A few weeks before 4-year-old Paul Peterson was scheduled to have surgery to close a hole in his stomach as part of his recovery from a stroke, he was dropped from Medicaid coverage. While his mother frantically worked to figure out what happened and get him re-enrolled, his surgery was delayed and he missed needed speech, occupational, and physical therapy appointments. Paul, like many others, lost coverage not because he wasn’t eligible but because of bureaucratic hurdles: burdensome paperwork, complex regulations, and changing deadlines.

Hurdles such as these are a type of administrative burden, that is – the time, money, effort, and other work needed for eligible people to access their benefits. Administrative burdens include compliance costs like completing paperwork, learning costs like navigating eligibility requirements, and psychological costs like overcoming stigma. Some administrative burdens are inevitable, but too often policymakers use them to purposely make it harder to access benefits. 

In previous years, Paul and other children with complex medical needs or long-term disabilities in Idaho, where Paul lived, were automatically re-enrolled in Medicaid. This “ex parte” renewal helps ensure eligible enrollees don’t lose coverage. It reduces the administrative burden on both beneficiaries and state administrators. Despite significant evidence on the benefits of ex parte renewal, in 2019 the Trump administration deemed the process “inadequate” and threatened to pull Idaho’s federal funding unless it required additional documentation from recipients. That left about 2,700 children in Idaho – including Paul – with little or no warning that they would have to complete a new process in order to keep their coverage. Such regulations, implemented nationwide by the Trump administration, are part of the reason why over 700,000 more children were uninsured in 2019 than 2016.

Administrative burdens are everywhere in American life: when we fill out our taxes, apply for a driver’s license, vote, or have almost any interaction with the government. For some, these requirements are just an annoying chore. But for people living with chronic scarcity – for example, people with limited time to gather necessary paperwork, limited money to pay required fees, or limited resources to travel to in-person appointments – administrative burdens can be the difference between getting a benefit or not. Administrative burdens also disproportionately harm those who most need benefits.

For example, many families find the Free Application for Federal Student Aid (FAFSA) – a 100+ question form – to be too complex to complete, despite the financial benefits. A Department of Education report found that 23% of students who did not complete the FAFSA (non-filers) stated that they did not have enough information to complete it. While this “learning cost” affected all non-filers, the burden was not evenly distributed: 34% of Hispanic students and 27% of Black students, compared to only 18% of white students, and 43% of students whose parents did not have a high school degree reported they did not have enough information to file. ideas42 has done work to help students navigate these administrative burdens, which in turn increased FAFSA filing rates.

The Temporary Assistance for Needy Families (TANF) program, which provides financial assistance to families with low incomes, is similarly burdensome to access. Families must navigate drug tests, educational requirements, benefit time-limits, restrictions on cash usage, and more. These harsh “compliance costs” are part of the reason why only 21 of every 100 families living in poverty received TANF in 2020. Additionally, many of these burdens are rooted in intentionally racist policies that have historically, and continue to systemically, deny access to Black families. Today, states with larger Black populations have less generous and more restrictive TANF policies. As a result, Black children are less likely than white children to receive TANF benefits when their families fall into crisis. ideas42 research suggests that removing these administrative burdens would increase access and support for eligible families.

On the other hand, the enhanced Child Tax Credit (CTC), enacted as part of the American Rescue Plan, successfully reduced child poverty, in part, because it did not impose unnecessary administrative burdens. Most families automatically received the credit through monthly deposits into their accounts or by check. As a result, families experienced an unprecedented 30% reduction in child poverty rates in 2021 and racial disparities in poverty narrowed. This had important implications for families’ well-being. ideas42 collaborated with several organizations on research that found that the CTC reduced financial stress for all eligible families, particularly among Black and Hispanic families. Unfortunately, the expanded Child Tax Credit was not extended and families received their final monthly payment last year. 

The Child Tax Credit is not a standalone example: the COVID-19 pandemic prompted policymakers across the country to reduce administrative burdens for critical social safety net programs. However, as the pandemic emergency has ended, these changes are expiring. This is unfortunate. While the changes may have been borne of necessity, reducing administrative burdens better served the American people and reduced disparities. Rather than rolling back the new streamlined systems, local, state, and federal governments should seek to make many of the changes permanent and look for additional ways to reduce administrative burdens. 

We at the ideas42 Policy Lab are working to reduce administrative burdens so that all eligible people can easily access their benefits. This includes supporting policies like the extended Child Tax Credit, which puts money directly into families’ hands without unnecessary hurdles, and leveraging our research to provide recommendations to policymakers on how to reduce administrative burdens in safety net programs.

The post Rebuilding the Safety Net by Reducing Administrative Burden appeared first on ideas42.

I used to not think much about narratives, let alone their role in shaping public opinion and policy. If you had asked me at the start of my poverty-fighting career what narratives were, I would have told you they were simply stories or referenced a quote about “controlling the narrative.” It’s true that I knew that narratives were important (I work in the behavioral sciences after all), but I never understood the centrality of narratives in all that anti-poverty organizations do or are able to accomplish. How if the narrative was right, the thing that we most want to accomplish, solving poverty, could have the political will to happen. They didn’t frame this as “narratives” in social work school when I attended, though they should have.

When I started working more closely with our Economic Justice team at ideas42 using a behavioral science lens to tackle thorny issues that create and maintain poverty and inequality in the United States, the importance of narrative work became more striking. When I would be in conversations with others that I didn’t agree with on social policy, I realized that our beliefs and attitudes were consistently driven by our underlying narratives. Narratives are a lens through which we make sense of the world, including the causes of poverty. Narratives help us conjure responses in debates about fundamental social policy questions, such as:

• What causes poverty? 
• Who deserves what type of support?
• What is the role of the government in providing that support?

I realized quickly that narratives provided a way for me to communicate ideas both around why I was doing the work I was doing, as well as how important it was for social change. Now that I have an understanding of common poverty narratives, I see them everywhere. In movies, what is conveyed about structural barriers as causes for poverty, versus individual fault? Overwhelming, as many say in religious circles, “God helps those who help themselves.”  

And not surprisingly, political rhetoric, which I will avoid repeating here, is omnipresent in how we think about and talk about poverty. Even in conversations with fellow organizations committed to fighting poverty, I sometimes have to ask – what do you mean by that comment? What are the implications of this position, and what narratives does it relate to? Truthfully, even those committed to fighting poverty can unintentionally reinforce some of the most harmful poverty narratives. It’s something we all need to look out for as an ongoing practice.

Even for me, when I took our new Poverty Associations Quiz, I was surprised that I was grappling with one or two of the statements related to the Fatalism narrative. While I didn’t score high, reading more about that narrative prompted me to reflect on where those beliefs and attitudes might be coming from, and what some of the implications might be in terms of my work.

We want other people to notice poverty narratives and their impact- so we decided to take survey work we’re doing nationwide as a part of Shared Prosperity Catalyst and let other people take it with real-time answers to see where they land. I challenge you to take it honestly – go with your gut – and see what poverty narratives you might hold, and reflect on whether those narratives align with your views on policy and what you’d want for your community.

If relevant, think about the implications of your views on the people you serve. Here’s what you’ll get as a part of taking the Poverty Associations Quiz.

1. See what common narratives exist about poverty, and what people across the U.S. believe.
2. Read more about what might be driving those narratives, such as demographics and ideological positions.
3. Start to understand how important narrative work is to addressing poverty in the U.S.

If this quiz gets a large response, we might consider developing a Poverty Associations Quiz 2.0 that contains many of the community-driven narratives from our work with Shared Prosperity Catalyst.  

To learn more about our narrative work, feel free to reach out to me directly at allison@ideas42.org and read up on our Shared Prosperity Catalyst website and data blog. 

The post Changing Poverty Narratives Starts with Understanding Our Own Associations appeared first on ideas42.

Photo by Nigeria Centre for Disease Control

It has been more than a year since the global roll-out of COVID-19 vaccines, yet the gap in vaccination rates between high- and low-income countries continues to grow. Supply shortages are no longer the primary issue, with logistics challenges and vaccine hesitancy emerging as the main barriers to uptake in many low-income countries.

Among an “infodemic” of abundant and potentially harmful misinformation about COVID-19, people already suspicious of the vaccine’s origins are drawn to information that seemingly confirms their beliefs and can be resistant to new and contradicting information. Even if few people believe conspiracy theories, they contribute to a cloud of uncertainty about the vaccine and possible adverse side effects. This undermines the public health response, fomenting mistrust of governments’ priorities and motivation, as well as suspicion about foreign actors’ involvement in pushing vaccines.

As part of the USAID-funded Breakthrough ACTION project, we are working with teams and governments in eight countries—Liberia, Côte d’Ivoire, Cameroon, Senegal, Mali, Burkina Faso, Philippines, and Nigeria—to understand and target demand-side barriers to improve acceptance and uptake of the COVID-19 vaccine. Our formative work has explored the context surrounding vaccine-related decision-making and behavior in each country through interviews with healthcare workers and community leaders, as well as the general public.

Below are three cross-cutting behavioral insights from our initial work across Liberia, Côte d’Ivoire, and Cameroon that suggest opportunities to encourage uptake in low-resource settings despite persistent challenges to vaccine acceptance.

Opportunity #1: Make peer vaccination more visible

Despite widespread exposure to misinformation, we found that seeing a peer or someone you identify with safely vaccinate can be a powerful driver towards personal acceptance. In some cases, this can serve to directly counter beliefs—for example, seeing that a friend who got vaccinated is now pregnant can help to overcome misinformation-related concerns about infertility. In other cases, someone may feel compelled to accept the vaccine after seeing others do so, even if they still harbor personal concerns or uncertainties. Whether peer vaccination effectively counters or simply trumps negative beliefs, this observation suggests that normative interventions to increase the visibility of vaccine uptake among peers can help drive demand, even without more intensive belief-shifting efforts. It also underscores the importance of making vaccines easily accessible to those already motivated to receive them, as their actions may have a downstream impact on their peer network.

“When the boss gets vaccinated, I stay without getting vaccinated—why? I said, ‘vaccinate me.’ If it did something to you it will do something to me.” – Community member, Cameroon

“I took the vaccine because I saw some of my friends who took the vaccine moving around smoothly.”– Provider, Liberia

Opportunity #2: Prime identities

We observed that one’s perceived status as a role model or desire to set a good example can help to override personal doubts about the vaccine among community leaders and health workers. We found examples of this responsibility either driving personal vaccine uptake or at least leading to a willingness to promote vaccination to others through their capacity as a community leader, even if they remained hesitant themselves. This suggests that prompting people to consider aspects of their identity that would also align with setting a good example with regards to vaccines, such as informal roles within family and friend networks, might help build more inroads into hesitant communities, in addition to leveraging local influencers.

“They themselves are taking the vaccine because we the health workers are the example, and the people look up to us. So, we are serious about the vaccine…” – Provider, Liberia

“…For someone to come and be vaccinated, I had to be vaccinated to motivate the population. When we went to the community, you had to be the model, the example.” – Provider, Cameroon

Opportunity #3: Communicate other downsides to staying unvaccinated

Finally, more recent emerging evidence suggests that anticipation of future hassles related to one’s unvaccinated status can increase the perceived urgency of getting vaccinated and willingness to do so among those otherwise on the fence or ambivalent. Several people we spoke to cited restrictions against traveling across borders, entry into government buildings, or future work requirements as reasons they expected to take the vaccine. This suggests that vaccine mandates for specific activities that people want to engage in could be a potentially effective tool in these settings, as they have been found elsewhere.

