For many rural low-income pregnant women in Liberia, the ability to deliver at a health facility is riddled with barriers. While they may intend to deliver their baby at a health facility and believe it’s the safest place to give birth, it often requires extensive planning and saving, from determining when and how to leave for the facility, to saving for the cost of transportation and medical supplies required at the facility. 

In 2021, our Global Health team in partnership with Breakthrough ACTION undertook a new project to address these challenges. We conducted formative research applying a behavioral science lens to explore the context-shaping decision-making and behavior of pregnant women—and others with influence—then undertook a collaborative co-design process that engaged local and national government stakeholders, pregnant and postpartum women and their families, and community and facility-based health workers. The resulting set of behaviorally informed solutions helps to address barriers and facilitate facility-based delivery (FBD); for example, by leveraging Liberian storytelling traditions to build on the important relationship between women and trained traditional midwives (TTMs). We are excited to share the next phase of this work!

We are currently piloting the solution set in two districts, Buchanan District and District 4, in collaboration with Americares, a health-focused relief and development organization that has been working in Liberia since 2015. 

After an initial training on how to implement the solutions, program implementers, policymakers, and health workers were enthusiastic about the designs and their ability to support women in their communities seeking to access safer deliveries. Some of the feedback we received included:

Before, pregnant women will come to the facility, we will just check you and tell you to do this, buy this, buy this, but now, through the tools we understand that early planning helps a lot to prevent you from difficulties while carry your baby. – Provider, Grand Bassa

It’s [savings tracker] a good thing because we never had the idea first, but now we have the idea, we used to just tell them when to come to the clinic, we didn’t use to tell them how to keep money in cash box. So the thing I learned from there it’s good because when the cash box is there you’ll be able to save small money. So when time come you can look in the cashbox to solve some problem. – TTM, Grand Bassa

Yes we never use to plan with them [pregnant women], but now right after the training we decided to plan how to save money for them for their saving…The training I really like it because it’s encouraging mainly the stories made for people to come to themselves and say yes let me go to the hospital, it’s helping we, the CHA, ourselves because we used to talk to them, they would say “all my children I been borning how I used to born them” but the stories when you talk to them they can listen. – Community Health Assistant, Grand Bassa

In the training where I was one participant–it was very interactive, the materials used were accessible and then, yes we had a good time because we were able to talk lengthily and the time for the training was appropriate… During the training that we saw, they [TTMs] were zealous, they have the interest. It is something that they have been doing, but not in this manner… From what I saw, I know that they are willing to use it [planning tools]. – Grand Bassa County Health Team

Leveraging this enthusiasm, we plan to apply forthcoming insights gained from the initial pilot period to continue to refine and update our facility-based delivery solutions and implementation guidance. Ultimately, implementation of the solutions will extend beyond the initial districts and will support more rural Liberian women to succeed in following through on their intention to deliver at the health facility—and help make more births safe for women and their infants. 

If you are interested in implementing the facility-based delivery (FBD) designs or would like more information, please visit our design guide and reach out to us at gh@ideas42.org.

The post Refining Solutions for Supporting Facility-Based Delivery in Liberia appeared first on ideas42.

Beginning April 1, 2023, people enrolled in Medicaid will have to renew their coverage for the first time in three years.

During the federally-declared COVID-19 public health emergency, people did not have to renew their Medicaid coverage. This continuous coverage ensured families had consistent access to health care. As a result, Medicaid enrollment increased by 20 million people since February 2020 to over 90 million current total enrollees. But when Medicaid’s continuous coverage provision comes to an end on March 31, 2023, 15 million people are at risk of losing their health-care coverage. While that prospect is worrying, states can leverage this moment to increase health-care coverage and promote racial equity by streamlining their Medicaid renewal processes.

Continuous coverage temporarily suspended the Medicaid renewal process, a process that was time-consuming and burdensome and too often prevented families from accessing health-care coverage. But when continuous coverage ends, enrollees will have to navigate existing and new barriers to renew their coverage:

• Many people who currently have Medicaid may be unaware that they must renew or are unfamiliar with the process.
• If a person’s contact information has changed, they may not even receive a notice to renew. 
• During renewal, people may need to gather proof of income and other paperwork, such as tax returns, recent pay stubs, alimony, or proof of citizenship or immigration. 
• People without access to a computer or internet may need to travel to renew their coverage in person. 
• Anyone with questions about the process may experience long wait times, as state agencies will likely be under-resourced and overwhelmed by their new caseloads. 

Around 7 million eligible people are at risk of losing their coverage because of the time, money, and other effort required to successfully renew coverage. These so-called administrative burdens will affect everyone, but they more acutely harm people with the fewest resources to overcome them.

These burdens also exacerbate existing racial inequity. Due to historical discrimination, people of color and immigrant populations are overrepresented in jobs that do not provide health-care coverage and are disproportionately covered by Medicaid. Therefore, they will likely lose Medicaid coverage at higher rates when these tedious renewal processes resume.

It doesn’t have to be this way. Historically, state policy makers have included more burdensome requirements in programs that disproportionately benefit people of color and people with low incomes. Yet policy makers did not include these same requirements in programs that disproportionately benefit white and middle- to high-income earners—like homeownership tax subsidies. While a person automatically gets the mortgage interest rate tax deduction when they complete their tax return, other income-based benefits—such as Medicaid, SNAP (Supplemental Nutrition Assistance Program), and TANF (Temporary Assistance for Needy Families)—require people to complete separate, time-consuming forms. Burdensome requirements are a policy choice, and decisions about when to add burdens are often rooted in false and racist beliefs about why people experience poverty. 

While the unwinding of the continuous coverage provision poses enormous risks to health-care coverage, it also presents an opportunity for states to improve their Medicaid programs. They can make the policy choice to reduce administrative burdens and test new ways to increase coverage. This will not only mitigate the anticipated harms of the unwinding process, but it can also address historical forms of injustice and advance racial equity.

What can states do to mitigate unwinding?

As the continuous coverage provision comes to an end, states can take several steps to reduce administrative burden in Medicaid and maintain health-care coverage:

1. Maintain continuous coverage wherever possible: The easiest way for states to reduce administrative burden is to maintain burden-free, continuous coverage for as many people as possible, regardless of income fluctuations or other changes during these specified periods of time. This might include, for example, coverage periods of 12 months, 24 months, or several years for certain populations, including postpartum individuals, young children, formerly incarcerated people, or adults who are chronically unhoused.
2. For those that must renew, make the process easy and simple: To reduce the burden associated with renewal, states should increase the number of people who are automatically (or ex parte) renewed. That is, states use available information to verify that certain people are still eligible without requiring them to submit additional paperwork; for example, people who qualify for other benefits programs like SNAP or TANF, or for those who previously reported no income. States can also hire more staff to cut wait times and make it easier for people to renew coverage.
3. Test new programs and policies explicitly designed to advance racial equity: Many states have (and should continue to) experimented with ways Medicaid funds can address the social determinants of health and reduce racial health disparities. Enhanced benefits could, for example, provide access to housing, healthy food, employment, transportation, child care or family care services, and more.

[See below for a chart of the different policy levers states can utilize to implement these policies]

Finally, as states begin their unwinding process, it is critical that they measure and report coverage losses, application numbers, average wait times, and more. In addition to following federally mandated reporting requirements, states should be as transparent as possible and release data as soon as it is available. States must use this data to evaluate their unwinding efforts and iterate as needed to improve their programs, expand coverage, and advance racial equity. 

Actions States Can Take During Unwinding

• State Plan Amendment (SPA): States submit a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS) to gain approval for proposed permanent program changes.
• Section 1115 Demonstration Waiver: States can submit Section 1115 waivers to the Centers for Medicare and Medicaid Services (CMS) to gain approval for experimental, pilot, or demonstration projects designed to implement and measure new policy approaches to improve their state’s Medicaid program.
• Section 1902(e)(14)(A) Waiver: States can submit Section 1902(e)(14)(A) waivers to temporarily support their unwinding process following the end of the COVID-19 public health emergency and the Medicaid continuous coverage provision.
• At State Discretion: These are policies that state Medicaid agencies and/or other state entities can take that do not require federal approval.

We’ve seen that health-care policies intended to be temporary stopgaps during the COVID-19 public health emergency actually make for good, longstanding policy. While these protections may soon be rolled back, state policy makers and advocates should use this moment to implement new policies that get more people the health coverage they need.

The post The Harms of Unwinding Automatic Medicaid Coverage appeared first on ideas42.

It’s February. How are you doing on your New Year’s resolutions for 2023? Here are 10 “microbehaviors” to keep your health goals on track.

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If you made a health-related New Year’s resolution this year, you’re not alone; health-focused resolutions make up the top three most common goals, year after year. And if you’re still going strong, congratulations! You’re in the minority; only 19% of resolution makers are still on track past the first month of the year.

Behavioral science gives us tons of insights about why New Year’s resolutions are so hard to stick to, as well as strategies for increasing our odds of success. Most of these insights and tactics are pretty intuitive: make goals that are specific, measurable, and achievable; enlist accountability buddies; create a plan for how you’re going to achieve them; be sure that they align with your values, and that they’re (at least somewhat) enjoyable; break them down into bite-sized pieces. Sound familiar?

That guidance is great, and can be helpful if you already know exactly what your goal is and how to achieve it. But what if you don’t know where to start, or feel overwhelmed by the prospect of making big changes to your lifestyle? I have good news: there are some relatively minor tweaks you can make to your daily routines that can have an outsized impact on your health.

I call these “microbehaviors,” and they’re the perfect first steps toward forging long-lasting habits. Starting with these can help you build momentum toward bigger lifestyle changes you may want to make down the line. Microbehaviors are easier to adopt than other, more “traditional” health behaviors. Here are some behavioral reasons why:

• Planning fallacy: People tend to underestimate the amount of time things will take, and overestimate the amount of time they’ll have to dedicate to something. These microbehaviors can be done any time, any place, don’t require any advance planning, and can be completed in five minutes or less.
• Choice overload: There are about a zillion things you can do to improve your health, and it can be hard to know which ones to try. The list of microbehaviors I’ve curated for you below take the guesswork out of the equation.
• Endowed progress: How good does it feel to cross something off your list? With microbehaviors, you can give yourself this sense of accomplishment every day, multiple times a day, instead of waiting to reach longer-term, yearlong milestones.
• Habits and automaticity: These microbehaviors fold in seamlessly with things you’re already doing as you go about your day. No need to add a reminder in your phone, pack a gym bag, or buy any special equipment.

Have I piqued your curiosity? If so, read on for 10 microbehaviors to jumpstart your healthy lifestyle and optimize your physical, mental, and social well-being. I’ve broken them down into three overarching categories: nutrition, physical activity, and mental health. If you’re looking to improve in one of these areas, start by choosing one or more from that list; if you’d like to go for a more general approach, you can start with one from each and work up from there!

