Understanding the perceptions and motivations of people in the workplace can be applied to many aspects of management, at the individual, team and organisational level. Collecting, analysing and interpreting behavioural insights allows us to consider different viewpoints and potential barriers to successful change. Therefore, the use of psychological models can arm us with additional evidence-based management strategies.

A recent scan of the literature conducted by Spoonful of Sugar has shown multiple gaps in the synthesis, scrutiny and reporting of management science and management psychology. We aimed to investigate the evidence for and benefits of applying psychology-based theories in a broad range of management disciplines including human resources, gratuity, and employee performance. Despite the essential role of management in day-to-day business, there were few reports evidencing practice in relation to psychology-based or theoretical models, which proved it difficult to draw conclusions. The lack of case-studies or analyses were supplemented by opinion articles, which can provide a false-impression of what defines and ensures good practice. This contributes to a second problem: we are unable to truly evaluate hypotheses in management and organisation science without sound evidence, so best practice remains unclear. For example, in managerial psychology, the relevance and utility of Herzberg’s two-factor theory (1959) is still debated, despite widespread application. This theory suggests that job satisfaction and dissatisfaction are influenced by independent and separate factors. Much criticism about its original methodology and limited context remain1,2,3. The power of academia and research in management can address these issues and provide clarity on best practice.

The absence of high quality research in management psychology and science can be detrimental to the educational, academic and practical applications. We need higher quality and more evidence to evaluate hypotheses and to truly understand how we can objectively measure and enhance the way we manage people, processes and organisations. Given the robust scientific methods we can now access and the technological advances in data collection, surveying and analysis, we are well-placed to understand the impact of science and psychology on management.

What’s your experience of using behavioural science in management? Now is your chance to contribute to the knowledge and science behind management –being able to capture people’s voices and experiences can help advance this field. Spoonful of Sugar are calling for research papers and case studies as part of the conference track ‘Using Persuasion Science in Practice’ at EURAM 2018, deadline 10 January 2018. Please contact amy@sos-adherence.co.uk or karen@sos-adherence.co.uk for more information.

1 Herzberg, Frederick; Mausner, Bernard; Snyderman, Barbara B. (1959). The Motivation to Work (2nd ed.). New York: John Wiley.

2 Bassett‐Jones, N. and Lloyd, G. C. (2005) Does Herzberg’s motivation theory have staying power? Journal of Management Development, Vol. 24 Issue: 10, pp.929-943

3 Malik, M. E., and Naeem B. (2013) Towards Understanding Controversy on Herzberg Theory of Motivation. World Applied Sciences Journal 24 (8): 1031-1036, 2013

Adherence tools are often employed to improve our understanding of the practical and perceptual barriers which stand between patients and their medication regimes. Substance misusers are a notoriously difficult-to-treat client group. There is continued debate around whether drug addiction can be classified as an illness. For the purpose of this blog, let’s assume addiction to be an illness. Could applying a Perceptions and Practicalities Approach (PAPA™) help to improve our understanding of why adherence to prescribed heroin substitutes breaks down among this client group?

PAPA™ provides a conceptual framework that explains non-adherence based on the overlapping categories of intentional and un-intentional non-adherence. Unintentional non-adherence can result from barriers, beyond the control of the individual, inhibiting the individual’s ability to adhere. Practical barriers could include, but are not limited to, homelessness, unemployment, and thus a lack of/ no financial stability. Intentional non-adherence relates to perceptions which shape an individual’s motivation to adhere. Motivation among this client group generally fluctuates, and other self-perceptions tend to exacerbate this issue. A lack of self-efficacy in one’s own ability to maintain abstinence, a lack of self-worth, and the self-disabling belief that one is undeserving of a better quality of life, are all potential perceptual barriers faced by this client group.

Considering the resources necessary to achieve and maintain recovery; many individuals released into the community have little ‘recovery capital’ to draw upon. They transition from behind bars, back into a life of chaos and instability. This is where adherence breaks down. It could be argued that the individuals’ ability, or inability, to adhere is the crux of the problem. Efforts to rehabilitate substance misusing offenders typically focus on perceptual factors including motivation, but seldom attempt to address the practical barriers that stand between individuals’ and adherence.

