Max Bazerman, co-director of the Center for Public Leadership; Odette van de Riet, Leader of BIT IenM, the Behavioral Insight Team of the Netherlands Ministry of Infrastructure and the Environment; and David Halpern, Chief Executive of the Behavioural Insights Team and Board Director of the Office of the Prime Minister of the United Kingdom, joined moderator Iris Bohnet, Professor of Public Policy at HKS and Director of the Women and Public Policy Program, and co-Director of the Behavioral Insights Group, in a conversation on behavioral insights. The panel discussed its experiences applying behavioral economics findings, such as "nudge" techniques, to issues of public interest.
Underpinned by reinforcement learning, a fundamental theory of the dynamics of behavior change, BCD also incorporates theories about the evolution of behavioral control and human motivation, and a revised version of 'behavior settings' theory which helps explain the relationship between individuals and the environment. These theories suggest that, in order to change specific behaviors, interventions must create surprise, revalue the target behavior and facilitate performance of the changed behavior by modifying the environment in which it takes place. BCD involves a process for designing such interventions that follows five steps: Assess, Build, Create, Deliver, and Evaluate.
BIT uses a simple framework to apply behavioral science to policy: in order to encourage a behavior, make it Easy, Attractive, Social, and Timely (EAST). The sections below give some examples of how this framework can be applied to improve health and health care. Many of these initiatives were tested through low-cost randomized controlled trials; we believe that such trials could be used much more by health care providers and policymakers to improve their everyday activities.
From Brian Cugelman
Parents had significantly higher odds of resisting vaccine recommendations if the provider used a participatory rather than a presumptive initiation format (adjusted odds ratio: 17.5; 95% confidence interval: 1.2–253.5). When parents resisted, 50% of providers pursued their original recommendations (eg, “He really needs these shots”), and 47% of initially resistant parents subsequently accepted recommendations when they did.
This clinical report provides information about addressing parental concerns about vaccination.
Pro-vaccine messages do not always work as intended. The effectiveness of those messages may vary depending on existing parental attitudes toward vaccines. For some parents, they may actually increase misperceptions or reduce vaccination intention.
Jobs to be Done
One author has developed a practical approach to categorizing vaccine-hesitant parents into five groups, depending on the source and strength of their vaccine beliefs: "Uninformed but educable" parents have been influenced by friends and relatives who have planted doubts about the safety of vaccines. They are unsure whether these messages are accurate and seek correct information and reassurance. "Misinformed but correctable" parents have heard only antivaccine messages, predominantly from media sources. They are open to provaccine messages and accurate information. "Well-read and open-minded" parents have researched pro- and antivaccine messages. They seek advice from a healthcare provider to assess the merits of the arguments and put them in a proper context. "Convinced and contented" parents have strong antivaccine views and go to the provider, sometimes owing to pressure from a family member, to listen to the other side of the argument. Although this group may change their attitudes over time, the chances of complete success are low. "Committed and missionary" parents hold firmly entrenched antivaccine views and may try and convince the provider to agree with them.
Diagram of cognitive biases clustered by meaning and application