Behavioral Science Approach Research Articles

Cohort retention in a pandemic response study: Lessons from the SIREN study

Abstract Background Cohort studies represent an important research-tool, yet participant retention is difficult. SIREN followed a cohort of healthcare workers across 135 NHS sites in the UK during a pandemic. We designed an evolving retention programme, underpinned by our Participant Involvement Panel (PIP). We aimed to evaluate cohort retention over time and identify learnings. Methods Mixed method evaluation of our evolving retention programme in the 12 and 24-month cohort. We described cohort retention by demographics and site, using odds ratios from logistic regression. Withdrawal reasons were collected by survey. We collected participant feedback via cross-sectional survey using a behavioural science approach. We conducted focus groups with research teams and conducted thematic analysis. Results 37,275 (84.7%) participants at 135 sites completed 12-months of follow-up. 12,635 (85.5%) participants at 87 sites completed 24-months. Retention increased with age (24-months: >65 vs < 25 years OR = 2.92; 95%CI: 1.78-4.88; p < 0.001) and was highest in the Asian and Black ethnic groups (24-months OR = 1.78; 95%CI: 1.42-2.25; p < 0.001, and OR = 2.12; 95%CI: 1.41-3.35; p < 0.001, respectively, Ref=white). SIREN scored highly in participant feedback. Lessons for future studies include the need to monitor changing participant motivation; using inclusive and comprehensive communication; acknowledging the contributions of participants and investing in the skillset of research teams. Conclusions Despite challenges to running a large multicentre cohort study in an evolving pandemic, retention in SIREN has remained very high. Some factors impacting retention were outside of study control, including the altruistic motivation of participants. Participant feedback was positive, suggesting SIREN methodology will provide useful learning for future retention programmes. Site feedback provided learning for future multicentre research studies, offering insights into key facilitators and common challenges. Key messages • Cohort retention is difficult. Mixed methods evaluation shows SIREN achieved high retention while following a cohort of healthcare workers across 135 NHS sites in four UK nations during a pandemic. • Lessons learned include the need to monitor changing participant motivation; using inclusive communication; acknowledging participants contributions and investing in the research team skillset.

To use or not to use behavioural science evidence in designing health promotion interventions: Identification of targets for capacity building.

The behavioural sciences provide useful evidence to design effective health promotion interventions, but evidence is infrequently integrated in practice. This study examined associations between theoretical domains framework (TDF) constructs and public health practitioners' use of behavioural science evidence to plan public health actions. Using a cross-sectional design, a convenience sample of 160 practitioners were recruited from public health agencies across Canada. Respondents completed an online questionnaire assessing TDF constructs and the use of behavioural science theory and approaches (i.e., evidence) in their practice. Logistic regression analyses allowed for identification of factors associated with evidence use and intentions. All analyses were adjusted for sex, years of experience, and type of public health agency. Greater skills (ORadj = 4.1, 95%CI 1.3, 13.5) and stronger intentions/aligned goals (ORadj = 9.2, 95%CI 2.3, 36.1) were associated with greater use of behavioural science evidence to plan public health actions. Greater perceived capacity to overcome widespread absence of use of behavioural science evidence in their organization (ORadj = 7.2, 95%CI 1.7, 30.3) was also associated with greater use. More knowledge (ORadj = 8.6, 95%CI 1.9, 39.1) and stronger beliefs about consequences (ORadj = 4.0, 95%CI 1.1, 14.7) were significantly associated with stronger intentions/aligned goals. Findings show that more knowledge, positive attitudes, and stronger perceived competence are associated with greater likelihood of using behavioural science evidence to plan interventions. The use of behavioural science evidence will also require strengthening the norm pertaining to this professional practice in public health organizations.

Influences on androgen deprivation therapy prescribing before surgery in high-risk prostate cancer.