Implementing aspects of PAPA™ into interventions for this client group, to ensure a focus on motivation and ability, could lead to more sustainable outcomes. If instability breeds inability then, without tackling the perceptual and practical barriers among this client group, could any rehabilitative effort be truly successful?

When it comes to communicating science, there’s a lot to think about. Design is an important and often overlooked aspect —many researchers focus most of their efforts on content.

But design deserves at least equal, if not more, attention. Fortunately for scientists, design is a science and can be learned. Get more scientific with your design — it’ll help you get a message across.

Posters are a popular way to showcase new research to the scientific community. The use of intelligent design principals is vital to maximise the impact of your poster. Here’s some advice for making better posters.

Text and tables

This is where most of what you want to say will be displayed, the right design and layout here is vital.

  • A large block of text is not inviting to anyone
  • Each section of text should be clear and concise, focusing on a single area.
  • Five to six lines of text with 25-30 characters per line is generally best. Use bullet points to break up sections and highlight important points.
  • A large font (minimum 24-point size) is important so that the text can be read from at least one metre away.
  • Poster text should be organised in columns — this helps your eyes move less as you read.
  • There should be a good balance of text, diagrams, tables and graphics. Avoid large blank areas.
  • Tables and figures with colours are more engaging and exciting to look at and are often a clear and easy way to show complex information. (But be careful with what colours you use.)
  • Black text on a white background is often the easiest to read.

Colour is important and should be considered carefully. Opposite colours tend to make a bold — if potentially clashing — statement and are therefore more likely to catch the eye of a passing delegate. But use your best judgement on making something look good first and striking second. Studies of Event Related Potentials (a measure of neural activity related to cognitive and sensory processes) have shown that higher attention is paid to yellow- and green-based colours.

Light at a conference is important to consider. Although glossy laminate may look better, opting for a matt lamination ensures everyone will be able to see it regardless of how much light you have. Many conferences or universities have set guidelines as to the layout and size of posters. This is always an important thing to consider: a rectangle in a sea of square posters stands out for the wrong reasons.

What happens when you’ve grabbed someone’s attention? In terms of information content, a study comparing the effectiveness of different methods of health education found that found that more specific topics were preferred over broad coverage, suggesting that it is better to pick a small area of research to focus on rather than attempting to cover an expansive topic.

Surveys have shown one to one discussions are more valuable, with 55.4% of conference delegates preferring individual discussions with authors about the posters rather than moderated presentations. This is the most important chance to discuss your research as it gives you the opportunity to discuss things that have not been included in the main body of the poster and gives you opportunities to answer questions.

Posters may not currently be the most valued way of showcasing results, but with the help of intelligent design, posters can be revolutionised! Posters are and will remain a vital part of scientific conferences. So next time you have a poster to design, consider the use of science to guide you.

Artificial intelligence, robotics, and nano-devices, among other rapidly expanding technologies have an overwhelming potential to shape many aspects of our not too distance future, not least our medical care.

With somewhat ease, we can now visualize a future with automated referrals, prescribing, monitoring and discharge – streamlining and synchronizing the care we receive.

However, it will be critical that such advances do not undermine what behavioural science and psychology have cemented over the last half century: that, contrary to standard economic theories, humans are not always rational. How we make decisions, such as whether to take a medicine, are complex and multi-factorial.

Consultations can often be key to ensure the optimal decision is reached. However, with automated services such as robotic drug dispensing, such human-human interactions will be lost.

Devices do not always have to be ‘unhuman’ though; many have been designed to be behaviourally smart. Such devices consider the irrational facets and individual complexities in human behaviour to improve outcomes and help people make better decisions for healthier, happier lives.

With the expanding accessibility of big data there is also a new opportunity to take advantage of, as quantitative behavioural insights and analysis can facilitate increasingly tailored and personalized support through medical devices.

Incorporating an understanding of human behaviour into artificial intelligence and other innovative medical devices will be vital in future healthcare, but done correctly could offer great potential to improve health outcomes.

Pharmacists and medicines go hand in hand, so it’s no surprise that assisting patients with medicines is what pharm-assist are best at.

