From changing cognitions to changing the context: a dual-route model of behaviour change

Existing theories of behaviour change in psychology and behavioural economics rely mostly on changing cognitions and incentives as a route to altering behavioural responses. We propose a more general reflective-automatic model (RAM), which postulates that, in addition to cognitive change, interventions can also rely exclusively on contextual change as an alternative route to behaviour change. RAM is a dual-process model which assumes that these two routes rely predominantly on different information processing systems – the reflective system is in charge of changing cognitions and the automatic system responds to changing the context. We also identify four processes: salience, norms, affect, and priming (SNAP), which can bring about behaviour change by relying mainly on the automatic system. The SNAP processes might be important targets for population-wide behaviour change initiatives and have important implications for psychological research, health promotion and policy analysisWorking Pape

Monetary cost for time spent in everyday physical activities.

publisher: Elsevier articletitle: Monetary cost for time spent in everyday physical activities journaltitle: Social Science & Medicine articlelink: http://dx.doi.org/10.1016/j.socscimed.2014.02.043 content_type: article copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.publisher: Elsevier articletitle: Monetary cost for time spent in everyday physical activities journaltitle: Social Science & Medicine articlelink: http://dx.doi.org/10.1016/j.socscimed.2014.02.043 content_type: article copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.We measured utility curves for the hypothetical monetary costs as a function of time engaged in three everyday physical activities: walking, standing, and sitting. We found that activities requiring more physical exertion resulted in steeper discount curves, i.e., perceived cost as a function of time. We also examined the effects of gain vs. loss framing (whether the activity brought additional rewards or prevented losses) as well as the effects of the individual factors of gender, income, and BMI. Steeper discount curves were associated with higher income (annual household ≥ median of $45,000) and gain framing (which indicates loss aversion). There were interactions between gender and frame, and also income and frame: Females and higher income participants showed loss aversion whereas males and lower income participants were not affected by framing. Males showed less discounting in gain frames relative to females, whereas females showed less discounting in loss frames relative to males. In gain frames, higher income participants discounted more but in loss frames there was no effect of income. We also found individual tendencies for discounting across activities: if an individual exhibited steeper discounting for one activity, they were also more likely to exhibit steeper discounting for the other activities. These results have implications for designers of interventions to encourage non-exercise physical activities, suggesting that loss-framed incentives are more effective for women and those with middle class (or greater) incomes. Furthermore loss framed incentives have more uniform impact across income brackets because people discount loss frames similarly regardless of income whereas those with middle-class incomes are not as motivated by gain frames. Our results also demonstrate a general method for examining the costs of effort associated with everyday activities

From gloom to doom: Financial loss and negative affect prime risk averse preferences

Previous research has shown that risk preferences are sensitive to the financial domain in which they are framed. In the present study we explore whether the effect of valence priming on risk taking is moderated by the financial context under consideration. A total of 260 participants completed an online questionnaire where risky choices were elicited for seven different financial scenarios. Participants were allocated to different valence (neutral, positive or negative) and arousal (low or high) priming conditions. Two factors were extracted: Factor 1 (Negative) included insurance and possibility of loss, whilst Factor 2 (Positive) included the remaining five scenarios (investment, salary, pension, possibility of gain, and mortgage). Moreover, only negative priming—regardless of arousal level—influenced people’s risky choices by inducing more risk-averse behavior; this effect was confined only to loss and insurance domains. The findings call into question the generalizability of priming effects on different financial context and show that the effects of priming on financial risk taking are sensitive to the financial context under consideration

Taking the Learner on a Journey – An analysis of an Integrated Virtual CME Program in Epilepsy during the COVID-19 Pandemic

