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| M Hallsworth, JA List, RD Metcalfe, I Vlaev|
Journal of Public Economics, Volume 148, Issue null, Pages 14-31 (2017)
This paper presents results from two large-scale natural field experiments that tested the effect of social norm messages on tax compliance. Using administrative data from > 200,000 individuals in the United Kingdom, we show that including social norm messages in standard reminder letters increases payment rates for overdue tax. This result offers a rare example of social norm messages affecting tax compliance behavior in a real world setting. We find no evidence that loss framing is more effective than gain framing. Descriptive norms appear to be more effective than injunctive norms. Messages referring to public services or financial information also significantly increased payment rates. The field experiments accelerated the collection of tax revenue at little cost.
A loan application should collect necessary information while providing a painless, easy, and engaging experience for members and potential new members. Our recommendations for improving the loan application process were driven by three behavioral principles essential to the design of any human process: (1) reducing perceived hassles and uncer-tainty wherever possible; (2) avoiding jargon; and (3) designing with potential user error in mind. Our recommen-dations for Alliant included a new process timeline to more accurately set applicant expectations and reflected progress through the application; reframing key decision points to ensure users do not accidentally cancel their applications; and revising language that may be unfamiliar to some applicants, such as “collateral,” “debt-to-income,” and “co-borrower.” These principles and recommendations may seem simple, but through our work we have seen how even small changes can have big impacts on client behaviors. Moreover, as service designers, intimately aware of the loan process, it can be difficult for financial experts to design financial products and services that feel intuitive and easy to understand to new users. Alliant has incorporated the majority of our design recommendations into the new loan application process.
Importance Interventions based on behavioral science might reduce inappropriate antibiotic prescribing. Objective To assess effects of behavioral interventions and rates of inappropriate (not guideline-concordant) antibiotic prescribing during ambulatory visits for acute respiratory tract infections. Design, Setting, and Participants Cluster randomized clinical trial conducted among 47 primary care practices in Boston and Los Angeles. Participants were 248 enrolled clinicians randomized to receive 0, 1, 2, or 3 interventions for 18 months. All clinicians received education on antibiotic prescribing guidelines on enrollment. Interventions began between November 1, 2011, and October 1, 2012. Follow-up for the latest-starting sites ended on April 1, 2014. Adult patients with comorbidities and concomitant infections were excluded. Interventions Three behavioral interventions, implemented alone or in combination: suggested alternatives presented electronic order sets suggesting nonantibiotic treatments; accountable justification prompted clinicians to enter free-text justifications for prescribing antibiotics into patients’ electronic health records; peer comparison sent emails to clinicians that compared their antibiotic prescribing rates with those of “top performers” (those with the lowest inappropriate prescribing rates). Main Outcomes and Measures Antibiotic prescribing rates for visits with antibiotic-inappropriate diagnoses (nonspecific upper respiratory tract infections, acute bronchitis, and influenza) from 18 months preintervention to 18 months afterward, adjusting each intervention’s effects for co-occurring interventions and preintervention trends, with random effects for practices and clinicians. Results There were 14 753 visits (mean patient age, 47 years; 69% women) for antibiotic-inappropriate acute respiratory tract infections during the baseline period and 16 959 visits (mean patient age, 48 years; 67% women) during the intervention period. Mean antibiotic prescribing rates decreased from 24.1% at intervention start to 13.1% at intervention month 18 (absolute difference, −11.0%) for control practices; from 22.1% to 6.1% (absolute difference, −16.0%) for suggested alternatives (difference in differences, −5.0% [95% CI, −7.8% to 0.1%]; P = .66 for differences in trajectories); from 23.2% to 5.2% (absolute difference, −18.1%) for accountable justification (difference in differences, −7.0% [95% CI, −9.1% to −2.9%]; P < .001); and from 19.9% to 3.7% (absolute difference, −16.3%) for peer comparison (difference in differences, −5.2% [95% CI, −6.9% to −1.6%]; P < .001). There were no statistically significant interactions (neither synergy nor interference) between interventions. Conclusions and Relevance Among primary care practices, the use of accountable justification and peer comparison as behavioral interventions resulted in lower rates of inappropriate antibiotic prescribing for acute respiratory tract infections.