“Crossing borders, they say, ‘Ah, you didn’t get the vaccine, you can’t go into such and such a country…’ So, it’s better to get vaccinated.” – Provider, Côte d’Ivoire

“You have to get vaccinated if you want to go to France…But if I don’t see this obligation, I’m in no hurry.” – Community member, Cameroon

Vaccine uptake is as much a behavioral problem as it is logistical, and our early insights in Liberia, Côte d’Ivoire, and Cameroon suggest opportunities to encourage vaccination that may resonate across other settings facing similar behavioral challenges. We believe such insights can be leveraged through behavioral design and will play an important role in boosting vaccine uptake efforts and reducing the vaccination disparity in low-income countries.

Write to gh@ideas42.org if you’re interested in exploring how these approaches could be applied to your setting.
We believe such insights can be leveraged through behavioral design and will play an important role in boosting vaccine uptake efforts and reducing the vaccination disparity in low-income countries.

The post Closing the Global COVID-19 Vaccine Gap: Three Encouraging Insights from the Countries of Implementation appeared first on ideas42.

Credit: Gabriela Carvalho PH, CC BY-SA 4.0, via Wikimedia Commons

Achieving gender equity doesn’t require better arguments or more evidence, it needs new narratives. Last year, Argentina’s marea verde, or green tide, delivered a sweeping abortion reform, moving the needle in favor of gender equity in a society that’s still influenced by prevailing Catholic values and norms that stigmatize a woman’s right to choose. Millions of Argentinians took to the streets to celebrate the landmark bill, and its rallying cry: “educación sexual para decidir, anticonceptivos para no abortar, aborto legal para no morir,” (or, ‘sexual education so we can decide, contraceptives so we don’t need abortions, and legal abortions so we don’t die’) inspired feminist movements and other civil society groups working for increased women’s rights throughout the region. But despite recent wins, Argentina, like many countries, is still far from achieving equal rights for women, and narratives are a part of why. In the first of a two-part series, I’ll start to unpack some of the behavioral barriers at play. 

Why is the political economy for issues impacting women’s rights and equal standing in society so difficult to shift in Argentina? Our Economic Justice team’s work changing narratives around poverty in the U.S. suggests that to unlock the kinds of policies and programs that promote equity and dignity, we need to uncover and dismantle the often false and harmful stories we hold about each other. Just as we unconsciously hold narratives around poverty and how it happens, we all have a powerful, unconscious script about what women should or should not do, what women deserve, and even what it means to be a ‘good’ mother. How we define womanhood may be based on what we’ve seen in our families or in popular culture and movies. I personally come from a Venezuelan family with very traditional gender roles – my father is the breadwinner and my mother stayed at home to raise me and my sisters. This seemed so normal that I didn’t question that division of labor until well into my 20s. 

We see the same gender roles play out in mainstream media: in 2017, among the 100 top-grossing films globally, male characters were more likely than females to have work-related goals (41% vs 34%). And between 2006-2009, not one female character in films marketed towards people of all ages was represented as a business leader or in professions with stringent education and certification requirements such as medicine, law, or politics. Given all the signals we get about gender and work, and the narratives underpinning them, it’s no wonder we internalize ideas about what’s ‘normal’—sometimes without even knowing it.

At ideas42, we believe that as long as we hold onto prescriptive, false narratives about what types of jobs women should or shouldn’t do and even what constitutes ‘work’, women’s labor will not be valued equally, and therefore their place in society will not be equal. To begin the hard work of changing false and deeply embedded narratives, we partnered with the International Labour Organization (ILO) in Argentina. We had two goals: first, to uncover the narratives that drive an unequal distribution of unpaid care work. Second, to design a social norms intervention to dismantle those narratives and replace them with new, more accurate ones that reflect the experience of women in the real world. 

We started by exploring how gender inequities around care work manifest in Argentina. The context is bleak: care work—activities that strengthen the health, safety, and emotional wellbeing of others—is invisible because it happens inside the home and is largely shouldered by women. Because it is invisible, it is also unpaid and undervalued, creating a vicious cycle that keeps women from making money for their labor while often excluding them from many paid economic opportunities. Indeed, we assign economic value to this work, it translates to more than 15.9%  of Argentina’s GDP with women contributing 76% of that effort. 

It also deepens income inequality. Women with higher socio-economic status can afford to pay for private care services and on average report spending three hours per day on care work while women living in poverty don’t have the option to externalize care—whether public or private—and are often forced to shoulder unpaid but important ‘community work’ like running neighborhood kitchens, taking care of neighbors, friends, or cleaning shared spaces. This is in addition to the family household work, where many women spend up to eight hours on childcare and housekeeping activities. This depresses economic mobility by increasing time scarcity on top of resource scarcity and toxic stress for women living in poverty, keeping them from joining the workforce and improving their livelihoods. 

We began to explore the narratives that create the conditions we uncovered in Argentina through an online survey with 1,010 respondents, and 15 in-depth interviews with adults that had at least one child in the province of Buenos Aires. We found there are clear ideas about how people conceptualize care and motherhood that get in the way of an equal distribution of care work in households: 

1. There are new reasons for old sexism. Social desirability has changed the ways sexism crops up—the traditional narrative that defines women’s role as stay-at-home mothers and men as providers had very low endorsement in our survey (only 11% of respondents). The modern version is more subtle—people believe that women should stay at home for a different reason: “if they don’t, it has negative consequences for the child’s development” (29% of respondents). Narratives around masculinity also contribute to unequal distribution of care work. Men are considered less competent and responsible and therefore less critical to a child’s development. In fact, an ILO-led survey revealed that when asked what’s an important characteristic for someone to take care of children, 68% answered that being a woman was somewhat and very important. This preference was also reflected in our qualitative interviews: ideal external caregivers were often women, such as aunts and grandmothers, and at times, we were explicitly told they should not be men.

2. (False) mental models of gendered parenting roles persist. ‘Good mothering’ is rooted in unachievable mental models that either keep women from considering re-entering the workplace or drown them in guilt if they do. Since a ‘good’ mother sacrifices herself for her children and is expected to be always present, a working mother is always lacking or struggling to live up to this expectation. Indeed, we saw high levels of guilt for working mothers overall. They feel guilty because their children take time away from their work and guilty because work gets in the way of spending time with their family. In interviews, women expressed the desire to go back to work to feel like themselves and have financial autonomy, with one woman saying, “If I need to buy a diaper, I’d like to pay for it myself instead of asking my husband.”

3. Labor is selectively devalued. Care work is seen as ‘altruistic,’ meaning people should do it out of love or selflessness without expecting anything in return. By turning care work into an intrinsic value, there are no incentives to recognize it as labor and place a market value on it. Interestingly, when asked about other people’s endorsement of gendered narratives interviews, women shared, “Many think: the man works and puts food on the table…she doesn’t work, she’s a housewife, I would live for them to put themselves in our shoes, what we go through, what we resist so they’re comfortable, have a clean house, food. Many of them don’t value that or don’t see it.”

If we can shift how people conceptualize care from altruism to true work, as well as shift our mental models from masculinity being antithetical to care and femininity making someone an ideal caregiver to shared and equal responsibility, we can unlock the ability for women to achieve the same agency over their lives as men. Specifically, women would be able to enter and participate in the workforce meaningfully as they choose, achieve financial autonomy, and prioritize caring for themselves and living meaningful lives of their own choosing. 

In the next post, we’ll share how we co-created behaviorally-informed designs to begin to counter these narratives and reshape social norms in Argentina with ILO, civil society organizations, UN agencies, and other stakeholders in the country. Our hope is that we can contribute to the ongoing efforts by ILO and others that foster an equitable distribution of care work, allowing women to have the time they need to take care of themselves, join the labor force, or just watch a movie in peace (hopefully with a female protagonist that is fulfilled by more than her romantic relationships).

The post Changing Narratives Around Care Work in Argentina and Beyond appeared first on ideas42.

In the decade since becoming eligible to vote, I’ve moved seven times across four different states. Along the way, I’ve prided myself on re-registering with each move and doing my best to get familiar with my new elected officials. But despite the fact that my job literally revolves around elections, I still struggle like most Americans when it comes to voting in local elections and down ballot races during higher-profile elections. 

When my city recently held a ballot referendum over building a new high school, I felt completely out of my depth. I only learned about the race a week before election day and I had trouble making sense of what we were being asked to vote on. The handful of articles I found felt incomplete and had agendas that were difficult to decipher. Talking it out with my fiancé, we debated whether it was even our place to weigh in since we didn’t have deep roots in town or plan to raise kids here. 

As I attempted to untangle what a “yes” or “no” vote meant, the fear of getting it wrong loomed large, especially since the consequences would be borne by people already marginalized within the community. While the city I live in is overwhelmingly white, the high school primarily served Black and Latino students. The demographic mismatch between the school system and the voting population forced me to consider the potential equity impacts of the referendum even more deeply. 

Although I ultimately made it to the polls for that referendum, millions across the country sit out similar elections every year, with turnout in local elections often struggling to crack 30%. Some simply never hear about these low salience elections, while others drop off somewhere along the way between setting an intention to vote and actually voting—especially if they lack the time and resources to navigate the process. While conventional wisdom is quick to ascribe low turnout to voter apathy, the reality reveals a much more complicated picture.

Voting Local: Promoting More Equitable Participation in Local Elections

Over the past year, ideas42 partnered with Democracy Works, the makers of TurboVote, to learn more about the barriers to voting in local elections. Given our organizations’ shared goal of increasing the representativeness of local electorates, we paid close attention to barriers that were particularly pronounced among voters who are traditionally underserved by elections infrastructure, especially communities of color. 

With the help of voters in New York City, Detroit, Boston, Atlanta, Richmond, and New Orleans, our team uncovered four key barriers to participation, which we detail in our new report Voting Local: Promoting More Equitable Participation in Local Elections. We then delivered over 85,000 custom text message notifications to TurboVote users in our target cities to tackle these barriers head on.

The barriers we uncovered provide important nuances for how people’s desire and ability to vote in local races are commonly undercut. For instance, we found that many people disengage from local elections because they lack a strong connection to the place where they currently live or are skeptical that candidates would reliably represent their needs. We found these sentiments repeated even by those who otherwise were eager to participate in national elections for high-profile offices like the President, even though local races often have a more direct impact on their day to day lives. Like me, they were transplants or had strong preconceived notions about who local elections were meant for. Their image of the “typical” local voter was often of an older person who owned their home and had kids in public schools. 

Of course, there are those who intend to vote in every election who still struggle to follow through. We heard reports in every city that people do not feel prepared enough to participate in local elections and as a result the consequences of making the wrong decision feel worse than not voting. Contrary to popular belief, almost everyone we spoke with had an intuitive understanding of how important local elections were to their daily lives. They felt that choosing “correctly” was in fact so important that it was less risky to sit out all together than risk voting in a way that caused harm to their community. One man in Atlanta captured this do no harm ethos poetically when he told us a local race, “has a more direct impact, and you don’t know if you’ve led the snake into the garden. You like the wrong politician, and suddenly your waters are polluted.” 

While a typical voter outreach campaign may go all in to convince voters about the stakes of the election, if they don’t properly support people by connecting them to simple, actionable, and resonant resources, then they risk demobilizing voters by amplifying the consequence of making the wrong choice.

