Baffled by Numbers

Navigating information towards better health decisions.

What's organ donation got to do with Macy's?

When driving health behavior change, think Macy's

 

I was recently honored to be an invited keynote speaker at Donate Life America's annual national conference. As a researcher, who cares a lot about spreading the word, I do a considerable amount of public speaking. Public crying, however, is something I get to do far less often. The exception was in Indianapolis, as the Donate Life America (DLA) conference. DLA is tasked with the sacred mission of promoting organ donations, so I sat there before my talk as the mike was passed around and DLA employees from so many states introduced themselves and their connection – some were living donors, some recipients, some had family members who received a donation, and others with related to donors. I was crying, emotionally overwhelmed, knowing that, by this single talk, I could perhaps help make the biggest difference ever in my career.

 How can I, a decision scientist, help motivate people sign up as potential donors? The problem with organ donation, as with other domains of behavior change, is that there is no immediate cause to action. Even if you have a positive attitude toward the topic, this does not mean you'll necessarily act upon it.

 You would think that if people grasp the importance of organ donation – either when one passes away or through living donation – they would just sign up to do it. But this is not the case. It's easy to demonstrate with the 2011 Earthquake in Japan. I asked that everyone who's heard about it stand up. The entire room did. Then I asked everyone who cared about the earthquake and the suffering of the Japanese people to remain standing, which they all did. Then came the tricky part: "please remain standing only if you donated something – food, time, money – to help the earthquake victims." As you can imagine, most people sat down. Not because they did not care, or would not have helped had they been given the opportunity, but because people need a boost, need it to be available and easy, in order to act upon their attitudes, positive as these may be. This applies to organ donation as well, and can help explain why not all of us are donors.

 

Perhaps counter intuitively, one issue that hampers organ donation is the fact that you can always sign up for it. Why go on Facebook and sign up today? Why not tomorrow, or next month? Next year, even? No urgency, because none of us are planning to die today.

 

Think of women over 50, who need to undergo routine mammograms. They might be busy, or afraid that the exam would hurt, or maybe they have the best intentions and really mean to go, but not today. There is no urgency, and when no urgency exists, execution can be indefinitely postponed. This is just like organ donation.

 Wharton's professor Katherine Milkman partnered with a life style company to promote mammograms, which women know are important to get, but never seem to have the time to. She used the advanced technology of refrigerator magnets and randomly assigned women to one of two magnet conditions. Half said "get a mammogram", whereas the other half promoted "get a mammogram by Thanksgiving". Yes, it's false urgency, because the clinics are not going to run out of mammograms by Thanksgiving, and there really is not connection between radiography, turkeys and yams. But knowing that mammograms are important just does not seem to be enough to prompt action. The deadline helped women prompt themselves to action, and being assigned a deadline is apparently easier than creating one for yourself.

 If you think people don't fall for false urgency, well, think back to the last time you rushed to Kohl's or Macy's on a Super Saturday. One of these really rare and urgent events that happen, what, once a month? I'm sure you get it.

 In another study, prof. Milkman took care of yet another important topic where motivation isn't trivial – flu shots. She collaborated with a company that provides its employees with an online health clinic. The fact that the clinic is open eyar round neutralizes urgency – why get a shot today when I could go get it next week? Indeed vaccination rates were as low as 33.1%. Prof. Milkman mailed the employees a letter in 3 versions – the first was the usual invitation, the second was the same invitation, but employees were asked to write down the date when they will go to the clinic. This increase vaccination rates by 1.5%. The third version required employees to write down both the date and the time of day when they will go to the clinic. Vaccination went up by 4.2%, which may not be a lot, but is statistically significant.

 Going beyond statistics, and back to organ donations: any small increase in the number of donors can help save lives, or bring a huge improvement to the lives of those receiving a cornea or tissue donation. To avoid falling into the "I'll do it when I get a chance" trap, set a date. Decide that by your birthday, Labor Day, or even this weekend, you will sign up to be an organ donor. Anyone can be a donor, even if they're old or unhealthy, they can still donate their corneas, So sat that date, and treat it with the same sense of ungency you would treat a Macy's Super Saturday. Do it now.  

 

Talya Miron-Shatz, Ph.D., is a researcher at Princeton University. She specializes in medical decision making of patients and health professionals.

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