Persuasive Decision Support: Improving Reliance on Decision Aids

The primary role of a decision aid is to guide and support a decision maker. As reliance on a decision aid is largely discretionary the persuasiveness of the system becomes critically important. In this paper characteristics thought to affect systems persuasiveness are examined.This paper asserts that the target and source of a decision support message, along with the design of the message itself, act to influence the persuasiveness of the decision support provided.Using a purpose built experimental platform with seventy subjects the research finds that the persuasiveness of a decision support message is varied by the perceived difficulty of the task being undertaken, and the perceived usefulness of the decision support provided. The type of decisional guidance provided also affects persuasiveness of the system; in particular, providing suggestive decisional guidance is shown to significantly improve system persuasiveness. The implications of these findings relate to the appropriate design of decision aids, and the contexts within which a decision aid can be expected to persuade decision makers to reply on the support provided. Available at: https://aisel.aisnet.org/pajais/vol4/iss3/2

Women Veterans’ Descriptions of the Patient-Provider Interaction with Civilian Providers

BACKGROUND: Women veterans require care for unique gender, and war-related health issues. Concerns exist regarding non-Veterans Health Administration (VHA), civilian healthcare providers’ preparedness to deliver care to the veteran population. Health outcomes are influenced by the quality of care provided to patients. There is a significant gap in the literature with regard to woman veterans’ perspectives about the quality of the patient-provider interaction between women veterans and non-VHA, civilian providers. PURPOSE: The purpose of this study was to describe women veterans’ perspectives about interactions between themselves and civilian providers and to critically analyze the veterans’ data to further inform the use of the Interaction Model of Client Health Behavior. METHODS: A qualitative descriptive methodology was employed. A purposive sampling plan was used to recruit 13 women veteran participants who exclusively obtained care from non-VHA, civilian healthcare providers. Data collection and analysis was guided by directed content analysis. RESULTS: Six themes surrounding the four factors that comprise the patient-provider interaction element of the model emerged and were coherent with the model. Affective support is knowing me as a person by hearing my story and being attentive to my needs. Professional-technical competence is recognizing and acknowledging women are veterans, comprehending the military experience, and being thorough and accepting accountability for attending to a health concern. Information giving is uncomplicated explanation that facilitates decision making. Decisional control is collaborating by seeking input, providing options, and supporting decisions. CONCLUSIONS: The themes indicate that among non-VHA, civilian providers, there is an absence of consistent screening for military service in female patients, a deficit in knowledge regarding the role and experiences of women during military service, and the need for additional training about military-related health conditions. Further, the themes highlight the importance of the woman veteran’s story, as well as the need to recognize and acknowledge the service of women veterans. Finally, the themes inform the use of the IMCHB to guide research, practice, and policy related to the care of women veterans who obtain care from non-VHA, civilian providers

The Use of Human Behaviour in Fire to Inform Canadian Wildland Urban Interface Evacuations

Wildland urban interface (WUI) communities are generally the most at risk of being impacted by wildfires. In order to assess the vulnerability of these communities, it is important to understand the impact that human behaviour in fire (HBiF) can have on wildfire evacuations, specifically in Canada where such data is lacking. To lay the groundwork for a comprehensive vulnerability assessment of a Canadian case study community, a conceptual model of protective action decision-making during WUI fires was created. This was used to develop a survey to understand the WUI fire awareness and experience as well as the anticipated protective actions of the case study community residents. The microsimulation software PTV VISSIM was used to model 10 evacuation scenarios to identify key evacuation modelling considerations and potential evacuation challenges faced by the community. In doing so, a framework for using HBiF to inform WUI vulnerability assessments and evacuations was developed

Improving uptake of Fracture Prevention drug treatments: a protocol for Development of a consultation intervention (iFraP-D).

Funder: Wellcome TrustINTRODUCTION: Prevention of fragility fractures, a source of significant economic and personal burden, is hindered by poor uptake of fracture prevention medicines. Enhancing communication of scientific evidence and elicitation of patient medication-related beliefs has the potential to increase patient commitment to treatment. The Improving uptake of Fracture Prevention drug treatments (iFraP) programme aims to develop and evaluate a theoretically informed, complex intervention consisting of a computerised web-based decision support tool, training package and information resources, to facilitate informed decision-making about fracture prevention treatment, with a long-term aim of improving informed treatment adherence. This protocol focuses on the iFraP Development (iFraP-D) work. METHODS AND ANALYSIS: The approach to iFraP-D is informed by the Medical Research Council complex intervention development and evaluation framework and the three-step implementation of change model. The context for the study is UK fracture liaison services (FLS), which enact secondary fracture prevention. An evidence synthesis of clinical guidelines and Delphi exercise will be conducted to identify content for the intervention. Focus groups with patients, FLS clinicians and general practitioners and a usual care survey will facilitate understanding of current practice, and investigate barriers and facilitators to change. Design of the iFraP intervention will be informed by decision aid development standards and theories of implementation, behaviour change, acceptability and medicines adherence. The principles of co-design will underpin all elements of the study through a dedicated iFraP community of practice including key stakeholders and patient advisory groups. In-practice testing of the prototype intervention will inform revisions ready for further testing in a subsequent pilot and feasibility randomised trial. ETHICS AND DISSEMINATION: Ethical approval was obtained from North West-Greater Manchester West Research Ethics Committee (19/NW/0559). Dissemination and knowledge mobilisation will be facilitated through national bodies and networks, publications and presentations. TRIAL REGISTRATION NUMBER: researchregistry5041

