Applying Behavioural Insights to Policy:
From Evidence to Practice
Executive Summary
Authors
Hannes Jarke, University of Cambridge
Grihith Varaday, University of Cambridge 
Kai Ruggeri, Columbia University & University of Cambridge
Evidence from the behavioural sciences is increasingly used to
inform and improve policy around the world across many domains.
These behavioural insights can be used for a number of purposes,
such as improving communication to the public, encouraging
healthier behaviour, and increasing the uptake of social services
that improve life outcomes. However, not all evidence can be
equally applied to any policy; the strength of the evidence and
suitability for the situation at hand should be assessed case by case
and ideally more evidence within the new context should be
established. This report presents an approach to incorporating
behavioural insights into policy using a number of examples while
leveraging original work on mental health, trust, and decision-
making in Lebanon. The aim is not to present a specific recipe or set
of recommendations, but to share general concepts and examples
for consideration in establishing a behavioural policy framework.
This report complements our workshop on evidence-based policy
and provides basic information to participants in advance.
This publication is funded through the UK Research and Innovation GCRF
Research for Health in Conflict (R4HCMENA); developing capability,
partnerships and research in the Middle and North Africa ES/P010962/1.
Introduction
What are behavioural insights?
The success of a policy largely depends on the assumptions it is built on. This includes
tailoring a policy to the environment where it is applied as well as anticipating how the
target population will react to it. While policies for decades relied on economic models
assuming that people think rationally and want to maximize their outcomes, research from
behavioural and decision sciences has shown that decisions are dependent on a number of
internal motivators and external factors. Accounting for such factors based on reliable
evidence can therefore improve policy outcomes and acceptance.
What are the advantages of behavioural insights?
Behavioural policy is typically implemented through small changes in the environment
(see next page) with positive effects and without coercion (‘nudging’). For example, having
found that surgeons are often under stress and can forget minor but crucial checks, the
WHO developed a checklist that was associated with an error reduction from 23% to 6%1.
Instead of assuming that people will behave in a fully rational and error-free way, by
incorporating behavioural insights, we can account for actual behaviour.
Why build on behavioural insights in Lebanon?
For this report, we will predominantly focus on the interplay of behaviour and health: The
behaviours and habits of non-clinical populations may increase or decrease the risk of
subsequent health problems. This includes habits relating to diet, exercise, smoking,
driving, and more. At the point of service delivery, doctors make decisions relating to
diagnoses and treatment, patients make decisions with regards to when to seek aid,
whether to keep appointments, whether to follow the doctor’s prescriptions, etc.
Therefore, behavioural science can be used to inform proactive interventions, designed to
increase the overall health of the population and reduce pressure on healthcare providers
as well as set up interventions that makes the service delivery itself more efficient and
effective. This report aims to provide guidance on translating behavioural and mental
health research into policy, building on a practice previously successful in Lebanon2.
Common behavioural interventions
Choice architecture
We face numerous decisions every day. Some of these decisions may be
conscious and deliberate (such as buying a car), while others are less thought
out, such as selecting a beverage for lunch, or deciding on which side of the
road to walk. Choice architecture is a way of designing the environment in
which decisions are made in a way that the more beneficial option is more
likely to be chosen. As a result, we ideally make more directly beneficial
decisions – for ourselves or for society – without giving away our freedom of
choice. Two common ways to do this are nudges and boosts.
Nudges Boosts
Nudges are low-cost, easy-to-
implement interventions that alter
the environment of a decision in a
way that highlights a more beneficial
option3.
If the goal was to have people eat
healthier, one example of a nudge
would be placing healthy food
options more visibly or salient. This
preserves a person’s free choice of
meal, but still increases the number
of people who choose healthy
nutrition.
Boosts aim to foster a decision-
makers competence or build new
competence regarding the choice
at hand, often by encouraging a
more informed, deliberate
process4.
Boosts can involve simple tools
such as calculators for determining
budget allocations or interactive
apps from grocery stores that help
consumers estimate health value
of their choices as they shop.
. .
. .
.
Consider what influences 
decisions
In classic economic models, humans are
assumed to always act rationally and gain-
oriented - that is, choosing to their highest
benefit. This is often the case in decisions
with certainty, where the outcome is clear:
we would prefer $120 over $100 if given the
choice. When it comes to decisions under risk,
humans do not always choose the option with
the highest potential value – this is because
gains and losses are not perceived equally5. In
other words: the prospect of losing $100 often
appears more dangerous than the prospect of
winning $100 seems appealing. This is not
only limited to decisions regarding money.
Value
Outcome
Losses
Gains
Reference point
Based on an individual’s reference point, they may make different decisions,
which is why framing a message or situation6 is important to consider: telling
a patient that 90% of people survive an operation is much more comforting
than being told that there is a 10% chance to die.
Not only the reference point is important when communicating with the
public: People engage with information more if it is salient and simple. One
large-scale study showed that letters simplifying their content, or using short
bullet points receive more responses, than a standard text7.
+1.4%
+3.9%
Simplified Bulletpoints
Communicating effectively
Simply not being aware of available public
services is a crucial structural barrier to the
uptake of healthcare services. Evidence
suggests large differences in education
between the Lebanese population and
refugees8, and also the generally low
healthcare service uptake of Syrian refugees9:
These findings alone may not give clear indications for policy but indicate
that further testing of simplifying messages may reveal how uptake could
be increased through small changes in communication.