Nutrition

1. Up your veggie intake by adding a handful of microgreens (such as microkale), sprouts (such as broccoli sprouts), or fresh herbs (such as basil) to one meal a day. Microgreens, sprouts, and herbs are some of the most nutrient-dense foods you can find, go with pretty much anything, and don’t require any chopping or cooking. And many are grown hydroponically or aeroponically, meaning you don’t even need to wash them!
2. Drink more water by filling up a big jug with markings to keep you on track throughout the day, and keep it on your desk. The jug itself will serve as a reminder to drink, and the markings will serve as an accountability mechanism. When you drink enough water—about 13 cups per day for men and about 9 cups per day for women—everything works better, from your joints to your muscles, your brain to your digestive tract (and beyond)!
3. Snack healthier by replacing a sugary or salty afternoon snack with a sour one (namely, a fermented one). Fermented foods like pickles, sauerkraut, kimchi, kefir, yogurt, and kombucha stay good for a long time, so you can stock up and always have it in the house. Regularly eating fermented foods can help with digestion, absorption of nutrients, and may even reduce feelings of stress and anxiety and reduce sugar cravings. You can even make your own fairly easily and cheaply.

Physical Activity

1. Gain strength with “exercise snacking.” A few times a day, perhaps when you find yourself mindlessly scrolling on your phone, do a quick “full body circuit”: 10-20 push-ups (on your knees is fine), 10-20 squats, and a 30-60 second plank. You’ll feel the burn and get all the benefits of moving your body, without having to change your clothes, wash your hair, or drive to the gym. If those movements aren’t accessible to you, try stretching as you’re able, or contracting a muscle group for a few seconds at a time.
2. Get extra movement by taking the long way. Instead of grabbing the parking spot closest to the store or getting off the metro right at your destination, consider parking a bit farther away or getting off a stop early. Five minutes of walking here and there can really add up over time, bringing benefits like reduced joint pain, decreased cancer risk, and increased immune function, to name just a few!
3. Stretch out with a three-minute circuit right when you get out of bed in the morning and right before getting into bed at night. Run through two series of cat/cow, downward dog, and forward fold, holding each for 30 seconds while taking deep breaths. After doing these three poses, you’ll feel taller, lighter, and more relaxed.

Mental Health

1. Nurture your relationships by calling friends and family members while you’re doing other tasks, like driving to pick up your kids, walking to the metro, or folding laundry. Connecting with others, even briefly (about eight minutes seems to be the sweet spot) can reduce feelings of loneliness, depression, and anxiety.
2. Cut out the noise by performing a social media audit. People spend hours of our lives on social media, which has been linked to depression, anxiety, and low self-esteem. However, you have the power to curate your virtual spaces so they bring you joy. There are a few ways to do this, one of them being to unfollow any accounts that make you feel upset, anxious, or bad about yourself with the content they post.
3. Re-center yourself with a one-minute breathing exercise when you return to work after a break. With feet flat on the floor and eyes closed, breathe in for seven seconds, hold for seven seconds, and breathe out for seven seconds; repeat three times. Simple mindfulness practices like this one can help reduce stress, improve your focus, and relieve anxiety—potentially even as much as medication.
4. Protect your peace and quiet by setting your phone to “do not disturb” during working and resting hours. Most phones can be set to automatically do this during specified hours, so you don’t have to remember every day. You won’t miss the constant pinging, but you will almost definitely increase your productivity and focus. Just do it. Now. Go.

We’re living in a world where many people want to get healthier, but believe that they need to drastically change their behavior—and give up things that make them happy—in order to do so. We’re also inundated with information about different diets, workouts, and other healthy habits we should adopt, making it hard to know where to start. The microbehaviors I’ve offered here are meant to be actionable, simple steps that you can easily take to get over that first hurdle and build momentum on a path toward your best health.

What are your favorite healthy microbehaviors? Let us know by sharing this post to your social media and tagging @ideas42!

The post Want to Get Healthier but Don’t Know Where to Start? Try Microbehaviors appeared first on ideas42.

To those looking in on the scientific process, it can often seem like a tidy operation of perfectly measured ingredients and serene labs. Researchers and journalists tell the story of this work from idea to insight as relatively linear. Whether or not they arrived in the same place they expected, this often makes it seem like the results were inevitable.

The reality, of course, is much messier.

Behavioral science is no exception. Ideas that produce fantastic results in one place and time maddeningly fail to reproduce in other contexts. Work that is theoretically sound sometimes doesn’t translate to the real world. Mistakes sometimes lead to crucial breakthroughs.

This disconnection between how science is neatly told but haltingly performed does a disservice to those looking on. Science’s messiness is a feature, not a bug, because if we were never surprised or confounded, there would be no need to perform studies. It is often where our expectations are dashed and our patience tested that we learn the most about how to remedy some of the world’s toughest problems.

Let’s correct that artificial neatness. As 2022 winds down, we’d like to celebrate the mess of science—and its power to move us past our expectations and toward unimagined futures. In the spirit of continually learning, here is a small smattering of surprising findings that have provided invaluable insight into how to make our work even more impactful.

1. People on both sides of the political spectrum have authoritarian tendencies.

This surprise came to us from our research into what narratives people believe about individuals living in poverty in the United States. In particular, our Narrative Change team has been looking at how constructs such as social dominance orientation, right-wing authoritarianism, and racial resentment relate to harmful poverty narratives in the United States.

Let’s look closer at the first two. Social dominance orientation measures people’s opposition towards equality for everyone in society, known as anti-egalitarianism, and their willingness to maintain (and increase) dominance of their group versus others. Right-wing authoritarianism is broadly defined as the tendency to submit to traditional authorities and values, as well as punish those who disagree.

Belying expectations, we found people across the political spectrum endorse authoritarian and anti-egalitarian views. Although there is a pattern where more Republicans rate higher in social dominance orientation and right-wing authoritarianism than Democrats in the U.S., there are a fair number of Democrats that also score highly on social dominance orientation. In fact, many more than we expected.

These findings offer important insight about how to get people to the polls or to vote for policies that promote generous social policy (in particular those types of policies that may help reduce inequality).

2. Job seekers persist more when asked to affirm their skills and accomplishments, rather than their identity as unemployed.

One project from our Global Livelihoods work aimed to help young Egyptians tap into their existing skills to get hired.

Unemployment is often associated with harmful stereotypes that may lead people to believe that they don’t have the skills for a job. For example, many job seekers told us that they had previously believed formal jobs required a bachelor’s degree, so without that level of formal education, they felt unqualified for the positions offered. We found that a basic priming activity could discourage people from following through on seeking employment.

To combat this, we designed an affirmation activity that allowed job seekers to reflect on their skills and accomplishments (rather than their identity as unemployed). Job seekers were more likely to think of their positive identities and strengths, which, when paired with an interview checklist, led to 58% more people getting a job. Wow!

3. Supplemental materials may have led more probation officers to deny petitions.

A third surprising finding concerns our work out of our U.S. Safety and Justice portfolio to reduce the costs of probation—both to courts and to people who use them.

A growing body of evidence shows that long probation terms are costly for court systems, drive up incarceration rates, and do not contribute to greater public safety. Many people on probation face significant challenges to rebuilding their lives, such as being barred from employment and housing opportunities.

With the Georgia Department of Community Supervision (DCS) and the Council of State Governments, we developed new supplemental materials for probation officers and judges that reinforced the idea that emphasized the benefits of early termination.

We found that in places where these supplemental materials were used, judges were more likely to approve petitions to end parole. But to our surprise, probation officers who used the materials denied about 35% more petitions.

This points to the different context of judges and parole officers, a critical insight on the path to ensuring that more efficient processes are also delivering fair results. As we’ve long known and this work confirmed: context matters. Now we have a new question to answer about what will help parole officers increase approval of petitions early termination for qualified parolees.

4. Do girls in Ghana think smoking is socially acceptable? It depends on socioeconomic status.

Tobacco use is rising exponentially among adolescent girls in Ghana. Our Global Health team is studying which interventions and behavioral barriers can help disrupt this rise.

In particular, we found that girls on either end of the socioeconomic spectrum—those with very low or very high access to resources—are more likely to smoke compared to their middle-class peers.

Why are girls on either socioeconomic extreme more likely to pick up smoking? We don’t yet know, but we’re working to find out.

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The apparent paradox of behavioral science is that the more we learn about human behavior, the less confident we are that we can predict it. Change comes from testing our ideas, co-designing solutions with people who know the experiences best, and methodically seeking to understand the contextual features. We have to see how real people behave in real situations.

The upshot of this is that despite a sense that the world’s problems are only growing more complex, our way of approaching those problems—with humility and a rigorous dedication to evaluation—remains sound. In the years to come, we are optimistic about what we can learn and how we can use that to build a more equal world.

The post Behavioral Science Can Still Surprise Us appeared first on ideas42.

Staff members at Springboard To Opportunities heard repeatedly from their clients that the thing they needed to successfully reach their goals was more cash. In response, the Jackson, Mississippi, organization launched the Magnolia’s Mother’s Trust in 2018. It couldn’t have been simpler: for 12 months, it provided low-income Black mothers with $1,000 cash, no-strings attached, each month. According to Aisha Nyandor, the chief executive at Springboard To Opportunity, “We launched with the bold idea that you can trust individuals with money, you can trust Black women with money, you can trust financially vulnerable Black women with money.” Trust was at the center of this idea, and the ultimate key to the program’s success.

Over 100 similar guaranteed income programs—sometimes called guaranteed basic income—have been launched across the country. Although there is considerable variability in the amount and timing of payments, most distribute monthly payments ranging from $500 to $1,000 to people living at or below certain income thresholds, many of whom are members of historically marginalized groups. Participants are able to purchase the things they need, on their own terms, to improve their lives—from food security to investing in durable goods, such as a car or a refrigerator, and seeking education and training that creates longer-term economic security.

Providing these resources can have a profound impact on families’ lives. Deontrez, a 23-year-old father of a one-year-old daughter, explained, “The funds have helped me pay for things that my daughter needs like diapers and wipes and some household needs. Due to receiving these payments, I was able to pay for my test to get my Commercial Driver’s Licence, which is how I provide for my family. These payments have helped me set the foundation for my family.” Friends and family members in the recipient’s network can also benefit from the increased resources.

Giving People Cash Relieves Stress and Creates Bandwidth

Unconditional cash transfers support dignity and self-determination by placing decisions about how to spend cash in the hands of those experiencing poverty. Unlike other benefits programs, guaranteed income programs recognize that poverty is a context—not a personal failure. Unconditional cash transfers help change that context.

People living in poverty experience chronic scarcity, a continued lack of key resources—such as time, money, food, and other resources. Experiencing chronic scarcity is particularly harmful to mental bandwidth because it causes tunneling—a narrow focus on addressing the acute lack of resources that can lead people to ignore or deprioritize other needs. If rent is due, for example, you may focus exclusively on paying that bill to keep a roof over your head. As a result, you may not be able to pay for your driver’s license renewal. In the short term, the decision makes sense. But, in the long term, it can have dire consequences. Late fees will add up. Driving without a license can even lead to jail time.

Unconditional cash transfer programs directly address chronic scarcity by simply freeing up bandwidth and letting people focus on longer term goals.

Such programs work by giving people the primary resource they lack—cash—and letting them use the money where they need it most. And because they don’t require people to complete multiple rounds of complicated paperwork or travel to and from offices, or spend hours waiting for appointments, they give people an often overlooked but incredibly important resource—time. Halimah, a single mother of two who participated in the I.M.P.A.C.T. program in Atlanta, which provides participants with monthly payments of $500, described it this way: “I have worked since I was 16 and now I am 40 years old still working hard—this past year I didn’t have to feel like I was just scraping by, I could actually breathe.” Unconditional cash cuts the costs to participate in the program and creates slack by providing cash that people can use when and where they need it most.

