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«Query: To what degree has behavioural economics and, in particular, the concept of 'nudging' been understood and used in development interventions to ...»

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2706491/ Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child caretakers HWWS after the toilet. Handwash ‗habits‘ were generally not inculcated at an early age. Key ‗motivations‘ for handwashing were disgust, nurture, comfort and affiliation. Fear of disease generally did not motivate handwashing, except transiently in the case of epidemics such as cholera.

‗Plans‘ involving handwashing included to improve family health and to teach children good manners. Environmental barriers were few as soap was available in almost every household, as was water. Because much handwashing is habitual, selfreport of the factors determining it is unreliable. Candidate strategies for promoting HWWS include creating social norms, highlighting disgust of dirty hands and teaching children HWWS as good manners. Dividing the factors that determine health-related behaviour into planned, motivated and habitual categories provides a simple, but comprehensive conceptual model. The habitual aspects of many healthrelevant behaviours require further study.

From mindless eating to mindlessly eating better Wansink B., Physiology and Behavior; 2010; 100: 454-63.

http://www.ncbi.nlm.nih.gov/pubmed/20470810 Plate shapes and package sizes, lighting and layout, color and convenience: these are a few of hidden persuaders that can contribute to how much food a person eats.

This review first posits that these environmental factors influence eating because they increase consumption norms and decrease consumption monitoring. Second, it suggests that simply increasing awareness and offering nutrition education will be disappointingly ineffective in changing mindless eating. Third, promising pilot results from the National Mindless Eating Challenge provide insights into helping move from mindless eating to mindlessly eating better.

Cue based decision making: A new framework for understanding the uninvolved food consumer Hamlin RP., Appetite, 2010; 55:89-98.

http://www.ncbi.nlm.nih.gov/pubmed/20420871 This article examines the processes that occur within the consumer's head as they make a choice between alternative market offers at a low level of involvement. It discusses recent research that indicates that the Theory of Planned Behaviour and its derivatives have restricted validity as a predictor of food consumers' evaluations and purchase patterns. This has significant implications as Planned Behaviour is the dominant paradigm within food industry research. The article demonstrates that Planned Behaviour has acquired this status more by default than by proven merit.

The specific reasons for the failure of Planned Behaviour are discussed. An alternative paradigm, Cue-Based Decision Making is developed from an existing literature, and is proposed as a basis for increasing our understanding of the uninvolved food consumer in order to predict and influence their behaviour.

The alternative Cue-Based Decision Making model proposed here contains no radically new components. The major innovation that distinguishes it from earlier models is the concept that multiple cues can also act as an input to create the temporary structure of a low involvement evaluation that is driven by otherwise amorphous information. However, this is also consistent with, and is a development of, core brand theory. Like any other theoretical innovation, it is untested by peer research, but even in this state it addresses many of the easily observed contradictions and inconsistencies that the application of Theory of Planned Behaviour to low involvement decision situations creates. It also possesses the main requirement of any scientific paradigm. It is testable, and it is capable of further development by such testing.

A well-timed nudge: Enabling farmers to prepay for fertiliser when they had cash on hand was effective in promoting fertiliser adoption.

J-PAL affiliates Esther Duflo (MIT), Michael Kremer (Harvard University), and Jonathan Robinson (UC Santa Cruz) j-pal policy briefcase, October 2011 http://www.povertyactionlab.org/publication/well-timed-nudge ‗Farmers in western Kenya were offered the chance to pre-purchase fertiliser right after the harvest, when they had cash on hand. This programme significantly increased fertiliser adoption, and its effect was not statistically different from that of a more expensive 50-percent subsidy just before fertiliser application time. A small ―nudge‖ helped some farmers make an investment they wanted to make, but otherwise could not carry out due to difficulty saving money.‘ A Nudge in the Right Direction Ethan Geiling and Stephanie Halligan http://cfed.org/blog/inclusiveeconomy/a_nudge_in_the_right_direction/ Saving money isn‘t always easy – especially for low-income families. But with the right support, encouragement and a few behavioral ―nudges,‖ savings programmes can help combat those inherent biases and guide savers in the right direction.

