Design for choice-making: incorporating design research and behavioural economics into healthcare interventions in China

Abstract

Despite its interdisciplinary nature and capacity to solve wicked societal problems, design research faces gaps in conceptual scholarship and theory-driven methodologies. Influential theories, such as Heskett’s Value Creation Theory, have delved into the nexus of design and economics, underscoring design’s role in economic value creation. Nonetheless, there appears to be a deficiency in theory building at the intersection of design and economics, especially regarding the broader impacts of design. Such an endeavour demands a robust theoretical foundation, advocating and demonstrating design’s growing role in shaping societal interventions and policymaking.Introducing the concept of ‘Design for Choice-Making’ has a potential to bridge this intersection between design and economics. Choice-making, being integral to economics, reflects individuals’ decisions within constraints and biases. Yet, its representation in design, despite having roots in the discipline, remains scarce. This research explores a behavioural and inclusive approach to choice-making, embedding it within a designerly way of thinking and doing. By doing so, it outlines the Inclusive Behavioural Design process to incorporate design research and Behavioural Economics insights into designing interventions. To examine and evaluate the effectiveness of the proposed concept and process model, empirical studies were conducted in the context of rural health in China. The empirical research began by expanding the context to systematically map the health choices available for rural residents and the contextual and behavioural influences. Employing the behavioural model of choice, which includes concepts such as psychological scarcity, present bias, and risk aversion, through an economics perspective, led to the reframing of problems and the generation of hypotheses. Subsequently, a field experiment (with 479 participants) and a quasi-experiment (with 677 participants) were carried out to test these hypotheses in rural areas and urban environments among lower and higher income groups, respectively. Merging these contextualised insights with evidence from experiments laid a solid foundation for the development of inclusive, context-appropriate interventions, classified as choice architectures and choice infrastructures. The empirical studies confirmed the effectiveness of the concept and the process model, while also identifying challenges and discrepancies that need future refinement.This thesis provides a fresh theoretical perspective on the study of choice-making in design, potentially paving the way for applying the behavioural model of choice-making in economics into design research. Furthermore, it brings an inclusive perspective to designing interventions. The thesis also offers recommendations for health intervention design, with a focus on improving choice-making behaviours and outcomes among lower income groups.</p

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