by Roger Dooley
I hope you find The Persuasion Slide to be a useful way of thinking about your own persuasion tasks.
In particular, I hope you extend its utility by building you own ideas into its framework. When you read about a new academic research finding or explore a business success story, think about how one or more elements of it might fit into a Persuasion Slide that you are working on.
It’s been many months since I formulated the slide model, and I find myself looking at business problems and saying things like, “Too much friction!” and “That’s a really weak nudge!”
In particular, thinking about conscious and non-conscious factors separately forces us to focus on those often overlooked persuasion elements that aren’t features, benefits, or price.
Free Resources
To help readers begin applying The Persuasion Slide to their own marketing efforts, I’ve created a free workbook. Just go to rogerdooley.com/ps to download it.
The Persuasion Slide is still evolving. As I get feedback at speaking or consulting engagements or via my blogs, I continue to refine it.
I hope you can be part of that process – drop me a note or ping me on social media. To connect with me in any way or to get updates on The Persuasion Slide, start by visiting: rogerdooley.com/ps or ping me on Twitter at @rogerdooley.
In addition to your suggestions for improvement, I’d love to hear any success stories from applying these principles. And if they failed you, let me know why you think that is.
I look forward to hearing from you!
Appendix: Real-World Slides
We have focused mainly on digital applications in the book.
While simple web persuasion tasks can be easily visualized in terms of The Persuasion Slide model, getting people to do things in the real world can be more difficult.
I’ve included a few examples in this chapter that show how the model can be applied to less-obvious persuasion tasks. You may be able to draw parallels to some of your own needs.
But, if they don’t apply to your situation, feel free to skip this appendix.
Example: Compliance With Medical Instructions
You may or may not be surprised to know that many patients fail to comply with their doctor’s instructions.
Sometimes, those instructions may be genuinely difficult to follow, like “stop smoking” or “lose 50 pounds.” Thousands of books have been written about accomplishing these challenging but important behavior modifications.
Often, though, even relatively simple directions are ignored or followed incompletely. Studies around the world show that often fewer than half of patients comply with treatment instructions.
This is true even for something as simple as taking pills. People typically take less than half the prescribed doses when medication is self-administered.
There are a host of reasons why people might not follow instructions. Difficulty and effort may be major ones. The expense of doing so may be a factor.
During a recent Ebola outbreak in Africa, some people didn’t follow the instructions for medically safe burial of victims for cultural or religious reasons.
We can’t solve all of these complex problems here, but we can offer a simple example.
Getting a Patient to Take An Entire Course of Antibiotics
Antibiotics have dramatically increased the lifespan of humans by ensuring that simple infections don’t kill us all.
But, they don’t remain effective forever. Bacteria can become resistant to particular antibiotics to the point where those antibiotics are no longer potent enough to eliminate the infection.
There are multiple reasons for the rapid evolution of these resistant strains, but a major one is the failure of many patients to take the full quantity of pills.
A patient may be instructed to take the pills for ten days. Often, though, the patient feels much better after a day or two. By day five or six, continuing the drugs may seem pointless. Why take any more drugs than you have to?
The problem with stopping early is that a small percentage of the bacteria may not have been killed at that point. These were the ones able to resist the drug for longest, and now begin reproducing many more resistant bacteria. Over time, truly resistant strains evolve.
So, if you were a medical professional, how would you employ The Persuasion Slide to get patients to take their drugs as instructed?
The Typical Scenario
Usually, patients who are prescribed antibiotics have come to a medical office because they have some kind of an infection. It might be painful, or they may feel ill and feverish.
At that point, symptom relief is the patient’s main driving force.
After being diagnosed, the patient is handed a prescription with the dosing instructions and, in most cases, reminded to take them all.
The patient fills the prescription at a pharmacy, where personnel may repeat the directions verbally as well as providing them in written form.
For some drugs, just getting the prescription filled may be a point where things break down. If the patient has no symptoms, things like cost, convenience, or fear of taking medicine may outweigh the weaker motivation of avoiding problems in the remote future.
But, for this example, we’ll assume that the patient is highly motivated and picks up the pills.
It’s also a good bet that the high level of initial motivation will ensure the patient takes the first few doses more or less as directed.
After that, the outcome is less certain. Often, the first few days of taking the antibiotic will relieve the patient’s symptoms.
With no pain or fever, the patient feels “cured.”
At that point, continuing to take the medication is less certain. Some patients may prefer not to take any more medication than is necessary to relieve symptoms.