To understand how best to further reduce the inappropriate use of pre-surgical androgen deprivation therapy (ADT), we investigated the determinants (influences) of ADT prescribing in urologists in two European countries using an established behavioural science approach. Additionally, we sought to understand how resource limitations caused by COVID-19 influenced this practice. Identification of key determinants, of undistributed and disrupted practice, will aid development of future strategies to reduce inappropriate ADT prescribing in current and future resource-limited settings. We conducted semi-structured qualitative interviews with urologists practicing in Italy and the UK from February to July 2022. Interviews focussed on undisrupted (usual) practice and disrupted practice (changes made during COVID-19 restrictions). Codes were generated inductively and were mapped to the 14 domains of the Theoretical Domains Framework. Relevant domains of influence were identified, and the similarities and differences between the UK and Italy were distinguished. We identified 10 domains that were influential to ADT prescribing in the UK and eight in Italy. The role of guidance and evidence, the cancer care setting, the patients and the urologist's beliefs and experiences were identified as areas that were influential to ADT prescribing before surgery. Twenty-one similarities and 22 differences between the UK and Italy, for usual and COVID-19 practice, were identified across these 10 domains. Similarities and differences influencing ADT prescribing prior to surgery should be considered in behavioural strategy development and tailoring to reduce inappropriate ADT use. We gained an understanding of usual, undistributed care and resource-limited or disrupted care due to COVID-19 in two European countries. This gives an indication of how influences on ADT prescribing may change in future resource-limited circumstances and where efforts can be focused now and in future.

A scoping review of behavioural science approaches and frameworks for health protection and emergency response

Aims: Rapid intervention development, implementation, and evaluation are required for emergency public health contexts, such as the recent COVID-19 pandemic. A novel Agile Co-production and Evaluation (ACE) framework has been developed to assist this endeavour in future public health emergencies. This scoping review aimed to map available behavioural science resources that can be used to develop and evaluate public health guidance, messaging, and interventions in emergency contexts onto components of ACE: rapid development and implementation, co-production with patients or the public including seldom heard voices from diverse communities, and inclusion of evaluation. Methods: A scoping review methodology was used. Searches were run on MEDLINE, EMBASE, PsycINFO, and Google, with search terms covering emergency response and behavioural science. Articles published since 2014 and which discussed a framework or guidance for using behavioural science in response to a public health emergency were included. A narrative synthesis was conducted. Results: Seventeen records were included in the synthesis. The records covered a range of emergency contexts, the most frequent of which were COVID-19 ( n = 7) and non-specific emergencies ( n = 4). One record evaluated existing approaches, 6 proposed new approaches, and 10 described existing approaches. Commonly used approaches included the Behavioural Change Wheel; Capability, Opportunity, and Motivation Behaviour model; and social identity theory. Three records discuss co-production with the target audience and consideration of diverse populations. Four records incorporate rapid testing, evaluation, or validation methods. Six records state that their approaches are designed to be implemented rapidly. No records cover all components of ACE. Conclusion: We recommend that future research explores how to create guidance involving rapid implementation, co-production with patients or the public including seldom heard voices from diverse communities, and evaluation.

Session 7. Oral Presentation for: Advocating for a behavioural science approach to inclusion and diversity

Session 7. Oral Presentation for: Advocating for a behavioural science approach to inclusion and diversity

Advocating for a behavioural science approach to inclusion and diversity

In recent years the benefits of inclusion and diversity have become increasingly clear. Australian and international studies have demonstrated the significant improvements in innovation, productivity and growth that can be achieved when teams are both inclusive and diverse. However, meaningful progress requires moving beyond traditional diversity initiatives. This paper highlights the potential use of behavioural science to design successful implementation strategies to improve diversity and inclusion in the upstream energy industry. This paper will also provide guidance on how scientific methodologies can be applied to measure impact and return on investment (ROI), aligning the business case for diversity and inclusion with individual interventions. Behavioural science involves the observation, hypothesis, experiment and analysis of human behaviour to draw conclusions. It is now a leading school of thought at the world’s top research and learning organisations. This paper argues that by measuring outcomes of diversity and inclusion interventions through a behavioural science approach, organisations can make informed decisions, identify areas of improvement, and refine their strategies to improve ROI. This approach not only ensures that resources are invested effectively but also fosters a culture of continuous learning and adaptation, leading to sustainable and meaningful progress for all employees and stakeholders. Drawing on international research and local case studies, this paper showcases successful applications of behavioural science in transforming organisational cultures, creating safer and more inclusive workplaces. Ideas for quantitative and qualitative measurements are proposed for application in the upstream energy industry, with a particular focus on operational people and performance.

