defined with real precision — not just what you want your audience to know, but what you want them to think, do, and feel. These are distinct objectives that require distinct strategic approaches, and they should each be reflected in your customer journey map.

The research that makes it work  

None of this is possible without rigorous, empathetic audience research drawing on multiple data sources. Quantitative data tells you what people are doing. Qualitative data, social listening tools, and one-to-one interviews begin to tell you why. Blending both is the foundation of a truly strategic communications approach.  

 The most important questions are not about knowledge gaps but about emotional states: What does your audience fear? What are they anchored to? What would they stand to lose or feel they would lose by behaving differently?  

 This is where psychographic audience segmentation earns its value. Two people with identical demographic profiles may be at entirely different points on the motivational spectrum, driven by entirely different fears or desires. Standard demographic audience segmentation will not surface this distinction. Psychographic segmentation, informed by social listening data and qualitative research, will. A message that empowers one segment may alienate another and without this level of granularity in your audience research, you will not know which is which until after the campaign has launched.  

Testing: the discipline that turns instinct into evidence

Behavioral science is, at its core, empirical. Hypotheses about what will drive change need to be tested, measured, and refined and this discipline should be built into the campaign planning process from the outset, not treated as an optional post-launch activity. 

A repeatable testing process 

What this means in practice 

The healthcare communicators most likely to drive genuine behavior change are those who resist the temptation to lead with information and instead begin with understanding. They ask not “what do we want people to know?” but “why are people behaving the way they are, and what would need to change — emotionally, practically, environmentally — for them to behave differently?”

The answers rarely emerge from a single data source or a single analytical lens. They require synthesis across audience research, social listening tools, and first and third-party data and a willingness to sit with complexity before reaching for creative solutions. But the reward is a strategic communications strategy that does more than inform; it moves people.  

And in healthcare, where the gap between the best available evidence and actual clinical practice can cost lives, that distinction is everything.  

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