With the 2022 midterm election cycle officially underway, these insights are critical to help understand how voters across the country are approaching the decision of whether or not to participate, especially in lower salience contests. As organizations and campaigns craft their voter outreach strategies, the insights outlined in Voting Local can help people communicate more effectively with voters and avoid some common pitfalls that may inadvertently hamper their efforts. 

Interested in learning more about our efforts to apply a behavioral lens to increase voter turnout and by extension the representativeness of our democracy for all? Reach out to us at omar@ideas42.org

The post Overcoming Barriers to Voting in Local Elections appeared first on ideas42.

Behavioral science provides a crucial framework for understanding human responses to uncertainty. As we unpacked in a recent post, we’ve all been living with high levels of uncertainty and instability throughout the COVID-19 pandemic. 

When it comes to uncertainty regarding COVID-19 vaccines, there are four “cognitive pitfalls” in particular that are likely to affect decision-making. In the previous post, we examined the first two: ambiguity aversion and the possibility and certainty effects. Here, we take a look at the next two pitfalls. 

With these cognitive tendencies in mind, healthcare practitioners and others who communicate about vaccines can help people overcome these pitfalls, to protect themselves, their families, and their communities from COVID-19.

Zero Risk Bias

We like to take actions that completely eliminate one kind of risk, even if it increases our overall exposure to a negative outcome. This is known as zero risk bias. Remember all that panicked toilet paper buying in early 2020? It’s a great example of the zero risk bias in action. Rushing to a crowded grocery store to stock up on toilet paper eliminates your risk of a tricky situation in the bathroom, but in aggregate it exposes you to a much worse risk of contracting a potentially deadly disease. In this case, people were opting to reduce their bathroom risk to zero, and in doing so neglect the broader category of COVID-19 related risks.

Getting vaccinated against COVID-19 lowers risk of becoming infected, particularly the chances of severe illness leading to hospitalization or death. But vaccines don’t entirely eliminate those risks, and they also introduce another possibility–experiencing side effects. Avoiding the vaccines eliminates that risk of side effects. Essentially, people may accept a much higher risk of getting COVID-19 if it allows them to eliminate another category of risk, even though the levels of those two risks are very different. 

One approach to address this bias is to find ways to eliminate categories of risk relating to vaccination, such as guaranteeing paid sick leave so people won’t need to risk income loss if they experience side effects. Another is to reframe how people are conceiving risks, shifting the focus away from contracting COVID-19 to more serious outcomes like hospitalization or death. While vaccines will not eliminate your possibility of contracting COVID-19 or even coming down with symptoms, early evidence around the Omicron variant suggests that a recent booster shot all but eliminates the risk of serious illness and death for otherwise healthy people.

Attribute Substitution and Negativity Dominance

Objectively evaluating the odds of catching COVID-19 is hard (especially with each new variant bringing different rates of transmissibility), to say nothing of assessing how severe the illness might be. A much easier question to answer might be, “how many people do I know who got COVID-19, and how serious was their illness?” When confronting hard-to-evaluate questions, our brains tend to substitute easier questions like these to help us navigate complexity and uncertainty. This cognitive process is known as attribute substitution. Like the other biases, while it often serves us well in making quick judgments, it can lead us astray when evaluating risks and benefits around COVID-19 vaccines. And when we are evaluating these risks, our thinking tends to be biased even further by negativity dominance, which is the tendency to give more weight to negative events and information relative to positive.

To counter these effects, vivid and intuitive graphics (such as the example for an imaginary “Behavioria County” below) showing the tiny scale of breakthrough infections that lead to hospitalizations and deaths compared to the magnitude of total vaccinations can be effective. This visual would make it easier for our brains to process just how rare serious infections among vaccinated individuals are, better highlighting the positive benefits.

Graphic for illustration only (not based on actual figures)

Throughout the pandemic, a core component of public health messaging has depended on the assumption that people calculate risk and probability effectively and then make informed choices about whether or not to get the COVID-19 vaccine or any boosters. But as the four cognitive pitfalls we’ve discussed in this series show, it’s very easy for anyone to be swayed by psychological biases. When systems are designed around assumptions about human behavior that don’t hold true, it’s a failure of the system, not of the person doing their best to navigate it. As behavioral scientists and practitioners, we need to make sure that we’re meeting people where they are, and working to ensure that our messaging and systems account for the ways people actually think and behave. 

The post How Does Uncertainty Influence Decisions About COVID Vaccination? Part 2 appeared first on ideas42.

This is part of a series of conversations with members of the National Innovations Team (NIT), a group of 54 health professionals across government and non-profit sectors in Burkina Faso and Niger. NIT members engage in a hybrid online and in-person applied learning curriculum developed by ideas42, which includes an introduction to behavioral design and hands-on coaching from our behavioral economics experts.

Through the course, members develop and refine innovative solutions based on feedback from end users to address behavioral challenges across a range of health areas. The NIT was established in 2020 by Breakthrough ACTION, the U.S. Agency for International Development’s flagship SBC program.

This spotlight features Binta Soumana Gaoh, who is working within the postpartum family planning (PPFP) group in Niger to promote uptake of PPFP methods as part of the second cycle of the National Innovations Team (NIT) course in 2021–22. Binta also participated in the first cycle of the NIT activity, which focused on improving caregivers’ complementary feeding of infants aged six-eight months. In this interview, she discusses the effects of this training on her daily work as a communicator and as Head of the Communication Division at the Family Planning Directorate of the Ministry of Public Health of Niger.

Name: Binta Soumana Gaoh
Country: Niger
Title: Head of the Communication Division
Organization: Directorate of Family Planning, Ministry of Public Health, Population and Social Affairs

What motivated you to participate in this training?

In the beginning, I thought it was just the usual two- or three-day training session and then everyone would go their separate ways. But when we went for the launch, the Breakthrough ACTION team explained the different modules—ideation, prototyping, user testing—and I thought, “Ah, this is what I need!” Especially because when we typically create behavior change communication materials, we have to hire designers and explain to them what we want. Then they go and make sketches and come back, and we usually tell them, “No, that’s not quite right,” and then they have to do another draft and come back to us. It’s a lot of back and forth. So, I thought to myself, if we knew how to do that work ourselves, it would go a lot faster.

In 2020, you participated in the first cycle of the NIT, which focused on developing innovations to increase adequate complementary feeding for infants. Why did you decide to come back again for this second cycle?

The first cycle was a learning process where I realized how much it helps to capture the attention of your target audience. That was innovative to me, because before that everything we designed really came from the West; all of our images and messages were not adapted to our context. But when we developed designs ourselves, we were able to consider our own culture and incorporate what is available in our country to reach our target audience. That really interested me.

For the second cycle, now that we were equipped with the skills from cycle one, I advocated for a theme on family planning, because that’s what I focus on. We recently set up a new department, but we don’t have enough behavior change materials. I convinced Breakthrough ACTION to select postpartum family planning (PPFP) as one of the four focus behaviors of this second cycle by making the case that with the designs that we will develop, I can mobilize partners to reproduce and scale them up on the ground.

What are you working on in this second cycle?

The facilitators understood and accepted the theme of PPFP because it is part of the high-impact interventions that we are scaling up, especially since here in Niger, there are a lot of barriers to PPFP. For example, it is the man who decides everything, including reproductive health and the woman’s health. We’ve already generated more than 200 ideas and synthesized the different features of our designs. Now we are working on a dialogue tool that will help a woman and her husband choose a specific moment to talk to a health provider about FP, select a preferred method, and identify the exact moment when they will start using it. The dialogue starts at prenatal consultation and continues through delivery, so the couple can decide on their preferred method before the birth of their child. Then, immediately after the woman delivers, she can start using her preferred method.

“Before, everything we designed really came from the West; all our images and messages were not adapted to our context. But when we developed designs ourselves, we were able to consider our own culture and what is available in our country”

Was there anything you learned from the course that was different from your regular way of working?

By participating in the NIT, we learned how to transform our own ideas into behaviorally informed communication materials and interventions. Before the NIT, I had never developed a design myself. With the NIT, I learned that I could design on my own. Maybe my sketch isn’t well done, and the illustrator will fix it when he sees it, but it’s what I want that’s in the document. That’s new! And there’s also the user testing. Here, we don’t always pre-test our designs. Sometimes we rely on the image—it’s beautiful—and the writing is good. If we understand, we think that the others will understand too, and we just go ahead and implement it. Now, with the NIT, we’ve learned that we really should be doing internal user tests, where other colleagues give us feedback on the designs, and then we should go to the target population to get their opinion. That allows us to investigate whether our design and the messages we are expressing through it are presented in a way that users really understand.

To what extent did user testing improve the designs your team developed?

When we did it during the first cycle, we presented our design to our colleagues and they said, “Yes, this is good, when you see this, you understand.” And clearly, we saw all the steps. But, when we went out into the field to user test it with our target audience, we presented it to women who had never been to school, and they told us, “No, this doesn’t mean that, here you should have done that. This part goes on this side, and it’s such and such an image that should be used.” We were so astonished that women who hadn’t been to school were giving us this really relevant feedback that our colleagues back at the office with their advanced degrees hadn’t seen or thought useful. Our big takeaway from that was that gathering feedback from your target audience is always very important.

“We were so astonished that women who hadn’t been to school were giving us this really relevant feedback that our colleagues back at the office with their advanced degrees hadn’t seen or thought useful.”

How has being a part of the National Innovations Team changed the way you do your work?

Even our colleagues in the office who are not part of the NIT have been influenced by it, because sometimes when we are going through the course lectures, we’ll do a debriefing with them to share what we’re learning. Also, when we were creating our designs for this cycle and last cycle, they would walk by and notice and ask us what it’s about. So, we would explain it to them and many of them became really interested in the NIT, but they just didn’t have the chance to enroll. Maybe they’ll have another chance next year? Overall, I’d say being a part of the NIT has allowed us to rethink the way we do our work and to improve it.

This series is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Breakthrough ACTION and do not necessarily reflect the views of USAID or the United States Government.

The post Building Behavioral Design Skills: Conversations with Breakthrough ACTION Innovators appeared first on ideas42.

The success of social protection programs often hinges on people’s ability to make and act on a series of choices. For example, participants of cash transfer programs have to consider what their financial priorities are, and how best to allocate cash transfer between those priorities. They may also have to decide how to engage in the program’s other components: for example, whether to attend supplemental financial management trainings; how to implement what they learn from those trainings; and how long to sustain the new behaviors or habits that come out of what they learn. In contexts of extreme poverty or instability, these choices can be complex, forcing people to make tough trade-offs between competing needs (e.g. looking after a child versus attending training sessions) and long-term goals (e.g. spending cash on food versus saving it to invest in productive assets). An understanding of behavioral science can help program administrators anticipate the barriers that participants are likely to face throughout the program cycle, and offer behaviorally informed tools and techniques to help participants navigate those barriers and achieve the intended program outcomes, which are generally an improvement in livelihood for individuals and their families.

In December 2021, we launched a new virtual training series as part of our efforts to make behavioral science ubiquitous in the design and implementation of social protection programs—including cash transfer programs—around the world. With support from the Wellspring Philanthropic Fund, our virtual training was designed to equip practitioners and policymakers with a behavioral toolkit so that they can better understand how the behavior of program participants as well as staff can limit the impact of social protection programs. The training shed light on simple behavioral design principles to address behavioral bottlenecks common to social protection programs. 

