Social Norm Feedback Research Articles

Effects of experimental, network-based social circle norm feedback on studying behavior and alcohol consumption.

Misrepresentation of peer behavior has often been observed in college students and may lead to over-expression of alcohol consumption and under-expression of studying. While social norm feedback approaches have had mixed success in addressing these misrepresentations and altering behavior, they may have been too unspecific to be effective and did not directly assess individual perception accuracy. We thus investigated how specific, one-time feedback on the behavioral distribution of alcohol consumption or study time of a clearly defined, individually-adjusted social circle would affect the respective norm estimations and behavior of a class of Psychology students (n = 89 in January) across their first year of study. Students overestimated alcohol consumption and partially underestimated studying norms. While social circle feedback on alcohol consumption did not clearly affect both individual estimation accuracy and alcohol consumption, feedback on peers' studying time increased studying with no clear effect on estimation accuracy. This indicates that social circle norm feedback may be suitable to evoke behavioral effects. The correction of the detected inaccuracies did not appear to be a precondition for the feedback to be effective.

Norm From The Top: A Social Norm Nudge To Promote Low-Practiced Behaviors Without Boomerang Effect

Social norms are an essential determinant of conformity in decision-making, a powerful nudge for helping people adopt prosocial behavior. Informing people that most of their peers behave virtuously encourages them to improve their own behavior. Nevertheless, social norm mechanisms are efficient if the proportion of people who already act prosocially is sufficient, otherwise, the norm can lead to a ”boomerang effect” namely, this induces a person who acts prosocially to abandon her previous choice since she is informed that the majority does not support her prosocial behavior. The purpose of this paper is to develop a new norm that can be efficient even when implemented in behaviors practiced by a minority of people, by contrast to current social norm nudges. In our experiment, we create a new type of feedback that includes descriptive and injunctive norms and then observe whether they are more effective than standard social norm feedback. This new feedback, named ”Norm From The Top”, provides information based on the most altruistic people in the population. The experiment was run online due to the sanitary conditions in 2021. 203 participants were recruited from Cirano (Montreal, Quebec). Cirano is an interuniversity center, multidisciplinary and intersectoral. The sample comprises 120 women and 83 men (Average age = 37.2; SD = 10.5). In the experiment, participants were randomly exposed to a social norm that elicited prosocial behavior from other participants, and we observed whether the group exposed to the Norm From The Top increased their prosocial behavior compared to the other groups. Specifically, participants were asked whether they were willing to complete surveys without compensation. This study found that this norm acted as an effective nudge, increasing the average decision regarding prosocial behavior and addressing the boomerang effect issue. The Norm From The Top sets a high reference point compared to the standard norm and does not induce a reduction of contributions higher than this reference point. In contrast, the standard norm does not have a significant effect due to the boomerang effect and leads to a concentration of the contributions towards the average, resulting in an inefficient nudge in this context. These results show the potential of the Norm From The Top enforcement to promote low-practiced prosocial behaviors, thereby increasing the range of prosocial behaviors that social norm nudges can reinforce. Applying this norm to different types of prosocial behaviors in field experiments would allow for observing its impact on actual behaviors and assessing the external validity of this new instrument before making it available to policymakers.

