A behavioral design approach to improving a Chagas disease vector control campaign in Peru

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.

Chagas Disease in Pregnant Women in the Peruvian Amazon Basin. Cross-Sectional Study

“…It is important to implement measures for controlling transmission of T. cruzi by triatomines in the Amazon basin, with vector surveillance and control with insecticide as has been happening in other parts of Peru ( 5 ). In light of our exploratory results and other cases reported in the area, it could be of interest to perform similar studies to those carried out in other parts of Peru ( 15 , 17 , 23 ). Another topic to investigate in the area is dogs, which are important reservoirs of T. cruzi and may play a role in reinitiating transmission in previously sprayed areas.…”

“…While the low prevalence does not justify screening in pregnant or puerperal women, other measures are called for. WHO/PAHO recommends interventions to disrupt vector transmission, including the elimination of the triatomines or other vectors from the study area; another possibility is assessing seroprevalence of T. cruzi infection in children 5 or younger ( 23 ). Several environmental and social factors may also directly or indirectly influence the biology and behavior of triatomides ( 24 ).…”

Promoting Respectful Maternity Care using a Behavioral Design Approach in Zambia: Results from a Mixed-Methods Evaluation

“…We employed Datta & Mullainathan's (6) behavioral design approach to systematically design the interventions. This approach has been used to address a wide range of public health challenges in low-and middle-income countries including gender-based violence, reproductive health, and neglected tropical diseases (7)(8)(9). First, we de ned the problem and then conducted qualitative, formative research to identify the behavioral barriers inhibiting the provision of RMC.…”

Application of behavioral economics principles to reduce injectable contraceptive discontinuation in rural Ethiopia: A stratified-pair, cluster-randomized field trial

“…Job aids are another widely used behavioral solution that has been effective in improving family planning counseling ( Kim et al , 2007 ; Leon et al , 2005 ). Insights from BE and a structured behavioral design methodology have recently been used to improve reproductive health programming ( Buttenheim et al , 2019 ; McConnell et al , 2018 ; Spring et al , 2016 ), suggesting that the approach could be applied to mitigate the contraceptive discontinuation problem in Ethiopia. Further application is needed to understand how insights from behavioral economics can be applied to solve persistent public health challenges particularly in low-resource settings where scarcity increases the likelihood of intention-action gaps.…”