The virtual training consisted of 10-15 minute pre-recorded video lessons, delivered over two weeks, that covered the foundations of behavioral science and its applications to real-world issues, using relatable examples from everyday experiences. After viewing each video lesson, participants independently completed reflection activities that prompted them to begin applying their learnings to their day-to-day tasks. Participants spent about 20-30 minutes each day during the course to watch the lesson and complete related activities and attend weekly “office hours” hosted by ideas42 experts. 

Our inaugural training cohort included 17 participants from the Nigeria National Social Safety Net Program (NASSP) and the Accelerating Nutrition Results in Nigeria (ANRiN) project who are responsible for implementing ongoing cash transfer and nutrition support programs in Northeastern Nigeria (and are our partners in the behavioral designs for cash transfer portfolio that we launched in collaboration with the World Bank thanks to financial support from the Global Innovation Fund). Through this training, participants were introduced to what behavioral science is, how situations can shape behavior, and how psychological principles such as scarcity, social norms, and identity often drive people’s decisions and actions. It also introduced participants to simple behavioral design tools: allowing them to use their unique vantage points in overseeing these social protection and nutrition programs to identify persistent, impact-limiting behavioral bottlenecks and opportunities to apply behavioral insights to better meet the needs of their participants and staff. 

Participants were enthusiastic about the self-guided training, with more than half of the invited participants choosing to join each session of our optional office hours. During these office hours, we discussed behavioral science concepts covered in our video lessons (such as scarcity and social norms) and answered questions that the training participants had (e.g. what the distinction is between prescriptive and descriptive social norms). Participants shared examples of those concepts from their professional and day-to-day lives and how they may contribute to barriers to action or optimal decision-making. We also touched on different ways to begin applying behavioral science methods to identify viable solutions to these barriers, and the need for those solutions to be tailored to local contexts to be effective. Feedback from participants collected after the training suggested that the content was useful in their work, and our training structure helped them learn key concepts.

“All lessons shared were related to our daily routine and what I liked the most was the approach of the lesson, which made it easier for me to relate it to my day-to-day activities.” –Training Participant, Nigeria, 2021

The feedback we collected from our participants, as well as lessons we learned from this first cohort about how best to structure and share materials with training participants, will help us adjust our materials and approach for future training sessions with social protection teams in other countries. As cash transfer programs continue to expand across economies in the Global South, they face growing demands to deliver greater benefits for social protection per dollar spent. With light-touch improvements to the design of cash transfer programs, behavioral solutions can improve social protection outcomes at little, if any, additional cost. Equipping more practitioners and staff members with new skills through our easily scalable training curriculum, we are making progress toward our goal of increasing an understanding of behavioral science and its usefulness among program administrators and frontline staff in the strongest position to strengthen social protection programs, and by extension, improve lives.

If you would like to learn more about our virtual training series for global social protection programs, please contact Kate MacLeod at catherine@ideas42.org. 

The post Introducing Behavioral Science to Global Social Protection Program Staff and Policymakers: Our New, Virtual Training Series appeared first on ideas42.

Nearly two years into the COVID-19 pandemic, it can feel like there’s new developments and updated guidance every week. Consider the last few months of 2021 alone, which saw the first full FDA approval of a COVID-19 vaccine, authorization of a vaccine for the 5-11 age group, two different pills to treat COVID-19, and the omicron variant spreading rapidly and sending cases soaring to new heights worldwide. 

What isn’t news is that we’ve experienced high levels of uncertainty and instability throughout the pandemic, which makes decision-making difficult. It’s hard to make good choices when the information we use to make those choices keeps changing. As Richard Thaler often says, the problem isn’t that people are dumb, it’s that the world is hard. This is true both in and out of a pandemic, and it’s why behavioral scientists focus on making processes, systems, and decisions easier to navigate. 

Behavioral science provides a crucial framework for understanding human responses to uncertainty. When it comes to uncertainty regarding COVID-19 vaccines, there are four “cognitive pitfalls” in particular that are likely to affect decision-making. Fortunately, healthcare practitioners and others who communicate about vaccines can help people overcome these pitfalls, to protect themselves, their families, and their communities from COVID-19. We’ve been working with a variety of partners, including community-based organizations and community health workers, to incorporate these behavioral approaches into their vaccine outreach.

Ambiguity Aversion

Ambiguity aversion is the tendency to favor known over unknown risks. Humans prefer certainty, but among outcomes involving some level of risk, we’re attracted to familiar options and odds. 

For example, two years into the pandemic, the virus may feel like a familiar enemy. By comparison, COVID-19 vaccines became available to the general public in the U.S. a year or more later, with risks and benefits that may feel more novel. In surveys, unvaccinated individuals consistently report concern over unknown long-term side effects of vaccines as a principal driver of hesitancy. In effect, many unvaccinated Americans seem to opt for the devil they know (COVID-19) over the devil they don’t (vaccines). 

With that in mind, public health messages could contrast the fluid nature of a constantly evolving virus against increasingly widespread and familiar vaccines–while of course still being transparent about what we know and are still learning about side effects. And when communicating new developments related to the virus or the vaccines, studies suggest one way to mitigate people’s anxiety without conveying a false sense of certainty is to explicitly normalize uncertainty–in effect, tell people that, while there’s a lot we may not know, that’s not at all unusual and in fact to be expected.

Possibility and Certainty Effects

How much would you pay to shift the odds of rain on your wedding day from 1% to 0%? Now how about from 51% to 50%? Even though these changes both involve a difference of 1%, if your answer to the two hypotheticals was different, it may be because your judgment is swayed by what’s known as the possibility effect and the certainty effect. If instead of brains we had supercomputers in our heads, the way we compared those two sets of risks would have the same impact on our cost/benefit analysis. But humans aren’t robots, and we’re very sensitive to changes that take an outcome from impossible to possible, or from certain to highly probable–so we end up putting a far greater weight on that shift from 1% to 0%. 

How does this thinking apply to the pandemic? Headlines in 2020 touting 95% efficacy of vaccines, rather than building confidence about a highly effective vaccine, may have brought to mind the question “Even if I get vaccinated, I can still get this disease?” And data from May showing that 99% of Americans dying from COVID were unvaccinated may also have led people into possibility-effect thinking: “It’s still possible to die from COVID even if I’m vaccinated?” These reactions are probably not what the writers of these headlines intended, but it’s the way many likely interpreted them nevertheless. Better messages could speak in more certain, less probabilistic, terms: Vaccines have saved many thousands of lives, while COVID has killed hundreds of thousands in the U.S. alone.

These two tendencies—ambiguity aversion and the possibility and certainty effects—can cause people to avoid getting life-saving vaccines. With this knowledge in mind, communications and outreach about COVID vaccines can assuage concerns and help more people get vaccinated. 

Stay tuned for the second post in this series to learn about two more cognitive pitfalls that affect decision-making during times of uncertainty. 

The post How Does Uncertainty Influence Decisions About COVID Vaccination? Part 1 appeared first on ideas42.

International Women’s Day is a day of reflection—an acknowledgment that women around the world have long faced barriers to equal economic and social opportunities, and health services (and by extension outcomes). While at times it might seem like many women are fighting an uphill battle with challenging policy environments and resource constraints, behavioral science can help change the contexts that lead to policies, programs, products, and services that don’t reflect the realities of women’s lives. It can help #BreaktheBias across a range of complex problems that directly and often disproportionately impact women. 

Because using behavioral science as a problem-solving tool involves taking a closer look at drivers of behaviors, decision-making, and the contexts in which they occur, this approach can support women, communities, and policymakers working to overcome gender biases and lead to more equitable outcomes across health, wealth, justice, and sustainability. Since our inception, we’ve worked around the world in pursuit of improving opportunities for women to make the choices that are best for them. 

From our work, we know we can use the power of behavioral science to…

…understand and mitigate the hassles and administrative burdens in public benefits programs such as the Supplemental Nutrition Program for Women, Infants, and Children (WIC), helping more women and their families access nutrition when they need it.

…develop tools to reduce preventable deaths from postpartum hemorrhage during childbirth. In Madagascar, a package of interventions including a well-placed digital countdown timer helped clinic workers deliver life-saving oxytocin when postpartum women need it. 

…strengthen the impact of unconditional cash transfer programs in the Global South, which often provide direct support to women and provide critical means for them to make investments in themselves and their families.

…reduce the gender pay gap in the United States using actionable strategies that employers can implement and test in their workplaces to create more equitable work environments. 

…ensure women are aware of their family planning options and better positioned to make the choices they want. Our solutions in Malawi, including a gamified counseling tool, helped resource-constrained health workers to better counsel women on the family planning method that most aligns with their needs. 

…establish and scale a novel financial heuristics training for female micro-entrepreneurs in several countries. These trainings meet busy women where they are, allowing them to build financial acumen and skills to grow their businesses more effectively while juggling many responsibilities.

…work with new entrepreneurs in the United States to develop technology solutions benefitting women with care obligations. One of the newest solutions in our Venture Studio, Handoff, focuses on providing quality employment opportunities to single mothers by enabling two individuals to share one full-time job, providing flexibility to manage parenting while building a career.

…reinforce the value of contraceptives during the postpartum period. These solutions encourage providers to counsel women on family planning at various stages, helping women to avoid unintended pregnancies that threaten their health and the health of their children. 

This is just a small sample of our work aiming to change systems, policies, and programs for the better. Together with women around the world, we see behavioral science as a crucial tool to positively impact the lives of millions. We’ll continue to do our part to help #BreaktheBias on this International Women’s Day and every day, seeking evidence-based solutions that provide more equitable opportunities and allow women to make the best decisions for themselves. 

Interested in partnering with ideas42 to create workplace equity and tackle other issues facing women around the world? Reach out to us at gender@ideas42.org. We also encourage you to tweet us @ideas42 to join the conversation this International Women’s Day and every day.

The post International Women’s Day: Breaking the Bias With Behavioral Science appeared first on ideas42.

Health providers provide feedback on potential interventions to improve the feeding of young children during and after an illness.

For young children experiencing an illness, adequate nutrition is critical for recovery. However, children often don’t receive the recommended amounts of food during and after an illness. In the Democratic Republic of the Congo (DRC), 70% of children under five receive less food than usual or no food during episodes of diarrhea. Similar gaps exist across many low- and middle-income countries like Pakistan (63%), Ethiopia (65%), and Peru (72%). In settings like these where childhood illness is common, too little food during and after illness contributes to high rates of child malnutrition, as children are unable to recoup lost weight. Malnutrition, in turn, can lead to stunted growth and development and higher child mortality.

Why aren’t young children fed enough during and after illness? As part of our behavioral approach to understanding this problem, we conducted qualitative research with families and health providers in the DRC. Working through the USAID-funded Breakthrough ACTION project and in collaboration with the USAID Advancing Nutrition Project and local partners, we learned that while caregivers want to feed their child well during an illness, they understandably feel discouraged and at times powerless in the face of the myriad constraints they encounter. These significant constraints, discussed below, obscure steps that caregivers could take with the resources available to them.

Sud Kivu is the region in the DRC where research was conducted to better understand the barriers to feeding young children during and after an illness.

