Financial Interventions Research Articles

Electronic capture of cancer-related distress in a community oncology program.

1577 Background: Cancer related distress can be seen in as many as one in two patients. Many organizations such as the Commission on Cancer require distress screening. National Comprehensive Cancer Network (NCCN) distress thermometer is a common tool used for screening. We studied feasibility of embedding the NCCN thermometer into oncology electronic health record (EHR) for routine patient care. We concurrently studied feasibility of using a mobile health tool for serial evaluation of cancer related distress. Methods: A flowsheet containing NCCN distress thermometer questions was created in Epic EHR (Epic Systems, Verona, WI). Oncology nurses used the flowsheet for routine patient assessment. Patients with distress level ≥ 4 answered additional questions. Ancillary care providers such as palliative care nurses or social workers addressed the identified needs by providing appropriate ‘services’. A field to capture these interventions was created. We also adapted our previously reported web based mobile tool [1] for monitoring cancer distress. Patients rated their distress on a 1-10 scale and highlighted the distress domain (physical, emotional, practical, family). Distress level ≥ 4 generated a color-coded flag for provider review and intervention. Data from both electronic tools was periodically analyzed to inform patient care and quality improvement. Results: Between January and December 2021, Epic EHR based distress flowsheet collected 28,594 distinct responses in 911 patients. 57.4%, 14.9%, 14.1%, 9.4% and 2.3% of the responses were in the physical, emotional, practical, familial and spiritual domains respectively. ‘Other’ responses were 1.4%. Cumulative frequency of non-physical problems was 42.5%. 1819 ‘services’ were provided with 357 emotional, 351 work, 351 housing, 350 transportation and 350 financial need-based interventions. Of 1231 patients who used the distress scale and provided additional comments, 315 (25.5%) had distress levels ≥ 4. The mobile tool captured 849 unique patient responses to the distress question between April 2020 and February 2022. Distress level ≥ 4 was flagged by 281 unique patients (33.09%). Average distress level was 2.7. Emotional domain problems generated the greatest distress level followed by family, physical and practical problems in decreasing order. Conclusions: We demonstrate feasibility of electronic capture of cancer related distress to facilitate holistic patient care in a community-based oncology program. EHR based and mobile tool distress evaluations generated concordant results. Distress caused by emotional, practical and familial domain problems was nearly as frequent and often more severe than distress caused by physical problems, underscoring the need for comprehensive cancer care.

Coordinating a multi-disciplinary team to reduce financial hardship from cancer: A clinic-based financial navigator approach.

e13527 Background: As efforts to reduce financial hardship within oncology settings increase, development of multidisciplinary approaches based on principles of care coordination – effective communication, shared goals, role clarity, handoff – are essential. Cancer Financial Experiences (CAFÉ) is a randomized controlled trial [NCT05018000] of a financial navigation intervention in two regions of Kaiser Permanente. Our objective was to develop workflows for CAFÉ Financial Navigators (CNs) to provide navigation to trial participants by engaging a multidisciplinary team. Methods: Workflows are based on our conceptual framework of unique care pathways to address financial concerns among cancer patients: resolving acute financial needs; planning for out of pocket (OOP) costs; and making cost-informed care decisions. Influenced by user-centered design, we collected multi-stakeholder perspectives through interviews with approximately 39 staff from 15 departments between 2019-2021 including clinicians (e.g. physicians, nurses, social workers), health care staff (e.g. case managers, patient navigators) and operations/business staff (e.g. business operations analysts, financial counselors). Topics included the current state; existing organizational and informal relationships between operations units; and opportunities for improvement relative to current evidence on patient needs for cancer-related financial navigation. Results: We identified several opportunities to create or enhance workflows to provide financial navigation for oncology patients. We also identified organizational barriers that require further work (e.g., providing detailed oncology-specific fee estimates for treatment and OOP costs). Workflows centered the CN as a primary contact for patients to facilitate engagement with services and ensure effective, consistent connections between patients and care delivery and operations units. We developed (1) cost coordination maps outlining the healthcare team member points of contact within departments and sequence of contacts, for addressing each financial pathway and (2) resource directories that detail the unique financial needs, contact information and role for CNs. We maintained these strategic relationships throughout the trial to serve participants and support sustainability. Conclusions: Our multi-stakeholder strategy aligns clinical and healthcare operations workflows to optimize patient experience and outcomes to reduce financial hardship from cancer. Our work suggests research teams can facilitate process improvement within care delivery settings. However, barriers to certain financial navigation processes remain, reflecting future research needs. An oncology-specific financial navigation model supported by multidisciplinary workflows is key to addressing financial hardship from cancer.

