Behavioral Economics, Health and Education...2. Nudges: Behavioral Economics offers a menu of cost-effective tools to help individuals optimize decision-making 3. Behavioral Economics

BehavioralEconomics,HealthandEducation

AnaBalsaUniversidaddeMontevideo

InterAmericanDevelopmentBankWashingtonDC,October102018

BehavioralEconomics,HealthandHealthPolicy

Healthmotivation

• Unhealthybehaviorsexplainasignificantfractionoftheproblemsfacedbyhealthsystemstoday• Diabetes,cancer,cardiovasculardiseaseandrespiratorydiseaseexplainbetween60%and80%ofbefore-timedeathsinAmerica• Whiletheworldprevalenceofoverweightandobesityis37%,inLACitis59%.Obesityis25%inLACversus12%inrestoftheworld.• Nudgeunits:BehavioralInsightsTeamUK;WhiteHouseSocialandBehavioralScienceTeam

Centralideas

1. BehavioralEconomicsoffersanewtheoreticalbackgroundtounderstandandpredictbehavioralbiasesthatleadindividualstoengageinunhealthybehaviors

2. Nudges:BehavioralEconomicsoffersamenuofcost-effectivetoolstohelpindividualsoptimizedecision-making

3. BehavioralEconomicsandHealthPolicy:TheTobaccoControlCampaigninUruguay,traditionalmeasuresandnudges

4. ThescopeandlimitsofBehavioralEconomicswhendesigningHealthPolicy

1. BehavioralEconomicsoffersanewtheoreticalbackgroundtounderstandandpredictbehavioralbiasesthatleadindividualstoengageinunhealthybehaviors

RationalandImpulsiveSystem

Alternativemodelsofdecision-making• Thaler:HumansandEcons• Neuroscience:2neurobiologicaldecisionsystems

• Impulsiveorautomatic(brainlimbicandparalimbicregions):responsibleforemotions,motivation,impulses,immediategratification(system1)

• Reflectiveorexecutivefunctions(prefrontalcortex):setgoals,memory,planning(system2)

• Ittakesmorethan20yearsoflifeforthesesystemstomature,andtheyevolveatdifferentpaces• Bickeletal.,2007;Bickel&Yi,2007:disease(i.e.addiction)desregulatesbothsystem,makingtheimpulsivesystemmorehyperactiveandtheexecutivesystemmorehypoactive.

Behavioraleconomics

• Traditional economic theory• Rational individuals• Elegant andsimplemodel that generates reasonable predictions attheaggregate level but less accurate predictions atthe individuallevel

• Behavioraleconomics• Combineselements ofpsychology,sociology,neuroscience andeconomics• Studies how consumers make realchoices,not how they should choose ifthey behaved rationally• Identifiessystematicbehavioralbiasesthatunleashandreproduceunhealthybehaviors• Thesebiasescanbeaddressedwiththeobjectofoptimizingindividualwelfare

Promiseofbehavioraleconomics

• Very cost-effective policies• Smallchanges inthe way choices arepresented or inthe wayinformation is conveyed canleadtolarge changes inbehavior• Tax systems• Retirement savings• Organ donations

Behavioral biasesPreferences,beliefs anddecisions depend on:

•How options areframed

•Attitudes towards uncertainty

•Perceptions about time

•Socialinteractions

BehavioralbiasesandFRAMING• Thechoicedependsontheframingofalternatives(forexample,framingahealthinterventionintermsoflivessavedorliveslost)Framing

• Choiceaffectedbyspuriousinformation• Status-quobias,intertia,habits• Defaultoptions,subjecttomarketingframes

Anchoring

• Moreoptionsdonotnecessarilyimproveconsumerwelfare• DifficultytochoosewhenvarietyishighToomanyoptions

• Bandwidth• Sweetsandunhealthysnacksatcashiers• Povertyandhealthdecisions

Inattentionanddecisionfatigue

Framing andthe disease dilemma

Adisease affects 600people.Two treatment options areoffered A&B• Treatment A:200lives aresaved• Treatment B:1/3probability ofsaving 600vidasand2/3probability ofnotsaving anyone• Which treatment would you choose?

Now consider treatments CandD.• Treatment C:400people diefor sure• TratamientoD:600people diewith probabilidad2/3andnoone dies withprob 1/3• Which treatment would you choose?