A Behavioural Science approach to tackling Sexism and Misogyny in Policing: interventions for instigating cultural change

AbstractChanging ingrained behaviours linked to sexism and misogyny in policing cannot be achieved by a quick fix. There are numerous barriers to change within the policing system, which require multiple targeted interventions running in parallel to tackle sexism and misogyny successfully. A behavioural science approach was applied to ‘diagnose’ the problem and identify interventions systematically. This approach does not seek to explain behaviour in terms of the characteristics of individual officers or staff. It combines insights from a range of disciplines to understand how people act in particular contexts. There is no single intervention that can shift ingrained behaviour; a package of targeted interventions is needed. Using the ‘behaviour change wheel’ as the underpinning framework, four target behaviours, seven key influences on behaviour and twelve interventions for change were identified. The connections between the behaviours, influences and interventions illustrate how a holistic package of interventions is required to change culture across the policing system.

Behavioral Science: Enhancing Our Approach to the Development of Effective Additional Risk Minimization Strategies.

Additional risk minimization strategies may be required to assure a positive benefit-risk balance for some therapeutic products associated with serious adverse drug reactions/risks of use, without which these products may be otherwise unavailable to patients. The goals of risk minimization strategies are often fundamentally to influence the behavior of healthcare professionals (HCPs) and/or patients and can include appropriate patient selection, provision of education and counselling, appropriate medication use, adverse drug reaction monitoring, and adoption of other elements to assure safe use, such as pregnancy prevention. Current approaches to additional risk minimization strategy development rely heavily on information provision, without full consideration of the contextual factors and multi-level influences on patient and HCP behaviors that impact adoption and long-term adherence to these interventions. Application of evidence-based behavioral science methods are urgently needed to improve the quality and effectiveness of these strategies. Evidence from the fields of adherence, health promotion, and drug utilization research underscores the value and necessity for using established behavioral science frameworks and methods if we are to achieve clinical safety goals for patients. The current paper aims to enhance additional risk minimization strategy development and effectiveness by considering how a behavioral science approach can be applied, drawing from evidence in understanding of engagement with pharmaceutical medicines as well as wider public health interventions for patients and HCPs.

Proposed Intervention: A Behavioural Science Approach Towards Tackling Alcoholism in Professional Settings

Proposed Intervention: A Behavioural Science Approach Towards Tackling Alcoholism in Professional Settings

Native Hawaiians' Views on Depression and Preferred Behavioral Health Treatments: a Preliminary Qualitative Investigation.

Behavioral health issues, especially depression, are a major health disparity concern for Native Hawaiians in Hawai'i. Following the cultural safety framework and contextual behavioral science approach to intervention development, the present preliminary qualitative investigation aimed to gather better insight into Native Hawaiians' views of depression and its causes as well as their preferred forms of behavioral health services. Data were initially collected from a 2-hour virtual focus group with three behavioral health service providers working with Native Hawaiians, followed by a total of 38 online one-on-one in-depth interviews with Native Hawaiian clients with depression (n = 19), behavioral health service providers working with Native Hawaiian adults (n = 9), and Native Hawaiian cultural leaders (n = 10). Our qualitative data suggested that Native Hawaiians tend to view depression contextually and socioculturally as the manifestation of one's vital connection to the 'āina (land), 'ohana (family; continuity from ancestry and future generations), community, culture/spirituality, and one's authentic self being disrupted. Our findings also suggested that Native Hawaiians often attribute these disruptions to disparities due to the ongoing impact of colonization, historical trauma, and cultural loss. As a preferred form of treatment for depression, participants recommended various Hawaiian cultural practices to be integrated into existing behavioral health services to nurture the above-mentioned vital connection.

