From January 24th-25^th, I got the opportunity to participate in the workshop “How can behavioral economics help improve population health and health care delivery” organized by the Institute of Social and Preventive Medicine at the University of Lausanne, Switzerland, and led by Prof Ivo Vlaev. Ivo Vlaev is professor of Behavioral Science at the University of Warwick and co-author of the famous Mindspace report that advises policy makers how to incorporate insights from behavioral science into their policies. The following paragraphs illustrate my experiences during the workshop and serve as a brief introduction to the topic of behavioral economics.

Day 1: What is behavioral economics?

On the first day, we were introduced to the broad topic of behavioral economics. At the very core, behavioral economics is the study of human decision making. A central assumption of behavioral economics is that many everyday decisions made in a lazy way: Instead of using all available information to make the best decision, we tend to use mental shortcuts or “rules of thumb” that bias our decision making in predictable and systematic ways.  For example, one prominent short cut is the so-called availability heuristic, namely the tendency to make a decision relying predominantly on information that is easily recalled. This leads many people to overestimate the probability of rare events that are often featured in the media, such as plane crashes or lottery wins.

While these biases can lead to suboptimal decision making, they can also be used for good when it comes to health-related behaviors. Once a bias is understood, it can be used to design environments or interventions that facilitate better and avoid poorer decision making. For example, King et al. (2016) utilized the fact that human behaviors can be influenced by subconscious cues to improve hand hygiene compliance in a surgical intensive care unit. The authors used commercially available aroma dispensers to expose visitors of the intensive care unit to a clean and fresh citrus smell. Compared to control, this raised hand hygiene compliance from 15% to 47%.

Day 2: Application

On the second day, we worked in small groups to design our own health interventions using the framework of the Mindspace report. A neat feature of the Mindspace framework is that it is integrated easily into the COM-B approach (Michie et al., 2011), an intervention development guideline widely used by behavioral scientists. My group worked on increasing the frequency of gym visits by redesigning gym subscription plans in a way that leveraged loss aversion, the human tendency to overweigh the relative impact of (financial) losses. I found the combination of the two frameworks very useful and recommend it to anyone confronted with the daunting task of designing an intervention. Particularly, it facilitates the “behavioral diagnosis”, the detailed understanding of environmental and individual barriers and facilitators that affect the target behavior.

Bottom line

Applying behavioral insights and the Mindspace framework to health behaviors has great potential, especially since other approaches to behavior change have often neglected the role of automatic processes (Marteau et al., 2012). Automatic processes may be especially important in everyday decisions that have direct behavioral and health-related consequences, such as what to eat at a buffet, whether to attend a health screening, whether to apply hand sanitizer and so on. To develop interventions for more complex behaviors, such as chronic disease management or weight loss maintenance, the Mindspace framework needs to be combined with existing approaches (e.g. COM-B) in a meaningful way. More empirical evidence is needed regarding the sustainability and moderating variables of effects of interventions based on behavioral economics.

Further reading:

Dolan, P., Hallsworth, M., Halpern, D., King, D., & Vlaev, I. (2010). MINDSPACE: Influencing behaviour for public policy. Available from:
https://www.instituteforgovernment.org.uk/publications/mindspace

Marteau, T. M., Hollands, G. J., & Fletcher, P. C. (2012). Changing human behavior to prevent disease: the importance of targeting automatic processes. Science, 337(6101), 1492-1495.

Michie, S., Van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science, 6:42.

King, D., Vlaev, I., Everett-Thomas, R., Fitzpatrick, M., Darzi, A. & Birnbach, D. (2016). “Priming” Hand Hygiene Compliance in Clinical Environments. Health Psychology, 35 (1), 96-101.

Vlaev, I., King, D., Dolan, P. & Darzi, A. (2016). The Theory and Practice of “Nudging”: Changing Health Behaviors. Public Administration Review, 76 (4), 550-561.