Importance “Nudges” that influence decision making through subtle cognitive mechanisms have been shown to be highly effective in a wide range of applications, but there have been few experiments to improve clinical practice. Objective To investigate the use of a behavioral “nudge” based on the principle of public commitment in encouraging the judicious use of antibiotics for acute respiratory infections (ARIs). Design, Setting, and Participants Randomized clinical trial in 5 outpatient primary care clinics. A total of 954 adults had ARI visits during the study timeframe: 449 patients were treated by clinicians randomized to the posted commitment letter (335 in the baseline period, 114 in the intervention period); 505 patients were treated by clinicians randomized to standard practice control (384 baseline, 121 intervention). Interventions The intervention consisted of displaying poster-sized commitment letters in examination rooms for 12 weeks. These letters, featuring clinician photographs and signatures, stated their commitment to avoid inappropriate antibiotic prescribing for ARIs. Main Outcomes and Measures Antibiotic prescribing rates for antibiotic-inappropriate ARI diagnoses in baseline and intervention periods, adjusted for patient age, sex, and insurance status. Results Baseline rates were 43.5% and 42.8% for control and poster, respectively. During the intervention period, inappropriate prescribing rates increased to 52.7% for controls but decreased to 33.7% in the posted commitment letter condition. Controlling for baseline prescribing rates, we found that the posted commitment letter resulted in a 19.7 absolute percentage reduction in inappropriate antibiotic prescribing rate relative to control (P = .02). There was no evidence of diagnostic coding shift, and rates of appropriate antibiotic prescriptions did not diminish over time. Conclusions and Relevance Displaying poster-sized commitment letters in examination rooms decreased inappropriate antibiotic prescribing for ARIs. The effect of this simple, low-cost intervention is comparable in magnitude to costlier, more intensive quality-improvement efforts.
Compared to whites, African Americans have a greater incidence of diabetes, decreased control, and higher rates of micro-vascular complications. A peer mentorship model could be a scalable approach to improving control in this population and reducing disparities in diabetic outcomes. Objective
To determine whether peer mentors or financial incentives are superior to usual care in helping African American Veterans improve their glycosylated hemoglobin (HbA1c) levels. Design
A six month randomized controlled trial. (ClinicalTrials.gov registration number: NCT01125956) Setting
The Philadelphia VA Medical Center. Patients
African American veterans, age 50-70 years old, with persistently poor diabetes control. Measurements
Change in HbA1c at 6 months Intervention
118 participants were randomized to one of the three arms. Usual care participants were notified of their starting HbA1c and recommended goals for HbA1c. Those in the peer mentor arm were assigned a peer mentor who formerly had poor glycemic control but now had good control (HbA1c < 7.5%) who was asked to talk with the participant at least once a week. Peer mentors were matched on race, sex, and age. Those in the financial incentive arm could earn $100 by dropping their HbA1c by one point and $200 by dropping it by two points or to a HbA1c of 6.5%. Results
Mentors and mentees talked the most in the first month (mean calls 4: range 0-30) and dropped to a mean of 2 calls (range 0-10) by the sixth month. HbA1c dropped from 9.9% to 9.8% in the control arm, 9.8% to 8.7% in the peer mentor arm and from 9.5% to 9.1% in the financial incentive arm. Mean change in HbA1c from baseline to 6 months relative to control was −1.07 (95% CI −1.84 to −0.31) in the peer mentor arm and −0.45 (95% CI −1.23 to 0.32) in the financial incentive arm. Limitations
The study included only veterans and lasted only 6 months. Conclusions
Peer mentorship improved glucose control in a cohort of African American Veterans with diabetes.
Vote-buying and vote-selling obstruct the democratic process, yet they remain pervasive in many developing democracies. Researchers asked voters in the Philippines to make a simple, unenforceable promise not to accept money from politicians or to promise to vote according to their conscience, even if they do accept money, to test the impact of promises on voters’ behavior. A majority of respondents made promises not to sell their votes. Researchers found that the promise significantly reduced vote-selling, cutting the number of people who sold their votes by 11 percentage points in the smallest-stakes election, but was not effective in the mayoral election with higher pay-outs. These results suggest that simply asking voters to promise not to sell votes can help reduce vote-selling in elections where vote-buying payments are typically small.
