Moving beyond a limited follow-up in cost-effectiveness analyses of behavioral interventions

Background Cost-effectiveness analyses of behavioral interventions typically use a dichotomous outcome criterion. However, achieving behavioral change is a complex process involving several steps towards a change in behavior. Delayed effects may occur after an intervention period ends, which can lead to underestimation of these interventions. To account for such delayed effects, intermediate outcomes of behavioral change may be used in cost-effectiveness analyses. The aim of this study is to model cognitive parameters of behavioral change into a cost-effectiveness model of a behavioral intervention. Methods The cost-effectiveness analysis (CEA) of an existing dataset from an RCT in which an high-intensity smoking cessation intervention was compared with a medium-intensity intervention, was re-analyzed by modeling the stages of change of the Transtheoretical Model of behavioral change. Probabilities were obtained from the dataset and literature and a sensitivity analysis was performed. Results In the original CEA over the first 12 months, the high-intensity intervention dominated in approximately 58% of the cases. After modeling the cognitive parameters to a future 2nd year of follow-up, this was the case in approximately 79%. Conclusion This study showed that modeling of future behavioral change in CEA of a behavioral intervention further strengthened the results of the standard CEA. Ultimately, modeling future behavioral change could have important consequences for health policy development in general and the adoption of behavioral interventions in particular

Opening the Black Box: Explaining the Process of Basing a Health Recommender System on the I-Change Behavioral Change Model

Recommender systems are gaining traction in healthcare because they can tailor recommendations based on users' feedback concerning their appreciation of previous health-related messages. However, recommender systems are often not grounded in behavioral change theories, which may further increase the effectiveness of their recommendations. This paper's objective is to describe principles for designing and developing a health recommender system grounded in the I-Change behavioral change model that shall be implemented through a mobile app for a smoking cessation support clinical trial. We built upon an existing smoking cessation health recommender system that delivered motivational messages through a mobile app. A group of experts assessed how the system may be improved to address the behavioral change determinants of the I-Change behavioral change model. The resulting system features a hybrid recommender algorithm for computer tailoring smoking cessation messages. A total of 331 different motivational messages were designed using 10 health communication methods. The algorithm was designed to match 58 message characteristics to each user pro le by following the principles of the I-Change model and maintaining the bene ts of the recommender system algorithms. The mobile app resulted in a streamlined version that aimed to improve the user experience, and this system's design bridges the gap between health recommender systems and the use of behavioral change theories. This article presents a novel approach integrating recommender system technology, health behavior technology, and computer-tailored technology. Future researchers will be able to build upon the principles applied in this case study.European Union's Horizon 2020 Research and Innovation Programme under Grant 68112

Improving nutritional status through behavioral change: lessons from Madagascar

This paper provides evidence of the effects of a large-scale intervention that focuses on the quality of nutritional and child care inputs during the early stages of life. The empirical strategy uses a combination of double-difference and weighting estimators in a longitudinal survey to address the purposive placement of participating communities and estimate the effect of the availability of the program at the community level on nutritional outcomes. The authors find that the program helped 0-5 year old children in the participating communities to bridge the gap in weight for age z-scores and the incidence of underweight. The program also had significant effects in protecting long-term nutritional outcomes (height for age z-scores and incidence of stunting) against an underlying negative trend in the absence of the program. Importantly, the effect of the program exhibits substantial heterogeneity: gains in nutritional outcomes are larger for more educated mothers and for villages with better infrastructure. The program enables the analysis to isolate responsiveness to information provision and disentangle the effect of knowledge in the education effect on nutritional outcomes. The results are suggestive of important complementarities among child care, maternal education, and community infrastructure