In other cases, the lack of symptoms means there is no external trigger to remind the patient to take the pills. The timing may be more erratic, doses may be missed, and the patient may simply stop at some point.
Regardless of the reason, failing to complete the course of antibiotics is bad for the patient and bad for society.
Gravity – The Patient’s Motivation
To get the patient to fill the prescription and begin taking the medication, relatively little motivation needs to be added. The patient is suffering, and is highly motivated to seek relief.
In designing our slide, when possible nudges and motivation efforts should take the patient’s primary drivers, symptom relief and continued health, into account.
The Nudge
The nudges that count in this process are those needed to get the patient to fill the prescription and take the medication as directed each day.
This is a bit different than a simple conversion on a website, as it’s actually a series of events. There’s the event to fill the prescription, and then, if the prescription is to be taken twice a day for 10 days, 20 other events that must happen.
We know that the patient is motivated by unpleasant symptoms, so the initial nudges won’t be too critical. Handing the patient a prescription and providing simple “two per day” instructions might be enough for the first day or two.
The symptoms and discomfort will be constant reminders to keep taking the pills.
But, what happens after a few days?
Enhanced Nudging
Once the symptoms are gone, the remaining nudge in most cases is the visible prescription bottle. Patients may leave it on the bathroom sink or kitchen counter as a reminder to take the medication as part of another routine, like eating a meal or brushing one’s teeth.
This is a rather weak nudge for people whose lives aren’t highly regimented or who are preoccupied with other matters as they perform their daily routine.
Other sources of failure are confusion and forgetfulness. The patient probably remembers when she took the first few doses.
Once the behavior has become fairly routine, though, there’s a good chance that the patient won’t recall taking a sp
ecific dose. In that case, they may accidentally either take an extra dose or skip one.
A variety of solutions for better nudging for all kinds of medications have been developed.
Labeled pill holders let the patient put the pills in slots for specific days and times. That eliminates confusion, and if taking medications is a strong habit already compliance should be high for the new one.
Sometimes, pills meant to be taken daily are issued in blister packs with days of the week printed by each pill. This reduces the chance of missing doses due to confusion. Antibiotics are more commonly issued in bottles, but adapting the labeled blister-pack method to, say, a morning and evening dose for ten days would be feasible.
In fact, “reminder packaging” of either the blister pack or prefilled pill boxes has been shown to increase compliance by 11-13%.15
Those nudges are weak, though, and many patients may need something stronger.
There are a variety of pill holders equipped with electronic timers and alarms. The holder, programmed by the user for the specific dosing times, provides an audible announcement when each time arrives.
There are also smart phone apps that operate in a similar manner. One study found 160 such apps16, and today the total is surely higher.
One failure point with these better nudges is that they require effort by the patient to configure. Some may require purchasing items like apps or electronic pill boxes. Most patients are unlikely to do it.
To ensure optimal nudging, the patient could be issued the antibiotics with the nudging schedule already set. An electronic pill holder could be loaded with pills and pre-programmed by the pharmacy.
As an alternative, a series of automated emails, phone calls, or SMS messages could be programmed as reminders. Electronic reminders, particularly SMS messages, have been found to be effective in increasing compliance.17
Better Nudges, Better Results
In short, a broad swath of research shows that more effective nudges do increase compliance with medication instructions.
Better nudges are just the start, though. By themselves, they won’t convince skeptical patients to take pills they think are no longer needed.
The Angle – Motivation from Health Care Professionals
As in every slide, we can employ both conscious and non-conscious motivation in our persuasion efforts. And, both will be necessary to maximize the number of patients taking the full course of antibiotics.
Conscious Motivators
We know the customer’s primary motivation is to become healthy and alleviate symptoms. Therefore, the first conscious motivator is to explain that adherence to the instructions is the only way to achieve that.
Specifically addressing the concept that the symptoms may go away early in the treatment process is important. The patient must be informed that the absence of symptoms does not mean that the infection is gone. Failing to maintain the regimen could result in the return of the symptoms and perhaps an infection that is more difficult to treat.
Presenting patients with simple statistics showing, say, how often infections reoccur when antibiotics are stopped early, will underscore the importance of taking them as directed.
Psychologists call behaviors that don’t directly benefit the individual but do help the larger community “pro-social.” In the case of antibiotics, there’s an important benefit to everyone if their potency can be maintained.
According to the US Centers for Disease Control, each year 2 million people are sickened by antibiotic-resistant bacteria and 23,000 die from such infections. An explanation of how antibiotic-resistant bacteria are created, along with statistics like these, could stimulate the pro-social act of taking the full regimen even after the symptoms were gone.