The thing with medicines is that despite how good they are, they work most effectively only when they are taken as prescribed. The act of ‘not taking medication as prescribed’ is known as non-adherence, a straight forward term for behaviour that emanates from a complex set of beliefs. The resulting behaviours are not conducive to optimising outcomes for patients’ health.

There are many perceptual and practical factors that influence the patient’s motivation and ability to adhere to agreed treatments(1), and it’s estimated that non-adherence is somewhere between 30-50%(2). This in turn results in poor health outcomes for the patient, but also it becomes costly for the NHS in terms of the medicines wasted (an estimated £110 million worth of medicines are returned to pharmacies annually)(3) and the burden this creates for the healthcare system to keep on offering alternatives.

Non-adherence is not just a problem for developed countries, but places a burden on medicines outcomes globally; there are the same perceptual and practical concerns for developing countries(4,5). Regardless of location, once patients gain access to medicines trade-off between necessity (needing the medicines) versus the concerns (e.g. about potential long-term side-effects) come into play. This underpins a common need for healthcare systems, of all sizes and resource levels, to adopt ways to improve adherence.

What’s the solution?

The good news is, there are many ways to help patients remain adherent to their medicines and the role for pharmacists in supporting patients can be pivotal. There is an increasing call for medicines information to be embedded in the community and not just confined to a clinician’s room. Pharmacies can provide an ideal environment for patients to have an informal conversation about their medicines without the time pressures that are often associated with appointments with clinicians.

There is huge choice and flexibility for patients, with over 11,500 pharmacies in England(6) hence the potential impact of channelling adherence programmes through pharmacies can make a real difference to non-adherence rates. Internationally, organisation such as the Commonwealth Pharmacy Association are also working to increase access to pharmacy expertise in resource-scarce settings. Moreover, what’s needed by pharmacists to support behaviour changes are not complex or expensive.

Pharmacists can hold more than just the keys to the medicines cabinet, they are experts in medicines and their vital role in the community allows them to advise and support patients in making the most of their medicines.
1. Clifford S, Barber N, Horne R. Understanding different beliefs held by adherers, unintentional nonadherers, and intentional nonadherers: application of the Necessity-Concerns Framework. J Psychosom Res. 2008 Jan;64(1):41–6.

2. NICE Clinical Guidance 76: Medicines adherence: involving patients in decisions about prescribed medicines and supporting-adherence; 2009 Jan.

3. Pharmaceutical waste reduction in the NHS: A best practice compilation paper; 2015 June

4. Oqua D, Agu KA, Isah MA, Onoh OU, Iyaji PG, Wutoh AK, et al. Improving pharmacy practice through public health programs: experience from Global HIV/AIDS initiative Nigeria project. SpringerPlus. 2013;2:525.

5. Khanam MA, Lindeboom W, Koehlmoos TLP, Alam DS, Niessen L, Milton AH. Hypertension: adherence to treatment in rural Bangladesh–findings from a population-based study. Glob Health Action. 2014;7:25028.

6. General Pharmaceutical Services in England: 2006/07 to 2015/16; 2016 November

It is well-recognised that certain sectors of society are repeatedly underrepresented in research studies. Ethical guidelines for the inclusion of children, women and the cognitively impaired in research exist, but researchers tend to bias recruitment towards ‘normal’ people, applying the ‘one-size fits all’ approach to results and missing important physiological and psychological insights that could be gained from including a diverse group of individuals.

We should ask ourselves why certain groups, such as the elderly, ethnic minorities and people with a history of mental health, hearing impairment or complex comorbidities, are excluded in research: is the exclusion scientifically justified by the study (i.e. the evidence collected from the study can be generalised to all patients), or are they excluded because of the difficulty in managing vulnerable groups and the trouble and budget/ time constraints of going through research ethics committees’ applications? Although current ethical guidelines require a justification of both inclusion and exclusion groups, a recent review of trials on secondary prevention of cardiovascular disease found only one of 113 studies justified their exclusion criteria1.

