Reducing Negative Citizen Behaviour: Testing a three-dimensional integrated intervention strategy using a randomised quasi-field experiment

Abstract

When citizens show negative behaviour, such as incivility and aggression, to street-level bureaucrats, such as healthcare workers, this has a profoundly negative influence on public service. Therefore, contextually sensitive intervention research reducing this behaviour is in high demand. Yet, such research remains scarce. We address this lacuna by testing an intervention strategy via a randomised quasi-field experiment in the emergency department of a Dutch medium sized urban hospital. Specifically, we address the impact of an integrated three- dimensional intervention strategy developed with practitioners –based on information, distraction, and deterrence–on negative citizen behaviour towards emergency healthcare workers. We collected ‘within-person’ and ‘within-location’ data using a daily diary survey administered to healthcare staff. Hierarchical data was analysed using multilevel modelling in R. The results provide limited and fragmented support for the effectivity of the interventions strategy. Similarly, expected moderation effects from department busyness and part of the week were not established; the intervention effect was not clearly reduced by an increase of department busyness nor weakened during weekends. We conclude that the three-dimensional strategy did not produce the expected results and adjustment, strengthening, and separate testing of the dimension is required in further research to understand this outcome.