Mental models of “worthwhile” foods limit the choice set

First, caregivers described a need for the child to recoup strength lost during illness with specific, “high quality” foods they associate with strength, like meat, dairy, and eggs. Health providers, leveraging their nutrition training, reinforce this perception by counseling on the importance of feeding children animal-source foods. However, most families can rarely afford or access these products. This rigid mental model of worthwhile foods leads caregivers to underestimate more locally available, affordable options such as small fish, fruits, and vegetables. Redirecting attention to these foods can expand a family’s choice set of which foods are worthwhile and may increase feeding during recuperation. 

Strengthening coaxing skills can help overcome a child’s limited appetite 

Second, caregivers expressed frustration with their child’s limited appetite during illness, which they saw as outside their control and a reason not to offer more food. Coaxing is critical for encouraging a sick child to eat, yet caregivers do not have broad repertoires of coaxing tactics. The tactic caregivers most frequently mentioned was offering their child’s favorite foods, but these foods are often unaffordable. Strengthening caregivers’ coaxing skills through counseling programs, workshops, or peer-to-peer sharing networks could empower caregivers to feel that they can win over their child’s appetite and allow them to feed more when the child is sick. 

The consultation room at a health center in Sud Kivu, DRC. Providers and caregivers alike focus intensely on medical treatment during a sick child consultation and do not currently discuss lost nourishment. Optimal feeding during and after illness is a critical behavior not widely practiced.

These insights and others identified through our formative research provide a roadmap for program design that supports caregivers to feed their children well with the resources they have, building skills and habits that are critically important during periods of illness and recovery but that remain relevant in times of good health. 

We, along with our partners in Breakthrough ACTION and at USAID Advancing Nutrition, are currently developing a suite of solutions with caregivers and health workers. In one solution, for example, community health workers use a set of cards during home visits to families with sick children to identify affordable foods and make a feeding plan. Another intervention uses the time mothers spend waiting for child vaccinations to facilitate peer-to-peer sharing of coaxing strategies. These solutions, and others, work across multiple health system touchpoints to help families better feed their children to promote recovery from illness, fight off future illness, and ensure infants grow into healthy children and adults. 

Stay tuned for our full suite of solutions and more insights from our work supporting caregivers to feed their children well. We’ll be sharing an in-depth look at our intervention designs in an upcoming post. Questions? Reach out to the Global Health team at gh@ideas42.org.

This content is also available on the Breakthrough ACTION blog.

The post Barriers to Feeding Young Children Well During and After Illness: Insight from the Democratic Republic of Congo appeared first on ideas42.

In the U.S., Black History Month is a time to reflect on the contributions made by Black people in all walks of life, across all industries and in all parts of our society. It’s also a time to celebrate and amplify the voices of those in the Black community and reflect on those who inspire us, or are engaged in history in the making. This celebration should include our field, behavioral science, which is an amalgamation of economics, psychology, sociology, anthropology, neuroscience, and more. Across these fields, there are a number of Black researchers and practitioners who are not as well-known, and as with much Black history in the U.S., they have not received the recognition for their work that they should. This is more evidence, if we needed it, that even those studying human biases (including ourselves) are still subject to bias.

Behavioral science has also made significant contributions to understanding the causes and sources of discrimination and conscious and unconscious biases, as well as discovered additional ways to fight discrimination and biases. Highlighting the Black people who have contributed to our field, as well as research that can continue to be applied, is a small step in our ongoing commitments to racial justice and correcting historical injustices. 

That’s why throughout the month of February, we’ll once again use our Twitter feed to shed light on Black researchers, thought leaders, and practitioners who contributed to the advancement of the different disciplines that comprise the behavioral sciences, but who have been less recognized publicly for their achievements that make our work at ideas42 possible. We will tweet about one person from history each day, as well as highlight research that either deepened our understanding of discrimination or bias, or were used to create ways to fight them. Both will be updated on this post with a growing list below.   

We invite you to reach out to us @ideas42 to share additional historical figures or research. We also encourage you to read our previous Black History Month blog examining the psychology of race in history.

Highlighting Black figures in the behavioral sciences (updated daily throughout February):

The post Black History Month: Honoring Black Behavioral Scientists appeared first on ideas42.

Since the onset of the COVID-19 pandemic, cash transfer programs across the globe have been trying to respond to the increased demand for assistance from those who need it most. In many countries, cash transfers are a vital component of the livelihoods of those living with extreme poverty. Timely and effective delivery of these programs is critical, and insights from behavioral science can aid cash transfers in having a greater impact on the lives of those in need. 

For the last six years, ideas42 has been working with governments in sub-Saharan Africa to incorporate behavioral designs into cash transfer programs in order to enhance their impact. Though our in-person work in the field came to a halt at the beginning of the global COVID-19 pandemic, we still worked to generate insights about our designs in this new context. For example, in Kenya, we worked with the Kenyan Ministry of Labor and Social Protection to determine if designs created pre-COVID were still effective during the pandemic.

However, the pandemic persisted, and there was a greater push for innovative solutions to provide timely assistance to support those directly impacted by the growing economic crisis. Practitioners and governments agree that the COVID-19 pandemic created a turning point for the delivery of social protection programs. This, in turn, presented us with a challenge: how to adapt interventions designed to be delivered in-person in a context that for all intents and purposes no longer existed, and maintain their effectiveness for cash transfer recipients.

We worked with the World Bank and the Fonds Sociale de la République Démocratique du Congo (FSRDC) to add a behavioral lens to their COVID-19 response cash transfer program. The goal of this program was to assist people experiencing poverty in urban Kinshasa in managing their cash payments, enabling them to spend cash in a way that would build resilience and reflect their own goals. Potential recipients were identified through satellite mapping, after which they registered over text message or through a telecommunications company on the ground. Once identified, they received the equivalent of $25 per month for six months, delivered through mobile money. Given the digital nature of this program, we aimed to assess whether a behavioral intervention, delivered fully through an SMS platform, would have a positive impact on recipients’ spending in accordance with their own goals.    

To help recipients manage their money and spend in line with their priorities, we worked to develop a pair of behaviorally informed text messages to be sent to recipients around the time of their cash transfer payment. These messages sought to help recipients identify a priority goal for spending their cash, and then spend their cash accordingly. The first message, sent the day before the transfer, prompted recipients to identify their priorities and to write out a plan for how they wished to spend their money. A day after receiving the mobile money transfer, recipients received a second message encouraging them to recall their plan and follow through with it. Both messages centered the recipient’s agency and ability to change their household stability through the program. 

To assess if the messages were effective, we rolled out a randomized controlled trial (RCT) in which half of the recipients were randomly selected to receive the messages and the other half did not. We then sent out a survey using interactive voice response (IVR) three and a half weeks after participants received both of our messages and their cash. We aimed to learn whether the messages had an impact on recipients identifying a goal for their cash and if it was a future-oriented goal (such as spending on a business or education, paying off debt, or saving), and whether they created a plan to follow through on this goal. We also wanted to know if they spent their cash on their identified goals. 

Overall, the results showed a positive, and significant, impact for those who received the messages:

• 2.5% increase in recipients reporting having identified a priority.
• 4.1% increase in recipients reporting having written down a plan for spending their cash. 
• 3.6% increase in recipients reporting having spent their cash in line with the identified priority.  
• 6% increase in recipients who reported having identified priorities that were future-oriented. This could be in part due to the framing of the text messages aiming to empower them to use the cash to improve their family’s livelihoods. 

The positive results from this work are similar to what we’ve found previously with in-person interventions, for example, in Kenya and Tanzania where we tested behavioral designs. Though these designs were delivered differently, they utilized the same behavioral principles and tools of goal-setting, plan-making, self-affirmation, and timely reminders. We’re excited to see that the results from this fully text-based intervention are in line with our previous work, as a digital approach could be more cost-effective and scalable than in-person delivery methods. 

COVID-19, and the economic crises that followed, created a turning point in the social protection landscape. Many in the field are seeking new ways to innovate as a result of the challenges posed by the pandemic, and behavioral science can offer insights and context-driven tools to design more effective transfers that can reach large numbers of new transfer recipients. Over the coming months, we plan to work with the FSRDC in the Congo to scale our messages in order to reach thousands more cash transfer recipients and help practitioners and governments alike make the most of the resources they have available.  

The post Pivoting to Digital Behavioral Designs: Lessons from Kinshasa’s COVID-19 Response Urban Cash Transfer appeared first on ideas42.

This is part of a series of conversations with members of the National Innovations Team (NIT), a group of 54 health professionals across government and non-profit sectors in Burkina Faso and Niger. NIT members engage in a hybrid online and in-person applied learning curriculum developed by ideas42, which includes an introduction to behavioral design and hands-on coaching from our behavioral economics experts.

Through the course, members develop and refine innovative solutions based on feedback from end users to address behavioral challenges across a range of health areas. The NIT was established in 2020 by Breakthrough ACTION, the U.S. Agency for International Development’s flagship SBC program.

This conversation features NIT member Emeline Ouedraogo, from the Ministry of Agriculture in Burkina Faso. Emeline’s team works outside the health sector to improve nutrition by tackling behavioral challenges related to food supply. We connected with Emeline in August 2021 to hear about her experience participating in the NIT.

Name: Emeline Wendyam Ouedraogo
Country: Burkina Faso
Title: Technical Assistant, Permanent Secretariat for Coordination of Agricultural Sectoral Policies
Organization: Ministry of Agriculture NIT member since March 2021

What motivated you to join the National Innovations Team?

I am that person who always asks, “but, why?” I wanted to learn another way of doing things, to have a greater impact on the ground, and make a positive change. When Breakthrough ACTION reached out to me about joining the NIT, I accepted because I saw it as an opportunity to do just that.

Was there anything you learned in the course that was completely new or that surprised you?

The ideation phase went so much deeper than anything I’ve ever done before. So often, when we have a problem, we just respond without thinking deeply about the best way to intervene. We apply a solution without exploring what else we could do. For me, the ideation phase was so eye-opening because it was a new way of analyzing things. It challenged the assumptions we often make. It helped us better understand the problem, think exhaustively about how we could make a change, and consider which among those many ideas is best. It pushed us to come up with the best solution to the real problem and move beyond the things we are used to doing.

Can you describe your group’s innovation? How is it different from other programs you’ve worked on?

My group is working on increasing farmers’ use of improved seed varieties, and I really think our innovation is going to make a change. We are going to distribute free or subsidized seeds of improved varieties to producers and have them plant comparison plots. Then, we’ll accompany them throughout the season and assess yields at the end. We’ve done similar things before, but what’s different about our innovation is that, at the end of the season, we’re going to help them to plan for the next season. Through the NIT course, we realized we were missing this critical moment at the end of the season. We assume producers will use the improved variety seeds after seeing the results, but they don’t even when they say they will. This time, we’re going to help them solidify their plans for the next season—maybe even purchase the improved seeds at that moment—in the hopes of changing this behavior.

What else will you need to implement your solution?

We’ll need to mobilize financial resources to acquire everything we need—from seeds and fertilizers to staff who can monitor implementation. We can’t be certain we’ll find those resources, but it won’t be the first time we’re looking for them, either. Often, we’ll have several partners who will see one or two lines in the budget that they can finance, and they’ll take on those activities. That’s why it’s so important that the people who develop our proposals can write them in a way that’s compelling. We can find the resources, but only if we make a convincing case. The challenge is, that’s not always easy to do, and the people who are best at it often leave, because their skills are so valuable. As a result, we have to consistently build our capacity in this area to get the resources we need.

Have you shared information about the course with anyone outside of the NIT?

