Behavioral Economics and Social and Behavior Change Communication at CCP

"Behavioral economics is a rapidly growing area of study rooted in psychology, economics and behavioral sciences. A driving force behind the growth of behavioral economics has been its recent application to behaviors that affect health."

This article on behavioural economics (BE) by the administrators of the Johns Hopkins Center for Communication Programs (CCP) gives examples from CCP social and behaviour change communication (SBCC) programmes to illustrate how BE concepts can aid the understanding of how people think, decide and act as they make choices that affect their health and the health of their families and communities.

1) "Framing (and a corollary, priming) refers to characterizing a choice situation in a way that suggests how an audience should think about it. The frame that is introduced first primes the audience to think about the issue through that frame or lens rather than some other perspective....The language used to describe a set of choices can shape people’s decision-making. People make default ('gut' reaction, quick) decisions and can be more motivated by emotional messages with immediate benefit."

The example of framing is the Communication for Healthy Living (CHL)’s Mabrouk campaign in Egypt.  (See related summaries) Contraceptive use, a primary behavioural goal, was framed within a cycle of family health behaviours with celebrating marriage (Mabrouk!-Congratulations!) as the entry point for the communication strategy. The branded theme was designed to create a mindset ("your health is your wealth") with messaging focused on benefits of "lifestage" behaviours, including, for example: 1) longer birth spacing resulting in better maternal and child health; 2) immunization and breastfeeding improving the mental and physical development of infants; and 3)avoidance of secondhand smoke reducing cardiovascular disease and cancer risk.

2)  Commitment devices/Reminders are items "(like texts or SMSs) that remind us of a commitment we made. Behavioral economics posits that people make decisions automatically, by using mental shortcuts. Commitment devices and reminders can help decrease the cognitive burden required to sequence or complete a complex task. Pre-committing to a particular decision can help people align their actions with their preferences."

The example of this strategy is Tanzania Capacity and Communication Project’s Wazazi Nipendeni SMS campaign (See related summaries). This national safe motherhood SBCC campaign is from CCP in partnership with Media for Development International (MFDI) and the Tanzania Communication and Development Center (TCDC).  "All Wazazi Nipendeni media encourages listeners and viewers to send a free text message to a dedicated short-message-service (SMS) number to receive more information on healthy pregnancy. " Introductory questions are provided for registration of pregnant women and mothers to establish the date of pregnancy and provide 3-4 timed information, tips, and reminders per week. From 2012 - 2016, 1,507,828 users had enrolled.

3)"A heuristic is a mental script or guide that simplifies decision-making or judgments. These rule-of-thumb strategies shorten decision-making time and allow people to function without constantly stopping to think about their next course of action. One way that communication can affect heuristics is through modeling behavior so that people can have a mental image of how to do something without having to think about it. "

The Suaahara integrated nutrition project led by Save the Children and supported by CCP provided the Bhanchhin Aama (“Mother says”) communication platform and campaign integrating SBCC messages and activities about nutrition with hygiene/sanitation, agriculture and health services promotion at all levels. The campaign centered on the positive mother-in-law ‘Bhanchhin Aama’ who modeled how to be a supportive mother-in-law through scripts that influenced family members to support their pregnant women and mothers.

4) " Behavioral defaults refers to what some research calls a “nudge,” a simple change in a situation that makes one choice more likely than another....A default is the option an individual will receive if he or she does not make an active choice. In behavioral economics, the default is often something that an external entity such as a government agency or company has implemented in order to maximize (optimally) the welfare of the group. The system is setup so that the person will automatically receive the default unless they ‘opt out’. For example, countries, whose default is that people will be organ donors, though they can ‘opt out’, have much higher rates of organ donation than other countries."

MyChoice, from the Gates Foundation in Indonesia, led by CCP with JSI and Jhpiego, has a key objective of increasing the number of clients who adopt family planning after childbirth by improving facility readiness to provide contraceptive methods. The programme uses the Balanced Counseling Strategy plus postpartum family planning (BCS+PPFP) for postpartum uptake of family planning counseling provided to clients in 44 facilities across four provinces beginning in 2016. With opting out as an option, "[i]t uses a client-centered design, wherein the provider uses counseling cards and initiates the counseling by asking the client or couple questions about their fertility desires and breastfeeding intentions. Based on the client or couple’s responses, the provider explains the family planning methods that best meet their needs before discharge from the postpartum ward." As a result of counseling, between August and October 2016, "more than half of women who received BCS+PPFP adopted postpartum family planning prior to discharge, an increase from previous months. "