BehavioralbiasesandFRAMING• Thechoicedependsontheframingofalternatives(forexample,framingahealthinterventionintermsoflivessavedorliveslost)Framing

• Choiceaffectedbyspuriousinformation• Status-quobias,intercia,habits• Defaultoptions,subjecttomarketingframes

Anchoring

• Moreoptionsdonotnecessarilyimproveconsumerwelfare• DifficultytochoosewhenvarietyishighToomanyoptions

• Bandwidth• Sweetsandunhealthysnacksatcashregister• Povertyandhealthdecisions


UNCERTAINTY

•Traditional economics:only totalwealth matters (integration ofassets)• Individuasl tend toseek insurance for losses that aresmall andpredictable (excessrisk aversion)

•Endowmenteffect(howtoframeincentives)Lossaversion

•Patients rely on experinces ofclose relatives andfriends (“small number”experience)

•Non-representativeexamplesofpeoplethatsmoke,usedrugsordoesnotexerciseEjemplos norepresentativos degente quefuma,usa drogas onohaceejercicio

Lawofsmallnumbers

TIMEPREFERENCES

• Exponential discounting:The rate atwhich the individualis willing toexchange consumption between 2periods is the same regardless ofthedeparture point (decision att=1or att=2)

• Timeconsistency

Traditionaleconomics

• Hyperbolicdiscounting:Individualdiscounts the near future moreheavilythan the far future

• Timeinconsistency• Preferencereversal

Presentbias&timeinconsistency

SOCIALNORMS

•Peopleevaluatetheirbehaviorrelativetotheirpeers’(Bursztyn andJensen2017)•Obesityassociatedwithchangesinappearancenorms(Etile 2007,EisenbergandQuinn,2006,Gwozdz 2015)•Anti-tobaccosentimentmoreimportantthanpricesinexplaininginitiation(DeCicca 2008):•Learningandpregnancy(Fletcher&Yakusheva 2015);socialnormsandpregnancy(Yakusheva yFletcher2016)•Balsa,A.I.,Gandelman,N.,&González,N.(2015);Balsa,A.I.,Gandelman,N.,&Roldán,F.(2018).

Peerinfluence

•Relativedeprivationinsocioeconomicstatusmayleadtostressandengagementinriskybehavior•Marmotstudies•Thecompanyyoukeep•Movingtoopportunity•Balsa,A.I.,French,M.T.,&Regan,T.L.(2014)

Relativedeprivation

1. 2. Nudges:BehavioralEconomicsoffersamenuoftoolstohelpindividualsoptimizehealthchoices

NUDGEBovens 2008Interventionthatseeksto

guidetheconsumertowardsanoptimaldecision

NUDGEBovens 2008

NUDGEBovens 2008

Should notrestrict freedom

ofchoice

NUDGEBovens 2008


ofchoice

The object ofthenudge must beofinterest tothe

individual

NUDGEBovens 2008


ofchoice


individual

Involvesachangeinchoicearchitecture/

choiceenvironment

NUDGEBovens 2008


ofchoice


individual


choiceenvironment

Impliesthestrategicuseofbehavioralbiases(irrationality)

NUDGEBovens 2008


ofchoice


individual


choiceenvironment

Impliesthestrategicuseofbehavioralbiases(irrationality)

Theactiondoesnotstemfrom

lackofinformation

aboutthechoicecontext

NudgesassociatedwithFRAMING

•Framepreventiveactionsintermsofgains(healthybehaviors)andharmfulactionsintermsoflosses(riskybehaviors/avoidingpreventiveexams)Framing

•Defaultoptions(schoolcafeterias,saltinrestaurants,fruitcartinsupermarkets,organdonation)Anchoring

•Lessoptions(healthinsurance)Toomanyoptions

•Simplifyhowinformationispresented(packaging,warnings)•Checklistsinprocedureswithmultiplestepstoavoiderrorsandomissions(hospitals)


NudgesassociatedwithUNCERTAINTY

• Presentconsequencesofunhealthybehaviorsintermsoflosses

• (Framingintermsofgainsandlossesexploitslossaversion)Lossaversion

• Priming.Adolescentscanrespondmoretodrugpreventioninterventionwhenacelebrityhasdiedofoverdoses.

Lawofsmallnumbers

NudgesassociatedwithTIMEPREFERENCES

• Ex-antecommitments.Stickk• Contingentincentives• Futureepisodicthought

Presentbiasandtimeinconsistency

NudgesassociatedwithSOCIALNORMS

• Avoidpassingthemessagethatanimportantfractionofadolescentsusedrugs• “Sayno”interventions• Associatehealthcompromisingbehaviorstonon-statusimages

Peerinfluence

• TrackingRelativedeprivation

Nudgesintobaccocessation,drugrehab,orweightlossprograms• Increasethebenefitsofthepresentactionsorthecostsofdeviatingfromthechoicewithfuturebenefits• Contingentincentives

• Vouchersexchangebleforpresentsifindividualissubstancefree((Higginsetal.,1994;Silvermanetal.,1996,Davisetal.)• Smokingcessationprogramsingeneralpopulation(Halpernetal.,2015),pregnantwomen(Higgins&Solomon,inpress)andadolescents(Krishnan-Sarin,2013)

• Weightlossprograms(Jeffery,2012),medicationadherenceprograms(DeFulio &Silverman,2012).