Policy Makers Should Expand Guaranteed Income Programs

Worldwide, cash transfer programs have been successful in helping people reach their financial goals and build resilience. ideas42 has worked extensively to help countries in the Global South implement behaviorally informed cash transfer programs that help people make the right choices for themselves. Giving people the money they need, to use how they need it, works. Momentum is building in the United States to expand guaranteed basic income and other unconditional cash transfer programs.

Most guaranteed income programs in the United States have been implemented by local governments or community organizations. States should fund guaranteed income programs, as California has recently done, and more localities should adopt these programs.

No-strings-attached cash-benefits programs check all the boxes for behaviorally sound policy, as they recognize that families are experts in their own lives and meet them where they are. Giving them the resources they need to use how and when they need them helps them build long-term economic stability, while freeing up their time and reducing chronic scarcity.

Watch our recent panel discussion, Basic Income Programs: Successes, Challenges, and Policy Solutions, to learn more.

The post Policy Lab: Guaranteed Income Programs Give People What They Need Most appeared first on ideas42.

Savings help families secure a comfortable retirement, weather financial emergencies, make major purchases, and decrease stress. Unfortunately, nearly 57 million workers in the U.S. do not have access to an employer-based retirement plan, including over 63% of Hispanic workers, 53% of Black workers, 45% of Asian American workers, and 41% of white workers. Even workers with access to a retirement plan might not use one: over 20% of full-time workers and about 60% of part-time workers that have access to a retirement account don’t participate. 

What’s worse, those with access who choose to participate might still not have sufficient savings by the time they retire: over 22% of retirement contributions made by people 50 or younger are withdrawn from accounts each year. People often withdraw retirement funds early to address immediate needs, particularly when they don’t have short-term savings. A recent study found that 45% of households couldn’t pay an unexpected $400 expense without dipping into their retirement accounts; this number jumps to 65.2% for Black households, compared to only 46.7% for white households. 

To build savings and promote financial equity, families must have access to a retirement account, choose to save, and limit their pre-retirement withdrawals. Congressional action is needed to ensure that all workers have access to retirement accounts. Additionally, policymakers should leverage the principles of behavioral science included below so that more families with the ability to save choose to do so and reduce their pre-retirement withdrawals.

1. Automaticity and Defaults Increase Participation in Savings

A key insight from behavioral science is that we, as humans, can be lazy. We have limited cognitive energy yet face thousands of choices every day; to get by, we minimize active effort and utilize heuristics and other cognitive shortcuts wherever we can. Therefore, we might put off actions we know we should do because they are tedious or overwhelming. We are more likely to engage in behaviors that are easy and simple. Automatic processes eliminate the required effort and make engagement easy. For example, automatic enrollment and automatic escalation policies have tripled participation in savings programs and nearly quadrupled dollars saved. Similarly, default options reduce effort by offering pre-set options that take effect unless the user elects otherwise. Defaults can eliminate the need to take action at all or can serve as powerful references to ease decision-making. Default contribution rates, when set appropriately, can significantly increase dollars saved. An effective savings program should automatically enroll new employees, default employees into a contribution plan, and automatically escalate contributions to a set maximum in order to increase savings.

2. Financial Incentives Can Motivate Pro-Saving Behavior

Financial rewards, even small micro-incentives, can have outsized impacts on behavior. Small payments can signal the importance of an action, make the future benefits of an action more concrete today, or incentivize behavior in cases of true uncertainty. Financial incentives – like tax credits or micro-payments – have been shown to increase retirement savings. Financial incentives can also serve as rewards that encourage certain behaviors repeatedly; over time, the behavior might become a habit, leading to long-term pro-saving behavior. As much as possible, Congress should provide financial incentives that motivate employers to offer retirement plans to their employees and encourage employees to save.

3. Trusting People Promotes Self-Efficacy while Saving

People need to feel empowered to make their own choices. When people feel forced or coerced, they may avoid engaging in certain behaviors, even behaviors in their best interest. For example, messaging to eat healthier or stop smoking can have opposite effects on behavior if framed in ways that threaten people’s perceived autonomy. For savings, Congress must promote self-efficacy so people feel they can save on their own terms. This includes trusting people to make their own financial decisions, providing people with the option to opt out of any program feature they don’t like, and allowing people to make tax-free emergency withdrawals from their retirement account if they deem it necessary.

An Ideal Congressional Solution

Ideally, Congress would create a national savings program that provides all workers with a retirement plan if their employer does not offer one. This program should cover both traditional as well as nontraditional workers – including contract, gig, and independent workers – who are disproportionately people of color and/or people with low incomes. Workers should also have the ability to build rainy day funds to more permanently address immediate needs when they arise, rather than being forced to make costly pre-retirement withdrawals. The MarylandSaves program offers one potential model for a solution. This program provides state-sponsored retirement plans to any uncovered worker, as well as emergency savings accounts. The worker’s payroll deductions first fill their emergency savings account up to $1,000 and then go towards their 401(k). Tax-free withdrawals can easily be made from their emergency account for immediate expenses. Additional contributions replenish the emergency account first (if applicable) before adding to their 401(k). Regardless of the specifics, an ideal Congressional solution would provide all workers with access to a retirement account and a vehicle to build emergency savings.

The Path Forward

Currently, in Congress, there are two bipartisan savings bills that begin to tackle these issues. In March 2022, the House passed the Securing a Strong Retirement Act of 2022, and in June 2022, the Senate Finance Committee unanimously approved the Enhancing American Retirement Now (EARN) Act, clearing it for a full Senate vote. To learn more about what these bills do, and which specific provisions from each incorporate the behavioral science principles mentioned above, read our policy brief here. In addition to highlighting which provisions from each bill should be included in a final savings bill passed by Congress, we also include other actions Congress can take to help families build savings.

The post Policy Lab: Leveraging Behavioral Science to Help Families Build Savings appeared first on ideas42.

This year, we mark one decade of an overlooked occasion with outsized impact: Giving Tuesday. During this season, we come together to donate to causes we care about, an altruistic extension of the previous days of indulgence in the United States and a socially conscious way to use any bonus cash we’ve accrued. In 2021, about 35 million Americans donated on Giving Tuesday alone, amounting to over $2.7 billion in collective donations, jump-starting a generous period through December.

At ideas42, we believe in the power of behavioral science to make it easier for people to achieve their charitable giving goals. On Giving Tuesday, many people feel excited about the call to give, but taking action can still feel challenging. In our work with donors, we’ve found that actual giving behavior is not always aligned with the giver’s own values. Instead of giving strategically to causes we care about, for instance, we often donate spur-of-the-moment when a direct solicitation moves us. Yet relying on reactionary donating can bias our decision-making away from deserving and effective charities.

So how can you give intentionally and make the most of your donations? Here are four considerations rooted in behavioral science to help you be more generous and impactful this giving season.

1. How much can I spend?

   Good news! You probably have more to spend on donations than you think. As a first step, take a few minutes to think about how much of your budget you can set aside for charitable giving. Planning your budget will ensure you maximize your charitable donations while preventing you from spending more than you intend to.

   Try putting your giving budget in tangible terms—ordering takeout once a week, going to the movies twice a month, or taking a cab instead of public transportation a few times a year. This will help you steer clear of mental shortcuts that limit your desire to give.

2. What causes matter to me?

   Charitable giving is emotional, so it’s helpful to think about what motivates you to give. This will help strengthen your connection to your giving practice and make it more sustainable over time. Once you determine what drives you and what issues you want to focus on, search for organizations that serve those causes, communities, or geographies. To broaden your impact past the most visible causes, challenge yourself to consider organizations that you usually wouldn’t.

   You can direct your whole giving budget to a single organization, or you can distribute it across a few if that feels better to you. With thousands of options to choose from, it can be hard to choose which organizations to support. One way you might consider distributing your donations is by thinking of a range of causes: one cause in need of urgent aid such as a global crisis or natural disaster, one organization in your area that serves a community you care about, and one organization focusing on solutions that address the root causes of societal issues through advocacy and policy change.

3. How can I multiply my impact?

   Your donation is great, but why not triple it? One of the most powerful mental shortcuts we use when making a decision is to look to what people we trust are doing. Your friends and family may be feeling overwhelmed by the many causes and organizations seeking donations this season. You can help them and increase your impact on the causes you care about by letting your network know where your donations will be headed. To reduce friction that may cause people to give up on donating, make it easy for them: share a direct donation link or post your fundraiser on social media.

4. How can I have an impact throughout the year?

   So you gave your budgeted amount to your favorite causes and shared these causes with your friends and family. Nice! Now can you keep that up all year? It’s going to be harder than you think. Even if we have the best intentions of incorporating a practice of charitable giving into our lives in the new year, we get busy, and grand plans of finding a new and exciting cause to donate to each month get overshadowed by laundry, doctor’s appointments, and birthday parties.

   But you can stop giving from being crowded out by setting up a recurring donation. Setting recurring donations is a smart way to take the burden of remembering off your future self. Even small monthly donations will make a big difference in your overall giving by Giving Tuesday next year.

* * *

Once you’ve hit that last “Donate” button (and checked “Set recurring donation”), take a moment to pat yourself on the back and feel good about what you did. Giving isn’t a requirement, and it comes from the generosity you feel toward people and causes that need help. The warm glow we feel from giving can be a big motivator for continued generosity, so don’t forget to let yourself enjoy it.

The post 4 Tips for Making the Most of This Giving Season appeared first on ideas42.

While most rural pregnant women in Liberia intend to give birth in a health facility, there are many barriers that often prevent them from following through on this intention. Facility-based childbirth requires extensive preparation, from determining when and how to leave for the facility to saving for the cost of transportation and drugs and medical supplies required at the facility. This can create delays in receiving care throughout the course of a woman’s pregnancy and ultimately in arriving and receiving care at the time of delivery. 

In tackling this challenge, our Global Health team, working through the USAID-funded social and behavior change project Breakthrough ACTION, learned about the important and influential role of traditionally trained midwives (TTM), community-based health workers who support and counsel women during pregnancy and often accompany them to the facility both for prenatal care and at the time of labor and delivery. Pregnant women primarily seek advice from the TTMs during pregnancy as a trusted source of information.TTMs often the first point of care during pregnancy, and they advise women on when to leave for the facility for delivery. 

To support women in identifying the necessary logistics and developing a plan to reach the health facility at the time of labor, as well as saving the funds required to support the plan, we conducted a collaborative co-design process to develop a suite of ideas. The co-design process engaged officials from the Liberian Ministry of Health, health care providers, TTMs, and pregnant women and their families. Many of the ideas  leveraged the important relationship between women and TTMs; however, we were faced with a design challenge given the realities of the rural Liberian context:

How do we create an easy to use, engaging tool for childbirth planning and saving — which is institute and can be used by a low literacy population — and needs minimal support and training?

We decided to leverage the tradition of Liberian storytelling to create stories that could be retold by TTMs and could convey the importance of planning for facility-based delivery. Liberian storytelling is a traditional improvisational and participatory oral art form used to share important lessons, oral history, and customs. To develop compelling and memorable stories in a familiar Liberian tradition that could impart important details about how to prepare and save for facility-based delivery, the project worked with Gbahtou Comgbaye, a Philadelphia-based Liberian storyteller. 

