Malik and Amina

The community includes many migrants from different racial and ethnic backgrounds. Malik is conversant, but not fluent, in most of their languages.

He encounters Amina, who has brought her two-year-old daughter to be vaccinated.

Amina learned about the availability of primary health care services by chatting with her neighbour. She also remembers hearing a radio campaign promoting free immunization services for children under 5 every Tuesday morning.

She has heard several rumours in the community that some vaccines are not safe nor of high quality.

As the communication progresses between Amina and Malik there are several biases and barriers on both sides of the interaction that might hinder the successful vaccination of Amina’s child.

Let's explore Malik's story first

Malik arrives at his clinic early in the morning, ready to immunize children under the age of five. He has a very busy day ahead and there is already a line of caregivers and children waiting for services.

Amina and her daughter are first in line. As Malik greets them, he notices that Amina’s clothes are worn and that her child is barefoot. Amina appears somewhat anxious and hesitant.

He escorts them into the room where the vaccine will be administered, and asks Amina to put her daughter in her lap. Yet when he approaches the girl with the vaccination needle, Amina instinctively moves both of them away.

Malik frowns and asks if there is a problem. Amina looks embarrassed, and says, “My uncle told me that this vaccine could cause infertility and showed me a video to prove it.”

Malik rolls his eyes and huffily tells Amina that these videos are fake and that the vaccine is safe and effective. He finds it so frustrating when his patients choose to believe such nonsense.

Malik also wonders why this woman would trust a video over his medical advice. After all, he is an educated medical professional. He thinks to himself, "How can we make medical professionals appear more credible to the general public?”

What are Malik’s biases?

As Malik interacts with Amina, both of them may experience biases or barriers that affect their communication. What type of biases might Malik be facing?

Select each of the following to discover the answer to this question.

How can we help Malik and Amina overcome these biases?

Thankfully, behavioural science has provided us with a toolbox of solutions we can apply to a variety of situations.

As we can tell from Malik's and Amina’s story so far, there are many biases he’ll encounter in his interactions at work.

Many of these biases can be categorized as a Cognitive Bias, a Social Barrier, a Structural Barrier, or a Hassle Factor.

Cognitive Biases

Cognitive biases are mental obstacles that decrease an individual’s likelihood of taking action. Examples include the tendency to think in the short term and resist changing one’s current situation.

Social Barriers

Social barriers are the inequalities associated with different types of individuals in society. These include socio-cultural and gender-related obstacles that prevent certain groups from accessing services or benefitting from resources.

Structural Barriers

Structural barriers are external factors that stem from how a decision-making environment is built, thus making desired actions difficult. These may include inadequate transportation or the distance to essential services.

Hassle Factors

Hassles are the frustrating demands that often characterise everyday transactions with the environment. Hassles may include, for example, filling out long forms, waiting in line, or complex administrative processes.

Solution #1:

Interpersonal Communication

Health care providers with strong interpersonal communication skills are more effective in encouraging healthy behaviours among patients. Such skills can also help them build trusted relationships with individuals, households and the wider community. Providing Malik with the training and tools he needs to be a better communicator would help address many of the challenges he encounters with patients.

Malik could then use his improved skills to assure Amina that healthcare workers are there to help and support her in keeping her child healthy.

What type of barrier do you think this solution would help Malik overcome?

Solution #2:

Sludge Reduction

Sludge reduction can include simplifying forms and processes and improving reporting channels. Malik and his team can implement strategies to help the clinic function more smoothly. For example, they can create simple, easy-to-complete intake forms, patient checklists, or set up a system to regularly update electronic medical records, thus avoiding backlogs.

Sludge reduction can also help Amina. Limiting the amount of forms Amina needs to fill out, or ensuring health care providers have a copy of their patient’s vaccination records can create a more positive experience for patients.

What type of barrier do you think this solution would help Malik overcome?

Computer with intake forms on the screen

Great work

Malik is starting to feel more equipped to perform optimally in his role, and Amina is more eager to visit the clinic…keep going!

Solution #3:

Removing Friction Costs

Barriers like travel distance, transportation costs, and long wait times can discourage parents from following through on health-seeking behaviours, even if they are in favour of vaccinating their child.

The health clinic could provide mobile clinics to improve access to vaccination in the community. Vaccination could take place at a convenient location such as the local place of worship or as part of regular community meetings.

What type of barrier do you think this solution would help Malik and Amina overcome?