• $depositsthatarereturntoowneronlywhengoalsareachieved

• Futureepisodicthought(Bickel2017)• Recreateorimaginevividlythefutureexperience• Warnings(graphicimages)andlabellingincigarrette andfoodpackages

• Shorter goals• Public commitments or announcements (AA)• Have someone help toencourage or disincentive certain behaviors(weight loss clinics,personaltrainers,support teachers,Stickkhttps://www.stickk.com/aboutus

Nudgesintobaccocessation,drugrehab,orweightlossprograms

Nudgesbasedonchoicearchitectureaimedatimprovingconsumptionofhealthyfood• Keepunhealthyproductsawayfromsight• Fruitratherthansweetsinsupermarketregistries• Saladbarsinthecenteroffoodretailers• Caloriccontentinmenu• Informativelabelsinfoodpackages• Makesocialnormsvisible,emphasizingthemajorityoption(ifitisagoodone)ortheoptionofanadmiredgroup• Nudgesincreasethechoiceofhealthyfoodinchildren(Cravener etal.,2015;Anzman-Frasca etal.,2015;Radnitz etal.,2013)

3. BehavioralEconomicsandHealthPolicy:TheTobaccoControlCampaigninUruguay,traditionalmeasuresandnudges

TheTobaccoControlCampaigninUruguay

The tobacco controlcampaign inUruguay

Prices Smoke-freespaces Warnings,brandandpackage

Advertizing andsales

Precios

• 2007:salestax totobacco products

• 2009,2010,2016,2018:increases inspecific tobacco tax

Espacioslibredehumo Advertenciaeimágenes(paquete) Publicidadyventa

Increases intobacco taxes

Fuente:Harris,BalsayTriunfo2016

Smokingisprohibitedinpublicplaces,workspaces,andtransportation

Precios

• 2007:seaplicaIVAalosproductosdeltabaco

• 2009,2010,2016,2018:aumentodelIMESI

Smoke-freeregulation

• 2005:Bars andrestaurants,schools andpublicfirms

• 2006:Alldelimited publicplacesandworking spaces

• 2008:Taxis,busesandother meansoftransportation

Advertenciaeimágenes(paquete) Publicidadyventa

Warnings,branding andpackaging

Precios



Espacioslibredehumo

• 2005:Espaciosdelimitadosenbaresyrestaurantes

• 2005:Prohibiciónenempresaspúblicasyescuelas

• 2006:Prohibiciónentodoslosespaciospúblicoscerradosyespaciosdetrabajo

• 2008:Prohibiciónentaxis,autobusesyotrosmediosdetransportepúblico

Warnings,branding andpackaging

• 2005:References tolight,soft,low intararebanned

• 2005:rotatingpictograms in50%offront andposteriorsurface ofpackage

• 2008:singlepresentation(references to“blue”,“silver”,…arebanned)

• 2009:warning sizesincreases to80%

• 2018:plain packaging

Publicidadyventa

Advertizing andexhibition atsalespoint arebannedPrecios



Espacioslibredehumo

• 2005:Espaciosdelimitadosenbaresyrestaurantes

• 2005:Prohibiciónenempresaspúblicasyescuelas

• 2006:Prohibiciónentodoslosespaciospúblicoscerradosyespaciosdetrabajo

• 2008:Prohibiciónentaxis,autobusesyotrosmediosdetransportepúblico

Advertenciaeimágenes(paquete)

• 2005:seprohíbereferenciasalight,suave,bajoenalquitrán,etc

• 2005:pictogramasrotativosen50%delasuperficiefrontalyposteriordelpaquete

• 2008:regladepresentaciónúnica(seprohíbe“azul”,“plata”,…)

• 2009:aumentatamañodeadvertenciasa80%

Advertizing andsales

• 2005:advertizing isprohibitted duringchildren TVhours andinsportevents

• 2008:advertizing andexhibition prohibitedeverywhere,except atpoint ofsale

• 2014:advertizingbanned even atpointofsale

Smokingcessation programs

Cessation programs

• 2003:FNRcessation programsinpatients that hadundergone cardiacinterventions

• 2005:FNRextendsfreecessationprograms throughagreements withproviders (trainings+buproprionstickers)

Nudges andother policy measures

Prices Espacioslibredehumo

Advertencias,marcaypaquete PublicidadyventaArepricesnudges?