The impact of intersectional racial and gender biases on minority female leadership over two centuries

This study scrutinizes the enduring effects of racial and gender biases that contribute to the consistent underrepresentation of minority women in leadership roles within American private, public, and third sector organizations. We adopt a behavioural data science approach, merging psychological schema theory with sociological intersectionality theory, to evaluate the enduring implications of these biases on female leadership development using mixed methods including machine learning and econometric analysis. Our examination is concentrated on Black female leaders, employing an extensive analysis of leadership rhetoric data spanning 200 years across the aforementioned sectors. We shed light on the continued scarcity of minority female representation in leadership roles, highlighting the role of intersectionality dynamics. Despite Black female leaders frequently embracing higher risks to counter intersectional invisibility compared to their White counterparts, their aspirations are not realized and problems not solved generation after generation, forcing Black female leaders to concentrate on the same issues for dozens and, sometimes, hundreds of years. Our findings suggest that the compound influence of racial and gender biases hinders the advancement of minority female leadership by perpetuating stereotypical behavioral schemas, leading to persistent discriminatory outcomes. We argue for the necessity of organizations to initiate a cultural transformation that fosters positive experiences for future generations of female leaders, recommending a shift in focus from improving outcomes for specific groups to creating an inclusive leadership culture.

Using the Journey to Health and Immunization (JTHI) Framework to Engage Stakeholders in Identifying Behavioral and Social Drivers of Routine Immunization in Nepal

Although the Government of Nepal has achieved high and sustained childhood vaccination coverage, reaching under-immunized and zero-dose children requires different approaches. Behavioral science offers promise in better understanding the drivers of vaccination and development of more effective programs; however, the application of behavioral science to immunization programs in Nepal is nascent. Through the Behavioral Science Immunization Network, JSI, UNICEF Nepal, and Dhulikhel Hospital–Kathmandu University School of Medical Sciences established a Behavioral Science Center to engage a diverse group of stakeholders in increasing the capacity of practitioners to use behavioral science in immunization programming. As a result of the engagement during formative research, government stakeholders requested and applied tools from behavioral science to solve different immunization challenges. Of particular value was the use of the Journey to Health and Immunization framework, which helped stakeholders identify behavioral and social drivers of zero-dose communities in Kathmandu. Our experience in Nepal demonstrates that there is strong demand for approaches and tools from behavioral science to use in relation to immunization and that this type of engagement model is effective for generating demand for and strengthening capacity to use behavioral science approaches.

Behavioural Sciences for Better Health: WHO Resolution and Action Framework

Abstract Behavioural factors are important contributors to increasing trends in communicable and non-communicable diseases and their risk factors, injuries, and health emergency risks as well as other health challenges that pose a significant challenge to health systems and increase disease burden globally. The World Health Organization (WHO) has recommended the adoption of a Resolution on Behavioural Sciences for Better Health to the Seventy-sixth World Health Assembly #WHA76, held in Geneva, Switzerland on 21-30 May 2023. Brief summary of the resolution The resolution recognizes that behavioural science is a multidisciplinary scientific approach that deals with human action, its psychological, social, and environmental drivers, determinants and influencing factors. It acknowledges the contribution of behavioural science in achieving improved health outcomes and the value of high-quality data about behaviours in guiding the health sector. It also recognizes that no single discipline can provide a complete understanding of how to support individuals to enact healthier behaviours to achieve improved health outcomes. The resolution notes that behavioural science can facilitate the understanding of how behavioural influences and communications guide decision-making. It highlights the contribution of behavioural science in achieving Universal Health Coverage (UHC) and in strengthening prevention of, preparedness, and response to public health emergencies. It also recognizes the importance of building capacity to systematically adopt evidence, including evidence from behavioural science and implementation studies. Finally, it urges member states to mainstream behavioural science approaches in health policies and to advocate for necessary structural considerations including behavioural science teams, units or functions, and for the allocation of sufficient funding and human resources.

Management of virtual teams: behavioral aspects

Since the announcement of the COVID-19 pandemic, the vast majority of companies have switched their employees to remote work. This has led to a number of problems, both technical and psychological. Technical problems related to online work are accompanied by questionable employee productivity and an unsatisfactory psychological climate in virtual teams.In order to address these shortcomings of working in virtual teams, the purpose of the article is to systematize employees’ feedback on the specific positive and negative aspects of remote work, and to propose effective methods for improving the efficiency of such work, using the principles of behavioral economics already tested in practice.The paper attempts to describe the importance of a comprehensive approach to evaluating work in virtual teams, which is based not only on the analysis of the effectiveness of such work, but also on the moral and psychological state of the team. It is also shown that behavioral principles (including various motivational tools) should be considered in the management strategy of virtual teams.The article proposes a comprehensive approach to the management of virtual teams based on the systematization of problems and specific ways to solve them.As a result of this study, it is proposed to use behavioral science approaches to improve remote work, such as loss aversion, endowment effect, framing effect, priming, and social comparison, which has already proven to be effective to a certain extent. Further studies, taking these aspects into account, will need to be undertaken.
 JEL classіfіcatіon: D03, D21, M31, M37

An anti-infodemic virtual center for the Americas.