Most opioid prescription deaths occur among people with common conditions for which prescribing risks outweigh benefits. General psychological insights offer an explanation: People may judge risk to be low without available personal experiences, may be less careful than expected when not observed, and may falter without an injunction from authority. To test these hypotheses, we conducted a randomized trial of 861 clinicians prescribing to 170 persons who subsequently suffered fatal overdoses. Clinicians in the intervention group received notification of their patients’ deaths and a safe prescribing injunction from their county’s medical examiner, whereas physicians in the control group did not. Milligram morphine equivalents in prescriptions filled by patients of letter recipients versus controls decreased by 9.7% (95% confidence interval: 6.2 to 13.2%; P < 0.001) over 3 months after intervention. We also observed both fewer opioid initiates and fewer high-dose opioid prescriptions by letter recipients.
| GB Chapman, H Colby, K Convery, EJ Coups|
The effectiveness of a pedometer intervention was affectedby manipulating the goals given to participants and byproviding social comparison feedback about how partici-pants’ performance compared with others. In study 1(n= 148), university staff members received a low,medium, or high walking goal (10%, 50%, or 100%increase over baseline walking). Participants walked1358 more steps per day (95% confidence interval [CI],729, 1985), when receiving a high goal than when receiv-ing a medium goal, but a medium goal did not increasewalking relative to a low goal (554 more steps; 95% CI,–71,1179). In study 2 (n= 64), participants received individual feedback only or individual plus social com-parison feedback. Participants walked 1120 more stepsper day (95% CI, 538, 1703) when receiving social compar-ison feedback than when receiving only individual feed-back. Goals and the performance of others act asreference points and influence the effect that pedometerfeedback has on walking behavior, illustrating the applica-bility of the principles of behavioral economics and socialpsychology to the design of health behavior interventions.
We conducted two Facebook experiments (the first one during July 21–25, 2016, and the second during April 22–25, 2018) to determine what type of message related to injunctive norms is more effective in getting Hispanic women interested in learning about financial planning for retirement. We also explore how social media tools could be used in future interventions to promote retirement saving among Hispanic women. In both experiments, we found that a message centered on peer influence may be more successful than a message centered on familism in getting Hispanic women interested in learning more about financial planning for retirement. When we disaggregate our data by age and state, we find that click-through rates were higher among Hispanic women between 45 and 55 years old, and the largest numbers of impressions were among Hispanic women in California and Texas. When we disaggregate our data by device, we find that most study participants were reached through an Android smartphone.
To increase uptake of flu vaccines and maintain a healthy workforce during the 2016-17 flu season, New York City’s Behavioral Design Team (NYC BDT) partnered with WorkWell NYC to design behaviorally informed emails to encourage New York City employees to visit a worksite flu clinic. One version of the redesigned email used the strategy of “enhanced active choice,” whereby employees were prompted to make a choice that had a clear right answer. IMPACT
Behavioral emails more than doubled click-through rates and statistically increased appointment sign-ups. Most importantly, the enhanced active choice version of the email increased vaccine uptake by 5 percent at worksite locations.
The City of Philadelphia in Pennsylvania offers a discount to low-income senior citizens living in the municipality on their water bills. Senior water and sewer customers can apply to receive 25 percent off their payments for water in an effort to reduce the financial burden on those elderly citizens with lesser means.
In 2014, only 48.6% of Nigeria's adult population had access to, and used, formal financial products.To make these products more accessible to people of all incomes, a major bank and a telecommunications company in Nigeria jointly launched a mobile bank account.
To help first-year students understand that the challenges they faced were neither unique to them nor evidence of personal failure, all incoming first-year students at SF State were asked to watch a three-minute video in which older students described the struggles they had faced and their routes to success.
A randomized evaluation found that among families where both students and parents received the redesigned emails, 50% filed their financial aid application by the priority deadline.
A randomized evaluation found that households which received letters comparing water consumption to their local neighbors reduced water consumption by 1.5 m 3 (from 28 to 26.5 m 3).
Traditionally, utility companies have tried to promote energy conservation by providing subsidies for energy-efficient appliances. But recently there has been an increased focus on influencing consumer behavior.
| MJJ Handgraaf, Margriet van Lidth de Jeude, Kirstin Appelt|
Energy consumption is a major source of CO2 emissions, which contribute to global climate change. Although technological solutions can help reduce CO2 emissions, behavioral changes are necessary to achieve sufficient reductions.