Only 6% of Lebanese adolescents affected
by mental disorders report to have sought
help10. Social stigma is a common barrier
for people all over the world to access
mental health services11. Behavioural
insights can be used to support people in
their choice to seek help. One example of
engaging people affected by a stigma-
heavy disorder is the successful use of
financial incentives for HIV testing in
Malawi. Participants collected test results
more often when given a small financial
incentive12.
Reducing mental health stigma 
Mental health literacy has been identified as one of the crucial aspects in
reducing barriers to mental healthcare11. While reducing stigma on a wider
level is a complex and complicated task, it can be achieved through
education, as well as through contact with stigmatized groups13,14.
37%
80%
No incentive Vouchers
Stigma interventions can be more
effective in different age groups…
Education
Contact
Replacing stereotypes 
with facts
Interacting with 
members of 
stigmatized groups
St
ig
m
a
re
d
u
ct
io
n
20%
10%
10%
Face-to-face contact has larger impact than by video.
24%
10% Adolescents Adults
20%
Addressing stigma with behavioural insights 
C
o
lle
cted
 H
IV
 test resu
lts
Adapted from Bojanić et al. (2016)
Providing patients an active role in their treatment
71%
of patients prefer to
have an active role in
treatment decisions16
A?
B?
C?
17%
10% Higher completion rates18
Higher life satisfation18
58%
Chance to show higher improvement19
Potential benefits of involving patients in decision-making
Increases 
trust
Increases 
uptake?
Lebanese and refugees report very low trust towards others but put much
higher trust in family members8, which may also explain some successes of
former Syrian healthcare workers in refugee camps15. More and more
patients prefer to make active decisions in their own healthcare16. Evidence
also indicates that patient involvement is often related to an increase in trust
into the healthcare system17.
Trust plays a large role in the decision to start treatment
and choosing a physician or provider.
Which Treatment?
Despite knowing about many health
outcomes, people often neglect simple
beneficial behaviours such as taking
their medication as scheduled or
showing up to healthcare
appointments.
Brief text-message reminder messages
can improve various kinds of health
behaviours, such as medicine
adherence20 or support smokers in
quitting21.
x2
+33%
Reminding people to carry 
out daily healthy behaviours
E-Mental Health interventions
The use of digital applications in mental healthcare remove the barrier of
requiring patients to be physically present at a care facility or provider. This
has been particularly helpful since the start of the COVID-19 pandemic22.
However, clear ethical guidelines are still missing.
High satisfaction as well as positive
attitudes towards apps among
refugees and immigrants22
Symptoms improve in…
Anxiety
Depression
Post-Traumatic Stress Disorder
However…
Poor implementation and reporting 
of ethical standards so far
Preliminary results exist regarding
one WHO guided E-Mental health
intervention in Lebanon23. The
intervention is a brief self-help
programme with minimal
guidance.
While the intervention shows
potential effects on depression
and anxiety, the study also found
that it needs to be better tailored
to younger people and singles,
made more motivating, and easier
to use.
Example: Behavioural insights and mental health in Lebanon
When using evidence to inform policy, it is always crucial to remember that
populations often differ from another. It is reasonable to assume that
refugees—who have left their homes and are more likely to have recently gone
through other traumatic events—feel and behave differently from the average
population of the host country. If the goal is to develop inclusive policies, a
first step could be to capture and compare levels of well-being.
Researchers tried to 
find out how 
strongly refugee 
well-being may 
differ from local 
populations. 
Surprisingly, there 
were no significant 
differences in any 
dimension in a 
sample of over 600 
people in Lebanon8.
Well-being in 
Lebanese nationals 
and refugees
Can policy be derived from these findings alone?
Will refugees with low or high well-
being behave like Lebanese with low
or high mental health?
Exploring traits of the population
Well-
Being
Positive 
Relationships
Optimism
Emotional 
Stability
Resilience
Engagement
Vitality
Positive 
Emotions
Self-Esteem
Meaning
Competence
Lebanese Refugees
The role of mental health in risk-taking: 
Example from Lebanon
No differences in 
risk-taking on average
While both are in a very different situation, researchers found that
refugees in Lebanon make about the same amount of risky financial
decisions as the general population. Both groups take more risk when
choices involve losses8.
Does mental health play a role in decision-making?
How could we encourage more risky decisions, when they
are beneficial, especially in those with poor mental health?
If well-being is…
Poor to 
moderate
Lebanese and 
Refugees make 
similar decisions
Data shows…
High
Refugees make 
more risky 
choices
Findings reported on this and the previous page are based on research by the authors,
currently under review.
What are the reasons for 
poor/good mental health?
Which other factors need 
to be taken into account?
Where are risky choices 
beneficial or suboptimal?
When do we need other 
measures of risk?
Developing policies using scientific evidence
What is the issue?
• Define target population & outcome for improvement
• Can be proactive to create opportunity, prevent 
unwanted situation, or  treatment for persisting issue
How useful is the 
available evidence?
• Quality, accuracy, and objectivity of evidence
• Credibility: Is there a clear argument for the use of 
methods and conclusions drawn?
• Practicality: Is the evidence accessible and 
interventions feasible to implement?
Is the evidence 
valid in context?
• Relevance: Can it be generalised? 
• Is evidence appropriate for this population & context?
Conduct research in 
context
Adapt best 
practices to context
• Clarify and operationalise research goals
• Adapt methods to context
• Identify factors that distinguish the situation at hand 
from those previous research has been conducted in
• Scaling: Moving from controlled projects to wider 
implementation
• Phasing: Breaking down implementation in stages
• Sensing: Evaluating the practice
This process is based on information compiled in Ruggeri et al. (2019)
A process model generating and incorporating evidence into policy24
G
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