Clinician Job Satisfaction After Peer Comparison Feedback

Interventions that improve clinician performance through feedback should not contribute to job dissatisfaction or staff turnover. Measurement of job satisfaction may help identify interventions that lead to this undesirable consequence. To evaluate whether mean job satisfaction was less than the margin of clinical significance among clinicians who received social norm feedback (peer comparison) compared with clinicians who did not. This secondary, preregistered, noninferiority analysis of a cluster randomized trial compared 3 interventions to reduce inappropriate antibiotic prescribing in a 2 × 2 × 2 factorial design from November 1, 2011, to April 1, 2014. A total of 248 clinicians were enrolled from 47 clinics. The sample size for this analysis was determined by the number of nonmissing job satisfaction scores from the original enrolled sample, which was 201 clinicians from 43 clinics. Data analysis was performed from October 12 to April 13, 2022. Feedback comparing individual clinician performance to top-performing peers, delivered in monthly emails (peer comparison). The primary outcome was a response to the following statement: "Overall, I am satisfied with my current job." Responses ranged from 1 (strongly disagree) to 5 (strongly agree). A total of 201 clinicians (response rate, 81%) from 43 of the 47 clinics (91%) provided a survey response about job satisfaction. Clinicians were primarily female (n = 129 [64%]) and board certified in internal medicine (n = 126 [63%]), with a mean (SD) age of 48 (10) years. The clinic-clustered difference in mean job satisfaction was greater than -0.32 (β = 0.11; 95% CI, -0.19 to 0.42; P = .46). Therefore, the preregistered null hypothesis that peer comparison is inferior by resulting in at least a 1-point decrease in job satisfaction by 1 in 3 clinicians was rejected. The secondary null hypothesis that job satisfaction was similar among clinicians randomized to social norm feedback was not able to be rejected. The effect size did not change when controlling for other trial interventions (t = 0.08; P = .94), and no interaction effects were observed. In this secondary analysis of a randomized clinical trial, peer comparison did not lead to lower job satisfaction. Features that may have protected against dissatisfaction include clinicians' agency over the performance measure, privacy of individual performance, and allowing all clinicians to achieve top performance. ClinicalTrials.gov Identifiers: NCT05575115 and NCT01454947.

Keeping up with my neighbors: The influence of social norm feedback interventions on recycling behavior in urban multifamily buildings

Existing research indicates comparative social norm feedback can be influential in nudging recycling in more sustainable directions, but little work has explored this mechanism in urban multifamily buildings. This research builds upon existing work in this area by conducting 12 weeks of interventions in two multifamily buildings in New York City, in which one building (n=372) received weekly comparative feedback comparing their building's recycling to neighbors and another building (n=602) received weekly non-comparative feedback data about their building only. Two main findings emerged: (1) Data indicate increased recycling by bag weight (interpolated for a one-year period from the weights of waste samples) in the intervention period in both buildings, pointing to effectiveness in increasing recycling from social norm feedback, and (2) the comparative feedback mechanism appears to be a stronger driver of behavior change. Takeaways from this work can inform urban policy and property manager decision-making for solid waste management.

Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review

ObjectivesAntibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic...

“Meat” Me in the Middle: The Potential of a Social Norm Feedback Intervention in the Context of Meat Consumption – A Conceptual Replication

ABSTRACT Meat consumption has detrimental environmental effects. Research shows that social norms are important when it comes to meat consumption. However, social norm interventions have shown mixed effects regarding their effectiveness for decreasing meat consumption. Therefore, an experiment was conducted (n = 279) with a 2 (baseline meat consumption: above- vs. below-average) x 3 (social norm feedback: descriptive norm only, descriptive plus injunctive norm, no feedback) x 3 (time: T0 [baseline], T1 [+1 week from baseline], T2 [+2 weeks from baseline]) mixed-factorial design. Results showed that reported changes in meat consumption at T1 and T2 relative to T0 were not different after receiving social norm feedback (i.e. descriptive norm only or descriptive plus injunctive norm) compared to receiving no feedback. Irrespective of the social norm feedback condition, participants reporting above-average meat consumption at baseline reduced their consumption, whereas those reporting below-average meat consumption at baseline increased their consumption over time. A plausible explanation for these findings may be statistical regression to the mean. Further understanding is needed of how social norm interventions may be used to reduce meat consumption.

Promoting rational antibiotic therapy among high antibiotic prescribers in German primary care—study protocol of the ElektRA 4-arm cluster-randomized controlled trial

