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Buttenheim AM, Levy MZ, Castillo-Neyra R, McGuire M, Toledo Vizcarra AM, Mollesaca Riveros LM, Meza J, Borrini-Mayori K, Naquira C, Behrman J, Paz-Soldan VA. A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health 2019; 19:1272. [PMID: 31533762 PMCID: PMC6751594 DOI: 10.1186/s12889-019-7525-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 08/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Individual behavior change is a critical ingredient in efforts to improve global health. Central to the focus on behavior has been a growing understanding of how the human brain makes decisions, from motivations and mindsets to unconscious biases and cognitive shortcuts. Recent work in the field of behavioral economics and related fields has contributed to a rich menu of insights and principles that can be engineered into global health programs to increase impact and reach. However, there is little research on the process of designing and testing interventions informed by behavioral insights. METHODS In a study focused on increasing household participation in a Chagas disease vector control campaign in Arequipa, Peru, we applied Datta and Mullainathan's "behavioral design" approach to formulate and test specific interventions. In this Technical Advance article we describe the behavioral design approach in detail, including the Define, Diagnosis, Design, and Test phases. We also show how the interventions designed through the behavioral design process were adapted for a pragmatic randomized controlled field trial. RESULTS The behavioral design framework provided a systematic methodology for defining the behavior of interest, diagnosing reasons for household reluctance or refusal to participate, designing interventions to address actionable bottlenecks, and then testing those interventions in a rigorous counterfactual context. Behavioral design offered us a broader range of strategies and approaches than are typically used in vector control campaigns. CONCLUSIONS Careful attention to how behavioral design may affect internal and external validity of evaluations and the scalability of interventions is needed going forward. We recommend behavioral design as a useful complement to other intervention design and evaluation approaches in global health programs.
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Affiliation(s)
- Alison M. Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Curie Boulevard, 416 Fagin Hall, Philadelphia, PA 19104 USA
| | - Michael Z. Levy
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Ricardo Castillo-Neyra
- Department of Biostatistics, Epidemiology, and Informatics, Perleman School of Medicine of the University of Pennsylvana, Philadelphia, PA USA
| | - Molly McGuire
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
- Chagas Disease Working Group, Arequipa, Peru
| | | | | | - Julio Meza
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Katty Borrini-Mayori
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cesar Naquira
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jere Behrman
- Department of Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Valerie A. Paz-Soldan
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA USA
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Paz-Soldán VA, Bauer KM, Hunter GC, Castillo-Neyra R, Arriola VD, Rivera-Lanas D, Rodriguez GH, Toledo Vizcarra AM, Mollesaca Riveros LM, Levy MZ, Buttenheim AM. To spray or not to spray? Understanding participation in an indoor residual spray campaign in Arequipa, Peru. Glob Public Health 2016; 13:65-82. [PMID: 27189446 DOI: 10.1080/17441692.2016.1178317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Current low participation rates in vector control programmes in Arequipa, Peru complicate the control of Chagas disease. Using focus groups (n = 17 participants) and semi-structured interviews (n = 71) conducted in March and May 2013, respectively, we examined barriers to and motivators of household participation in an indoor residual spray (IRS) campaign that had taken place one year prior in Arequipa. The most common reported barriers to participation were inconvenient spray times due to work obligations, not considering the campaign to be necessary, concerns about secondary health impacts (e.g. allergic reactions to insecticides), and difficulties preparing the home for spraying (e.g. moving heavy furniture). There was also a low perception of risk for contracting Chagas disease that might affect participation. The main motivator to participate was to ensure personal health and well-being. Future IRS campaigns should incorporate more flexible hours, including weekends; provide appropriate educational messages to counter concerns about secondary health effects; incorporate peer educators to increase perceived risk to Chagas in community; obtain support from community members and leaders to build community trust and support for the campaign; and assist individuals in preparing their homes. Enhancing community trust in both the need for the campaign and its operations is key.
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Affiliation(s)
- Valerie A Paz-Soldán
- a Department of Global Community Health and Behavioral Sciences , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA.,b Facultad de Salud Pública y Administración , Universidad Peruana Cayetano Heredia , Lima , Perú
| | - Karin M Bauer
- a Department of Global Community Health and Behavioral Sciences , Tulane University School of Public Health and Tropical Medicine , New Orleans , LA , USA
| | - Gabrielle C Hunter
- c Department of Health, Behavior and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Ricardo Castillo-Neyra
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA.,e Facultad de Ciencias y Filosofía , Universidad Peruana Cayetano Heredia , Lima , Perú
| | - Vanessa D Arriola
- f Department of Epidemiology , Tulane University , New Orleans , LA , USA
| | - Daniel Rivera-Lanas
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | - Geoffrey H Rodriguez
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA
| | | | | | - Michael Z Levy
- d Department of Biostatistics and Epidemiology , University of Pennsylvania Perelman School of Medicine , Philadelphia , PA , USA.,e Facultad de Ciencias y Filosofía , Universidad Peruana Cayetano Heredia , Lima , Perú
| | - Alison M Buttenheim
- g Department of Family and Community Health , University of Pennsylvania School of Nursing , Philadelphia , PA , USA.,h Center for Health Incentives and Behavioral Economics , University of Pennsylvania , Philadelphia , PA , USA
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