Stock market reactions to COVID-19 shocks: do financial market interventions walk the talk?

PurposeFollowing the COVID-19 outbreak, various economies imposed different financial interventions as part of initiatives to cushion their stock markets from deteriorating performance. Our article examines the effectiveness of these interventions in protecting stock markets during the pandemic.Design/methodology/approachThe authors employ Panel Vector Autoregression to model the magnitude and timing of shocks from COVID-19 to stock markets. The fixed effects regression is then utilized to assess the role of financial interventions in protecting stock markets during COVID-19. The study uses daily stock index returns as well COVID-19 containment measures stringency index data from 39 countries ranging from 2nd January 2020 to 30th September 2021.FindingsOur findings firstly reveal a significant positive stock market reaction to country-level containment measures stringency but only during the first wave of COVID-19. We secondly show that stock market functioning interventions that include short selling bans and circuit breakers amplify the positive effects of COVID-19 containment measures stringency on stock market performance.Research limitations/implicationsThe authors stress the need for policymakers and regulators to timely intervene in protecting economies and stock markets during crises such as COVID-19 in order to reduce panic among investors. Moreover, investors should adjust their portfolios by investing in stocks from countries that have proper financial market interventions in place.Originality/valueDespite growing body of literature on COVID-19 and stock market performance, there is limited evidence on the role of financial sector interventions to cushion stock markets during tumultuous conditions caused by the pandemic.

The Cancer Financial Experience (CAFÉ) study: randomized controlled trial of a financial navigation intervention to address cancer-related financial hardship

BackgroundThere is an urgent need for evidence on how interventions can prevent or mitigate cancer-related financial hardship. Our objectives are to compare self-reported financial hardship, quality of life, and health services use between patients receiving a financial navigation intervention versus a comparison group at 12 months follow-up, and to assess patient-level factors associated with dose received of a financial navigation intervention.MethodsThe Cancer Financial Experience (CAFÉ) study is a multi-site randomized controlled trial (RCT) with individual-level randomization. Participants will be offered either brief (one financial navigation cycle, Arm 2) or extended (three financial navigation cycles, Arm 3) financial navigation. The intervention period for both Arms 2 and 3 is 6 months. The comparison group (Arm 1) will receive enhanced usual care. The setting for the CAFÉ study is the medical oncology and radiation oncology clinics at two integrated health systems in the Pacific Northwest. Inclusion criteria includes age 18 or older with a recent cancer diagnosis and visit to a study clinic as identified through administrative data. Outcomes will be assessed at 12-month follow-up. Primary outcomes are self-reported financial distress and health-related quality of life. Secondary outcomes are delayed or foregone care; receipt of medical financial assistance; and account delinquency. A mixed methods exploratory analysis will investigate factors associated with total intervention dose received.DiscussionThe CAFÉ study will provide much-needed early trial evidence on the impact of financial navigation in reducing cancer-related financial hardship. It is theory-informed, clinic-based, aligned with patient preferences, and has been developed following preliminary qualitative studies and stakeholder input. By design, it will provide prospective evidence on the potential benefits of financial navigation on patient-relevant cancer outcomes. The CAFÉ trial’s strengths include its broad inclusion criteria, its equity-focused sampling plan, its novel intervention developed in partnership with clinical and operations stakeholders, and mixed methods secondary analyses related to intervention dose offered and dose received. The resulting analytic dataset will allow for rich mixed methods analysis and provide critical information related to implementation of the intervention should it prove effective.Trial registrationClinicalTrials.gov NCT05018000. August 23, 2021.

