How can we improve uptake of public services and programs?
Low uptake of public services usually gets attributed to lack of awareness. So agencies invest in campaigns, websites, and outreach. But the evidence consistently shows that awareness is rarely the binding constraint. People know the service exists. They are just not using it.
The barriers are behavioral. Registration processes with too many steps (opportunity, physical). Forms that require information people do not have readily available (capability). Services that carry social stigma (opportunity, social). Appointment systems that require proactive scheduling rather than offering defaults (motivation, automatic). Each of these barriers has a different fix, and information campaigns address none of them.
Behavioral diagnosis follows the same COM-B structure used in organizational settings. Specify the uptake behavior precisely (not "use the service" but "complete the online registration within 14 days of eligibility notification"). Then diagnose: can they do it (capability)? Does the environment make it easy (opportunity)? Is it worth the effort at the moment they would act (motivation)?
Interventions that have demonstrated impact:
Simplifying registration to fewer steps (removing opportunity barriers), pre-filling forms with available data (reducing capability load), sending timely prompts at decision points (BCT 7.1, Prompts/Cues), using social proof in communications ("87% of eligible residents in your area have already registered"), and defaulting to enrollment with an opt-out rather than requiring opt-in.
The hospital hand-hygiene example is instructive for service contexts too: multimodal nudging (combining environmental cues, feedback systems, and social norms) increased compliance by 27.5 percentage points. Single-channel interventions rarely produce that level of change. The design principle is to layer techniques across all three COM-B domains.