The Pan American Health Organization/World Health Organization (PAHO/WHO) Anti-Infodemic Virtual Center for the Americas (AIVCA) is a project led by the Department of Evidence and Intelligence for Action in Health, PAHO and the Center for Health Informatics, PAHO/WHO Collaborating Center on Information Systems for Health, at the University of Illinois, with the participation of PAHO staff and consultants across the region. Its goal is to develop a set of tools-pairing AI with human judgment-to help ministries of health and related health institutions respond to infodemics. Public health officials will learn about emerging threats detected by the center and get recommendations on how to respond. The virtual center is structured with three parallel teams: detection, evidence, and response. The detection team will employ a mixture of advanced search queries, machine learning, and other AI techniques to sift through more than 800 million new public social media posts per day to identify emerging infodemic threats in both English and Spanish. The evidence team will use the EasySearch federated search engine backed by AI, PAHO's knowledge management team, and the Librarian Reserve Corps to identify the most relevant authoritative sources. The response team will use a design approach to communicate recommended response strategies based on behavioural science, storytelling, and information design approaches.

Barriers and enablers towards benzodiazepine-receptor agonists deprescribing in nursing homes: A qualitative study of stakeholder groups

BackgroundDespite recommendations to deprescribe chronic benzodiazepine receptor agonists (BZRA) among older adults, the prevalence of their use in Belgian nursing homes (NHs) remains above 50%. The use of a behavioral science approach, starting with the evaluation of barriers and enablers for BZRA deprescribing, has the potential to decrease BZRA prescribing. ObjectivesTo identify barriers and enablers for BZRA deprescribing perceived by the different stakeholders involved in nursing home care in Belgium. MethodsIn a purposive sample of 6 NHs, we conducted face-to-face interviews with general practitioners (GPs), and focus groups with other healthcare providers (HCPs), including nurses, pharmacists, occupational therapists, physical therapists, and with NH residents and relatives. All interviews with HCPs were analyzed through deductive thematic analysis, using the theoretical domains framework (TDF) as the coding framework. Residents' and relatives' interviews were analyzed using an inductive thematic approach. ResultsWe interviewed 13 GPs, 35 other HCPs, 22 nursing home residents, and 5 relatives. Overall, 9 TDF domains were identified as most relevant among HCPs interviewed: Skills, Beliefs about capabilities, Goals, Memory attention and decision processes, Environmental context and resources, Social influences, Knowledge, Social/professional role and identity, and Beliefs about consequences. Five additional themes emerged from residents' and relatives' interviews: knowledge on medications used, communication with NH staff and GPs, perceived efficacy and necessity of BZRA, influence of the environment, and reluctance towards BZRA deprescribing. Some domains and themes differ between stakeholders (e.g., knowledge), while others match between groups (e.g., environmental aspects). ConclusionBZRA deprescribing is influenced by knowledge and skills gaps, automatic BZRA refilling, competing priorities, social challenges, environmental factors and poor nursing home residents involvement. Targeting these barriers will be a key step for implementation of BZRA deprescribing.

Guidance through the jungle of behavioral science theories, models, and concepts for non-behavioral scientists

ABSTRACT Interdisciplinary research is becoming increasingly important to tackle complex problems such as climate change. Human behavior is one key factor that needs to be considered to find solutions to these complex problems. Working in an interdisciplinary field requires scientists to engage in tedious studies of disciplines that are beyond their core expertise. This is also true for the selection of behavioral science approaches best suitable for the research question at hand. To provide a concise introduction to behavioral science, this article provides four clusters of behavioral science approaches. These four clusters, in conjunction with the further developed 4 DBC framework, can assist the analyst in systematically selecting the most suitable behavioral science approach. To illustrate the application of the framework, the examples of cycling and Practice Theory are used.

Introducing the global antimicrobial stewardship partnership hub (GASPH): creating conditions for successful global partnership collaboration.