Yes, I’ve shared it with my colleagues because I find it so interesting, and so, even without being in the group, they all know a little bit about the content! It’s a shame that those who are involved in decision-making don’t have access to this information. I share it with my manager, but we don’t really discuss it at length. It’s just 5 to 10 minutes so that he understands the course. I want to organize something where we sit down and reflect on our approach—really think about what we are doing—but I haven’t been able to do that yet. It will happen when I finish the course.

Any other thoughts or suggestions?

During this course, everyone has learned a lot that is certainly useful in their daily work, but if we limit it to that, it will be incomplete. What would be really, really interesting is to maintain this team and continue to meet periodically. We could identify key behavioral problems and lead the process from ideation through the creation of solutions. This would allow us to build a bank of innovative solutions that we can propose to other partners for different behavioral issues we identify in our communities. I think something like this would be worthwhile to help continue the progress we’ve made so far.

This series is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of Breakthrough ACTION and do not necessarily reflect the views of USAID or the United States Government.

The post Building Behavioral Design Skills: Conversations with Breakthrough ACTION Innovators appeared first on ideas42.

Many employees indicate that they want to be a part of a workplace that is socially meaningful in some way.  America’s Charities’ 2017 Snapshot study found that “71% of surveyed employees say it is imperative or very important to work where culture is supportive of giving and volunteering.” More recently, many employees are seeking to work at companies that are advancing equity, diversity, and community.  

At the same time, COVID-19 has accelerated remote work trends for some workers, resulting in a sense of disconnection. While the acceleration of flexible work arrangements has afforded certain benefits for some, it has also created new challenges. For example, in today’s remote and hybrid work arrangements, many workers are feeling more isolated than ever before.  

What if there were a way to help employees feel more connected to their colleagues at work, while also enabling them to support social causes they care about by directly donating a portion of their salary?

Since 2015, our team has been researching donor behavior and designing and testing behavioral solutions that bridge the gap between good intentions and impactful actions in giving. We’re sharing some of the designs from our most recent phase of work and the insights we learned from testing them in real workplaces. Up next: Work for Good, which gives employees the opportunity to support social causes they care about while connecting with their colleagues.

Transforming hours at work into dollars for impact

Work for Good is a workplace volunteer campaign that combines the emotional rewards and shared experience of an in-person, company-wide volunteer experience with the impact and ease of automatic donations. On a designated campaign day, participating employees work  as usual, and choose to donate their salary-equivalent earnings to an organization or cause they care about. Their employer automatically donates earnings from their next paycheck for the number of hours they choose to “work” for the cause of their choice. The campaign is designed to support social connection among  colleagues through shared social experiences like Slack channels, email groups, and in-person gatherings, and a warm glow feeling from doing their  ‘Work for Good.’

Work for Good is uniquely designed to help people follow through on their intentions to give by leveraging three key behavioral design components:

• Frame giving in terms of time
  Donating time activates an emotional mindset that helps people feel more connected and generous compared to donating cash. For example, when giving ‘effort’ (that translates into earnings), individuals have been found to give two to five times more dollars on average, than when giving monetary amounts. Additionally, in our initial online tests with donors, we found that framing the ask to donate in terms of time (e.g. hour-equivalent of your salary) led to significantly greater donation amounts than when asked to donate dollar amounts. We further explored this  insight in partnership with 1% for the Planet on an email campaign A/B test and found that presenting a donation in terms of volunteering time significantly increased click-through rates compared to the option to make a flat monetary donation. This insight is central to the Work for Good campaign, which aims to shift people’s default mindsets away from money, which can trigger loss aversion (i.e. people feeling monetary losses more acutely than gains), and instead to unlock the, warm glow of dedicating time to a cause they care about.
• Alleviate hassles from the giving process
  Once an individual has decided to give, their good intentions can be easily derailed. They may have uncertainty about where or when to donate, or run into too many steps in the process and procrastinate the task for another day. Automating the donation from a paycheck makes the process easy and hassle-free, without relying on sustained attention. In addition, companies that already provide donation matching could effectively double the employee’s impact, making the option even more compelling. Another benefit is that donating future income via payroll deduction reduces the perceived ‘loss’ felt when people donate out-of-pocket.
• Create a shared social experience
  A major benefit of volunteering compared to donating cash is the shared experience and feelings of connection fostered among fellow volunteers. Donating money is often an invisible action, and people may feel uncomfortable sharing the amount they gave. However, participation in the Work for Good campaign is visible and celebrated, and framing it as a volunteer experience makes people more comfortable sharing their engagement with others. This can create new social norms around generosity.  Ideally, the opportunities for social engagements would build on existing organizational culture and social channels. Social components such as dedicated chat channels, emails from the organization’s leadership about the event, or even a physical artifact on one’s desk can build connections between colleagues who are participating in a Work for Good day at the same time.

Shifting the metric of donation amounts from dollars to hours also puts individuals at more equal terms without the social taboos of discussing monetary amounts. For example, instead of saying “I donated $50 to this cause,” employees can tell their peers “I dedicated two hours of my day to this cause.”

In January of 2020, we ran a small internal pilot with Benevity, a workplace giving platform. Over a third of all employees participated, and 88% of those who signed up for Work for Good followed through on donating at least one hour to a charity of their choice. The majority of participants surveyed after the event (93%) said that the recipient of their Work for Good donation aligned with their values and interests, and 73% of those surveyed said they would participate again. Overall, the initial pilot was successful in demonstrating promising participation numbers. 

What’s next for Work for Good?

The Benevity pilot also elevated valuable lessons about the implementation of Work for Good for the future.

• Provide employees with ease and agency to select organizations and causes to donate to: When given the option of selecting a “mission” (cause area) or designating a specific organization to donate to, the plurality of participants (44%) selected the “choose your own” option, signed up for more hours and donated an average of 48.7% more than those who selected a cause area fund of several nonprofits, curated by their employer. Offering pre-validated causes or organizations can still be helpful for employees who want to participate and care about a cause, but don’t have an organization in mind to donate to. 
• Find ways to make Work for Good events feel “different” from a normal work day and strengthen team connections: For our pilot, we generated excitement through Slack and email marketing. Additionally, leaders at the company were encouraged to boost messaging about the event by sharing about the organizations they would be donating to and why. These steps created buzz – 71% of participants who responded to our survey spoke with a friend about the event, and 29% updated their Slack status to indicate their participation. For future implementations, we’d like to explore even more ways to encourage making Work for Good events feel social, special, and different from a normal workday, such as a virtual chat room accessible for the hours an employee is “working for good” or tangible keepsakes like a desk sign or pin.
• Develop a clear explanation of how employees’ salary equivalent donations are calculated: We heard from some participants in interviews and surveys that a clearer explanation of how their salary-equivalent donations would be calculated would have been helpful. Fortunately, employees were not deterred from following through on their donations – 87% of individuals who signed up for the program for at least one hour ended up making their donation, even though they were given the option to modify or cancel.
• Work for Good year-round: We initially envisioned and implemented Work for Good as a workplace campaign, so it could generate a discrete and communal point of engagement and interest. We also believe the solution could be scaled and sustained more regularly. For example, employers could implement ‘Work for Good Wednesdays’, or individual employees could initiate a fundraising drive for a personally identified cause through a “Work for Good Week” at any point throughout the year. Future iterations of Work for Good can explore and test other variations of the core design to tease out more behavioral insights about which features most impact employees’ giving behavior and experiences.

Giving tends to be more top-of-mind at the end of the year for many people. On top of that, the COVID-19 pandemic continues to affect social connection and how some employees do their jobs. Work for Good can help workers stay connected and infuse additional purpose into their days — whether working from home, an office, or a mix of both. Work for Good lets us re-imagine what it means to ‘dedicate our time’ to a cause we care about, allowing us to both enjoy the personal connections, meaning and thoughtfulness of volunteering while also taking advantage of the convenience, direct impact, and efficiency of monetary donations. We plan to use our insights from the Work for Good pilot for future testing of this design, and in future engagements with workplace giving platforms, in order to continue to unlock additional donor satisfaction and generosity for everyday givers.

Learn about other behaviorally informed giving designs from this series: The Personal Giving Review and Charity of the Month.

The post Work for Good: Turning Hours at Work into Dollars for Impact appeared first on ideas42.

A beneficiary of the South Sudan Safety Net Project (SSSNP) after receiving her cash in Juba
Photo by Janet Maya Mulukwat, UNOPS (South Sudan)

Saving money, or spending it in ways to support long-term goals, is difficult for anyone. Living in extreme poverty makes it even more challenging and is almost inconceivable during a global pandemic that continues to disrupt lives and livelihoods.

In South Sudan, high levels of poverty, exacerbated by decades of conflict, escalating food insecurity, shortages of basic services and recurring natural disasters, inhibits planning for the future for the majority of the population that lives in in poverty. Additionally, the economic and health risks created by COVID-19, and the consequent depreciation of the South Sudanese pound (SSP) meant the value of money was constantly in flux.

The South Sudan Safety Net Project (SSSNP) was launched in July 2020 by the Government of the Republic of South Sudan, in collaboration with the World Bank that funds it and the UN Office for Project Services (UNOPS) that implements it. The SSSNP provides temporary cash assistance to protect and uplift households experiencing extreme poverty, and is accompanied by Cash “Plus” activities that provide basic trainings on topics such as how to save and manage money. The cash assistance is crucial in meeting immediate needs and strengthening recipients’ financial resilience. However, behavioral science shows that constantly dealing with shocks and worrying about depreciation can deplete the cognitive capacity recipients need to optimally use the money and training provided through the program. To this end, the SSSNP partnered with ideas42 to develop and introduce context-specific behavioral interventions to help recipients make the most of their cash.

A survey conducted with SSSNP recipients revealed that they intend to use the cash transfers for urgent needs, such as food. But they also have mid- to long-term goals, such as expanding a business or improving their home. While achieving long-term financial goals is generally difficult for all, the situation was significantly more challenging in South Sudan during the height of the rapid depreciation of the SSP in 2020, when recipients had to use the cash they received immediately to mitigate losing the value of their money. While recent economic reforms are expected to stabilize the currency, inflation remains high and continues to restrict household capacity and savings behaviors. Given these challenges, the process of setting priorities and taking practical steps to achieve future goals is far from straightforward. Key barriers are listed below:

• Allocating cash to support long-term goals requires prospective memory. Remembering to take a specific action at some point in the future — known as prospective memory — can fail to happen without reminders delivered at the right time. While 99% of SSSNP recipients report having plans for how they will spend their cash, 66% say they don’t follow through once they receive the money, with most reporting that they forgot what they intended to purchase by the time they had the cash in hand.
• Resource scarcity can make it difficult to follow through on plans. Living in poverty saps finite mental energy and cognitive bandwidth needed to make decisions, plan, and budget. As a result, SSSNP recipients may focus on immediate needs at the expense of more future-oriented behaviors that can help them reach their goals.
• Time scarcity can further zap mental bandwidth. In addition to resource scarcity, SSSNP recipients have also been facing time scarcity due to ongoing inflation and depreciation of the SSP in 2020. It’s a significant reason why SSSNP recipients tend to spend their cash transfer right away. Also, 79% of recipients report spending all the cash in a week, with most citing depreciation as the reason. While inflation is a structural problem, it also leads to time scarcity, which also depletes the critical mental bandwidth needed to make and adjust plans during emergencies.
• Living in poverty can trigger identities that limit what recipients believe they can achieve. While cash transfers have been shown to preserve dignity and improve well-being and self-esteem, behavioral science research suggests that participation in a safety net program may trigger a recipient’s identity of “being poor,” which in turn can unintentionally prompt them to behave in ways counterproductive to their own best interests. Many SSSNP recipients believe the stereotype that those living in poverty can’t save or invest: 75% of SSSNP recipients report that people in their community don’t save or make investments “because they are poor.”

