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Nudging for Care: Applications of Behaviour Design in Community Support Settings


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Behavioural science has become an increasingly popular policy tool. In Canada, labs have been set up across provincial and federal jurisdictions to help government better design and implement social programs. This session will introduce participants to the practical applications of nudging, and how it can be used to improve access to, and delivery of, vital care services in Canadian community settings.

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Nudging for Care: Applications of Behaviour Design in Community Support Settings

  1. 1. Nudging for Care: 
 Applications of behavioural design in community support settings 2017 Ontario Community Support Association Conference Twitter: @JosephDonia
  2. 2. A TIMELY DISCUSSION 2 Carsten Rehder/AP
  3. 3. WHAT IS A NUDGE? A way to design choices to help people achieve better outcomes, as defined by themselves. Must not impose material incentives or disincentives (no taxes, fines, or subsidies) Must not forbid any options (no legislative or organizational policy interventions) 3
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  8. 8. (Owain Service, 2016) 8
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  10. 10. SYSTEM 1 Largely automatic Low effort Involuntary 10
  11. 11. Slower Effortful Calculated 11 SYSTEM 2
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  14. 14. DEFAULT RULES Preserves choice, but where choices are complex or difficult runs the risk of being ineffective or causing indirect harm. Status quo bias: people prefer to leave things as they are. Omission bias: people’s tendency to fear making an error of choice. 14
  15. 15. DEFAULT RULES Useful When: Individuals prefer not to choose
 The context or choice environment is confusing and unfamiliar to the individual
 Needs and preferences do not differ across the population of interest 15
  16. 16. 16 Yes, I would like to receive appointment reminders by email. DEFAULT RULES
  17. 17. 17 FRAMING & LOSS AVERSION 1 2
  18. 18. FRAMING & LOSS AVERSION Part of Kahneman & Tversky’s Prospect Theory (1979) - the way people choose between probabilistic alternatives that involve risk. More options ≠ better choices! Be mindful and deliberate in how you present choices. 18
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  20. 20. SOCIAL NORMS Based on what individuals perceive as standard or expected behaviour among groups they belong to. People can belong to more than one group and receive conflicting messages about what is ‘desirable’. 20
  21. 21. SOCIAL NORMS 21
  22. 22. SOCIAL NORMS 22 One out of every two homes on your street has donated to Community House at least once.
  23. 23. INFORMATION DESIGN Present key messages early Keep language simple Be specific about recommended actions Remove non-essentials Break down complex goals into simple, easy steps 23
  24. 24. INFORMATION DESIGN 24 Better Not Great Before checking a patient’s glucose levels it is essential that you confirm they have not had anything to eat before. Ask the patient when they ate before you check their glucose levels.
  25. 25. REMINDERS Relatively easy and inexpensive. Can be used to address service delivery issues or health outcomes. Can be combined with other nudges like social proof to improve effectiveness. 25
  26. 26. COMBINING NUDGES 26 Yes, please send me appointment reminders by email. No, I would not like to receive appointment reminders.
  27. 27. EAST FRAMEWORK 27 (BIT, 2014)
  28. 28. EASY: Simple messaging, clarity, use of defaults when appropriate ATTRACTIVE: Should draw our attention SOCIAL: Use the power of networks and commitment
 to others to boost pro-social behaviours TIMELY: Use nudges when people are most likely to
 be receptive and help people to plan 28 EAST FRAMEWORK
  29. 29. What change do you want to see? What is the quantified expression of this change? Which metrics will you use to identify whether it has worked? What is the time frame for seeing results? 29 STEP 1: FRAME THE PROBLEM
  30. 30. Frame the problem from the user’s perspective. What is the patient or client trying to achieve? What is getting in their way? 30 STEP 2: UNDERSTAND THE CONTEXT
  31. 31. How can we make this as easy as possible? Is the intervention as easy as possible? How can we make the option more attractive? Have we made the option as attractive as possible? How can we make the option more social? Is the intervention social in nature? How can we make the alternative more timely? Is the intervention appropriately timed? 31 STEP 3: BUILD THE INTERVENTION
  32. 32. Use RCTs when possible. If you are unable to, then use your earlier identified metrics to determine whether there has been a noticeable change over time. 32 STEP 4: TEST
  33. 33. LIMITATIONS Reactance: if people know they are being nudged, and don’t like it, they may actually perform the opposite behaviour. Reproducibility: Behavioural economics isn’t immune to the study replication issues that have plagued other disciplines in recent years. Range: Different nudges in different contexts have effects that span various time frames. 33
  34. 34. THE ETHICS OF NUDGING What do people do when they are acting rationally and are well-informed? Does the nudge educate and increase capacity for effective decision-making in the future, or is it paternalistic? How would this person feel if they knew they were being nudged in a particular direction? 34