Enjoy an excerpt from one of Gbahtou’s stories, “Red Deer, Black Deer,” and see how Gbahtou develops these stories in the video below.

To explore Gbahtou’s other stories and learn more about our other facility-based delivery designs visit our design guide.

The post The Art and Science of Planning for Facility-Based Childbirth in Liberia appeared first on ideas42.

ideas42 was founded nearly 15 years ago on the belief that many of the world’s greatest challenges, particularly those that disproportionately impact those with the least, could benefit from behavioral solutions.

Poverty, education, health, the justice system—across all of these issues and more, persistent inequalities resisted easy resolution. We’ve been at the forefront of pioneering an approach that centered insights about how people actually live and was sensitive to the contexts that shape people’s lives. Now, we’re more sure than ever that behavioral science has an irreplaceable role to play in building a more just world where everyone can thrive. 

What evidence do we have to support that? 

Our 2022 Impact Report showcases the broad range of our work and details how our approach to behavioral design is changing the world. Over the past decade, we’ve refined our work to be even more focused (and ambitious) on how we can counter global inequality.

Closing the gaps that create inequality using behavioral science is our North Star. In everything we do, we ask, How will this move us toward a more equitable world? Though ideas42’s work covers a range of issues, across all of them them our organizing principle remains the same: to remove barriers that perpetuate inequality.

What does this look like in practice? Here are just three Spotlights—representative case studies, chosen from dozens of insights—that showcase what we’ve accomplished and, most importantly, model how ideas42’s approach to behavior change can create impact across a broad range of contexts and in ever more ambitious ways. Recently, we’ve worked to:

1. End mistreatment in maternity care. In 2018, our Global Health team collaborated with birthing women, care providers, health administrators, and policymakers in Zambia to identify why women are often mistreated during childbirth. Our team then worked with the organization Safe Motherhood 360+ as part of the Breakthrough RESEARCH portfolio funded by USAID to develop four solutions that reduced abusive care, increased pain management support, and fostered greater empathy among providers.
2. Boost college students’ success. Our U.S. Education team has found time and again that seemingly minor issues—like procrastinating on an application deadline or being slow to make new friends on campus—can accumulate to push down overall graduation rates. After generating, applying, and testing dozens of behavioral insights to raise college completion rates, we’re scaling up our approach to help millions of U.S. students stay on track and earn degrees.
3. Redefine the narratives of poverty. Tens of millions of Americans live in poverty, struggling to make it from month to month, day to day. Through surveys and focus groups in six cities across the United States, we’ve worked to rigorously examine narratives behind systems that keep people in poverty and limit their ability to lead lives of their own choosing, so those narratives can then be changed. Now, our priority is to move from understanding negative poverty narratives to helping foster positive ones. From our perspective, this is the next frontier in behavioral science. 

We haven’t accomplished these successes (or taken steps in our ever-more ambitious ongoing efforts) alone. We are grateful to our partners, funders, collaborators, and the growing behavioral science community for working with us to fulfill our mission. Because you share a vision for a future where inequality is a thing of the past, we’re optimistic about what’s to come. 

Learn more about our work in our latest impact report or by contacting us at info@ideas42.org.

The post Using behavioral science to close the gaps that create inequality appeared first on ideas42.

The nature of work is changing, and so are the skills required to be successful. While technical or ‘hard’ skills are essential for most jobs, there is growing evidence that ‘soft skills’ such as problem-solving, teamwork, and resilience play a key role in job market success. This is especially critical in low- and even middle-income settings, where employment options can be informal, scarce, and unpredictable. 

Soft skills, sometimes referred to as transferable skills, employability skills, or non-cognitive skills, are non-technical skills and competencies that help people navigate their environment, interact positively with others, and perform well in the labor market. To date, we’ve worked on soft skills development programs that include persistence, teamwork, communication, resilience, self-efficacy, and problem-solving.

Soft skills, and even qualities typically deemed ‘personality traits’ like perseverance, are skills that can be learned. This is why many workforce development programs include ‘soft skills’ and ‘life skills’ trainings as part of their curriculum. However, as we know from behavioral science, an introduction to a skill does not often lead to a person adopting and using it—decreasing the effectiveness of these programs and increasing the obstacles job seekers face as they try to stay competitive in an unpredictable market. 

The designs of traditional workforce development programs are rife with behavioral barriers job seekers must overcome before they can adopt and use their new skills in the workforce. From the hassles associated with learning about, applying to, and, ultimately, enrolling in the program to begin with, to then attending and actively participating in it, job seekers juggling competing priorities may find themselves unsuccessful at completing every step–even if they have a clear intention. And then, completion of the training is not enough, as successfully utilizing new skills requires that the lessons are salient in the moments they need to use them.

The good news is behavioral science provides a clear—and often more cost-effective—path to designing workforce development programs that help job seekers overcome such obstacles and gain the benefits the programs were made to provide. Seemingly small changes to programs, such as adjusting program timing or reframing its benefits, can have outsize impacts on successful job seeker participation when informed by behavioral science.

Here are just a few examples of some of the common behavioral barriers job seekers face with workforce programs, and some solutions that could overcome them: 

1. Problem Structure and Timing

Soft skills cannot simply be learned from a book: learning them requires experiential, active learning approaches. Ample time for practice, feedback, and reflection are necessary for ensuring these skills are top of mind, especially for job seekers experiencing resource or time scarcity. Interactive trainings, such as personal initiative trainings, are an important alternative as they allow participants to learn by doing — bridging the “know-do” gap so that people are better equipped to apply the right skills at the right time. Programs should also include follow-up refreshers, reminders, and nudges such as prompts to think about soft skills, to maximize retention and practice.

2. Complex Curriculums 

All people have limited attention. The more their attentive capacity is stretched, the more difficult it is to process new information. Participants in workforce programs likely have numerous priorities in their day-to-day lives that compete for their attention. Adding in long and comprehensive soft skills lessons may be overloading participants with unnecessarily detailed and complex information that inadvertently hinders learning. Behavioral insights point to ways programs can make key lessons easier to learn, absorb, and apply. For example, using shorter formats delivered in channels that meet participants where they are. We’ve previously designed an effective mobile-based training that simplified financial management lessons into digestible rules-of-thumb for participants to follow. 

3. Priming Negative Identities

Programs may, intentionally or unintentionally, ‘prime’ identities that individuals hold, and subsequently reinforce false narratives or stereotypes associated with that identity, which could prevent learning and action from taking place. Priming could lead job seekers to behave in ways that are associated with negative stereotypes of that identity and limit their perceptions of what they can achieve. To combat this, behaviorally designed programs should promote positive self-identity by highlighting positive social norms and/or adjusting program components to account for different identities. For example, when we worked to support women in Liberia to start businesses, we found that women perceived they had limited opportunities in traditionally male-dominated fields. As a result, we designed posters portraying women in male-dominated fields, such as brick-making, construction and electronics shops, and included testimonials from previous female participants as advocates for the training.

Soft skills can add tremendous value to people seeking to stay competitive in a rapidly shifting job market, but workforce programs seeking to teach soft skills must be designed to support individuals throughout the process of learning, developing, and applying such skills. Behavioral science is a cost-effective solution for strengthening and scaling soft skills programs by redesigning the program around how job seekers really live, think, and behave.

At ideas42, we are actively looking for avenues to incorporate behavioral science insights to improve the impact of workforce development programs, and by extension the economic well-being and stability of the lives of people around the world. Interested in partnering with us to enhance the design of your program? Email us at livelihoods@ideas42.org.

The post Why Soft Skills Development Programs Need Behavioral Science appeared first on ideas42.

The words spoken by public government officials matter; and more often than not, such words have real-life implications for the decisions people make and the actions they do or don’t take.

For example, much attention has been paid to President Biden’s recent declaration that the pandemic is “over”. On a recent episode of the broadcast news program 60 Minutes: “We still have a problem with COVID-19. We’re still doing a lot of work on it. But the pandemic is over . . . If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape.” And although the president walked these statements back a few days later, the weight of those words were already felt, and the potential damage already done to current risk mitigation efforts.

While there may be nothing inherently untrue about any of these statements, their sentiment reinforces a pre-existing mental model Americans have of pandemics – in particular, regarding the behavior changes called for in the interest of public health over the last two years. In this case, the mental model of intentional risk mitigation acts such as public masking, staying up to date on vaccinations, and staying home when sick will no longer be necessary once the pandemic is over.

Declaring the pandemic over has created further division among two camps in the country. Those who agree with President Biden’s recent sentiments feel the emergency state of COVID-19 has stabilized and essentially ‘downgraded’ into an endemic disease, easily manageable like the seasonal flu (which continues to kill thousands of people each year). Those who disagree feel the pandemic is still widely unpredictable and dangerous, as evidenced by the fact that in addition to killing nearly 400 Americans from COVID-19 per day, it continues actively mutating and impacting people across the globe. Regardless of one’s position in this division, declaring the pandemic “over” has complicated the ongoing – and still necessary – public health efforts to fight COVID-19.

However the status of the pandemic is labeled, it continues to be a public health crisis in part because much of the early burden for risk mitigation was placed on individuals to change their behaviors (e.g. wear a mask, social distance, get vaccine/booster shots, etc.). It’s no surprise that as a population, we’ve grown somewhat complacent over time as the COVID-19 death toll no longer dominates our news or social media feeds. Much of this is understandable– gradually we will habituate to almost any new situation over time, even an emergency state. Moreover, the physical, social, and emotional toll of the pandemic has been difficult for many to bear and people are ready to move on. However, an authority making a declarative statement about the pandemic’s end has real-world implications for the way people perceive and respond to an ongoing crisis. Predictably, it can undermine behavioral recommendations made by public health officials to mitigate disease spread and protect its most vulnerable populations by making common-sense strategies – like wearing a mask in public when sick – seem less necessary. It also renders a government-run public health system that already suffers from lack of trustworthiness even weaker.

Beyond that, there are two key psychological principles — confirmation bias and decision fatigue — that help inform how people’s perceptions are formed, leading to behaviors that are either curbing the spread of COVID-19 or inadvertently contributing to its spread.

Confirmation Bias

Confirmation bias is the process of seeking or interpreting evidence in ways that align with existing beliefs, expectations, or a hypothesis at hand. It explains our tendency to cherry-pick information that confirms our existing beliefs or ideas, and dismiss information that goes against those beliefs. Initially, widespread social media misinformation and medical distrust amongst some communities had a significant impact on people’s interpretation of whether or not they should adhere to standard risk-mitigation guidelines. President Biden’s recent remarks about the pandemic being “over” merely caused people to strengthen their existing personal beliefs about basic risk mitigation behaviors–people who agreed feel justified in discontinuing those behaviors, and people who disagreed feel justified in continuing them. Confirmation bias helped entrench existing inclinations to disregard COVID-19 recommendations, at precisely a time when we need more people to increase risk mitigation behaviors.

To address confirmation bias, change the context

Our first recommendation is to reframe “COVID-19 mitigation behaviors” as “behaviors that further public health.” In particular, the group of people in the “movable middle” may have been taking certain actions (such as wearing a mask, handwashing, and covering up coughs and sneezes) because they felt temporary and limited to the context of a pandemic. This group is probably most likely to stop those behaviors once that context is removed, especially if they see those behaviors as burdensome. Now that we’ve had a statement from the president declaring the pandemic to be over, many of these people will now see that as a reason to let go of those behaviors, even though many of them are basic public health practices that are beneficial even outside of a pandemic.