The COVID-19 pandemic has significantly changed the way we treat patients and educate healthcare professionals (HCPs). In summer 2020, the International League against Epilepsy (ILAE) implemented a virtual CME program with three integrated program elements addressing challenges in patient treatment as well as challenges caused by the forced transition to a virtual environment. Despite the highly competitive environment with exponential increase of webinars offered to HCPs, the program achieved high participation and satisfaction rates. Over 60% of participants indicated a change in their clinical practice after the interventions. With our outcomes evaluation, we aimed to better understand how well such an integrated program resonates with the learner and if it can make a difference in a highly competitive environment by supporting educators to become more adaptive and responsive to learner needs. Our pilot project was shown to be well accepted, achieving high satisfaction and perceived impact by the learner. In the light of an upcoming "digital fatigue" and a wish to return to face-to-face, we reiterate the value of the digital approach and recommend continuing along this successful path as we believe that taking a learner on a digital educational journey has been successful in a highly competitive and challenging environment

Perceived ethical acceptability of financial incentives to improve diabetic eye screening attendance

To test the ethical acceptability of using financial incentives to increase diabetic retinopathy screening attendance.Financial incentives could be an effective way to increase attendance at screening for diabetic retinopathy, although there can be ethical concerns about this approach.Survey of people with diabetes in North West London. Those who were due to attend a screening appointment were invited to complete a questionnaire. Key demographic variables included age, gender, and deprivation.A questionnaire was issued to those invited to attend screening in North West London and those who run the screening service. The questionnaire captured views on aspects of the ethical problem and different incentive types.It captured views on the different dimensions of the ethical problem and different types of incentive. In order to understand how views might vary within a population, demographic variables were used to analyze the results.Vouchers were found to be the most acceptable form of incentive, significantly more so than cash payments. Most rejected the notion of targeting those who need incentivizing, preferring equality. Age was an important factor, with those aged between 40 and 64 the most optimistic about the potential benefits. Higher levels of deprivation were linked to increased acceptability scores. While some ethical concerns are strongly held among certain groups, there is also much support for the principle of incentivizing positive behaviors. This paves the way for future research into the effectiveness of incentivizing diabetic retinopathy screening attendance

Stating Appointment Costs in SMS Reminders Reduces Missed Hospital Appointments: Findings from Two Randomised Controlled Trials

BACKGROUND: Missed hospital appointments are a major cause of inefficiency worldwide. Healthcare providers are increasingly using Short Message Service reminders to reduce 'Did Not Attend' (DNA) rates. Systematic reviews show that sending such reminders is effective, but there is no evidence on whether their impact is affected by their content. Accordingly, we undertook two randomised controlled trials that tested the impact of rephrasing appointment reminders on DNA rates in the United Kingdom. TRIAL METHODS: Participants were outpatients with a valid mobile telephone number and an outpatient appointment between November 2013 and January 2014 (Trial One, 10,111 participants) or March and May 2014 (Trial Two, 9,848 participants). Appointments were randomly allocated to one of four reminder messages, which were issued five days in advance. Message assignment was then compared against appointment outcomes (appointment attendance, DNA, cancellation by patient). RESULTS: In Trial One, a message including the cost of a missed appointment to the health system produced a DNA rate of 8.4%, compared to 11.1% for the existing message (OR 0.74, 95% CI 0.61-0.89, P<0.01). Trial Two replicated this effect (DNA rate 8.2%), but also found that expressing the same concept in general terms was significantly less effective (DNA rate 9.9%, OR 1.22, 95% CI 1.00-1.48, P<0.05). Moving from the existing reminder to the more effective costs message would result in 5,800 fewer missed appointments per year in the National Health Service Trust in question, at no additional cost. The study's main limitations are that it took place in a single location in England, and that it required accurate phone records, which were only obtained for 20% of eligible patients. We conclude that missed appointments can be reduced, for no additional cost, by introducing persuasive messages to appointment reminders. Future studies could examine the impact of varying reminder messages in other health systems. TRIAL REGISTRATION: Controlled-Trials.com 49432571

Using behavioral economics concepts to increase organizational learning in an NHS hospital

