Blog Post
The Science of Sticking to it: How Commitment Bias Drives Behavior Change
Humans naturally lean towards consistency. We want our past actions and promises to be consistent with our future actions. Remaining consistent with earlier actions is a way to conserve mental energy, which we naturally prefer. Once we say “yes” to completing an action, we are more likely to stick with it. This is known as commitment and consistency bias—a well-established principle in behavioral science.
Robert Cialdini, author of “Influence: The Science of Persuasion,” outlines that once an individual takes a stand or makes a choice, they encounter significant internal and interpersonal pressures to behave consistently with that commitment. This psychological drive stems from a desire to maintain a stable self-image and avoid the discomfort of cognitive dissonance, which occurs when one's actions contradict one’s beliefs or previous decisions. He also mentions that social pressure is an important factor; we don’t want to be perceived as “flip-floppers,” “unreliable,” or “indecisive” in the eyes of others. These behavioral science findings can make a significant impact when it comes to how health plans communicate with members.
The Power of Behavioral Contracts
Behavioral contracts are one powerful way to implement the principle of commitment and consistency into communications with health plan members. Think of it this way: When members sign behavioral contracts, they mentally "close the file" on decision-making, conserving cognitive energy for action later.
Researchers have used behavioral contracts in many contexts to show their effectiveness:
- For example, researchers studied the effect of using a behavioral contract in the context of nutrition and physical activity in this study. They showed that those who signed a simple behavioral contract achieved greater beneficial health changes than non-contractors. This happened because the act of committing shifted their focus from deliberation to action.
- In another study, researchers showed that among members living with diabetes, those who stated in a survey that they would highly commit to a healthier lifestyle were more likely to achieve lower A1C levels.
At Engagys, we have seen upwards of a 15% lift in health outcomes for members who have said ‘yes’ to taking an action on an IVR call that asks a simple intent question, such as “Will you commit to scheduling your mammogram in the next few days?”
Designing Effective Commitment Strategies to Drive Action
So, what does this look like in practice? Below are some behavioral science-driven techniques that support driving members to action:
- Use reminders to your advantage. Reminders are powerful tools to start with. If you are sending a reminder through text, for example, use a two-way communication such as a two-way SMS to ask for a simple intent question.
- Design commitment experiences that intentionally leverage loss aversion. When a member commits to an action and completes it, reinforce that success by visualizing progress—such as establishing a streak or milestone within the app. This progress signal creates psychological value. For subsequent actions, plans can then activate loss aversion by emphasizing what is at risk if the behavior lapses (for example, “Don’t break your streak”).
- Simply create behavioral contracts. These could be implemented through a short web survey asking an intent question for immediate action, such as app registration, scheduling a doctor’s appointment, and so on.
Strategies To Make Commitment Bias Implementation Successful
The impact of commitment bias depends entirely on how it’s executed. Done right, it becomes a powerful driver of real behavior change. Here’s how to apply this principle in ways that actually drive action.
- Ask intent questions for specific, clear, and near-term action. Asking members to commit to complex or long-term goals increases cognitive burden, can undermine confidence, and may ultimately backfire by reducing self-efficacy and follow-through.
- The commitment should be paired with a low-friction pathway for the intended follow-through action. Think of immediately surfacing transfer to scheduling, useful links, or other call-to-actions. This way, the “consistency” drive can convert into action more easily.
- Make sure it’s easy and straightforward to capture the members’ intent (Yes/No). Avoid free text in response options or complicated language in the question. This will become important for the next step of A/B testing (see below) to shed light on the effectiveness of the intervention.
- Remember, this is not a place to create a long to-do list for the members. Don’t overwhelm members with frequent communications, and importantly, don’t overwhelm them with asking to do many things at once. Choose only one action at a time and choose it strategically. For example, data shows that those who complete their annual wellness visit are more likely to complete screenings and vaccinations; therefore, focus on the more impactful and important action first.
Don’t Forget To A/B Test
When implementing a new strategy in your member communication, it’s paramount to include A/B testing to see if it needs adjustment for future implementation or if it works for your target population.
- Design the A/B test in advance! Make sure you have both a test and a control group in your implementation design.
- Test group: message/call includes an explicit commitment prompt (“Can we count on you to…?”) followed by immediate call to action
- Control group: identical message/call without the commitment prompt (call to action still present).
- Decide on the primary KPIs in advance. These could be completion of the intended action, such as a scheduled exam, completed screening, refill, or enrollment.
- Don’t forget the secondary KPIs. These could be short-term engagement signals such as transfer rate, click-to-schedule, and callbacks.
In sum, commitment and consistency bias can turn intention into action. When members are explicitly asked to commit to a specific health behavior and are provided with a frictionless path to follow through with the action, they are far more likely to act in ways that align with that commitment. Used strategically, commitment prompts reinforce autonomy, reduce drop-off, and help health plans reliably convert engagement into real behavior change.