One potential way to address this response to the changed context is to work on detaching public health behaviors from the specific context of the pandemic. For example, sharing messaging that reframes what was previously “COVID-19 risk mitigation behaviors” as general “public health behaviors” that are evergreen. Repeating this evergreen advice and increasing coordination between public health entities/figureheads so that their messages are clear, consistent, and do not conflict can also help counter repeated misinformation and the confusion of ever-changing public health guidance.

Relatedly, we need to acknowledge that for many people (including people who are immunocompromised, elderly, or chronically ill), COVID will remain a major risk for the foreseeable future. We cannot leave these populations behind in our efforts to create a new normal. The early days of the pandemic forced us to confront the fact that many essential services have not been equally accessible to all, and many changes were made to increase accessibility–including more flexibility for things like telehealth services, paid sick leave, and virtual participation in classes, conferences, and other events. However, many of these options have gone away over the past year, taking with them many people’s ability to meaningfully participate in society and access essential services. Rather than viewing these options as pandemic-limited, we must reframe these accommodations as evergreen and continue to push for maintained (and improved) accessibility, which will be beneficial even in a COVID-free world.

Decision Fatigue

Decision fatigue describes the act of choosing between options depleting self-control. It refers to the deteriorating quality of decisions made by an individual after a long session of decision-making. Since the onset of the pandemic, many people have been forced to make staggering pandemic priority decisions in a rapid and constantly changing environment. The pandemic has also made the process of making routine decisions seem unavoidably non-routine. Yet, following President Biden’s remarks, it seems that making mundane decisions should become easier. But at what cost or risk?

Should we attend our favorite band’s concert next summer, or would it be a safer bet to ask Alexa to shuffle their greatest hits? Should we continue to get booster shots, or run the risk of getting exposure to and passing on immune-evasive variants to vulnerable populations? These are examples of a number of decisions that add up to a state of decision fatigue, which wouldn’t ordinarily be part of our daily lives if it were not for the COVID-19 pandemic.

To address decision fatigue, increase slack

To help the group of people who might be fatigued from the past 2 ½ years of COVID-19 avoidance, we can find ways to reduce the burden on individuals to take action. This involves refocusing efforts away from only promoting the take-up of individual behaviors, spending more time on changing the behaviors of groups and organizations. For example, pushing for upgraded HVAC systems for improved ventilation can help remove some of the burden of individual masking at all times indoors.

As we shift to a new phase of the pandemic, complacency threatens to take away many of the gains we’ve made fighting COVID-19 over the last 2 ½ years and exposes us to continued and greater public health consequences in the future. It will take proven, behavioral science strategies to keep people safe. Regardless of what we believe the current status of the pandemic is, we still need the government and public health institutions to communicate clear, reliable messages that protect its residents and prepare us for the next health crisis that will inevitably arrive. This will require messaging that better frames peoples’ perceptions and does not discourage them from engaging in risk-reducing behaviors.

The post What it means to say that the COVID-19 pandemic is “over” appeared first on ideas42.

This is part of a series of conversations with members of the Niger and Burkina Faso National Innovations Teams (NITs), a group of 54 health professionals across government and non-profit sectors. 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 Burkina Faso and Niger NITs were established in 2020 by Breakthrough ACTION, the U.S. Agency for International Development’s flagship social and behavior change program.

This spotlight features Hamsatou Moumouni Moudi, head of the Communications and Public Relations Division at the Ministry of Public Health, Population and Social Affairs in Niger. During this interview, she explains how the knowledge she has received is being disseminated within the Ministry of Health, within other organizations, and as a trainer at the Institute of Public Health to a new generation of communicators.

Name: Hamsatou Moumouni Moudi
Country: Niger
Title: Communications and Public Relations Head
Organization: Ministry of Public Health, Population and Social Affairs

What motivated you to attend the training for both cycles? 

My team designs media and communication tools that promote behavior change, but we’ve often been confronted with behavioral barriers and constraints getting the community to change their behaviors. No matter how much we raised awareness, there has always been a certain reluctance. In other words, we haven’t been able to change the community’s behavior the way we intended to. We knew that something was wrong with our approach, and we wanted to understand why. We recognized the need for innovation. Breakthrough ACTION has really helped us develop innovative solutions that have the potential for impact. My motivation is to learn and adopt innovative approaches that will improve our communication strategies and results.

Is there anything that surprised you about cycle 1, cycle 2, or the refresher training?

What surprised me the most was learning about the importance of the development process—the process of engineering of materials—during the design phase. Now, I understand that outreach alone does not lead to behavior change, and that design is an integral piece to behavior change approaches. You have to go beyond believing that just because someone becomes aware of an issue, you’ve consequently convinced them that it’s an issue that impacts them and they will now decide to change their behavior in response to it—or that deciding they’d like to change their behavior means that they will follow through with it. Before, we believed people when they said they had made a decision and believed that they would act on it. We really thought that they would do it, that they couldn’t not act according to it. Now, I’ve learned that making a decision is simply not enough to change people’s actions, you have to continue to nudge them toward it.

Is there anything different in the way you now work?

Admittedly, we used to produce communication materials and then think the problem was solved. All that was left to do was to display the material. Then, once that had happened, we believed we had sufficiently raised awareness. Now that we’ve joined the National Innovation Team, we’ve learned how to do real design, which calls on a lot of other expertise in areas like psychology and sociology—aspects that help us better understand our intended audiences and stakeholders. Since then, I don’t take design lightly and I don’t rely on pretense. Instead, I carefully investigate the context, which is often not an easy thing to do. Incorporating behavior goes beyond people’s knowledge and attitudes, and allows me to create more effective designs. For a long time, we allowed ourselves to design without considering the socio-ecological context, but now we realize that every aspect of this context has its own purpose and deserves to be explored further.

Can you give an example? 

We’ve started paying much more attention to mood, physical environment, and social context. We’ve also learned how to account for chronic scarcity. We didn’t consider these things before. For example, we’d often approach organizing events around increasing visibility. We didn’t think about how there could be specific moments or new things in people’s everyday lives that could push them to take action. We learned this through the NIT training.

What has been most useful for you, and what will be most useful to you in your daily work?

Our department is at the macro level of the ministry and is attached to the General Secretariat. This means we’re in charge of coordinating all forms of communication, including responding to any government communication concerns. With the arrival of Breakthrough ACTION, we’ve created another group to coordinate social and behavior change communication specifically. For example, if the nutrition department wants to design new tools, we submit the designs to this group for validation. Now that I’ve learned that design requires much more innovation, I make sure that we use NIT-trained colleagues in the development of new designs and prototypes. We’ve stopped doing things the way they used to be done in how we approach developing communication tools. We also make sure partners understand it takes time to incorporate innovative approaches into project planning and implementation—and that good design necessitates it. I’ve also since adapted the way I teach at the National Institute of Public Health to incorporate what I’ve learned through the training and teach my students innovative approaches. The training has all had a big impact on my philosophies and approaches to my everyday work.

Do you have any other thoughts on the course? 

Soon, we’ll be revising the curriculum in our health worker training institute and are counting on Breakthrough ACTION to help us set up a pool of trainers. Through this training, they will learn how to innovate in the field and will be prepared to practice and implement innovative approaches using behavioral economics. Creating small groups that receive more training after the original workshop could be helpful so that some trainers are able to deepen their mastery of design and provide ongoing training and supervision to others on the ground.

The post Building Behavioral Design Skills: A Conversation with Breakthrough ACTION Innovator Hamsatou Moumouni Moudi appeared first on ideas42.

Rigorous impact evaluations are essential to determining program effectiveness. Yet, they are often time-intensive and costly, and may fail to provide the rapid feedback necessary for informing real-time decision-making and course corrections along the way that maximize programmatic impact. Capturing feedback that’s both quick and valuable can be a delicate balance.

In an ongoing impact evaluation we are conducting in Ghana, a country where smoking rates among adolescent girls are increasing with alarming health implications, we have been evaluating a social marketing campaign’s effectiveness at changing girls’ behavior and reducing smoking prevalence with support from the Bill & Melinda Gates Foundation. Although we’ve been taking a traditional approach to this impact evaluation using a year-long, in-person panel survey, we were interested in using digital feedback as a means to collect more timely data on the program’s reach and impact. To do this, we explored several rapid digital feedback approaches including social media, text message, and Interactive Voice Response (IVR) surveys to determine their ability to provide quicker, more actionable insights into the girls’ awareness of, engagement with, and feelings about the campaign. 

Digital channels seemed promising given our young, urban population of interest; however, collecting feedback this way comes with considerable trade-offs. Digital feedback poses risks to both equity and quality, potentially reducing the population we’re able to reach and the value of the information we’re able to gather. The truth is that context matters, and tailored interventions are critical when collecting feedback, just as they are when designing programs. Below are three lessons to consider when adopting digital feedback mechanisms into your impact evaluation design. 

Lesson 1: A high number of mobile connections does not mean the target population has access to mobile phones. 

Despite an exceedingly high number of mobile connections in Ghana, numbers nearing 133% of the population in 2021, most urban, adolescent girls don’t have consistent mobile access. In fact, only 44% of the teenage girls we interviewed had regular access to a mobile phone, and even fewer had internet access. This gap in access was especially prevalent among younger girls, as well as girls that were not enrolled in school due to experiencing extreme poverty, living in a parentless household, or recent migration. Knowing this, mobile- and internet-based surveys would have excluded their critical perspectives from program feedback. 

Lesson 2: High literacy rates and “official” languages do not mean most people are able to read and write easily in a particular language.

English may be Ghana’s official language, but it’s not the most widely spoken language in the country. Even though Ghana’s adult literacy rates have been steadily rising, we found gaps in English literacy among urban teenage girls. Reading and writing were especially difficult for girls from lower socioeconomic backgrounds, due to barriers preventing them from accessing formal education. However, reading comprehension remained difficult for some girls enrolled in school, because the language they’re often taught to read in at school, English, differs from their primary spoken language. This made text message and IVR surveys, where participants would need to enter responses on their phones, difficult.  

Lesson 3: Gathering data on taboo topics may benefit from a personal touch. 

Reaching people through automated digital media provides an exciting way to reach more people faster than through traditional, in-person surveys. However, digital surveys limit the depth of information able to be communicated and collected, with text message surveys limited to 160 characters and IVR surveys shortened to hold the respondent’s attention. Text-based questions are also more likely to be misunderstood, with little to no opportunity to provide clarity. Finally, digital surveys don’t allow for the same level of trust to be built with a participant that in-person surveys do, which may leave sensitive groups like teenage girls less likely to respond freely about taboo topics, like smoking and intimate relationships. 

Ultimately, digital feedback mechanisms are a promising option for generating rapid feedback at scale, but there are important equity and quality trade-offs to consider before implementing them. Because of this, program evaluators must keep context top of mind, considering who the target population is, their level of access to mobile phones, and the level of sensitive or complex information needed when implementing them. For feedback that requires a wide range of perspectives, explores taboo topics, or necessitates high-level comprehension, in-person surveys or mixed-method approaches will be more effective at producing the high-quality data necessary for maximizing impact.

The post Is digital feedback useful in impact evaluations? It depends. appeared first on ideas42.