Tax-Preferred Savings Vehicles: Can Financial Education Improve Asset Location Decisions?

Abstract In this study, we conduct a stated-choice experiment to analyze the decision to contribute to either a front- or back-loaded tax-preferred retirement savings account. Our experimental design includes a randomized financial education intervention that provides information on the tax implications of both types of account. Respondents who were exposed to the intervention have greater knowledge of these accounts and make contribution choices that increase their after-tax income. Using a well-defined benchmark, we show that on average, respondents who experienced the intervention increase their discounted welfare by about 4% of their contribution amount.

Can educational interventions reduce susceptibility to financial fraud?

Financial fraud is pervasive and can be devastating for its victims. While there are numerous campaigns designed to warn and educate consumers about financial fraud, there is very little evidence on whether these initiatives are effective at reducing susceptibility to scams. We conduct a survey experiment among a representative sample of U.S. adults and find that short, online educational interventions can meaningfully reduce fraud susceptibility, and that effects persist for at least three months if, and only if, a reminder is provided. Investigating mechanisms, we find no evidence that the educational intervention reduced willingness to invest generally, but rather increased knowledge which participants were able to selectively apply. We find some evidence that beneficial effects are concentrated among individuals who are more likely to invest, particularly the financially sophisticated. Our results indicate that brief financial education interventions can meaningfully reduce susceptibility to financial fraud.

Wealth inequality, systemic financial fragility and government intervention

AbstractDoes wealth inequality make financial crises more likely? If so, how can a government intervene, and how does this affect the distribution of resources in the economy? To answer these questions, we study a banking model where strategic complementarities among wealth-heterogeneous depositors trigger systemic self-fulfilling runs. In equilibrium, higher wealth inequality increases directly the incentives to run of the poor, and indirectly those of the rich via higher bank liquidity insurance, thus increasing the probability of a systemic self-fulfilling run overall. A government intervention on illiquid but solvent banks redistributes resources towards the poor and makes systemic self-fulfilling runs less likely.

Active learning improves financial education: Experimental evidence from Uganda

We conduct a randomized field experiment to study the effects of two financial education interventions offered to small-scale retailers in rural western Uganda. The treatments contrast “active learning” with traditional “lecturing” within standardized lesson-plans. After six months, active learning has a positive effect on savings and investment outcomes, in contrast to small or zero effects for lecturing. After four years, estimates come with substantial uncertainty but are generally larger for the active learning group, such as a 60 percent increase in investments. As an adverse outcome, reported late payment on loans increases by about 30 percent for both treatments. The findings suggest that teaching methods can play an important role in affecting how financial education programs impact financial behavior and outcomes.

Availability of Healthy Food and Beverages in Hospital Outlets and Interventions in the UK and USA to Improve the Hospital Food Environment: A Systematic Narrative Literature Review.

The aims of this systematic review are to determine the availability of healthy food and beverages in hospitals and identify interventions that positively influence the hospital food environment, thereby improving the dietary intake of employees and visitors. Embase, Medline, APA PsycInfo, Scopus, Google Scholar and Google were used to identify publications. Publications relating to the wider hospital food environment in the UK and USA were considered eligible, while those regarding food available to in-patients were excluded. Eligible publications (n = 40) were explored using a narrative synthesis. Risk of bias and research quality were assessed using the Quality Criteria Checklist for Primary Research. Although limited by the heterogeneity of study designs, this review concludes that the overall quality of hospital food environments varies. Educational, labelling, financial and choice architecture interventions were shown to improve the hospital food environment and/or dietary intake of consumers. Implementing pre-existing initiatives improved food environments, but multi-component interventions had some undesirable effects, such as reduced fruit and vegetable intake.