Keep on nudging: Making the most of auto-enrolment Standard Life http://www.standardlife.com/static/docs/2011/reports/keep_on_nudging.pdf Auto-enrolment was designed using behavioural economics to ‗nudge‘ people into





savings. This report looks for practical solutions to two fundamental questions:

 How can we communicate the new workplace pensions to achieve the highest possible retention of savers?

 How can we encourage people to save more than the minimum contribution?

Push, Pull, Nudge OFWAT http://www.ofwat.gov.uk/publications/focusreports/prs_inf_pushpullnudge.pdf Nudge is about understanding consumer behaviour and using it to promote change.

It draws on best practice in advertising and marketing to encourage consumers to change their water-using habits. It is something that Government, the regulators and those providing services to consumers can all use.

We should not rely on price signals alone. Consumers can be nudged towards more sustainable water use. With better information and more helpful feedback, consumers should make better decisions.

Twixtmas – a chance to nudge mass „binge doing‟ for charity or voluntary work http://conversation.cipr.co.uk/posts/andy.green/twixtmas--a-chance-to-nudge-massbinge-doing-for-charity-or-voluntary-work Instead of binge shopping, or binge drinking, the campaign is trying to nudge people into ‗binge thinking and doing‘ by overcoming the problem of ‗time poverty‘ – where people avoid doing good deeds because they do not have enough time.

Nudging people towards desired behaviors with choice architecture http://microlinks.kdid.org/learning-marketplace/blogs/nudging-people-towardsdesired-behaviors-choice-architecture Sebstad suggested that one possible experiment in integrating choice architecture into upgrading a project may involve setting up bank accounts that receive agriculture payments as joint accounts by default and letting either spouse opt out if they prefer. Some of the other system changes that the presenters mentioned as

important for upgrading included:

 electronic savings systems,  mobile payment systems like Kenya‘s famed M-Pesa,  increased involvement of women in agriculture input supply,  inclusion of hired labor (which is especially important to women smallholders) in training and extension, and  promotion of women‘s access to farmers groups.

Behavior Change Perspectives on Gender and Value Chain Development http://microlinks.kdid.org/events/breakfast-seminars/behavior-change-perspectivesgender-and-value-chain-development Their field research, which was done in Ghana (citrus) and Kenya (sweet potato), showed that behaviors that affect upgrading are: money management, business practices, and value chain relationships. Manfre and Sebstad highlighted various types of vertical and horizontal relationships; why they are important; and implications for value chain programming. Specifically, trust and social capital were highlighted. They also discussed factors that support or impede behavior change, such as desire, incentives, and know-how to change. Some of the ways to nudge people to better practices include electronic savings, systems of payment, and financial capabilities to improve money management. The speakers closed by sharing lessons about behavior change and possible future use of the framework presented.

5. Has/will it improved human development outcomes?

Experts caution against rush to embrace 'nudge' theory in health White Paper LSHTM, Tuesday, 25 January 2011 http://www.lshtm.ac.uk/pressoffice/press_releases/2011/nudginghealth.html The Government should not rush to embrace the idea of 'nudging' people to adopt healthier behaviour, as there is no evidence to suggest it is an effective strategy.

They claim that it is a confused and ill-defined concept which many not offer anything new in terms of improving people's health behaviour. The LSHTM team argues that we shouldn't rush into doing lots of new research on nudges unless we're confident that it offers something new. But this is far from clear because like nudges most existing public health isn't coercive (and where it is, like the smoking ban, this is usually to prevent harm to third parties) and goes beyond the facts to influence how choices are presented (for example using techniques like social marketing, motivational interviewing and peer education).