New census data adds to the growing body of evidence showing that the expanded Child Tax Credit (CTC) helped reduce childhood poverty. In 2021, child poverty fell to a record low of 5.2%, a 46% decline since 2021. Yet, despite this success, Congress failed to extend the CTC, leaving families without this much-needed support.  

In fact, the end of monthly CTC payments created significant hardship for many, according to a new survey* of families making under $75,000 a year (ideas42 supported this survey work as part of our commitment to understanding the benefits of the CTC). Sixty percent of families stated that it has been more difficult for them to pay their expenses since the monthly payments expired in December 2021. These families reported they had trouble:

• Affording food and groceries (66%)
• Paying bills (65%)
• Buying clothing and shoes (49%)
• Paying their rent or mortgage (40%) 

More than half of the families who earned under $25,000 reported experiencing food hardships, such as difficulty affording more or higher quality foods, or visiting food banks or food pantries. 

Unsurprisingly, parents who had received monthly payments in 2021 reported increased financial stress since the monthly payments ended. By reducing scarcity and providing no-strings-attached monthly payments, the expanded CTC created much-needed slack for families with low- and moderate incomes. It was especially important for those earning the least. Taking the payments away left many families struggling and experiencing increased levels of stress, as they had to worry more about how to pay their bills or put food on the table.

There is still time for Congress to right this wrong and extend the expanded CTC. In recent days, there has been a renewed push from Democratic Congressmembers and the Biden Administration. The CTC is a behaviorally informed policy with plenty of evidence demonstrating that it reduced child poverty. Americans across the political spectrum overwhelmingly support the CTC. Congress must not let 2022 end without extending the CTC.

*The Center for Law and Social Policy collaborated with IPSOS to conduct these surveys, in partnership with University of California, Berkeley, the Center for the Study of Social Policy, the Children’s Defense Fund, ideas42, the National Women’s Law Center, Prosperity Now, UnidosUS, and the Urban-Brookings Tax Policy Center.

The post Policy Lab: Ending the Child Tax Credit Has Already Caused Hardships appeared first on ideas42.

America’s staggering economic inequality, particularly impacting people of color, and the
the financial instability of most individuals and families in the United States, show that our society is not on a sustainable path to prosperity. Historically, many philanthropists, NGOs, financial institutions, and other industries working to support economic mobility have approached financial health from a purely financial perspective, generating specific products, tools, or financial education aimed at helping people with lower incomes save, reduce debt, achieve home ownership, or manage money. But the fact is, for a person experiencing poverty, it’s nearly impossible to think about savings or planning for the future when they don’t know if they’ll have enough to eat this month.

To truly make an impact, we have to examine the larger context in which people make their
financial decisions, as well as address the systemic and structural barriers that prevent shared prosperity and have contributed to and amplified the racial wealth gap.

Of course, it matters whether a person is able to weather emergency expenses, afford to buy a house, build credit, or save for retirement. But equally important is what kind of neighborhood they live in, where they can send their kids to school, and if they have a reliable job with predictable hours that provides a living wage and affordable healthcare.

Traditional approaches to financial health have failed to account for the environmental, health, and social circumstances that impact a person’s overall wellbeing. That’s like clearing a street of litter each day without considering how to prevent litter from being dropped in the first place.

A deeper understanding of human behavior, and how people make decisions and take action in the real world based on their environment or context, can shed light on innovative ways to
address the myriad of factors that contribute to poverty both in the immediate- and long-term.

Reduce the excess cost of poverty

The COVID-19 pandemic laid bare the complex and deeply rooted inequities and structural
issues that have made it all the more challenging for people with lower incomes to escape the
cycle of poverty. The fact is: there are many excess costs faced by people with low
incomes making it more expensive to be poor in America.

Here are just a few examples. Across the U.S., those with less pay more in total for the same
quality of housing, yet they have access to lower-performing schools. Living in poverty means less access to healthcare and worse health outcomes. And basic financial services cost
significantly more for the 50 million people who are unbanked or underbanked in the U.S. than for others. While the unbanked population has declined in recent years, it’s important to note that unbanked rates for Black, Latino, Native American, and Alaska Native households remain substantially higher than for white households.

New, scalable technologies and tools that help reduce the many excess costs, be they financial, psychological, or time-bound, faced by people with lower incomes is one strategy for meaningfully improving financial mobility and overall well-being.

Nobody understands the excess costs of poverty like people who have directly experienced them. If we want effective solutions, those with lived experience must be directly involved in designing them. Yet they are often excluded from the problem-solving process. It’s critical that the development of new tools be driven by people from a wide diversity of backgrounds who have personally experienced the multiple decisions and challenges of living with lower incomes.

Craft evidence-based policy

Addressing systemic problems also requires changing public policies that have made financial inclusion and wealth building challenging, particularly for Black, Latino, and other historically marginalized communities. Public policy sets the rules of the road: it forms much of the context people must navigate, and it creates economic subsidies and incentives.

Policy decisions contribute to systemic racism and inequality, and continue to fuel inequality by giving the vast majority of economic subsidies for asset and wealth building to the wealthiest. In 2019, more than half of the $645 billion spent by the federal government on asset and wealth building went to the top 5% of income earners, while families with low incomes received very little.

More than half of the coronavirus emergency funds for small businesses went to just 5 percent of recipients, with about 600 mostly larger companies, including national chains receiving the maximum amount of $10 million dollars. In contrast, only 25% of funds were distributed in amounts of $150,000 or less.

If using billions of federal dollars to enable upper-income households to further build assets and wealth is desirable, then helping lower-income households build assets and wealth should be too. And the fact is, a more even distribution of wealth would benefit the economy and all Americans.

Let’s put it another way. According to the Brookings Institute, if Black and Latino Americans
held a proportional share of wealth, it would amount to $12.68 trillion in household wealth,
rather than the actual sum of $2.54 trillion, underscoring the economic potential of closing the racial wealth gap.

Evidence-based policy would help achieve this, but is often not widely supported due to
harmful false narratives about poverty.

Change false narratives of poverty

Why is there such resistance to public policy that supports everyone? False narratives about
poverty contribute to the wide discrepancies in who benefits from government spending. In the U.S., perspectives on poverty are deeply influenced by ideals of the “American Dream”: those who work hard prosper and become successful. As such, it is often wrongly believed that anyone struggling financially must not be working hard enough or are personally at fault in some way. This fuels a harmful narrative of the “undeserving poor” in our society that impedes the will to make broad policy changes.

In reality, living in poverty and trying to navigate a way out is incredibly challenging, and it’s
even harder if you are a Black American. Shifting the narrative from the people in poverty to
the context of poverty underscores that circumstances are often outside of most people’s
control. In order to create public will for policy solutions that can meaningfully tackle poverty for everyone, we need messaging and tools for changing deeply embedded, false cultural narratives about the causes and impact of poverty in the U.S.

Only by going beyond traditional financial solutions and taking steps to systematically tackle the complex drivers of poverty in three parallel efforts—reducing excess costs of poverty with
technological tools, relying on evidence to create policy that helps lift people out of poverty,
and changing harmful narratives about poverty—will the U.S. make meaningful progress on
reducing inequality and increasing economic mobility and prosperity for all.

Josh Wright (Executive Director, ideas42) and Bonnie Wallace (Head of Financial Health
Philanthropy, Wells Fargo) work together to create Shared Prosperity Catalyst, a multi-year initiative to bring financial health and prosperity to all in the United States.

The post Prosperity for All Starts with Making It Less Expensive to Be Poor In America appeared first on ideas42.

Last Tuesday, President Biden signed the Inflation Reduction Act of 2022—a major piece of legislation that will address the climate change crisis, reduce health care costs, and make our tax system fairer. While these are important measures that will help many families in the United States, the bill falls short of what is needed to help those with the fewest resources. Notably, the bill did not include the expanded Child Tax Credit (CTC)—which successfully reduced monthly child poverty by 30% when it was in effect.

Enacted as part of the American Rescue Plan, the expanded CTC provided monthly payments from July to December 2021 to families with children. The CTC benefit was increased from $2000 per child to $3,600 per child aged 5 and under and $3,000 per child aged 6-17. The American Rescue Plan also closed a hole that had kept one-third of children and half of all Black and Hispanic children from receiving the CTC because their families earned too little to be eligible.

Families who received the CTC used the money to pay for necessities, such as food, rent, and clothing. Families reported increased well-being, reduced stress, and more time to spend with their families. Yet, politicians allowed the expanded CTC to expire in 2022 and have, once again, failed to extend it. In many ways, this is not surprising.

Much of what made the expanded Child Tax Credit successful—automatic, no-strings-attached payments that disproportionately benefited Black and Latino people and those with the fewest resources—left it vulnerable.

As a nation, we mythologize the rugged individual who is able to succeed by perseverance alone. Handouts, too many believe, make people weak.  

At behavioral science non-profit ideas42, we’ve found that people hold a host of narratives about poverty—stories we have gained from the media, our schools, our families, and our communities—about why people are poor. People are more likely than not to believe incorrectly that there is a lot of fraud among people who receive public assistance and they are roughly split on whether public assistance programs “make people lazy.” Although these beliefs are demonstrably false, they nevertheless continue to hold sway, particularly when it comes to policymaking. Programs that benefit people living in scarcity and people of color have a hard time garnering support. And people often want to add unnecessary hurdles that make the process of getting these benefits even harder.

Senator Manchin, who had outsized power in deciding what was included in the Inflation Reduction Act, tends to hold fast to these false narratives. Manchin refused to support the expanded Child Tax Credit, telling CNN last year, “There’s no work requirements whatsoever. There’s no education requirements whatsoever for better skill sets. Don‘t you think if we’re going to help the children that the people should make some effort?” Despite all evidence to the contrary, he also claimed that parents would use the CTC to buy drugs. Senator Manchin is not alone among politicians to adhere to these false ideas. Politicians from Ronald Reagan to Bill Clinton to Donald Trump have expressed similar attitudes to justify policymaking and make it hard to access benefits. 

As long as politicians let these false narratives about poverty drive their policy decisions, they will continue to make the lives of people living in scarcity harder.

The Child Tax Credit reduced child poverty, increased labor force participation, and would be a net gain for the economy. Yet, despite the evidence, Senator Manchin and others refused to extend it. They let their biases and beliefs about poverty get in the way of good policy making, creating barriers to economic security for people with low incomes. American families should not be held hostage by false poverty narratives. Congress can still extend the CTC and keep more families from being pushed into poverty. 

Kelli Garcia is the Policy Lab Director at ideas42, a nonprofit that applies insights from behavioral science to address complex social problems.

The post Poverty Narratives Killed the Child Tax Credit appeared first on ideas42.

We are now over 900 days into the global pandemic that is COVID-19. Meanwhile, there has been hope for many with the introduction of vaccines and boosters; reintegration into society via hybrid working arrangements; and the resumption of sporting events, concerts, and international travel. A semblance of normal life has returned for most, yet we’re still left questioning what’s to come, what to do next, and what to believe. 

In light of the American public’s reaction to the original pandemic response, health experts in the United States (and globally) are beginning to explore new approaches to address current and future major health crises. This post aims to reflect on the U.S. Center for Disease Control’s (CDC) newly announced Center for Forecasting and Outbreak Analytics (CFA), in addition to sharing several suggestions informed by behavioral science, focused on better communication strategies for future disease outbreaks. 