Financial Outcomes of Interventions Designed to Improve Financial Capability through Individual Development Accounts: A Systematic Review

ABSTRACT Purpose Driven by a desire to improve the financial well-being of lower-income households, financial capability interventions are gaining attention in practice and public policy. IDAs are a financial capability intervention designed to build family assets through incentivized savings. Method This systematic review focuses on financial capability interventions that provide Individual Development Accounts (IDAs), a restricted-used savings account paired with financial education. Eligible studies included financial education and a matched saving account to be used for a financial asset purchase. Results Three large research projects with multiple studies and one additional unique study published through May 2020 were eligible for study inclusion. Results suggest that, thus far, there is mixed evidence on IDAs effects on financial behaviors or financial outcomes. Conclusion Our review suggests the need for additional studies that use rigorous research designs that investigate the IDAs effects on financial behaviors and outcomes.

Exploring Individual and Group Financial Coaching for Building Financial Capability

This article summarizes a field-based experiment exploring an individual and small-group financial coaching intervention. Both types of coaching programs had the same goal: To develop clients’ financial capability through a series of planned meetings focusing on client driven goals. Results indicated clients who were coached either individually or in groups demonstrated increases in financial knowledge, gains in confidence, reductions in stress, and positive changes in behavior. The findings provide support for coaching as an intervention for developing financial capability and suggests group coaching as an alternative for reaching more clients and spreading financial capability more widely in a cost-effective way.

How much does it cost to combine supply-side and demand-side RBF approaches in a single intervention? Full cost analysis of the Results Based Financing for Maternal and Newborn Health Initiative in Malawi

ObjectiveTo estimate the economic cost associated with implementing the Results Based Financing for Maternal and Newborn Health (RBF4MNH) Initiative in Malawi. No specific hypotheses were formulated ex-ante.SettingPrimary and secondary delivery...

Calling the Shots: Determinants of Financial Decision-making and Behavior in Domestic Migrant Households in India

This article explores financial decision-making and behavior in migrant households. Literature on migration and financial inclusion usually focuses on either migrant workers and their financial needs or remittance flows and their effects on development, leaving the subject of household decision-making significantly underresearched. Using primary data from two sample surveys, one with migrant workers and one with their household members, we employ descriptive analysis to study the financial decision-making processes and outcomes. Our sample is mostly composed of male Indian domestic migrants from Bihar, Jharkhand, and eastern Uttar Pradesh. Our analysis considers the following migrant typology dimensions: duration of migration cycle, skills, and destination. Key household characteristics explored in our study include household size, the number of financial contributors in the household, the presence of an older male and children below the age of 18, and overall household income. Our results show that household members compete for influence over financial decisions and power balances change significantly whether the migrant is at home or at destination. These dynamics play an important role in determining household financial preferences. This suggests that financial products and interventions targeting specific financial behavior (for instance, financial literacy programs) need to take these factors into account since different households and different migrant types make these choices differently. JEL Codes: D14, O15, O16

Interventions Designed to Improve Financial Capability: A Systematic Review

Purpose: This study’s aim is to review and synthesize the scientific evidence for financial capability interventions that combine financial education and financial products and services to affect financial behavior. Method: A systematic review process was used to search for, screen, and extract data from relevant studies. Following descriptive analysis, we calculated effect sizes. Results: After excluding duplicates, non-relevant and ineligible reports, this review included 24 unique studies. This review identified several different types of previously evaluated financial capability interventions. Few interventions were evaluated by more than one study that measured the same or similar outcomes. Therefore, evidence is sparse about whether financial capability interventions improved participants’ financial behaviors and/or outcomes. Conclusion: While each type of financial capability intervention has a unique evidence base, this lack of evidence across financial capability interventions points to the need to develop a more definitive evidence base for financial capability interventions about the financial outcomes.

The Feasibility and Acceptability of a Community-Developed Health Insurance and Financial Toolkit for Emerging Adults With Type 1 Diabetes.