With these behavioral barriers identified, the next step for this work is to design nuanced solutions to help SSSNP recipients put their money towards their future goals. Our hope is that by sharing the insights captured from this work so far, other cash transfer programs can find ways to adapt and adopt behavioral approaches to their unique contexts to improve lives of those living in extreme poverty.

The post How Do You Plan for the Future When the Value of Money Has a Time Limit? Initial Insights from Cash Transfers in South Sudan appeared first on ideas42.

Every day, working with a wide range of partners around the world, we use behavioral science to address complex social problems. And each year, we take a moment to reflect on this work, what we’ve learned, and how to build on this knowledge going forward. 

As 2021 draws to a close, here are five takeaways from our work this year.

Design is (still) crucial for truly improving access to relief programs.

High levels of fines and fees imposed by traffic courts are a major strain on low-income drivers. California recently instituted a new online system, MyCitations,  allowing drivers to request a reduced fine without having to go to court. This can provide relief to people experiencing financial hardship, but use of the system was initially low. 

It’s certainly not the first time a useful  program or service has gone significantly underused. Fortunately, finding and addressing barriers that suppress uptake is a classic application for behavioral design. We uncovered a number of behavioral barriers and redesigned key communications materials to help more people learn about the MyCitations system, complete an application, and resolve their fines. 

Some of these materials have already been implemented systemwide, and others we’ll evaluate in 2022. At scale across California, the MyCitations system would serve over half a million people each year who receive traffic violations, and even more across all infraction types—underscoring the impact of systems design on real people’s lives. 

Empowering participants as peer advocates can encourage program uptake.

An unplanned pregnancy during adolescence can dramatically impact a girl’s health and economic future, yet use of modern family planning services among adolescents remains low in many places around the world. Research has repeatedly shown that across many contexts, girls often don’t perceive themselves to have agency in matters concerning sex, family planning, and their reproductive futures. With this in mind, we sought to develop solutions which would put more adolescent girls in the role of advocates for family planning within their peer groups.

In Uganda, we created a refer-a-friend program and innovative materials for clinics. The monthly number of adolescent clients increased on average by 45% (5.4 more per clinic, on average). This suggests that nearly 2,000 adolescents became new family planning users as a result of the intervention during the six months of implementation.

These novel designs  were created with girls’ agency in mind–centering them as both active participants in and recipients of the program. Findings were published in the Bulletin of the World Health Organization, and we are exploring ways to expand their reach through other family planning service providers.

Making entrepreneurship more inclusive takes care—and it’s well worth it.

In 2021 we were thrilled to welcome our first cohort of entrepreneurs to our Venture Studio as part of a broader initiative to tackle inequality and mobility in the United States called Shared Prosperity Catalyst. Our team has been supporting these talented problem-solvers as they build scalable businesses to address excess costs of poverty. We look forward to sharing more about their innovative solutions in 2022. 

In the meantime, we reflected on the insights from our entrepreneur recruitment process, which we carefully designed to ensure that we were fostering inclusion in every aspect of the process, starting with the application itself . These insights—including designing for scarcity, bolstering transparency, and building in several features to combat individual unconscious biases—can be put to work by any organization seeking to revamp recruitment processes with an eye toward reducing bias and recruiting for lived experience. The process built on our report that proposed more equitable workplace norms, laid out  evidence-based solutions, and suggested new behavioral strategies to close the wage gap.

As we recruit more entrepreneurs to solve complex challenges in the coming months, we aim to continue building on these practices.

Equipping practitioners with the behavioral design approach can take proven interventions to new contexts.

We’ve spent the last decade working with dozens of postsecondary partners to develop behavioral solutions that help students get to and through college. We’ve developed effective interventions, but sending our experts to one or two schools at a time limits the number of students we can reach. 

This year we took the next step to grow our impact and the adoption of proven behavioral insights to help millions of college students across the U.S. with the launch of the Student Success Academy. Through these trainings, we aim to equip the people who know their students and their schools best with tools to develop contextually relevant, behaviorally informed programs, systems, and processes. 

In the first few months of this initiative, nearly 200 people from 40+ different colleges, universities, and non-profits participated in the program—and we look forward to working with even more to make the behavioral approach a ubiquitous feature of innovation in higher education. 

To truly tackle inequality, we must first change the narrative.

False narratives about poverty are deeply ingrained in our societies. They have extensive impact on policies and programs. Narratives about poverty are often at the heart of  the failures that plague even well-meaning programs, such as application processes full of hassles that place an administrative burden on prospective participants, the imposition of sludge such as work requirements, and stigma that can suppress participation and access in the first place. 

Program and policy design based on harmful narratives is destined to fail the very people they are meant to serve. That’s why we launched new initiatives to better understand and then fundamentally change narratives in several large U.S. cities such as New York City, Oakland, and Washington, D.C. This work explores ways to shift poverty narratives at a local level through targeted campaigns leveraging behavioral science research, and crucially, the lived expertise of people in the communities we are seeking to serve.

With a deep understanding of cognitive biases, coupled with our expertise in designing solutions for contexts of chronic scarcity and the partnership of local communities, we can shift harmful, false poverty narratives and create a path for programs and social policy that are more effective and generous. 

Keep reading

There’s always more to learn about applying behavioral science across the issues we focus on  to make the world more equitably healthy, wealthy, sustainable, and just. Keep reading the blog to stay up-to-date on the latest insights from behavioral science and the continuation of this work in 2022.

The post A Look Back on 2021: 5 Behavioral Science Takeaways appeared first on ideas42.

In recent decades, behavioral scientists around the world have partnered with government agencies and large institutions to enhance program impact and solve pressing societal problems. However, this body of empirical research and its practical applications have not usually been accessible to the multitude of people on the front lines of service delivery, crisis response, and community building. The ideas42 Behavioral Design Center (BDC) was established to help New York City non-profit staff identify and ameliorate behavioral barriers that emerge in service delivery and civic engagement efforts, with a particular focus on alleviating poverty. Through workshops, co-design projects, and Office Hour coaching sessions, the BDC teaches staff of community-based organizations (CBOs) how to apply behavioral approaches to reduce these barriers, increase the utilization of their services, and make good programs even more effective.

This is the final post in a three-part series about BDC Office Hours, which allow our small team to provide a diverse array of non-profit program staff and managers with practical, individualized assistance in a timely manner. The first post in this series showcased examples of enhancing communications to better capture the target audience’s attention and make programs salient to people who could benefit from them. And the second focused on overcoming obstacles to client engagement and persistence.  In this post, we’ll be taking a closer look at another of the most common themes:

• Gathering information about clients’ service needs and experiences in order to improve programs

Many non-profits are eager to learn as much as they can about their clients, current or potential, in order to maximize program participation and impact. Common strategies for gaining this insight often take the form of surveying the target audience. Surveys can be designed to inform program development or revision, or to obtain feedback on services received or programs attended. In both cases, there are many important relevant questions that service providers wish to ask, but survey completion is rarely a priority for any of us—particularly people with scarce resources and multiple competing demands on their limited time and attention. Thus, one of the first things we at the BDC encourage survey developers to consider carefully is the purpose and value of each proposed question in a client survey, and the use of design elements that make surveys easy to understand and quickly answer.

Creating a client survey to inform homelessness prevention efforts

Non-profit CAMBA’s HomeBase program provides financial, legal, education, and employment support services to people at risk of homelessness. Early in the pandemic, staff requested our advice in an Office Hour session on a survey they planned to send out to new clients to guide outreach and service delivery. They were eager for guidance on how to maximize client response and the quality of information provided. Based on their goals for the survey, we advised streamlining the survey by focusing on immediate priorities: what services people need right now, and how to contact them. We also discussed how to shorten, organize, design, and disseminate their survey to best capture attention and facilitate response.

Results:

CAMBA revised their survey and the cover email used to invite clients to answer the survey to incorporate our recommendations:

Instead of over 25 questions presented with no introductory explanation, the revised version opened with “How can we help you?”, posed five service-area questions to be answered by checking boxes to indicate service preferences, and a final “How can we reach you?” request for contact information. When the updated survey was sent to two groups of new clients, CAMBA staff reported that 82% of recipients opened the email and 40% completed the survey, including 92% of those who began it.

“The survey has served as a direct outreach tool to identify new HomeBase clients who are also interested in supplemental services in the areas of personal development, employment and financial wellness…the responses have helped us in two main ways: (1) we know which team is best suited to reach out to the specific client and most importantly, (2) the person following-up with the client uses the survey responses to tailor the conversation according to the client’s self-identified needs in each area. Staff have found this to be a more relatable way to communicate with clients about our services. The survey is also providing insight into our clients’ access to technology which helps us tailor how we provide services to each person.” – CAMBA staff member

Improving workshop materials and evaluation survey

In another Office Hour, we talked with staff from Legal Information for Families Today (LIFT) about how to improve outreach, workshop materials, and an evaluation survey for their webinars helping New Yorkers navigate the family court system. Recognizing the many demands on their clients’ bandwidth, we advised staff on how to make the workshop materials easier to use, shorten the evaluation survey, and motivate participants to complete it.

Results:

Based on our conversation, LIFT revised their workshop materials to be more concise, clearly laid out, and highlight very specific action recommendations to facilitate implementation (e.g.  show up an hour before your case is scheduled, instead of “show up early”).

“We revamped the evaluation form based on feedback from you all, and it felt like we got a lot more relevant information. … We spent a long time discussing what was the point of having an evaluation and why we wanted each piece of information. We have now applied this to other feedback forms as well…it is very reassuring to be making design decisions that are based in behavioral science.” – LIFT staff member

In a recent update, staff also reported that in reviewing a new “large-scale survey that asked for feedback on our Legal Resource Guides…I applied some of the things that I learned from ideas42. For example, I encouraged [the survey developer] to identify what question was the most important to us (the problem we are trying to solve) and put it first.”

Staff members at non-profits in New York City, can sign up here for a free BDC Office Hour to discuss how to mitigate any behavioral problems or barriers that might be affecting service delivery. The session may focus on redesigning processes (including data gathering), communications, or other features of the program environment. In addition to helping to address the specific problem identified, we will explain the relevant behavioral principles and strategies at work in the problem and solution so that the practitioner can take what they’ve learned and apply a behavioral lens on an ongoing basis. In this way, these short consultations advance the Behavioral Design Center’s guiding mission to build lasting capacity across the City’s non-profit sector, enabling critical and hardworking organizations to more effectively engage their clients and improve outcomes for the individuals and communities they serve.

Stay tuned to learn more about  the Behavioral Design Center’s ongoing work to bring behavioral insights to more non-profits in New York City.

The post Building Behavioral Science Capacity 60 Minutes at a Time: Better Client Surveys appeared first on ideas42.

The expanded Child Tax Credit (CTC), which provides families with payments of $300 per child aged 0 to 5 and $250 per month for each child aged 6-17 from July to December 2021, has helped ease economic stress for many families.  A new nationally representative survey of parents earning less than $75,000 sheds additional light on the benefits of an expanded CTC for low- and moderate-income families. 