The CDC officially launched the Center for Forecasting and Outbreaks Analytics (CFA) in April 2022. The overall goal of the CFA will be to “enable timely and effective decision-making to improve outbreak response using data, modeling, and analytics.” The new center will be led by experts in information and data analytics, disease modeling, and communication specialists. Their responsibilities include sharing access to and use of data for public health decision makers on the front lines of mitigating high-risk health concerns.

Amidst the many challenges (and several success stories) Americans experienced following their government’s original pandemic response, one thing is certain: the shortcomings were compounded by a lack of public data, which led to many health experts and government officials making moves without clear information or guidelines.

Having data collection processes at the onset of COVID-19 was important for a number of reasons. It could have helped people understand the impending impact of COVID-19 more clearly, and also inform a more appropriate response to the planning and allocation of resources for those in need. Even so, it’s evident the U.S. bungled the initial response around combating misinformation about how the disease is spread, social distancing, mask wearing mandates, coronavirus testing and contact tracing, and eventual vaccine hesitancy and booster uptake. 

The fact that initial decisions were made without previously established public health data collection systems likely accelerated the rate of disease spread and preventable deaths. However, now that we have collected, monitored and evaluated data over the past two and a half years, we have evidence that large pandemics are more likely than we may have previously considered. Thus, it’s important to recognize that public health decision making and messaging will be further strengthened by the support of data that is detailed and generated in real time for emerging disease outbreaks. 

This global health crisis has required large-scale behavior change, which means messaging around health recommendations needs to be nuanced. Effective communication is essential to the success of monitoring and evaluation during and after the implementation of any program. Insights from behavioral science can be used, with the support of public health experts, to help inform strategies around delivery of particular recommendations that will require changes in human behavior.

Communication competency refers to the effective expression of ideas using oral, written, visual, and non-verbal communication methods, as well as the listening skills to gain deeper understanding and recalibrate communication as needed. As previously mentioned, having the right data and information isn’t enough to get people to act (or change their actions). Practicing communication competency requires differentiating between various forms of communication behavior that is appropriate and effective for a given situation. Thus, effective communication provides added value in areas of demonstrating understanding, preventing conflict or confusion, improving engagement, and solving difficult problems.

The following are several behaviorally informed approaches, that take all of the above into account, for consideration when developing new messaging strategies in response to future public health crises.

Key Recommendation 1: Authenticity

Authenticity and transparency go hand-in-hand when it comes to communication competency. Perceptions of authenticity can affect the way we form judgments or how we might make decisions around certain actions and behaviors. Although there are many dimensions to authenticity – in this context, the way a message is perceived as authentic or inauthentic comes down to whether it is delivered in ways that resonate with and matter to the audience. If the messenger, whether a leader, media source, or public health agency, comes across as genuine, the audience is more likely to trust the message.  

Authenticity: When developing authentic communication and messaging, we suggest utilizing the 4C view of authenticity (consistency, conformity, connection, and continuity). Examples of the 4C view of authenticy in application at the individual level are included in the link for reference.

Key Recommendation 2: Transparency

Transparency, on the other hand, refers to a messenger’s capacity to share important information with all stakeholders so they can make timely and informed decisions. However, no matter how hard we try to be accurate and authentic with content and delivery of our messages, we may encounter challenges due to the spread of misinformation. Countering misinformation and potential data errors with transparency fosters opportunities for rebuilding the public’s trust and confidence after trust has been breached.

Transparency: As opposed to being hesitant about communicating difficult concepts or strategies with the general public, we suggest that healthcare experts be clear about the uncertainties while acknowledging that scientific advice is subject to change with emerging evidence. 

Key Recommendation 3: Empathy

Lastly, having an empathetic approach has profound implications for understanding the unique realities of lived experiences, motivators and/or stressors of populations from a diverse array of cultures and other identities during difficult times like a global pandemic. Empathy is the complex capability of individuals to understand and feel the emotional states of others, resulting in compassionate behavior. Empathy requires cognitive, emotional, behavioral, and moral capacities to understand and respond to the suffering of others. Thus, demonstrating empathy and trustworthiness in  communication has potential to yield behavioral outcomes favorable to all regardless of race, religion, gender identity, sexual orientation, age, ethnicity, socioeconomic status, or national origin. Moreover, we must be aware of and make sincere attempts to simultaneously lead with humanity and empathy while leaning on the data and measurable statistics when designing and iterating on future communication strategies touching on serious  healthcare topics that impact humans worldwide. 

Empathy: In the process of communicating difficult challenges or positive successes, communicating with empathy means prioritizing people and their well-being, while also making decisions that are in the public’s best interest. Additional examples of expressing empathetic communication include: actively listening, acknowledging people’s doubts and fears, offering flexibility for varying perspectives, seeking out opportunities to learn and grow, and lastly, choosing the appropriate medium to disseminate information. 

While the United States’ dismal pandemic response has made it clear that new systems and approaches to combat future health crises will be necessary in order to repeat such a devastating outcome, we are optimistic that shifts toward applying such behaviorally informed recommendations as these will yield better results when developing messaging for future public health emergencies. 

Interested in learning more about implementing a behaviorally informed communications strategy in your public health work? Email us at ushealth@ideas42.org.

The post Better Messaging About Future Public Health Emergencies Using Behavioral Science appeared first on ideas42.

This is part of a series of conversations with members of the Niger and Burkina Faso National Innovations Teams (NITs), a group of 54 health professionals across government and non-profit sectors. 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 Burkina Faso and Niger NITs were established in 2020 by Breakthrough ACTION, the U.S. Agency for International Development’s flagship social and behavior change program.

This spotlight features Bouraima Gnanou, who is part of a group working to increase the rate of antenatal care (ANC) visits in rural communities in Burkina Faso. In this interview, Bouraima discusses the effects of this training on his daily work as a communicator and Technical Advisor in the Department of Communication at the Ministry of Health (MOH) Burkina Faso. 

Name: Bouraima Gnanou
Country: Burkina Faso
Title: Technical Advisor, Science and Technique of Information and Communication
Organization: Department of Communication, Ministry of Health Burkina Faso

How  did  you  learn  about  the  Burkina  Faso NIT?

I heard about the NIT when Breakthrough ACTION started to create this program here in Burkina Faso. I was working in the communication department at the MOH. I wanted to discover something new, to do something else to allow me to act differently, and I wanted to learn about best practices from other countries. I participated in the NIT for two cycles [in 2020–21 and 2021–22].

What did you learn by participating in the NIT?

Before joining the NIT, when there was a problem, we thought about scenarios to tackle the problem, created messages, adapted the solution, then broadcast [those messages to the public]. We were satisfied with the messages that we broadcast. At that time, we were not engaging beneficiaries to provide feedback on the messages beforehand.

With the NIT, we learned new skills—really brand new! We would start with an idea and end up with a prototype of that idea. We analyzed the problems we were seeking to address, prioritized among these problems, considered the determinants of the problem, and then proposed ways to address these problems to implement. [This was all] very different from what I was used to doing. We went beyond messages and went as far as making prototypes that would be used by the beneficiaries and tested these prototypes to take into account the opinions of health workers, husbands, mothers-in-law, women of childbearing age, and the beneficiaries. This was really new for me.

What surprised you the most?

In the beginning, I did not know that I could have an idea and that my idea would be used throughout the process to create solutions and prototypes to test. My idea went to a certain level, to make sketches to implement [the solution] and [be] used by the beneficiaries. I also enjoyed the interactivity within the group, which allowed us to exchange opinions and develop the best ideas. It was a great formula for collaboration. The trip to the communities was also a great exercise, to be in contact with the beneficiaries and to have their opinion.

“In the NIT course, I can say there was a lot of discovery. Now, I have learned all the processes and am able to make proposals for an innovative intervention to bring change.”

Recently, we developed health communication strategies. We came up with many proposals of ideas that could feed into innovative behavior change strategies. We have already made a proposal for a National Health Communication Strategy that includes innovative interventions and workshops to allow the development of prototypes to address certain issues.

During COVID[-19], we tried to use innovative methods to solve problems. The course we completed served us well to improve our work and now innovative interventions have been introduced in the strategy.

When I joined the NIT I had expectations, but I feel that I got more than I expected. I feel capable of making innovative proposals [for interventions]. I really received a lot of support, I learned a lot, [and] I feel fulfilled. Today, if I am asked to make an innovative proposal, I will be able to make it because of the course.

How did you apply what you learned at work?

There has been a change today—we are working with many technical departments.

“Now, when there are problems to solve and we have to develop public health messages, I always think of using innovative approaches.”

I ask myself, “What can we do?” Whenever there is an opportunity, I give updates and inform the team about the innovation, and I [take] into account the different steps for an innovative intervention. Planning innovative activities in the communication strategy comes automatically to mind. This is a big change.

Recently, when we worked on [our] five-year strategy, we included innovative activities and interventions in the health strategy from 2022 onwards to solve problems.

Can you share with us how you practiced applying innovative methods during the course?

The ANC rate in Burkina Faso is low. For our group, our work was to determine how to bring the women from rural areas to complete all their ANC visits, which is usually four visits.

For this exercise, we challenged ourselves with the new World Health Organization guideline, which is eight ANC visits. In Burkina Faso, pregnant women usually come for their first ANC visit at the end of the first trimester or in the second trimester. Therefore, having a full four ANC visits becomes challenging due to that delay. The rate of one ANC visit is between 70% and 80%, but fewer than 30% of women have four ANC visits and we wanted to work upstream. From our analysis, women do not know the benefits of ANC, forget about appointments, and listen to taboos about pregnancy that are related to culture and beliefs. Hence, we identified four solutions to overcome these barriers.

First, [we] involved the key actors, such as husbands [and] mothers-in-law, who are very influential to the women. We thought that the contribution of the husband and mother-in-law in a voluntary and official way can help to tackle the problem related to benefits and the delay for the ANC. They were involved in encouraging women from the first month of pregnancy to start the ANC.

[For our] second solution, we put women in groups of two or three so they go to ANC together. [This] will encourage discussion and also break the taboo of attending ANC. Since they are in a group, at least one or two can remember the next appointment so they can remind each other of the date of the appointment.

[Our] third solution was the commitment card. The pregnant woman or husband or mother-in-law will encourage women to go and register with a community health worker (CHW). Then, the group will be formed, and the woman will take the commitment with the CHW to follow the ANC.

Finally, as a fourth solution, we have provided stickers that show the development of the fetus, which will encourage the woman to go for the next appointment. The health worker who does the checkup will put the sticker on the card. If she comes to the next appointment, she will get another sticker. We thought she didn’t want to miss out on knowing her child’s developmental level.

“During user testing, [women] said, “Ah, we’ve never seen this before, and we’re going to go to the care visit.” With that pretest, we think it will really enhance the outcome.”

Implementing [these solutions] will increase the rate of ANC and compliance with ANC appointments. We were comforted when we did the pretest. A midwife said, “No woman wants to miss her appointment for ANC. They will all make it all the way and come here to make sure they get the sticker.” With the women in the community, we feel that there is already an attachment to the sticker.

Do you have any projects or suggestions related to what you have learned?

I suggest the [Burkina Faso] MOH formalize the NIT. Annually, the MOH determines the priority issues and could request the support of the NIT to help solve the problems. The NIT should be given the technical support to work on the analysis [of problem determinants] and propose innovative solutions. The ownership of NIT by the MOH is important. Having a formalized NIT would help improve the whole process and achieve great results.