BackgroundThe rational use of antibiotics is of great importance in health care. In primary care, acute respiratory infections are the most common cause of inappropriate antibiotic prescribing. Since existing studies aiming to optimize antibiotic use are usually based on the voluntary participation of physicians, general practitioners (GPs) with inappropriate prescribing behavior are underrepresented. For the first time in Germany, the ElektRA study will assess and compare the effects of three interventions on antibiotic prescribing rates for respiratory and urinary tract infections among high prescribers in primary care.MethodElektRA is a 4-arm cluster-randomized controlled trial among German GPs in nine regional Associations of Statutory Health Insurance Physicians. On their behalf, the Central Research Institute of Ambulatory Health Care in Germany (Zi) analyses all outpatient claims and prescription data. Based on this database, high antibiotic prescribing GPs are identified and randomized into four groups: a control group (N=2000) and three intervention arms. We test social norm feedback on antibiotic prescribing (N=2000), social norm feedback plus online training on rational prescribing practice and communication strategies (N=2000), and social norm feedback plus online peer-moderated training on rational antibiotic prescribing, communication strategies, and sustainable behavior change (N=1250). The primary outcome is the overall rate of antibiotic prescriptions. Outcomes are measured before intervention (T0, October 2020–September 2022) and over a period of 15 months (T1, October 2022 to December 2023) after randomization.DiscussionThe aim of the study is to implement individualized, low-threshold interventions to reduce antibiotic prescribing among high prescribers in primary care. If successful, a change in behavior among otherwise difficult-to-reach high prescribers will directly improve patient care. The increase in quality of care will ideally be achieved both in terms of the quantity of antibiotics used as well as the kind of substances prescribed. Also, if effective strategies for high prescribers are identified through this study, they can be applied not only to the antibiotics addressed in this study, but also to other areas of prescription management.Trial registrationCurrent Controlled Trials ISRCTN95468513.

Using text and charts to provide social norm feedback to general practices with high overall and high broad-spectrum antibiotic prescribing: a series of national randomised controlled trials

BackgroundSending a social norms feedback letter to general practitioners who are high prescribers of antibiotics has been shown to reduce antibiotic prescribing. The 2017-9 Quality Premium for primary care in England sets a target for broad-spectrum prescribing, which should be at or below 10% of total antibiotic prescribing. We tested a social norm feedback letter that targeted broad-spectrum prescribing and the addition of a chart to a text-only letter that targeted overall prescribing.MethodsWe conducted three 2-armed randomised controlled trials, on different groups of practices: Trial A compared a broad-spectrum message and chart to the standard-practice overall prescribing letter (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively high overall prescribing). Trial C compared a broad-spectrum message and a chart to a no-letter control (practices whose percentage of broad-spectrum prescribing was above 10% and who had relatively moderate overall prescribing). Trial B compared an overall-prescribing message with a chart to the standard practice overall letter (practices whose percentage of broad-spectrum prescribing was below 10% but who had relatively high overall prescribing). Letters were posted to general practitioners, timed to be received on 1 November 2018. The primary outcomes were practices’ percentage of broad-spectrum prescribing (trials A and C) and overall antibiotic prescribing (trial B) each month from November 2018 to April 2019 (all weighted by the number and characteristics of patients registered in the practice).ResultsWe randomly assigned 1909 practices; 58 closed or merged during the trial, leaving 1851 practices: 385 in trial A, 674 in trial C, and 792 in trial B. AR(1) models showed that there were no statistically significant differences in our primary outcome measures: trial A β = − .199, p = .13; trial C β = .006, p = .95; trial B β = − .0021, p = .81. In all three trials, there were statistically significant time trends, showing that overall antibiotic prescribing and total broad-spectrum prescribing were decreasing.ConclusionOur broad-spectrum feedback letters had no effect on broad-spectrum prescribing; adding a bar chart to a text-only letter had no effect on overall antibiotic prescribing. Broad-spectrum and overall prescribing were both decreasing over time.Trial registrationClinicalTrials.gov NCT03862794. March 5, 2019.

Provision of social-norms feedback to general practices whose antibiotic prescribing is increasing: a national randomized controlled trial

AimThe Chief Medical Officer of England writes an annual social-norms-feedback letter to the highest antibiotic-prescribing GP practices. We investigated whether sending a social-norms-feedback letter to practices whose prescribing was increasing would reduce prescribing.Subject and methodsWe conducted a two-armed randomised controlled trial amongst practices whose STAR-PU-adjusted prescribing was in the 20th–95th percentiles and had increased by > 4% year-on-year in the 2 previous financial years. Intervention practices received a letter on 1st March 2018 stating ‘The great majority (80%) of practices in England reduced or stabilised their antibiotic prescribing rates in 2016/17. However, your practice is in the minority that have increased their prescribing by more than 4%.’. Control practices received no letter. The primary outcome was the STAR-PU-adjusted rate of antibiotic prescribing in the months from March to September 2018.ResultsWe randomly assigned 930 practices; ten closed or merged pre-trial, leaving 920 practices — 448 in the intervention and 472 in the control. An autoregressive and moving average model of first order ARMA(1,1) correlation structure showed no effect of the intervention (β < −0.01, z = −0.50, p = 0.565). Prescribing reduced over time in both arms (β < −0.01, z = −36.36, p < 0.001).ConclusionsA social-norms-feedback letter to practices whose prescribing was increasing did not decrease prescribing compared to no letter.Trial registrationNCT03582072.

