How to create change one behavior at a time.

What to Do About the Flu: Prevention Strategies

Chances are you heard something about the flu during this “cold season,” either in the news or perhaps you knew someone who came down with it. From the CDC reporting that this winter was one of the most severe flu seasons in decades, to speculation that the outcome of the Super Bowl could potentially be impacted by the virus (clearly it was not!), it’s been a hard subject to miss.

Final superbowl score 2018 eagles patriots

The good news is that the worst seems to be behind us, as the data indicate the number of illnesses peaked in February and is on the decline.

This year’s strain of flu—H3N2—is very nasty and relatively more difficult than some other strains to control with vaccines. The intensity and reach of this year’s strain, combined with difficulty predicting how effective the flu vaccine will be from year-to-year (the CDC estimates between 40% to 60% and emphasizes that vaccines should be your first line of defense) underscores the importance of everyday preventive actions we can take to keep germs away, in addition to getting a flu shot.

CDC Flu Vaccine Finder

As we were reviewing recent flu data from the CDC (we’re public health nerds, after all) we took particularly interest in how this year compared to the 2003-2004 flu season. In the last 15 years, 2003-2004 recorded the second highest week of healthcare visits for influenza-like illness, trailing only 2009-2010; this season ranks 3rd.

Percentage of US outpatient visits for influenza-like illness

The 2003-4 season jumped out at us because that was when the Florida Department of Health approached Marketing for Change to help develop an outreach strategy to encourage citizens to take preventive actions in advance of that year’s predominant flu strain, coincidentally also H3N2. In 2009, we also helped the Department with a media campaign during the H1N1 outbreak. In both cases, the recommended actions to protect yourself and avoid spreading the flu were the same, namely…

  1. Wash your hands. Cover your coughs with a tissue or your arm (not your hand)..
  2. Get a flu shot.
  3. If you get the flu, stay home (to avoid infecting others) and take antiviral drugs if prescribed by your doctor. 

In fact, these preventive actions are recommended virtually every year. And yet, despite the power of taking relatively simple steps, there continues to be a sense (even a frustration) among some that we’re not taking the flu seriously enough. One such person is the hospital nurse who created a viral video sparked, in part, by the fact that people aren’t washing their “stinking hands.”

Given this Groundhog Day-like situation, we wanted to take a closer look at various flu prevention efforts, specifically examining which behavioral science tactics they leverage.  As loyal readers of this blog know, our agency organizes 14 common behavioral determinants into three categories: fun, easy, and popular.

Fun: Maximizing the good stuff; minimizing the bad. This includes rewards, penalties, risks, and emotions.

Easy: Removing/reducing barriers to action. This includes skills/knowledge, efficacy, environment, control, investment and loss aversion.

Popular: Making the behavior feel like the right thing to do.  This includes norms / traditions and self-standards

Here’s how these behavioral determinants play out in flu prevention messaging.


Many flu prevention messages you see emphasize the risks of germ exposure and the corollary, often implicit, reward of avoiding them—namely, not catching the flu. This approach is useful for populations that are unaware of the risks and methods to minimize them, as well as caregivers for populations that are particularly vulnerable to flu infection such as infants and the elderly. It can be less effective, however, for more knowledgeable, healthy audiences as it essentially counts on the combination of preventing a potential risk and the reward of staying healthy as the impetus for a desired behavior. We know from behavioral science that maintaining the status quo (not having the flu) is a weak motivator at best, and that the accumulation of potential risks we’re confronted with (what doesn’t cause cancer at this point?) creates a form of cognitive fatigue that allows us to more easily dismiss the need to take preventive action.


Many efforts encouraging flu shots use these behavioral determinants very effectively. They include messaging and interactive tools emphasizing where and when shots are available (control and environment) as well as where discounted or free shots are provided (investment). If anyone has ventured into a drug store they’ve surely witnessed how ingrained these tools have become in the environment. From ubiquitous signs, to being offered discounts on flu shots during routine check-outs, to your pharmacist asking if you’ve had your shot yet, to text reminder messages when you’re nearby a pharmacy, these behavioral science tools are doing their best to reduce a key barrier to action—the perceived hassle factor. That said, psychological hurdles such as the planning fallacy (being overly optimistic about accomplishing a task), procrastination, and a reverse form of loss aversion (when people don’t think they really need a flu shot, they aren’t losing anything by not getting one) can still inhibit desired behavior.


While not employed as often as the previous tactics, the power of social norms can effectively counter some of the limitations inherent in other approaches. As noted with regard to everyday preventive actions such as washing hands, and as discovered in our own research for the Florida Health Department, the threat of a potential flu pandemic is not a compelling enough consequence for a large portion of the public to take action.

What is compelling enough, in a wide range of contexts, is the notion of fitting in, and the corresponding fear of not doing so and becoming an outlier. Harnessing this universal motivator—embodied by the statistic that 4 out of 5 people wash their hands after using the restroom—we emphasized, in a humorous way, the social consequences of not engaging in the target behavior—taking preventive actions to reduce the spread of germs. The central character in the outreach effort was the proverbial fifth guy, who practices poor hygiene and suffers the immediate social consequences. Messaging that accompanied the effort including, “Germs are Getting Stronger” and, “Can Someone Talk to the Fifth Guy” were designed to create a sense of urgency and build to a clear call to action: do not be the ‘Fifth Guy.’ By discussing germs in the context of social norms, and not the risks associated with the flu, we sidestepped the mental armor we have developed in order to live in a world of risks. Moreover, the humorous and unexpected execution garnered attention in a way that more familiar flu messages can’t access.

The power of applying behavioral science principles in order to make positive actions more fun, easy and popular is virtually unquestioned at this point; the discoveries to be made going forward will be learning when to reach for different tools in the toolbox and how to apply them in unexpected, innovative ways. This type of occasional reflection can help shed light on those discoveries.

Robert Bailey is the Research Director at Marketing for Change.

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