The post Building Behavioral Design Skills: A Conversation with Breakthrough ACTION Innovator Bouraima Gnanou appeared first on ideas42.

In the summer of 2020, we listed seven concrete ways we would support racial justice in our work, as calls for racial justice rang not only in the United States but around the world. As we did in 2021, we’re taking a moment to hold ourselves accountable to those commitments and report on the ongoing progress we have made, while acknowledging there is still more work to be done.

In all that we do as we strive to achieve our mission of improving lives around the world using behavioral science, we aim for diversity, equity, inclusion, and justice for all. It is our hope that by sharing our efforts in the service of this goal, we can encourage others to also be explicit with their own commitments to advancing racial justice.

Below are the commitments we made in 2020, and how we took further action over the last year. There is a fair amount of detail on the specific actions we took and data on progress towards our goal when those goals are quantitative. We continue to feel it is important to be specific and transparent with our progress, whether that progress is good or not.

Commitment #1 – As a means of greater accountability, we will publicly report annually on the progress we have been making on our existing internal commitments to increase our team diversity, and specifically to have a senior team and board of directors that reflect the populations we serve, both in the United States and around the world.

• Action:  Proactively sought diverse and underrepresented voices from the communities we serve to help guide our organization as board members. We joined the Board Challenge as a Charter Partner in 2021. Additionally, inside the organization, our leadership team is currently 69% female-identifying, up 9% from last year. And for the first time, a majority of our team outside of leadership roles (52%) identify as non-white. We have more work to do to reach gender parity across the organization as a whole, as well as make our board more representative of the people and communities we work with, and that continues to be our goal.

Commitment #2 – We will adopt a more race-conscious and anti-racist lens in project selection and project execution.

•  Action: We have refined and finalized an internal equity training and accompanying toolset, which includes a set of Equity Cards, a facilitated equity kickoff activity and conversation, and an equity pre-mortem exercise. We’ve rolled these resources out across ideas42 so all team members have a shared vocabulary to talk about identity, privilege, and power, and project teams intentionally and proactively integrate equity considerations into their work. We will continue to refine the tools by improving their usability, and we’ve begun creating additional complementary materials designed to build cultural competence, especially for team members working in new or unfamiliar contexts.
  

Commitment #3 – We will increase by eightfold the number of Black scholars in our academic affiliate network.

• Action: We continue to seek opportunities to expand our network of academic affiliates who inform our work with an eye toward ensuring that our network of scholars reflects the diversity of the populations we serve. We have not grown our affiliate network since the progress we made up to June 2021, however, we maintain near-gender parity (44% female-identifying) and have increased the number of Black scholars by 7.5x since 2020. We look forward to continue learning from our newest affiliates and expanding the diversity of scholars who contribute to our work along multiple dimensions. We also plan to ramp up engagement opportunities with our affiliates, through an expanded slate of lectures, and project collaborations. 
• We are also seeking to increase representation from experts in the issue areas we work in outside of academia who can inform our work in important ways. We started this work in 2022 with the launch of our Global Health Advisory Council. 

Commitment #4 – We will conduct more applied research in the service of designing anti-racist interventions in all of the policy areas in which we work.

• Action: The ideas42 Policy Lab continues to leverage behavioral science research to advocate for policy changes that would improve access to social safety net services for immigrant families. Our Policy Lab, along with others in the behavioral science community, also advocated for the extension of the expanded and fully refundable Child Tax Credit, which would reduce child poverty and existing racial disparities in eligibility. 
• Additionally, our Economic Justice team, as part of our ongoing narrative change work, launched a quiz to help people understand the false and harmful narratives about poverty that they might hold that perpetuate inequality in the United States, and influence the way policy is designed and delivered. Changing poverty narratives starts with understanding our own associations—so we created the short quiz to help people understand the most common types of false narratives, and which ones they may be subscribing to. We encourage you to reflect on your own views by taking the 5-minute Poverty Associations Quiz. 

Commitment #5 – We will challenge our funders and our partners to adopt similar diversity and inclusion practices in their internal and external structures, and also to consult viewpoints that are more representative of the populations they serve when setting their research and development agendas.

• Action: Candidly, we have not yet figured out a good way to further challenge our funders on these issues, a reflection of the current power dynamics between funders and grantees in philanthropy around the world that needs addressing. This is still an area of opportunity for ideas42 to improve.

Commitment #6 – We commit to expanding our existing Safety & Justice work and continue to focus on fighting racial injustice in the broken criminal justice system.

• Action: Explicitly tackled racial inequities in the policing, judicial, and probation spaces in the United States as part of our Safety & Justice work. Select projects include:
  • In partnership with Harris County, Texas, we redesigned all communications associated with misdemeanor court notifications and launched new research to more deeply understand and address challenges to appearing in court. A full report on this work will be released in fall 2022. 
  • Continuing to grow and develop Vergil, a technology designed to help parolees and those on probation set and achieve positive goals. Vergil connects users with desired and available social services, all in the service of helping them avoid incarceration or re-incarceration.
  • Collaborating with the Fines and Fees Justice Center to design tools that reform the high and often disproportionate costs of court-imposed fines and fees. These tools, supported by behavioral science research, can assess people’s ability to pay to ensure any fines and fees assessed are fair and affordable.

Commitment #7 – We commit to partnering with more organizations on the front line of this battle, and will publish a list of organizations with whom we have or are currently partnering in this effort. 

• Action: We remain committed to partnering with more organizations on the front lines of the battle for racial justice in the United States and around the world. Below are examples of how new partnerships have supported our racial justice efforts across two portfolios of work.
  • Civic Engagement: We partnered with the NAACP to run one of the largest voter mobilization programs for Black voters in Virginia. Focused on building power through civic engagement, we sent more than two million GOTV messages, activated 16,000 volunteers, and reached 675,000 Black potential voters, including 430,000 moderate-to-low propensity voters. We’re honored to work with the NAACP again this year to actualize an even greater impact in elections across the U.S.
  • Financial Health: College savings programs are often offered universally, and yet some families face specific barriers to participation based on their racial identity, financial situation, and immigration status, despite having arguably more to gain. Our research collaboration with the City of San Francisco’s K2C program found that behaviorally-informed text messages (primarily tailored to overcome barriers faced by Black and Latino families who had never made a deposit) resulted in 2.5 times more “new savers” and a significant increase in registration rates.

We know this progress is still not enough, and while we have more clarity around concrete steps that can be taken a year into our efforts, we still do not have all the answers. In the coming months and years, we will make additional commitments. Now more than ever, we know it will take all of us continuing to push for change to dismantle and rebuild our failing systems. We will report again on our progress one year from now.

The post Our Ongoing Commitment to Racial Justice: 2022 Updates appeared first on ideas42.

As behavioral designers, we know it’s important for end users and other stakeholders to participate in the design process for any new solution. But when a diverse array of perspectives are important, determining when and how to approach design collaboratively may feel daunting. A recent co-design process in South Sudan illustrates how stakeholders’ input, provided through different participatory design activities, can strengthen solutions and help adapt interventions to new contexts and ultimately improve outcomes for those impacted by our work.

Building on previous work in Uganda with IntraHealth International, ideas42 is supporting Breakthrough ACTION to develop an interactive game that aims to facilitate open conversation and joint decision-making among couples about family planning. Players work together as “household” teams to navigate choices for their families, see the consequences of their decisions, and learn about family planning. Several South Sudanese stakeholders have contributed to the game design, including representatives from the Ministry of Health, USAID’s MOMENTUM Integrated Health Resilience project, community-based organizations, local leaders, community- and facility-based health workers, and men and women living in the communities where the solutions are used.

These stakeholders participated in various ways, including through one-on-one conversations with our team members, participation in co-creation workshops, and playing draft versions of the game. This input was invaluable across the board, but there were three key ways these co-design activities strengthened the final design in South Sudan.

An example game card from user testing.

1. Program stakeholders offered insight into abstract questions of family values, status, and priorities and how to adapt the design to resonate with the South Sudanese context.

To be engaging and relatable, it was essential for the game to align with participants’ real-life priorities and with relevant norms about what makes a good parent and a strong family. Program stakeholders noted that the concept of “family harmony” resonates particularly strongly in South Sudanese communities and that men feel a strong sense of responsibility to foster harmony in their households.

Having many children is considered a source of pride, but not if parents fail to provide well for those children or if there is discord within the family. Stakeholders shared that focusing on the financial costs of children is most likely to resonate if presented as a means to build harmony, along with other factors such as keeping family members healthy and making important decisions jointly. In response, we structured the game so that players work to build household harmony and see the consequences of their choices, both negative and positive, in those terms. This was a shift from the approach we took in Uganda, in which a family planning decision-making game was framed around wealth and providing financially for one’s family.

2. In addition to sharing their perspectives and opinions, stakeholders taught us a lot by simply interacting with the game. What they didn’t say in these interactions (and who spoke when) was illuminating.

While we directly solicited stakeholder feedback, just as valuable was the more subtle insight we gained from seeing a person interact with a design. During user testing, we saw that when men and women played the game together, men would often defer to their wives to answer questions, particularly questions about contraceptive methods. Women have historically had more opportunities to learn about contraception, and both men and women tend to expect that women will know more. Men, by contrast, are viewed as decision-makers, but find it challenging to engage in conversations when they know less than their wives. Seeing women speak up is a positive sign that women’s voices and agency in decision-making are valued. But another important objective of the game is to boost all players’ comfort and confidence in discussing sensitive topics such as family size and contraception.

Seeing male players’ hesitancy to respond to knowledge questions in the game led us to add a new type of game card that provides an immediate and less intimidating opportunity for discussion between players. These new cards prompt players to discuss how they might approach an uneasy or uncomfortable situation, such as responding to a respected elder family member who wants the couple to have a child at a time that might be risky for the mother’s health. Many of the cards pointedly do not have a right or wrong answer.

An example game card from user testing.

3. Contrasting feedback suggested a need for local flexibility in some program details.

Our experience in Uganda suggested that men value the opportunity to learn and explore unfamiliar topics in a “safe space” with male peers. However, government and program stakeholders in South Sudan recommended the game be played by couples to build comfort discussing family planning together and to avoid potential adverse consequences of exposing only men (or only women) to the content. We tested the game with both single- and mixed-gender groups to determine the approach that worked best. User testing reinforced the benefits stakeholders expected, but also revealed significant challenges to playing the game with men and women together.

As noted above, men were less willing to participate actively and share openly when playing the game with women. We also encountered more challenges recruiting men to play in couples; while men consistently showed up to male-only games, some men interpreted couples-based invitations as allowing their wives to participate instead of them. These different insights suggested that there wasn’t a single correct approach, and that local stakeholders might be best positioned to weigh the pros and cons for their own communities. Ultimately, we decided to encourage couples-based participation but invite local leaders and game facilitators to make the decision.

By creating the space for these diverse (and at times contrasting) views, our team strengthened the game and identified avenues to create flexibility in the game when perspectives differed. The process also affirmed the game’s effectiveness as a fun and engaging way for participants to learn about contraception and become more comfortable having conversations about the topic. We continue to leverage the power of co-design as we work in several other regions of South Sudan to further refine the game and encourage male engagement in family planning discussion and use.

Write to gh@ideas42.org if you’re interested in exploring how these approaches could be applied to your setting.

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