Non-Conscious and Emotional Motivators
There are hundreds of techniques we could use as non-conscious and emotional motivators. We can’t be exhaustive here, and, as far as I know, none of these has been tested in a clinical study. So, we’ll look at a few representative examples.
Amping up Altruism. Humans tend to be altruistic, though they may not always favor helping others over their own self-interest. In this case, we’ve already demonstrated that it is in the patient’s own interest to take all of their pills. Above, we showed that it’s also a benefit to society at large.
This appeal could be made more personal by using more tangible versions of those numbers. Someone from Texas, for example, could be told that the people who become ill are the same as the entire population of Houston, and the number of deaths would be more than the entire population of Paris, Texas (or another small city the patient would know).
Yet another approach would be to use the single victim technique. Studies have shown people are more generous when they see a photo of a single needy child compared to a group. So, showing a photo and telling the story (also a powerful technique) of a real child who died from an antibiotic-resistant infection could be particularly effective.
Social Proof. Time and time again, research has shown that people will do what they think other people are doing. Robert Cialdini proposed social proof as one of his six principles of persuasion.
In a recent experiment described by Cialdini and his co-authors in The Small Big, a British tax authority tried multiple approaches to collect overdue taxes, including explaining the serious consequences of non-compliance.
What proved to be the most effective approach, though, was to truthfully inform the delinquents that most people like them paid their taxes on time.
Another real-world experiment described by Cialdini showed that telling people their neighbors were saving energy was more effective at cutting electricity use than highlighting cost savings or explaining the environmental impact.
Sharing an appropriate, truthful statistic showing that most patients do take all their antibiotics might be the most effective approach of all.
Reducing Friction
To get people to begin their course of pills, providing them with the actual pills and perhaps even supervising the first dose would be a very low friction way to start the process. It eliminates the trip to the pharmacy with a separate payment process, and ensures the first dose has been administered.
Some of the devices I described in the “nudge” section also serve to reduce friction. The dose is obvious and pre-set. Most confusion about whether a dose was taken or not is eliminated.
Non-conscious friction. One study found that the type font that medical instructions were printed in changed compliance levels.18 A harder to read font made the instructions seem more difficult to follow and fewer patients complied.
This effect is a fluency bias. When something is a bit harder for us to process, like instructions printed in a fancier font or in a low-contrast color, that difficulty is transferred to the described action.
To minimize this “imaginary” friction, instructions should be short, the fonts simple, and contrast high.
Multi-stage Slide Example: College Enrollment
Imagine the task of the executive in charge of admissions at a university. A common pain point for this role is the need to attract either more students or better-qualified students. She has to get potential students to take multiple steps.
Even in the simplest scenario, prospective students must first consider the school, take a proactive step like visiting the website or requesting information, then actually apply, and finally to agree to attend if they are admitted.
Slide 1 – Making the “List”
Often, these complex processes can be broken into multiple smaller slides. So, getting the high school student to add the college to his list of possibilities could be the first slide in a multi-slide process.
The college will need to nudge the student to build awareness and perhaps consume some information about the school – visit a website, read a brochure, watch a video, etc.
This slide is mostly about aligning the messaging with the student’s needs and providing enough motivation to ensure the c
ollege makes the initial cut.
Conscious motivators like campus resources, faculty reputation, career outcomes, and so on are important. Even when there is a strong emotional component to the decision, the multiple parties involved in the decision (parents, student, counselors, peers, etc.) will pay attention to these things and compare schools based on them.
Non-conscious motivators can be very powerful – many students consider just one school because of a family affiliation, local familiarity, or even a favorite sports team.
For students planning to commit four years of their life to a school, an emotional fit is often as important as the school’s resources and reputation.
In their marketing efforts, some schools eschew the detailing of features and benefits of their institution and try to convey an emotional vibe.
In this phase, depending on the type of student and the number of colleges he is considering, a successful outcome would be for the student to decide to add the school to his list. This list might include just a few schools or a dozen or more. Since the process is mainly in the head of the student, friction isn’t much of a factor.
Another successful outcome from the initial slide would be for the student to request more information from the school. That would put the student on the school’s radar for further follow-up and would also give them the direct chance to encourage the next step: completing an application.
Slide 2 – The Application
Not many years ago, the “application” slide would have been one of the most difficult steps in the process. Applying to a school involved a great deal of friction. Each college had a multi-page application that required unique essays and differed in both format and content from other college applications.