Solution #4:

Provide timely, automated appointment reminders

Parents and caregivers face many competing needs vying for their time and attention. Issuing a timely reminder will bring the upcoming clinic appointment top of mind for them.

Malik can set up an automated text reminder one week before the appointment, and again two days before the appointment. This can include the date and time of the appointment.

What type of barrier do you think this solution would help Malik or Amina overcome?

Let’s dive further into Amina’s story

Amina recently moved to the outskirts of a big city with her three children, leaving most of her belongings behind.

She does not have any medical documents for her family, including her youngest daughter’s vaccination card. She does not have high literacy and does not understand medical language. She has had bad experiences with healthcare workers she met in the past.

She hears rumours in the community that some vaccines are not safe or of high quality. She can easily recall a video her uncle showed her that raised questions about the safety of vaccines.

While Amina is grateful for the free immunization services for children under 5, she recalls her last trip to the clinic. It had taken an hour to walk there, and when she arrived she and the baby waited in line for several hours. She had also lost a full day’s earnings since going to the clinic meant she could not work at her stall in the market that day. In addition to that, she had to find someone to watch her two older children.

Amina holding her youngest daughter outside the medical clinic

What are Amina’s biases and barriers?

As Amina thinks about whether or not to vaccinate her youngest child, what factors might be influencing her decision?

Select each of the following to discover the answer to this question.

Solution #1:

Provide Social Proof

As humans, we are strongly impacted by our perception of what others are doing, and keenly aware when we are “out of step” with expectations. This inclination to fit in with the crowd can be a powerful motivational tool – one that incentivizes behaviour change.

To enhance Amina's confidence and increase the likelihood of her accepting immunization services, Malik can provide social proof. For example, he could share how many parents in this community have chosen to vaccinate their children.

What type of barrier do you think this solution would help Amina overcome?

Solution #2:

Organized Diffusion

Organized diffusion is a strategy that uses participant networks to increase program reach, disseminate positive change, and catalyse collective action.

Through existing community outreach programs, Malik could connect with opinion leaders, such as religious or community leaders. These leaders could, in turn, disseminate the benefits of immunization with Amina and others in the community. In his own clinic, Malik could encourage newly-informed mothers, such as Amina, to lead myth-busting discussions about vaccinations in the waiting room.

What type of barrier do you think this solution would help Amina overcome?

Great work

Amina is starting to feel more equipped to make a decision…keep going!

Solution #3:

Change the default option to auto-enrollment

People tend to adhere to pre-set options. This is because inertia can lead to inaction. Defaults are a way of making this inertia work for people, instead of against them, by automatically opting users into a beneficial choice.

Malik could frame immunization as the default choice, providing Amina with the time and date for her daughter’s next vaccination appointment, while emphasizing that this is part of standard practice.

What type of barrier do you think this solution would help Amina overcome?

Solution #4:

Provide Amina with simplified information

Simplifying the information means presenting it in a clear and concrete way, with ample illustrations where needed.

By using language for a lay audience and drawings that do not require high numeracy or literacy, Malik can help Amina to better understand the importance of vaccinations.

What type of barrier do you think this solution would help Amina overcome?

Malik and Amina standing together looking happy

Amazing job! You have completed this scenario and successfully helped Amina and Malik overcome barriers.

Explore other ways behavioural science can be used to help people overcome barriers by going through another scenario!

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Use this resources to learn more about biases, barriers, and solutions.

Behavioural Drivers Model

Everybody Wants to Belong

Social and Behaviour Change

Overcoming Barriers

Meet Malik & Amina

Malik is a young physician from the capital city several hours away from the clinic where he works. He is responsible for providing a variety of primary health services, including immunization, to the residents of a low-income, peri-urban community.

Amina is a mother who lives in this community.

The community includes many migrants from different racial and ethnic backgrounds. Malik is conversant, but not fluent, in most of their languages.

Let's explore Malik's story first

Malik arrives at his clinic early in the morning, ready to immunize children under the age of five. He has a very busy day ahead and there is already a line of caregivers and children waiting for services.

Malik also wonders why this woman would trust a video over his medical advice. After all, he is an educated medical professional. He thinks to himself, "How can we make medical professionals appear more credible to the general public?”

What are Malik’s biases?

As Malik interacts with Amina, both of them may experience biases or barriers that affect their communication. What type of biases might Malik be facing?