The findings from this survey demonstrate that the CTC has reduced scarcity and created much-needed slack for these families. Scarcity is the experience of not having enough of what you need—from not enough money to not enough time. In contrast, slack is the reserves we have leftover after our needs are met. Being able to save money for emergencies creates slack—something to draw upon when unexpected things happen. That monetary slack, in turn, creates cognitive slack. If you aren’t worrying about how to pay the bills, you have leftover cognitive reserves to invest in long-term planning, relationships, or other non-immediate goals. By reducing scarcity, the CTC increases slack—both of which are important for long-term well-being. 

Consistent with other research, the respondents in this survey largely plan on using the money from the CTC to pay basic expenses. The most common ways that respondents say they plan on using either the advanced monthly payments or their refund were to pay for bills, food, and groceries, help pay their rent or mortgage, towards clothing and shoes, and to pay down credit cards or debt. Reducing scarcity for low- and moderate-income families has a variety of benefits, including improved health and school performance, greater college enrollment, and increased earnings in the next generation. 

Not only does the CTC help ensure that families have the resources they need, it helps create slack. The next most common way families said they would use the refund or advance payments was saving or investing the money. Savings can help families weather financial emergencies and income volatility, something that is increasingly on the rise among households in the United States. One study found that families who had as little as $250 in savings were less likely to be forced to move because they could not afford housing payments. Even as little as $100 in savings meant families were more likely to be able to keep their utilities on. 

The benefits of the CTC extend beyond economic slack to creating other forms of slack, including reductions in stress and increased time. Nearly 70% of families who received the monthly payments said that the payments made them a lot or a little less stressed about money.  The percentage rose to 76% for low income families and 72% for Latinx families. 

Living in scarcity forces us to focus on how to get enough of what we need, sometimes to the detriment of other things. If your child breaks their leg, you will forget about cooking dinner or getting to your next meeting while you focus on dealing with the immediate needs—getting medical care. In the same way, when you don’t have enough money to pay rent at the first of the month, other, less urgent bills or goals may be ignored while you focus on keeping a roof over your family’s head. When you are freed from the worry of how to pay the rent, you have more cognitive resources available for other things. You can invest more time in longer-term goals, including caring for yourself and your family. Some respondents, for example, said that the CTC monthly payments freed up time for them to spend with their children and it improved their relationships with their spouse, friends, and family. 

At ideas42, we believe that good policy must be based on sound research and designed to meet the needs of the people the policy is supposed to serve. Drawing on our own research and reviews of the academic literature, we identified three behaviorally informed principles for designing policies and systems for people experiencing scarcity. Well-designed programs should cut the costs to participate, increase slack, and empower participants. 

The CTC does all three of these things. Most families were automatically enrolled, reducing the costs to participate. The CTC doesn’t place restrictions on how the funds can be used—empowering people to make decisions that are best for their families. And, as the current survey shows, the CTC creates slack for low and moderate income families. 

The expanded CTC is set to expire at the end of the year. If Congress doesn’t take action, families will lose this valuable resource. In order to protect the gains we have already seen, Congress must extend the expanded CTC, make full refundability permanent and eventually, make all of these improvements permanent. 

The post The Child Tax Credit Reduces Scarcity and Creates Needed Slack for Low- and Moderate-Income Families appeared first on ideas42.

Vaccines are one of the most powerful and cost-effective public health interventions in the history of medicine. Each year, vaccines save millions of lives and billions of dollars in indirect costs. Yet in the U.S. alone, about 42,000 adults and 300 children die of vaccine-preventable diseases (not including COVID-19) each year. And underserved populations, such as families who are underrepresented minorities and those experiencing poverty, are more likely to have lower rates of childhood vaccination – worsening already significant health disparities. 

So many illnesses and deaths could be avoided if more children were vaccinated for routine diseases in a timely manner. Yet vaccine hesitancy is a persistent problem; in 2019, the World Health Organization named it as one of the ten most important threats to health globally.

The COVID-19 pandemic only exacerbated hesitancy regarding routine childhood vaccinations. Between March and May 2020, when most places were under stay-at-home orders, administration of routine childhood vaccinations in the U.S. was significantly lower than the same time period in 2018 and 2019, by as much as 71.3% in some cases. Vaccination rates bounced back later in 2020, once stay-at-home orders had been lifted, but not enough to make up for all the missed doses. Additionally, COVID-19 has sparked new conversations, concerns, and opportunities for misinformation to spread about vaccines. 

Vaccine hesitancy is ripe for behavioral intervention. Over the past several years, ideas42 has examined this problem and explored ways to increase uptake and timeliness of childhood vaccines. We’ve done deep dives into the academic literature and existing field research, as well as conducted research of our own through a combination of surveys and interviews with parents, providers, and other stakeholders. Through this work, we’ve identified cross-cutting behavioral barriers keeping people from taking up vaccines, as well as promising solutions. 

For more on how we identify behavioral barriers, see this blog post.

What are some common behavioral barriers to on-time childhood vaccination in the United States?

• Parents are not actively presented with the decision to vaccinate. If a parent isn’t offered the choice to vaccinate or not vaccinate their children, they’re unlikely to consider it. Yet, in many cases, parents don’t experience this moment of choice, for a myriad of reasons. For example, parents may not regularly take their children to the pediatrician, the doctor may not bring it up, or they may not have friends who vaccinate/openly discuss vaccinating their children.
• Context and framing matter. If vaccination comes up, it’s important that the person who raises the decision is a trusted and reliable source of information, such as a pediatrician families have a good relationship with, a leader in their community, or a fellow parent who has vaccinated their children.
• Many parents – particularly in communities of color – harbor justified mistrust of doctors and the healthcare system. In these cases, parents are more likely to seek advice from unreliable sources, such as anti-vaxxers and unverified internet sources, where they are more susceptible to misinformation. This leads them to conclude vaccines are not right for their children.
• The perceived downsides of vaccination are more salient to parents than the perceived benefits. The pros of vaccinating one’s child – for example, immunity from rare diseases, many of which have been largely eradicated (due to vaccination) and protecting other children who cannot be vaccinated – are less salient and compelling than the cons. Stories about terrible side effects, even if false, can be scary and stick in parents’ minds more strongly than the theoretical benefits. Stories like these also cause parents to overestimate the likelihood that side effects will occur, since they tend to be vivid and easy to remember. And, of course, shots and needles are unpleasant, and no parent wants to see their kid cry. This immediate, uncomfortable experience is much easier to imagine, and therefore the downside is perceived as higher than the unknown risk of the child developing an unfamiliar disease sometime later.  
• Parents overestimate how common vaccine hesitancy is. People, like all humans, follow social norms – that is, do what others do – but norms aren’t always clear. Vaccination is a private, “invisible” behavior, so most parents don’t know how common it is and assume vaccination rates are lower than they actually are. Since vaccine hesitancy is more commonly discussed than vaccination itself, parents may perceive not getting their children vaccinated to be more common and widespread than it is.
• Hassle factors play a significant role. Vaccination schedules can be confusing. Scheduling and getting to appointments can be time consuming and frustrating. Some vaccines require multiple trips to the pediatrician’s office. For parents who are already strapped for time and attention due to juggling multiple responsibilities, these hassles can make it hard to get their children vaccinated, even if they intend to.

So how do we get people to vaccinate their kids?

The problem of vaccine hesitancy and delayed or missed childhood vaccinations is seemingly intractable, and there’s no silver bullet for addressing it. Many adept problem-solvers have been tackling vaccination rates for years, and yet the problem persists. Applying a behavioral science lens sheds light on barriers that may be overlooked, and can contribute innovative solutions.   

The behaviorally informed recommendations below can help increase vaccination rates [1]. They are not targeted to any one specific implementing body; they require action from many groups, across sectors, such as obstetricians, pediatricians, pharmaceutical companies, and community groups, to name a few. A multi-pronged approach is necessary to move the needle on such a difficult behavioral problem. We have categorized the suggestions below by target audience able to implement them, though some of them could certainly be adapted to work well for a variety of actors. Some of these appear in more than one category, but we’ve duplicated them to provide full slates of recommendations by audience. 

Physicians (specifically, OBGYNs, pediatricians, and family practitioners):

• Offer vaccines early and often. If parents aren’t offered the choice, they can’t make one. Use multiple channels (i.e., prenatal and pediatrician visits, social media posts, flyers at bus stations and benefits offices) so parents are exposed to the topic and credible information in several ways.
• Make the benefits of vaccination salient and concrete. Parents are more open to discussing vaccination during high-profile outbreaks. We happen to be in the midst of a high-profile outbreak of a vaccine-preventable disease. Leverage conversations about COVID-19 and other outbreaks to illustrate to parents how powerful vaccines can be at preventing illness and protecting their children.
• Work with communities to build trust. Work with trusted community leaders to offer services that are appropriate and desired by historically underserved communities. Listen to their concerns without judgment. Research and practice cultural competence. None of these things will happen overnight, but this work is needed to improve trust and help people become more comfortable seeking the care they need (including vaccinations).
• Make it easy. Offer vaccination clinics in places where families frequently spend time, such as at schools, places of worship, or grocery stores. Simplify vaccination scheduling and administration processes, such as by offering walk-in vaccine appointments and introducing easy online scheduling. Produce easy-to-follow infographics or calendars to help parents keep track of which vaccines are recommended and when.

Vaccine manufacturers:

• Communicate norms and make vaccination “visible.” Show parents the numbers to demonstrate that they would actually be in the minority if they chose not to vaccinate their children. Parents who get their children vaccinated on time should also be exemplified as champions. Encourage them to share about their decisions via social media, collateral such as buttons and bumper stickers, yard signs, and more.
• Work with communities to build trust. Work with trusted community leaders to offer services that are appropriate and desired by historically underserved communities. Listen to their concerns without judgment. Research and practice cultural competence. None of these things will happen overnight, but this work is needed to improve trust and help people become more comfortable seeking the care they need (including vaccinations).

Community groups:

• Make it easy. Offer vaccination clinics in places where families frequently spend time, such as at schools, places of worship, or grocery stores. Simplify vaccination scheduling and administration processes, such as by offering walk-in vaccine appointments and introducing easy online scheduling. Produce easy-to-follow infographics or calendars to help parents keep track of which vaccines are recommended and when.
• Communicate norms and make vaccination “visible.” Show parents the numbers to demonstrate that they would actually be in the minority if they chose not to vaccinate their children. Parents who get their children vaccinated on time should also be exemplified as champions. Encourage them to share about their decisions via social media, collateral such as buttons and bumper stickers, yard signs, and more.

Some of these strategies may seem like no-brainers, yet many of them have not been widely implemented. This may be because they require cross-sector partnerships, shifts in the way care has traditionally been delivered, and unique, creative ways of interacting with patients and communities. However, we believe that these investments, which specifically address the behavioral barriers we’ve identified, can go a long way in addressing the longstanding problems of vaccine hesitancy, delay, and avoidance. 

The COVID-19 pandemic has increased both the urgency of this problem and created a unique moment of action. Let’s take this opportunity, when vaccines are being discussed more than ever, to tackle pediatric vaccine avoidance–because our children deserve bright futures free of vaccine-preventable diseases. 

[1] Although behavioral barriers are very context- and community-specific, we have identified several that are common and pervasive. We strongly encourage practitioners aiming to increase vaccinations to work with communities to confirm these barriers and identify others.

The post Giving Childhood Vaccinations a Boost appeared first on ideas42.