Exclusion might, in some cases, be decided by the participant. For example, parents might not be comfortable with their children taking part in research, women of childbearing age might prefer to keep away from clinical trials and ethnic minorities might be reluctant to participate unless engaged through community support. In other cases, the inclusion criteria of the studies might be too restrictive. For example, a recent study found that depressed individuals included in antidepressant efficacy trials did not reflect the typical patient treated in clinical practice and 82% of depressed patients would have been excluded by the enrolment criteria2.

Excluding these groups from research comes with a range of implications: lack of sample diversity to be able to understand how the illness and treatment works, lack of information about the effectiveness of treatments across all members of society, and the potential danger of generalising the findings to those excluded groups which, in turn, might not even have access to treatment.

This has strong implications for adherence interventions and many ‘real world’ interventions may fail because we know that people who are the most ‘non-adherent’ might not partake in research. For example, a depressed patient has 1.76 times the odds of being non-adherent than a non-depressed patient3. Similarly, the most non-adherent groups to self-administered treatment for tuberculosis are prisoners, vulnerable migrants, homeless/people on temporary housing and people misusing alcohol or other substances4. It is likely that all these groups would be misrepresented (deliberately or not) in evidence-based adherence strategies.

Exclusion of patients from the developing world is another problem. For example, the difficulty of maintaining adherence rates to HIV medication in developed countries is well-documented5 but HIV-infected patients with the greatest adherence issues in those countries are repeatedly excluded from adherence intervention research even though this vulnerable group would benefit the most from these interventions6.

1 Schmidt, AF. et al. (2014). Justification of exclusion criteria was underreported in a review of cardiovascular trials. Journal of Clinical Epidemiology, 67(6):635-644.

2 Preskorn, SH, et al. (2015). How commonly used inclusion and exclusion criteria in antidepressant registration trials affect study enrollment. J Psychiatr Pract. 21(4):267-74.
3 Grenard, JL, et al. (2011). Depression and Medication Adherence in the Treatment of Chronic Diseases in the United States: A Meta-Analysis. Journal of General Internal Medicine, 26(10):1175-1182.
4 NICE. Tuberculosis in vulnerable groups. Local Government briefing [LGB11]. September 2013. 5 Bonolo PF, et al. (2008). Vulnerability and non-adherence to antiretroviral therapy among HIV patients Minas Gerais State, Brazil. Cad Saude Publica. 24:2603-2613.
6 Enriquez, M & McKinsey, DS (2011). Strategies to improve HIV treatment adherence in developed countries: clinical management at the individual level. HIV/AIDS. 3:45–51.

How we perceive the implications of an illness and potential treatments in the present compared to the future can shape our attitudes towards treatments and thus influence adherence and outcomes.

We have a tendency to choose small short-term gains over long-term larger ones, which is described as temporal discounting. The value of an item today appears to be worth more than in the future.

This tendency to make choices which bias the present, often to our long-term detriment, is particularly prominent in smokers1 and can also be applied to medical adherence. Discounting in the value of future health risks, has been found to be correlated with adherence and treatment outcomes in both diabetes2,3 and multiple sclerosis.4,5

One potential reason why we favour the present could be linked to future-self continuity, how we perceive ourselves now, in comparison to ourselves in the future. This also links to illness perception. If the person does not feel ill, the benefit is not obvious, so it is difficult for patients to even discount.

In experiments, when participants are asked to assess how similar they perceived themselves to their future self, using the sets of circles (see below) and then undertake a temporal discounting task to see how likely they were to choose delayed monetary rewards (e.g. £15 today or £50 in three months), future-self similarity (assessed by the circle task) correlate with their likelihood of choosing delayed reward. The more similar people perceive themselves as more similar to their future self the more they save.7

When shown avatars of either in their current state or looking elderly as a retired version of themselves8 and asked questions such as: How much of your current income would you like to allocate for your retirement fund? Seeing the older avatar of themselves people increase the average percentage of their income they would choose to save.8

This has strong implications as it demonstrates that making a connection with our future self can help us make better, more forward-thinking plans, and patients make treatment choices more aligned with their long-term needs.

1. Bickel W, Odum A, Madden G. Impulsivity and cigarette smoking: Delay discounting in current, never, and ex-smokers. Psychopharmacology. 1999;146 (4): 447-454.

