Using behavioural insights to change COVID-19 related public behaviour in Pakistan
Pakistan had its first confirmed COVID-19 case on 26th February this year. The first strategic impulse of all relevant stakeholders was to spread awareness about the virus and its prevention using all communication channels available. We saw an influx of messaging from development agencies, national and provincial governments, and media all at once. As a risk communication measure, our response required better coordination — to avoid creating confusion, misinterpretation and diffusion of responsibility.
To respond to the misleading guides and assumptions, a centralized communication strategy was developed in the COVID-19 response war room, housed at the Ministry of Health in collaboration with Digital Pakistan and other partners,  forming the Risk Communication and Community Engagement (RCCE) task force. The RCCE helps structure the information, with gatekeepers to manage the content and curation.
It ensures that all content is culturally sensitive, authentic in information, does not imply an exaggerated or under-represent the threat level, and empowers the audience.
Our challenge: can we be innovative? Introducing the ringtone message
For public campaigns, it is of utmost importance to use communication channels with the widest reach, but quite often there is a trade-off between reach and cost. This was exactly the challenge faced in the early days of COVID-19 in Pakistan. Below are the national level statistics that give perspective to the options that were available to us:
Our findings from Gallup Pakistan showed that using mobile phone channels for mass public messaging in Pakistan stands out in the trade-off between reach and cost. This brought the next question for us: what modality should be used within the mobile phone channel? We had the usual options such as blast SMS, SMS chatbot and Robocall but each had their drawbacks — low population literacy rates affected the usefulness of SMS; and non-response or immediate cancellation of calls upon start of the message to Robocalls.
Finding an opportunity to innovate to overcome this challenge, UNDP Innovation - AccLab Pakistan, came up with the idea of replacing the usual mobile phone ringtone with a recorded health message (labelled as ‘ringtone message’ from here on). The idea was simple - every time you call someone (even on a feature phone), you would hear the ringtone message.
After honing the idea further and developing messages for the first wave, the recording, implementation and dissemination was done in collaboration with Digital Pakistan, Ministry of Health, Eocean and Pakistan Telecommunication Authority.
The ringtone message was a clear winner among the different communication channels because not only it had the most outreach but was also the most cost effective. In addition, the message would get delivered to each person directly.
So what has been the impact of the ringtone message? We share the results in the next section.
Impact results of the ringtone message
Over 113 million people across the country directly heard the ringtone message, making it by far the most effective communication medium adopted by the Government of Pakistan.
The results were computed from Gallup Pakistan’s Coronavirus Tracker Wave 3 - 5 based on nationally representative samples.
The ringtone message had a positive impact on knowledge, perception and actual behaviours related to COVID-19 in Pakistan.
Behavioural insights underlying our creative process of the messages
One of the reasons leading to the successful impact of ringtone messages has been our effort to embed behavioural insights in the development of these messages.
Behavioural science represents a developing but established approach to understanding human behavioural change. Built on a strong scientific heritage, it draws on insights and methods from psychology, economics and neuroscience. Fundamentally, it challenges the view that people always behave with rational self-interest. Evidence shows that people often make decisions intuitively, effortlessly, with little conscious awareness and based on what others are doing. Crucially, an understanding of behavioural science provides a practical approach to overcoming barriers to change.
We carried out a rapid literature review to gather evidence of what has worked and what hasn’t worked in the past when it comes to changing behaviours like washing hands, wearing masks, maintaining physical distance, and so on. Based on the evidence and latest insights from behavioural science, we formulated a checklist ,,, to follow when developing each of the ringtone messages. It is fair to say that we improved upon each iteration.
While the impact evaluation shows positive effects of the ringtone message, we need to humbly acknowledge that this doesn’t imply that the behaviour change challenges are fixed now. The baseline measures for some of the indicators are still not where we would ideally like them to be (e.g. 55% of the people still perceive the threat of coronavirus being exaggerated). We have learnt many valuable lessons so far and there is a lot more that we hope to achieve.
In our next blog, we will share with you how each ringtone message was developed, the behavioural insights behind them and the inherent nuances of the timing and implementation of the ringtone messages.
These messages (see: Annex) have been proven effective and will continue to bring awareness and using precautions in direct reference to the progressing situation.
 Gallup Pakistan Media Habits Reports released yearly, data updated till 2019
 Gallup Pakistan Coronavirus Attitude Tracker Survey 2020, Wave 6
Javeria Masood is Head of Solutions Mapping at Innovation-AccLab Pakistan. You can follow her on twitter @javeria_mh
Dr. Umar Taj
Senior Behavioral Science Consultant
*First author's note: This has been a heavily coordinated initiative, involving a number of people without whose support these messages would not have been possible. Tania Aidrus (Digital Pakistan), Eocean Private Limited and Pakistan Telecommunication Authority (PTA) for the ultimate implementation and disseminating of my idea of trying ringtone messages. Dr. Zaeem Haq from the Ministry of Health, for providing quick feedback and approvals! Thank you, Shehr Bano and Ubaid for your help with the script, Tayyaba Seher and Faizan Haque for the recordings, and Dr. Umar Taj for now joining and adding more insights to this initiative. To test the effectiveness of these messages, surveys were recently done through Gallup Pakistan.