In 2015, 196 countries formally committed to a Global Action Plan to address antimicrobial resistance (AMR). However, translating policy into practice is not happening at pace and the recent Global Research on AntiMicrobial resistance (GRAM) Project report confirms the burden of AMR is increasing. Despite progress in establishing surveillance data and investment in new antimicrobials, education and training including use of behavioural science approaches to change practice is lagging. To contribute to addressing this, we have invited organizations to join us as founding members of the Global Antimicrobial Stewardship Partnership Hub (GASPH) (https://global-asp-hub.com/). We will work together to share education resources and foster collaboration to meet the needs of learners and of partner organizations working on tackling AMR. Membership is open to all-professional societies, academic institutes, nongovernmental organizations/civil society, philanthropists and commercial partners interested in supporting a multi-stakeholder global antimicrobial stewardship (AMS) education platform and network.

The effectiveness of a behavioral science and design intervention for family savings on use of maternal health services and male involvement: study protocol for a randomized controlled trial

BackgroundLack of financial preparedness for pregnancy can lead to adverse outcomes during childbirth. Behavioral science interventions have been shown to influence savings behavior. Financial savings interventions can be adapted for the purpose of encouraging individuals to save towards maternal healthcare costs. This article describes a protocol to assess the effectiveness of an intervention formulated with a behavioral science approach for encouraging use of maternal health services through increased financial savings for birth preparedness and maternal healthcare costs among pregnant women or their partners in Uganda.MethodsA randomized controlled trial will be conducted to assess the effectiveness of the intervention among pregnant women or their partners in Uganda’s central region, including the capital of Kampala. Seven hundred pregnant women (12–35 gestational weeks) or their partners will be recruited. All participants will receive access to a committed mobile money health savings account provided by a local organization that also offers savings targets and reminders for antenatal care appointments and health tips as part of a “Mamas Program” offered to expectant mothers. The time period in the intervention is from the day of enrollment until two weeks after the delivery date. The control group will receive the standard Mama Program offering. The intervention group will receive the standard Mama Program offering plus behavioral designs encouraging savings behavior through short-message service (SMS) text messages. The primary outcome is usage of maternal health services measured by level of birth preparedness and delivery at a health facility. Secondary outcomes include male involvement in maternal healthcare, measured by financial support, as well as total savings for healthcare, assessed using the validated amount of savings accrued in participants’ clinicPesa accounts from the day of enrollment plus any withdrawals for healthcare expenditures during the intervention period.DiscussionThe study will contribute to a better understanding of the effectiveness of behavioral designs encouraging financial savings during pregnancy into committed mobile money health savings accounts. The study could contribute to demonstrating the effectiveness of savings on birth preparedness, usage of maternal health services, and male involvement in maternal healthcare.Trial registrationUMIN-CTR Clinical Trial, UMIN000046472. Registered on 19 January 2022. https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000053008

Mainstreaming NUDGES in public health behavioural sciences in Saudi Arabia – seven steps to success

Introduction: Nudging by government health and welfare authorities has increased in popularity given the potential to add-value to the current arsenal of behavioural research tools and approaches. A needs assessment was conducted for the Health NUDGE Team, Ministry of Health, Kingdom of Saudi Arabia, with the intention of mainstreaming and institutionalizing NUDGES within the behavioural sciences in the Gulf State and the region. Needs assessment aims included identifying global progress, impact and lessons learned for continuous improvement. Method: A rapid evidence literature review was implemented, and standardised discussion agenda developed for consultations with sixteen stakeholders from leading global NUDGE Units from 9 country programs. Data was analysed with NVivo 2020 qualitative software. Results: The Benchmarking and SWOT analysis identified a number of challenges and opportunities for NUDGE Units in their infancy to consider. “Seven Steps to Success” are proposed. Discussion: Important considerations are provided for fine-tuning NUDGE organisational, functional and technical capacities, leveraging of activities, and advocacy and promotion of best-practice approaches. The steps can assist in optimising NUDGE performance as the strategy evolves in Saudi Arabia and the Eastern Mediterranean Region. Benchmarking with other providers plays an important part in continuous improvement as well as flexibility to adapt behavioural science processes and approaches to better reflect the needs of country and regional stakeholders.