The purpose of the study was to assess the feasibility and acceptability of a financial stress and health insurance education toolkit developed by a community advisory board for emerging adults, ages 18 to 25, with type 1 diabetes. This study is a longitudinal, randomized controlled trial that enrolled 39 emerging adults with type 1 diabetes. Participants randomized to the intervention group were given access to the T1D Financial Toolkit, an online financial and health insurance education toolkit, over 30 days. For the present analysis, feasibility was assessed by enrollment and attrition. Optional, qualitative interviews were conducted upon the conclusion of the intervention to evaluate feasibility, acceptability, satisfaction, and key recommendations for improvement. Of the 39 participants who enrolled, 36 completed the study. The intervention period had 100% completion in both the control and intervention groups. Eleven participants from the intervention group completed interviews. Participants described few challenges accessing the toolkit and were highly satisfied with the intervention aesthetics, display, and content. Key recommendations included integrating more applied problem-solving into the experience of watching the videos. The T1D Financial Toolkit is a financial and health insurance education intervention tailored to emerging adults with type 1 diabetes. This resource is feasible, acceptable, and satisfactory. Diabetes care and education specialists can utilize this tool in practice to provide relevant, developmentally tailored education to emerging adults with type 1 diabetes, prompt applied problem-solving, reduce barriers to self-management, and improve psychosocial outcomes.

Partner bereavement when parenting dependent children: What factors influence adjustment?

Little is known about those who are widowed while raising dependent children. This study aimed to explore the factors which influence adjustment to partner death. Seven fathers and five mothers were interviewed, and constructivist grounded theory was used. Three interrelated themes were identified: Interpersonal influences, Intrapersonal influences, and Contextual influences. Dependent children meant sole responsibility and increased demands, yet ultimately provided widowed parents a purpose. Participants highlighted the need for increased awareness of young widowhood at a systemic and cultural level, to improve communication around death and young widowhood. Implications included social, financial and therapeutic interventions.

Economic evaluation of a conditional cash transfer to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya.

There is limited evidence on the cost and cost-effectiveness of cash transfer programmes to improve maternal and child health in Kenya and other sub-Saharan African countries. This article presents the economic evaluation results of the Afya trial, assessing the costs, cost-effectiveness and equity impact of a demand-side financing intervention that promotes utilisation of maternal health services in rural Kenya. The cost of implementing the Afya intervention was estimated from a provider perspective. Cost data were collected prospectively from all implementing and non-implementing partners, and from health service providers. Cost-efficiency was analysed using cost-transfer ratios and cost per mother enrolled into the intervention. Cost-effectiveness was assessed as cost per additional eligible antenatal care visit as a result of the intervention, when compared with standard care. The equity impact of the intervention was also assessed using a multidimensional poverty index (MPI). Programme cost per mother enrolled was International (INT)$313 of which INT$ 92 consisted of direct transfer payments, suggesting a cost transfer ratio of 2.4. Direct healthcare utilisation costs reflected a small proportion of total provider costs, amounting to INT$ 21,756. The total provider cost of the Afya intervention was INT$808,942. The provider cost per additional eligible ANC visit was INT$1,035. This is substantially higher than estimated annual health expenditure per capita at the county level of $INT61. MPI estimates suggest around 27.4% of participant households were multidimensionally poor. MPI quintiles did not significantly modify the intervention effect, suggesting the impact of the intervention did not differ by socioeconomic status. Based on the available evidence, it is not possible to conclude whether the Afya intervention was cost-effective. A simple comparison with current health expenditure in Siaya county suggests that the intervention as implemented is likely to be unaffordable. Consideration needs to be given to strengthening the supply-side of the cash transfer intervention before replication or uptake at scale.

Exploring the structural effects of the ICT sector in the Greek economy: A quantitative approach based on input-output and network analysis

The aim of this paper is to present a quantification approach for the calculation of the ICT sector's structural effects in the economy, focusing on the case of Greece. We construct a composite sector using a hypothetical extraction methodology based on the most recent Greek input-output table and structural business statistics at the national level. Our framework builds on the formal definition of the ICT sector provided by OECD and includes two distinct sub-components, ICT manufacturing and ICT services. In the second stage of this study, we explore the production linkages among ICT services, ICT manufacturing and the rest of the Greek industries using input-output-based and network analysis-based metrics that build on the intermediate transactions of an expanded input-output table of the Greek economy that includes the two sectors. Our empirical findings suggest that the total ICT sector has a major contribution to the Greek economy in terms of GDP and employment, but this is driven mainly by the ICT services component. We further identify that ICT services are more integrated in the Greek production network compared to ICT manufacturing, but their production linkages are underperforming in terms of meaningful contribution to the activity of the rest of the sectors. These results reflect the low integration of digital technologies and can be further embedded in a discussion on the ICT deficiencies of the Greek economy and the need for targeted regulatory and financial interventions.