Persisting effects of social norm feedback letters in reducing household electricity usage in Post-Soviet Eastern Europe: A randomized controlled trial

In a large-scale randomized field experiment in Chisinau, Moldova, with over 120,000 households, we tested the influence of a simple, one-time letter presenting electricity-usage social comparison feedback. The letter was framed in either kilowatt-hour units or monetary values. We find that both letter versions significantly reduce recipient households’ electricity consumption by 1.7–2.1 percent in the following month, and the effect persists for at least three months. The effect's magnitude and duration resemble those seen in similar trials in the U.S., even though Moldova's average household electricity consumption level is much lower. As the first large-scale field experiment testing social comparison energy reports in a post-Soviet environment, this study provides empirical evidence that non-price nudges can be an inexpensive yet useful energy conservation policy tool even in non-Western and less industrialized settings. We explore the relationship between Moldova's socioecological contexts and environmental attitudes as a former Soviet Union country and the relatively strong social norm effect that we observed.

Improving Our Understanding and Practice of Antibiotic Prescribing: A Study on the Use of Social Norms Feedback Letters in Primary Care.

In the UK, 81% of all antibiotics are prescribed in primary care. Previous research has shown that a letter from the Chief Medical Officer (CMO) giving social norms feedback to General Practitioners (GPs) whose practices are high prescribers of antibiotics can decrease antibiotic prescribing. The aim of this study was to understand the best way for engaging with GPs to deliver feedback on prescribing behaviour that could be replicated at scale; and explore GP information requirements that would be needed to support prescribing behaviour change. Two workshops were devised utilising a participatory approach. Discussion points were noted and agreed with each group of participants. Minutes of the workshops and observation notes were taken. Data were analysed thematically. Four key themes emerged through the data analysis: (1) Our day-to-day reality, (2) GPs are competitive, (3) Face-to-face support, and (4) Empowerment and engagement. Our findings suggest there is potential for using behavioural science in the form of social norms as part of a range of engagement strategies in reducing antibiotic prescribing within primary care. This should include tailored and localised data with peer-to-peer comparisons.

Effect of a Social Norm Email Feedback Program on the Unnecessary Prescription of Nimodipine in Ambulatory Care of Older Adults

Nimodipine is a highly prescribed drug for the treatment of cognitive impairment and dementia in Argentina. There is little evidence to support the use of nimodipine for cognitive impairment and dementia. To test the effectiveness of a behavioral intervention based on social norm feedback to reduce prescription of nimodipine for cognitive impairment in Argentina. This pragmatic parallel-group randomized clinical trial included 2 arms with a 1:1 allocation ratio. General practitioner physicians in the national health care system for older adults in Argentina (INSSJP-PAMI) with history of high nimodipine prescription rate were enrolled. The study was conducted from May 2019 to October 2019, and data were analyzed from November 2019 to February 2020. The treatment group received 2 emails with evidence-based information about nimodipine plus the individual's level of nimodipine prescription compared with their peers. The control group received 2 emails with general information about the risks of overprescription in older adults. The primary outcome was the cumulative number of nimodipine prescriptions per 1000 prescriptions of all drugs made by the targeted physicians during the 6 months of the study. Secondary outcomes included annual monetary savings attributable to the intervention and physicians' qualitative perceptions of the acceptability of the procedure. Of 1811 physicians enrolled, 906 physicians (354 [39.1%] women; mean [SD] age, 57.10 [10.73] years) were randomized to treatment and 905 participants (331 [36.6%] women; mean [SD] age, 56.49 [10.47] years) to the control group. Physicians in the treatment group wrote a mean of 93.25 (95% CI, 89.27 to 97.24) prescriptions of nimodipine, compared with 98.99 (95% CI, 95.00 to 102.98) prescriptions among practitioners in the control group during the half-year of the intervention (mean difference, -5.73 [95% CI, -11.38 to -0.10] prescriptions; P = .046), which meant a 5.79% reduction. Regression analysis revealed a significant association of the group condition with number of prescriptions per 1000 total prescriptions when controlling for baseline prescriptions (B = -0.312 [95% CI, -0.465 to -0.160]; P < .001). The observed difference corresponds to a 4.48% reduction in nimodipine prescriptions per 1000 prescriptions of all drugs made by physicians in the treated group compared with the control group. Physicians who effectively opened the email in the treatment group (427 physicians [47.1%]) prescribed the drug 11.3% less compared with the control group (426 physicians) (mean difference, -10.78 [95% CI, -18.53 to -3.03] prescriptions; P = .006). Expenditures were 7.18% lower in the treatment group, resulting in an estimated annual net cost benefit of US $234 893.35 (95% CI, $225 565.35 to $237 112.30). In this randomized clinical trial, the social norm email feedback program showed an effect on curbing the nonrecommended prescription of nimodipine. It was highly cost-effective and well accepted by participants. ISRCTN.org identifier: ISRCTN17823729.

Youth Experiences with Social Norms Feedback: Qualitative Findings from The Drug Prevention Trial the GOOD Life.

Background: Normative feedback is an intervention strategy commonly used in drug prevention programmes. This study collected process evaluation data about how programme recipients engage with social norms (SN) feedback in The GOOD Life intervention and how they experience it. Methods: Eight focus group interviews were conducted with a total of 44 adolescents (pupils aged 14–16 years) who have participated in the social-norms-based intervention The GOOD Life. The interviews focused on three topics: (1) interest in and impact of the intervention; (2) perception of the intervention elements; and (3) suggestions for improvement of The GOOD Life. They were transcribed and analysed with content analysis. Results: The analysis revealed that The GOOD Life motivated pupils to re-evaluate their own drug use behaviour and overall met their interest regarding receiving engaging and non-moral forms of drug prevention programmes. While pupils perceived the normative feedback session in the classroom and the posters with SN messages as positive, stimulating and surprising, the web-based application with SN feedback was rarely used and less positively evaluated. Anonymity and confidentiality were regarded as essential to provide honest answers in the poll. The pupils suggested even more variety in ways to engage them and to use more gaming elements. Conclusions: SN feedback was well perceived by adolescents. The intervention met their interest and needs and was able to achieve the intended impact of challenging norm perceptions. Anonymity and confidentiality are key in order to build trust and engage adolescents in the intervention.

Mitigating Teen Driver Distraction: In-Vehicle Feedback Based on Peer Social Norms.

To investigate the efficacy of in-vehicle feedback based on peer social norms in mitigating teen driver distraction. Distraction is a significant problem among teen drivers. Research into the use of in-vehicle technologies to mitigate this issue has been limited. In particular, there is a need to study whether social norms interventions provided through in-vehicle feedback can be effective. Peers are important social referents for teens; thus, normative intervention based on this group is promising. Socially proximal referents have a greater influence on behavior; thus, tailoring peer norm feedback based on gender may provide additional benefits. In this study, 57 teens completed a driving simulator experiment while performing a secondary task in three between-subject conditions: (a) postdrive feedback incorporating same-gender peer norms, (b) postdrive feedback incorporating opposite-gender peer norms, and (c) no feedback. Feedback involved information based on descriptive norms (what others do). Teens' self-reported frequency of distraction engagement was positively correlated with their perceptions of their peers' engagement in and approval of distractions. Feedback based on peer norms was effective in reducing distraction engagement and improving driving performance, with no difference between same- and opposite-gender feedback. Feedback based on peer norms can help mitigate driver distraction among teens. Tailoring social norms feedback to teen gender appears to not provide any additional benefits. Longer-term effectiveness in real-world settings should be investigated.

The effectiveness of repeating a social norm feedback intervention to high prescribers of antibiotics in general practice: a national regression discontinuity design.

Unnecessary antibiotic prescribing contributes to antimicrobial resistance. A randomized controlled trial in 2014-15 showed that a letter from England's Chief Medical Officer (CMO) to high-prescribing GPs, giving feedback about their prescribing relative to the norm, decreased antibiotic prescribing. The CMO sent further feedback letters in succeeding years. We evaluated the effectiveness of the repeated feedback intervention. Publicly available databases were used to identify GP practices whose antibiotic prescribing was in the top 20% nationally (the intervention group). In April 2017, GPs in every practice in the intervention group (n=1439) were sent a letter from the CMO. The letter stated that, 'the great majority of practices in England prescribe fewer antibiotics per head than yours'. Practices in the control group received no communication (n=5986). We used a regression discontinuity design to evaluate the intervention because assignment to the intervention condition was exogenous, depending on a 'rating variable'. The outcome measure was the average rate of antibiotic items dispensed from April 2017 to September 2017. The GP practices who received the letter changed their prescribing rates by -3.69% (95% CI=-2.29 to -5.10; P<0.001), representing an estimated 124 952 fewer antibiotic items dispensed. The effect is robust to different specifications of the model. Social norm feedback from a high-profile messenger continues to be effective when repeated. It can substantially reduce antibiotic prescribing at low cost and on a national scale. Therefore, it is a worthwhile addition to antimicrobial stewardship programmes.

Social norm feedback reduces primary care antibiotic prescribing in a regression discontinuity study.

Reducing antibiotic prescribing is a priority for health authorities responsible for preventing antimicrobial resistance. Northern Ireland has high rates of antimicrobial use. We implemented a social norm feedback intervention and evaluated its impact. To estimate the size and duration of the effect of a social norm feedback letter to GPs who worked in the 20% of practices with the highest antimicrobial prescribing. The letter was sent in October 2017 to 221 GPs in 67 practices. To assess the effect of the intervention, we used a sharp non-parametric regression discontinuity (RD) design, with prescribing rates in the four calendar quarters following the intervention as the outcome variables. In the quarter following the intervention (October to December 2017) there was a change of -25.7 (95% CI = -42.5 to -8.8, P = 0.0028) antibiotic items per 1000 Specific Therapeutic group Age-sex Related Prescribing Units (STAR-PU). At 1 year, the coefficient was -58.7 (95% CI = -116.7 to -0.7, P = 0.047) antibiotic items per 1000 STAR-PU. The greatest change occurred soon after the intervention. Approximately 18900 fewer antibiotic items were prescribed than if the intervention had not been made (1% of Northern Ireland's annual primary care antibiotic prescribing). A social norm feedback intervention reduced antibiotic prescribing in the intervention practices. The diminishing effect over time suggests the need for more frequent feedback. The RD method allowed measurement of the effectiveness of an intervention that was delivered as part of normal business, without a randomized trial.

Encouraging energy conservation at work: A field study testing social norm feedback and awareness of monitoring

The financial cost of personal energy consumption is substantial at the organizational level. Rarely do incentives for saving energy for the individual employee and organization align, making conservation a challenge. Here we perform a 12-week field experiment piloting two behavioral strategies: (1) social norms feedback and (2) awareness of energy monitoring, to encourage savings among 46 administrative staff at a university who were given the impression of participating in an energy quality study to reduce self-selection bias. Those in the social norms feedback condition used significantly less energy during the intervention (10% less energy) and follow up monitoring (11% less energy) phases compared to their baseline consumption. Moreover, these participants demonstrated that they learned more about their energy use than did those in the awareness monitoring condition. For policy makers and building mangers interested in the effectiveness of behavioral nudges in inducing energy savings, social norms feedback appears to be an effective energy savings nudge in an organizational setting where there are neither financial savings at-stake nor intrinsic motivation to conserve.

A Critical Appraisal of the Social Norms Approach as an Interventional Strategy for Health-Related Behavior and Attitude Change.