Purpose The purpose of this paper is to assess whether the dissemination systems that hospitals use to spread information about particular safety incidents can be enhanced using behavioural economics concepts. Design/methodology/approach The current service evaluation took place within eight wards in a single acute care hospital. It was conducted as a randomized controlled trial with two groups. In the control group nothing was altered. In the intervention group ward managers received additional support to disseminate information to their nurses. Nurses were randomly selected to be surveyed during their scheduled shifts. The surveys revealed how the nurses learned about particular safety incidents and how many they remembered. Findings Nurses in the intervention group were more likely to learn about particular safety incidents than nurses in the control group. Practical implications Enhancing common dissemination systems in hospitals can increase organizational learning about safety incidents. The current study presents some means by which dissemination systems can be enhanced. Originality/value The current service evaluation is a unique application of behavioural economics concepts to enhance organizational learning of particular adverse safety incidents in an NHS hospital

Domain effects and financial risk attitudes

We investigated whether financial risk preferences are dependent on the financial domain (i.e., the context) in which the risky choice options are presented. Previous studies have demonstrated that risk attitudes change when gambles are framed as gains, losses, or as insurance. Our study explores this directly by offering choices between identical gambles, framed in terms of seven financial domains. Three factors were extracted, explaining 68.6% of the variance: Factor 1 (Positive)—opportunity to win, pension provision, and job salary change; Factor 2 (Positive-Complex)—investments and mortgage buying; Factor 3 (Negative)—possibility of loss and insurance. Inspection of the solution revealed context effects on risk perceptions across the seven scenarios. We also found that the commonly accepted assumption that women are more risk averse cannot be confirmed with the context structure suggested in this research; however, it is acknowledged that in the students’ population the variance across genders might be considerably less. These results suggest that our financial risk attitude measures may be tapping into a stable aspect of “context dependence” of relevance to real-world decision making

Toward a cognitive game theory

We argue that solving the heterogeneous problems arising from the standard game theory requires looking both at reasoning heuristics, as in Colman's analysis, and at how people represent games and the quantities that define them

Redesigning the 'choice architecture' of hospital prescription charts: a mixed methods study incorporating in situ simulation testing.

Objectives: To incorporate behavioural insights into the user-centred design of an inpatient prescription chart (Imperial Drug Chart Evaluation and Adoption Study, IDEAS chart) and to determine whether changes in the content and design of prescription charts could influence prescribing behaviour and reduce prescribing errors. Design: A mixed-methods approach was taken in the development phase of the project; in situ simulation was used to evaluate the effectiveness of the newly developed IDEAS prescription chart. Setting: A London teaching hospital. Interventions/methods: A multimodal approach comprising (1) an exploratory phase consisting of chart reviews, focus groups and user insight gathering (2) the iterative design of the IDEAS prescription chart and finally (3) testing of final chart with prescribers using in situ simulation. Results: Substantial variation was seen between existing inpatient prescription charts used across 15 different UK hospitals. Review of 40 completed prescription charts from one hospital demonstrated a number of frequent prescribing errors including illegibility, and difficulty in identifying prescribers. Insights from focus groups and direct observations were translated into the design of IDEAS chart. In situ simulation testing revealed significant improvements in prescribing on the IDEAS chart compared with the prescription chart currently in use in the study hospital. Medication orders on the IDEAS chart were significantly more likely to include correct dose entries (164/164 vs 166/174; p=0.0046) as well as prescriber's printed name (163/164 vs 0/174; p<0.0001) and contact number (137/164 vs 55/174; p<0.0001). Antiinfective indication (28/28 vs 17/29; p<0.0001) and duration (26/28 vs 15/29; p<0.0001) were more likely to be completed using the IDEAS chart. Conclusions: In a simulated context, the IDEAS prescription chart significantly reduced a number of common prescribing errors including dosing errors and illegibility. Positive behavioural change was seen without prior education or support, suggesting that some common prescription writing errors are potentially rectifiable simply through changes in the content and design of prescription charts