Interventions designed to improve financial capability: A systematic review.

There is growing recognition that people need stronger financial capability to avoid and recover from financial difficulties and poverty. Researchers are testing financial capability interventions with adults, children, immigrant populations and other groups, but little is known about the effectiveness of financial capability interventions on financial behaviour and financial outcomes. The purpose of this review is to inform practice and policy by examining and synthesizing evidence of the effects of interventions designed to improve financial capability. Financial capability interventions combine financial education and financial products and/or services. The research questions are: (a) What are the effects of interventions designed to improve financial capability on financial behaviour and financial outcomes? and (b) Does study(design), intervention (dosage, duration, type) or sample (age) characteristics relate to the magnitude of effect size? We conducted two identical rounds of electronic searches for two different time periods. In Round 1 searched for studies through May, 2017 and Round 2 searched from May, 2017 through May, 2020. For both rounds, we identified and retrieved both published and unpublished studies, including conference proceedings, through a comprehensive search that included multiple electronic databases, grey literature sources, organizational websites, government websites and reference lists of reviews and relevant studies. We also conducted forward citation searching using Google Scholar to search for studies citing the included studies. We also conducted a search on Google using key terms. We hand searched the table of contents of selected journals to identify potentially eligible reports not properly indexed. Finally, experts who were study or sub-study authors of prior studies were contacted in an attempt to obtain unpublished studies, studies in process and published studies missed in the database search. To be eligible for this review, the intervention must have included a financial education component and a financial product or service. Studies must have also been conducted in any of the 35-member countries of the OECD, and included a financial behaviour or financial outcome. To meet the criteria for delivering financial education, interventions must have delivered information about: (1) a variety of general financial concepts and behaviours, or advice about financial behaviours); (2) a specific financial topic; (3) a specific product; and/or (4) a specific service. To meet the criteria for access to a financial product or service, interventions must have facilitated access to one or more of the following: (1) a child development account; (2) a retirement account through an employer; (3) a 'second chance' checking account; (4) a matched savings account; (5) a financial service, such as financial counselling or coaching; (6) a bank account; (7) an investment vehicle; or (8) a home mortgage loan product. Electronic searches of bibliographic databases and searches of other sources identified a total of 35,484 hits. Titles and abstracts were screened for relevance and 35,071 were excluded as duplicates or deemed inappropriate. The full text of the remaining 416 potential studies was reviewed and screened for eligibility by two independent coders. We excluded 353 reports that were deemed ineligible and included 63 reports that met inclusion criteria. Of the 63, 15 reports were deemed duplicates or summary reports. Of the remaining 48 reports, 24 were unique studies (using unique samples) that were included in this review. Six of those 24 studies were large longitudinal studies that presented unique analyses (using different time points, subsamples, and/or outcomes). Thus, we extracted data from 48 reports, reporting data and analyses from 24 unique studies. At least two review authors who were not study authors independently assessed risk of bias in all included studies using the Cochrane Collaboration's risk of bias tool. The review summarizes evidence from 63 reports from 24 unique studies, which included 17 randomized controlled trials and 7 quasi-experimental designs. In addition, 17 duplicate or summary reports were also located. This review identified several different types of previously evaluated financial capability interventions. Unfortunately, few interventions that were evaluated by more than one study measured the same or similar outcomes, thus there were not a sufficient number of studies of any of the included intervention types that could be pooled to conduct a meta-analysis. Therefore, evidence is sparse about whether participants' financial behaviours and/or financial outcomes are improved. While the majority of the studies used random assignment (72%), many of the studies had some important methodological weakness. There is a lack of strong evidence about the effectiveness of financial capability intervention. Better evidence is needed about the effectiveness of financial capability interventions to guide practitioners.

Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research.

In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation.