A systematic review and meta-analysis of the effectiveness of social norms messaging approaches for improving health behaviours in developed countries

Papakonstantinou, Trisevgeni; Flecke, Sarah Lynne; Edmunds, C E R; Cross, Rosina; Tran, Ahn; Gold, Natalie

Abstract

Social norms approaches have been widely applied in health promotion, as a cost-effective behaviour-change strategy, but have been little evaluated as a whole. We conducted a pre-registered systematic review and meta-analysis of randomised controlled trials using social norms messaging in developed countries targeted at changing health behaviours among 16+ year-olds, to evaluate their effectiveness. Relevant studies were identified through searches in PsycINFO, Medline, Embase, Web of Science, TRIP, Cochrane, and grey literature sources. Risk of bias was assessed independently by two reviewers using the Cochrane RoB 2 tool. A random-effects meta-analysis standardized effect sizes to Cohen’s d, assessed heterogeneity with I², and applied Robust Bayesian Meta-Analysis to adjust for publication bias.

Searches resulted in 89 studies (n = 85,759), which exhibited a small effect of social norms messaging on health behaviours (Cohen’s d = 0.16, 95% CI [0.11, 0.22], p < .001). However, once controlling for publication bias, this effect disappeared. We conducted moderator analyses that showed no significant differences from the overall effect for different types of social norm messages, delivery modalities, health domains, or target populations.

The review is limited by the lack of studies assessing whether normative information changed participant perceptions, inconsistent use of manipulation checks, and high heterogeneity across studies in terms of target behavior, population, and intervention delivery, affecting the robustness of conclusions. Our analysis suggests that when appropriately controlling for publication bias social norms messages are not effective at improving health behaviours. Thus, future attempts at improving public health should focus on alternative approaches.

• Journal Article Type: Article
• Acceptance Date: May 6, 2025
• Deposit Date: May 8, 2025
• Journal: Nature Human Behaviour
• Electronic ISSN: 2397-3374
• Publisher: Nature Research
• Peer Reviewed: Peer Reviewed
• Public URL: https://uwe-repository.worktribe.com/output/14407922