The Social Norms Approach is a widely used intervention strategy for promoting positive health-related behaviors. The Approach operates on the premise that individuals misperceive their peers’ behaviors and attitudes, with evidence of under- and over-estimations of behaviors and peer approval for a range of positive and negative behaviors respectively. The greater these misperceptions, the more likely an individual is to engage in negative behaviors such as consuming heavier amounts of alcohol and other substances and reduce positive behaviors such as eating healthily and using sun protection. However, there are many complexities associated with the use of social norms feedback in interventions and empirical studies. Many social norms interventions do not attempt to change misperceptions of social norms or measure changes in normative perceptions pre- and post-intervention. This has led to a conflation of generic social norms interventions with those that are explicitly testing the Approach’s assumptions that it is misperceptions of peer norms which drive behavior. The aim of the present review was to provide a critical appraisal of the use of the Social Norms Approach as an intervention strategy for health-related behaviors, identify the current issues with its evidence base, highlight key opportunities and challenges facing the approach, and make recommendations for good practice when using the approach. There are three core challenges and areas for improved practice when using the Social Norms Approach. Firstly, improvements in the methodological rigor and clarity of reporting of ‘social norms’ research, ensuring that studies are testing the approach’s assumption of the role of misperceptions on behaviors are differentiated from studies investigating other forms of ‘social norms.’ Secondly, the need for a more explicit, unified and testable theoretical model outlining the development of normative misperceptions which can be translated into interventional studies. Finally, a need for a more robust evaluation of social norms interventions in addition to randomized controlled trials, such as the inclusion of process evaluations, qualitative studies of participant experiences of social norms feedback, and alternative study designs better suited for real-world public health settings. Such improvements are required to ensure that the Social Norms Approach is adequately tested and evaluated.

Designing feedback to mitigate teen distracted driving: A social norms approach

ObjectiveThe purpose of this research is to investigate teens’ perceived social norms and whether providing normative information can reduce distracted driving behaviors among them. BackgroundParents are among the most important social referents for teens; they have significant influences on teens’ driving behaviors, including distracted driving which significantly contributes to teens’ crash risks. Social norms interventions have been successfully applied in various domains including driving; however, this approach is yet to be explored for mitigating driver distraction among teens. MethodForty teens completed a driving simulator experiment while performing a self-paced visual-manual secondary task in four between-subject conditions: a) social norms feedback that provided a report at the end of each drive on teens’ distracted driving behavior, comparing their distraction engagement to their parent’s, b) post-drive feedback that provided just the report on teens’ distracted driving behavior without information on their parents, c) real-time feedback in the form of auditory warnings based on eyes of road-time, and d) no feedback as control. Questionnaires were administered to collect data on these teens’ and their parents’ self-reported engagement in driver distractions and the associated social norms. ResultsSocial norms and real-time feedback conditions resulted in significantly smaller average off-road glance duration, rate of long (>2s) off-road glances, and standard deviation of lane position compared to no feedback. Further, social norms feedback decreased brake response time and percentage of time not looking at the road compared to no feedback. No major effect was observed for post-drive feedback. Questionnaire results suggest that teens appeared to overestimate parental norms, but no effect of feedback was found on their perceptions. ConclusionFeedback systems that leverage social norms can help mitigate driver distraction among teens. Overall, both social norms and real-time feedback induced positive driving behaviors, with social norms feedback outperforming real-time feedback.

A Randomized-Controlled Trial of Social Norm Interventions to Increase Physical Activity.

Physical activity confers numerous health benefits, yet few adults meet recommended physical activity guidelines. The impact of brief messages providing descriptive and injunctive social norm feedback on physical activity was tested in this conceptual pilot study. Young adults (N=111) were randomly assigned to one of three conditions: descriptive norm feedback, descriptive-plus-injunctive norm feedback, or no social feedback (control condition). Participants used pedometers for eight weekdays and recorded their step counts each evening. The descriptive norm group received feedback about the average number of steps taken by group members the previous day. The descriptive-plus-injunctive norm group received feedback about the group average, as well as a sad face if the participant was below the average or a happy face if the participant was above the average. The control group received no feedback throughout the study. By days 7 and 8, the descriptive-plus-injunctive norm group reported significantly more steps relative to the control group, whereas the descriptive norm group showed a trend toward higher step counts relative to the control group. These effects did not differ for participants above versus below the group average at baseline. The combined use of descriptive and injunctive social norms increased physical activity over a short period. This simple feedback strategy has potential for achieving wide reach and dissemination on its own or combined with more comprehensive interventions. This initial evidence can guide larger trials of longer duration. The trial was registered with the ClinicalTrials.gov database (NCT02710201).