They point out that many of the examples in Thaler and Sunstein's book don't fit with their own definition - for example a programme paying a 'dollar a day' to teenage mothers contingent on their having no further pregnancies would exert major pressure on young women in poverty, contradicting their definition of nudges as not exerting such pressures.

Lead author Chris Bonell comments: 'The notion of nudging adds nothing to existing approaches. Public health policies should be based on the best available evidence, but the Government has shown a worrying tendency to undermine the collection of such evidence, for example by stopping the National Institute for Health and Clinical Excellence from undertaking appraisals of several strategies to improve public health. 'Nudge' contains some eye-catching ideas, but little progress will be made if public health policy is made largely on the basis of ideology and ill-defined notions that fail to deal with the range of barriers to healthy living'.

Media maladies: Nudging out the Nanny State Dr Rosalind Stanwell-Smith, Perspectives in Public Health 2011 131: 149 http://rsh.sagepub.com/content/131/4/149.full.pdf+html Launched last summer, the nudge unit has recently run into criticism, including a report from the National Audit Office that said the unit‘s ideas had not yet been taken up by any Whitehall department. Critics are wary of the use of marketing techniques, such as using social networks to spread ‗healthy‘ messages; also the lack of a strong evidence base and the inherent contradiction in the nudge philosophy of ‗libertarian paternalism‘: free choice, so long as you make the one decided by authority. One of the unit‘s ideas is to encourage employers to promote healthy messages in the workplace, for example, not taking jam roly poly off the canteen menu, but listing calorie contents on all the options. Any one who has ever tried to diet will be puzzled why a unit, costing over £500,000 a year, was needed to think of this strategy.

„It Only Takes a Minute Girl‟: Insights in Women‟s Perceptions of Cervical Screening in Blackpool M. Lyons, D. Neary, J. Harris, K. Jordan, J. MacIntosh, H. Carlin, C. leavey, Centre for Public Health, Liverpool John Moores University, August 2009 http://www.cph.org.uk/showPublication.aspx?pubid=599 Health beliefs are important determinants of behaviour. Essentially people only change their behaviour because they believe that in some way or other it will create a benefit either for themselves or their family. Reference to various models can help unpick the stages that people go through prior to changing their behaviour, and help to identify what services can do and where they can effectively intervene to help people move towards the ―desired‖ behaviour.

Some more recent research has built on the older theories and created more useable guidelines or principles.

American economists Richard Thaler and Cass Sunstein have developed „nudge‟ theory based on a libertarian paternalist approach (Thaler and Sunstein, 2009).

According to this theory, people will change their behaviour incrementally if they are given small nudges in the ‗right‘ direction. These nudges may simply be a question posed by a health professional or a poster providing some positive facts. Both approaches suggest that changing community norms is important, so for example instead of highlighting that coverage data suggest that 25 percent of eligible women in Blackpool do not go for a smear, turn this around and reinforce the fact that 75 percent do go for a smear. Both resonate well with government policy expressed in the White Paper ―Choosing health: making healthy choices easier‖ (2004). According to the literature, lack of knowledge and fear are the main factors which affect

participation in screening including:

 lack of knowledge of cervical cancer and risk factors  fear of embarrassment and / or pain  lack of understanding of the screening procedure  low level of awareness of the benefits of screening

Other more practical issues also play a part and can include:

 never received the invitation (Neilson & Jones, 2001)  inaccuracy of target list  style of letter, illiteracy, poor English skills (Neilson & Jones, 2001)  unsuitability for screening, e.g. previous hysterectomy (Neilson & Jones, 2001)  experience from previous testing as reason for non-attendance, e.g. dislike of a male doctor (Neilson & Jones, 2001)  an assumption of sexual surveillance which suggests that cervical screening may be viewed as a method of monitoring the sexual activity of women (Bush 2000) Tom Coates (University of California, USA) has pulled together ideas from a wide variety of theories and suggested that there are a few basic factors that are needed to support and sustain behaviour change. These can be used as a checklist to ensure that campaigns maximise the potential for success.



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