Improving nutritional status through behavioral change : lessons from Madagascar

This paper provides evidence of the effects of a large-scale intervention that focuses on the quality of nutritional and child care inputs during the early stages of life. The empirical strategy uses a combination of double-difference and weighting estimators in a longitudinal survey to address the purposive placement of participating communities and estimate the effect of the availability of the program at the community level on nutritional outcomes. The authors find that the program helped 0-5 year old children in the participating communities to bridge the gap in weight for age z-scores and the incidence of underweight. The program also had significant effects in protecting long-term nutritional outcomes (height for age z-scores and incidence of stunting) against an underlying negative trend in the absence of the program. Importantly, the effect of the program exhibits substantial heterogeneity: gains in nutritional outcomes are larger for more educated mothers and for villages with better infrastructure. The program enables the analysis to isolate responsiveness to information provision and disentangle the effect of knowledge in the education effect on nutritional outcomes. The results are suggestive of important complementarities among child care, maternal education, and community infrastructure.Population Policies,Health Monitoring&Evaluation,Early Child and Children's Health,Housing&Human Habitats,Nutrition

Metropolitan Area Home Prices and the Mortgage Interest Deduction: Estimates and Simulations from Policy Change

We simulate changes to metropolitan area home prices from reforming the Mortgage Interest Deduction (MID). Price simulations are based on an extended user cost model that incorporates two dimensions of behavioral change in home buyers: sensitivity of borrowing and the propensity to use tax deductions. We simulate prices with both inelastic and elastic supply. Our results show a wide range of price effects across metropolitan areas and prospective policies. Considering behavioral change and no supply elasticity, eliminating the MID results in average home price declines as steep as 13.5% in Washington, D.C., and as small as 3.5% in Miami-Fort Lauderdale, FL. Converting the MID to a 15% refundable credit reduces prices by as much as 1.4% in San Jose, CA, San Francisco, CA, and Washington, D.C. and increases average price in other metropolitan areas by as much as 12.1% (Miami-Fort Lauderdale). Accounting for market elasticities produces price estimates that are on average 36% as large as standard estimates

Inducing Behavioral Change: an Experiment

¿En qué medida la política pública puede afectar el comportamiento de las poblaciones objetivo sin hacer cambios institucionales u organizacionales de gran alcance? Investigamos la eficacia de un instrumento de política diseñado para aumentar la adherencia de las personas al ejercicio físico. Con base en la teoría de las normas sociales, desarrollamos una estrategia de comunicación consistente en el envío semanal de dos tipos de mensajes a los teléfonos celulares de las personas: uno que les informaba sobre su asistencia previa al gimnasio y otro que los animaba a hacer ejercicio a través de una frase motivacional. e imagen Realizamos un experimento de campo para probar la eficacia de dicha estrategia. Nuestros resultados demuestran que, para las personas que ya habían desarrollado el hábito de hacer ejercicio, los mensajes descriptivos no les inducían a mejorar su asistencia al gimnasio dado que consideraban que habían superado su cuota semanal de ejercicio. Por el contrario, los mensajes de motivación mejoraron la asistencia. Nuestra investigación enfatiza que las motivaciones no racionales pueden tener importantes consecuencias en la inducción de hábitos saludables. También afirma que intervenciones como la que llevamos a cabo son de importancia práctica para los diseñadores de políticas y los gerentes de implementación quienes, al carecer del poder formal para crear cambios radicales, pueden, sin embargo, influir en el comportamiento de las poblaciones objetivo.ITESO, A.C

Degradation of water resources in rural Burkina Faso: drivers, local perceptions and solutions.

Burkina Faso reformed its water management institutions and adopted integrated water resources management (IWRM) for more than two decades, yet the country still suffers from weak institutions and ineffective implementation of water management reforms. The key institutional question is: “How can IWRM reforms be adapted to increase effectiveness and sustainability of water management, and improve livelihoods of rural populations through increased participation of local stakeholders?” A key practical issue related to this bigger institutional question is to understand the barriers to adoption of good land and water management measures by riparian farmers and other land/water users, and the mechanisms to induce behavioral change among these users. Knowledge gaps exist in understanding the local perceptions and preferences of alternative management measures, and the incentive mechanisms to induce behavioral change. The aim of this study, which was part of a 3-year project entitled ‘Participatory planning for more inclusive and sustainable water management in rural Burkina Faso’, was to understand the perceptions, preferences and willingness of farmers and other land/water users to adopt environmentally friendly land and water management measures. The study also examined potential mechanisms that could induce riparian economic actors to adopt such measures