2. Lansing A, Stanger C, Crochiere R, et al. Delay Discounting and Parental Monitoring in Adolescents with Poorly Controlled Type 1 Diabetes. Journal of Behavioral Medicine. 2017

3. Lebeau G, Consoli M, Le Bouc R, et al. Delay Discounting of Gains and Losses, Glycemic Control and Therapeutic Adherence in Type 2 Diabetes. Behavioural Processes. 016;132: 42–48.

4. Bruce J, Bruce A, Catley D, et al. Being Kind to Your Future Self: Probability Discounting of Health Decision-Making. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine. 2016;50 (2): 297–309.

5. Jarmolowicz D, Reed D, Bruce A, et al. Using EP50 to Forecast Treatment Adherence in Individuals with Multiple Sclerosis. Behavioural Processes. 2016;132: 94–99.

6. Hershfield H, Wimmer G, Knutson B. Saving for the future self: Neural measures of future self-continuity predict temporal discounting. Soc Cogn Affect Neurosci. 2009;4 (1): 85-92.

7. Hershfield H, Garton M, Ballard K, et al. Don’t stop thinking about tomorrow: Individual differences in future self-continuity account for saving. Judgment and Decision Making. 2009;4(4): 280–286

8. Hershfield H, Goldstein D, Sharpe F, et al. Increasing Saving Behavior Through Age-Progressed Renderings of the Future Self. Journal of Marketing Research. 2011;48: S23–S37

Can too much information be harmful to your health? Informed consent is at the heart of many ongoing debates that seek to answer this question.

Informed consent refers to the permission granted in full knowledge of the possible consequences. Typically, it relates to that which is given by a patient to a doctor for treatment with knowledge of the possible risks and benefits. However, informed consent is a process that occurs both within healthcare and any research involving human studies.

There are many limitations and issues surrounding the process of informed consent that bring in to question its validity. One area that we at Spoonful of Sugar regularly consider within our work is the information that is given to patients around treatment side effects.

The informed consent process has the potential to increase patients experience of side effects purely by the mentioning of them as providing extensive information regarding adverse effects can generate nocebo responses; when the expectation of treatment side effects leads to those symptoms being realised. Extensive research has shown that including specific side effects within a consent form increases the incidence of the reporting of these symptoms. The variability in an individual’s risk perception in relation to side effects adds complexity to the issue.

Over the years researchers have investigated methods for minimising these nocebo responses whilst still maintaining patient autonomy, these are approaches SoS considers when designing patient support. One approach that has been suggested is contextualised consent which proposes a tailored approach to the information given, it considers adverse effects of a particular medication, the patient themselves and the illness concerned. Another method looks at how the information is presented, studies have shown that positive framing and personalising information helped patients to develop more functional treatment expectations and prevented expectation induced nocebo effects. These two techniques; framing and tailoring could go a long way to providing an effective informed consent procedure.

As of yet no consensus has been reached on the best way to approach the complex topic of informed consent and so continues the debate of ‘how much information really is too much?’


We love the movie ‘Lost in Translation’ with Bill Murray, it really captures how things can go wrong and easily be misunderstood with differences in culture and language.

Running adherence programmes internationally requires a deep understanding of the role of culture and language. Cultural and language differences have a direct impact on how successful an adherence program will be. It is hard to be aware of every single aspect of each country’s culture from afar. That’s why we really do take this factor into account and have an international team in place to create effective programs efficiently.

It is good to remind ourselves that in life, communication is key to success. Being aware of cultural backgrounds is key to the adoption and use of programmes. Direct translation rarely effectively translates all intended meaning. This is also why we conduct research, because customer needs and demands, decision making, and social role views all varies by culture, and to understand the exact words and meaning ascribed to those words in the language and context the program will be

We have yet to find a better way than using people who are native speakers of the language, have been immersed in the culture and are trained in the underpinning psychological constructs.


As the world becomes increasingly entrenched in big data, one must stop and ask – what will happen to our individuality? This 2-minute whiteboard video will discuss these issues and highlight the importance of the person-centred approach.