Overcoming Illusions of Control: How to Nudge and Teach Regulatory Humility

In this chapter we focus on how to use insights from behavioural theory in the process of impact assessment of EU policy proposals. Over the last decade, the European Commission and more generally the European Union (EU) have developed an integrated approach to impact assessment of policy proposals – legislative or not. The impact assessment process is now a major step in the development of proposals by the European Commission. Recently, the European Parliament being biased in this way!!as invested in analytical capacity to work dialogically with the Commission on this issue. Extant literature has established that the EU impact assessment system is, comparatively speaking (for example, in comparison to the systems of the 28 Member States and the United States [US]), sufficiently robust and comprehensive (Fritsch et al., 2013; Renda, 2011; Radaelli, 2009; Wiener and Alemanno, 2010). In the debate of how to conduct impact assessment and train policymakers, there are calls for integrating the insights of behaviour science into policymaking and design regulatory options that take into account the various biases that affect citizens’ responses (Alemanno and Spina, 2013; John, 2013; John et al., 2013; Sunstein, 2011; Van Bavel et al, 2013; Vandebergh, Carrico and Schultz, 2011). But policymakers have a brain too, and therefore their own choices can be biased. The starting point for this chapter is the potential impact of one over-arching bias – the illusion of control (Langer, 1975). The proposition is that this illusion – which leads humans to over-estimate their competence and ability to control outcomes – may be particularly damaging when the tendency to regulate is institutionalised. Specifically, while the EU impact assessment process obliges policymakers to consider the status quo option (non-intervention), this is rarely ever selected. We should be clear: we do not claim that cognitive biases explain the preference for public intervention. There are different political and economic justifications for intervention. An organisation can also deliberatively decide to manipulate the IA procedures towards interventionist choices. If this is so, cognitive biases have no role to play since the organisation is not misdiagnosing the facts; rather it is manipulating them. Rather, we are interested in increasing policy makers’ awareness of ‘regulatory humility’ (Dunlop and Radaelli, 2015b). We believe this should be encouraged among policy-makers, and specifically that the option of not using public intervention (so called ‘do nothing’ option in IA) be given due consideration – whether it is rejected or not. The classic policy-making literature has always pointed toward the limits of policymaking and policymakers (notably, Hogwood and Gunn, 1984; Simon, 1956; Vickers, 1965: chapter 8; Wildavsky, 1979: especially part 2). The increased complexity of the policy environment, the difficulty of getting evidence into policy, and greater clarity about human biases have all led to a re-discovery of these limitations. The result has been a renewed call for regulatory humility and humble decision-making (Dunlop and Radaelli, 2015b; Etzioni, 2014). We are interested in how EU policymakers might be de-biased in two main ways: first by structuring IA in ways that encourage policymakers act in ways that work with biases and second by using training to stimulate awareness and reflection about the biases and their possible impact on policymakers’ work. The chapter is structured as follows. In section one, we set up the proposition that EU policymakers are especially susceptible to an illusion of control. Then we explore what can be done to combat a pre-eminent bias. We outline two categories of solutions. In section two we look at how the IA system in the EU can be implemented and amended in ways that ‘go with the grain’ of cognitive biases (Dolan et al, 2009: 7). Here, we accept the reality of that policymakers often operate in ‘fast’ mode (Kahneman, 2011). Rather than try to re-wire the policymaker’s brain, we focus on re-wiring the context within which they work to ensure that what is automatic to them is also beneficial to policymaking. In short, how can we nudge EU policymakers to explore the ‘do-nothing option’, and indeed all policy options, with humility about the control they can exercise? Section three takes a slightly different tack. Here we focus on how policymakers can be exhorted to engage in more ‘slow’ thinking about the biases they carry. Such reflection can be triggered through training. We explore the possible teaching tools that can be and are being used including in-class behavioural experiments. The chapter concludes with a discussion of how some of these ideas can be taken forward by the Commission