- Traditionaljustification:makessmokersinternalizethecoststheyareimposingonsociety

- Behavioraleconomicsjustification:couldbeconsideredanudgebyincreasingthecostsofdeviatingfromtheactionwithfuturebenefits

Nudges andother policy measures

Smoke-freespaces Espacioslibredehumo

Advertencias,marcaypaquete Publicidadyventa

¿Nudge?

- Justificación tradicional:obliga ainternalizar los costos quelos fumadores imponen en elrestodelasociedad

- Justificación Economía delcomportamiento:aumentan loscostos dedesviarse delaacción conbeneficios futuros.

Nudge?

- Traditionaljustification:Propertyrightsoftheairarereassignedtonon-smokers

- Behavioraleconomics:Itisnotanudge,becauseitrestricts(impedes)choice

Nudges andother policy measuresWarnings,brandandpackaging Publicidadyventa Advertencias,

marcaypaquete PublicidadyventaTheyarenudges!

- Theydon’thaveatraditionaleconomicjustification

- They make long term costs moresalient

- They address inertia,timeinconsistency andthe saliencyofthe message,morethan lack ofinformation






Rather than WHATinformation is given,moreimportant isHOWit is presented






Rather than WHATinformation is given,moreimportant isHOWit is presented

Infact,oneofthemeasuresinvolvedELIMINATINGrerferences tolight,softorreferenes tonicotineortar.INFORMATIONISREDUCED!!

Nudges andother policy measuresAdvertencias,

marcaypaquete Publicidadyventa Advertencias,marcaypaquete PublicidadyventaTheyarenudges!


- They avoid the manipulation ofshort-term benefitsassociated tostatus

- Decrease the visibility ofthe option

- Address inertia,present bias andthe tendency topayattention tonewandvisiblemessages

Nudges andother policy measuresAdvertencias,

marcaypaquete Publicidadyventa Advertencias,marcaypaquete PublicidadyventaTheyarenudges!


- They avoid the manipulation ofshort-term benefitsassociated tostatus

- Decrease the visibility ofthe option

- Address inertia,present bias andthe tendency topayattention tonewandvisiblemessages

This type ofregulationsaims atcountering theindustry’s effort tomainpulate and

influence individualdecisions

Evaluation ofthe tobacco controlpolicySmokinginthe population aged 15-64

Apparent consumption inUruguay

Smokingamong studentsCurrentsmokingprevalenceamonghighschoolstudentsinArgentina,ChileandUruguay,2001-2014

Prices or (other)nudges?SmokingprevalenceHighschool students

CurrentsmokingprevalenceamonghighschoolstudentsinArgentina,ChileandUruguay,2001-2014

RealpriceofapackageofcigarettesinUS$inArgentina,ChileandUruguay,2001-2015

Smokingcessation rates among pregnant womeninUruguay,2007-2013

Smokingcessation rates amongpregnant women 2007-2013

Contribucióndelasdistintaspolíticasalaumentoenlatasadecesación

2007-2013

4%

25%

71%

ConvenioscesaciónFNR Impuestos

Empaquetado,publicidadyventa

Taxes

Packaging,advertizing andsales

AgreementswithFNR

Smokingcessation rates amongpregnant women Birthweight

• Smokingcessation increasesbirthweight among offspring ofprevious smokers by 188grams

• Nocorrelation found betweenpolicies andbirthweight forchildren ofnon-smokingmothers

4.ThescopeandlimitationofBehavioralEconomicsforPublicHealthPolicy

• Diagnostics:• Identifytheproblemanddecisionbiases• Usedataandevaluationstodesigneffectivepolicies

• Regulation:detectwhentheindustryorotherprivateagentsexploitbehavioralbiasestotheirprofitandregulate• Libertarianpaternalismanditschallenges• Scarceevidence,publicationbiasesandlongruneffects• Nudgesseemtobemoreeffectivewhenimplementedintandemandwhenchoicearchitectureisadaptedtothetypeofpopulationanditsdynamics

BehavioralEconomicsandEducation

Using behavioral insights inearlychildhood interventions:text

andvoice messages inapositiveparenting program

AnaBalsa,JuanitaBloomfield,AlejandroCidUniversidaddeMontevideo

IADB,October92018

Socioeconomicgapsinearlychildhoodandtheimportanceofparentalinvestments• Poorfamilies

• spendlesstimewiththeirchildren(Guryan etal.2008)• showthemlessexpressionsofaffectionatearlyages(Bradleyetal2001)• aremorelikelytoexertphysicalpunishmentonchildren• arelesslikelytocognitivelystimulatetheirchildren• speaklessandreadlesstotheirchildren(HartandRisley 1995):30mmfewerwordsbyage4

• Importanceofparentalinvestment(Cunhaetal2006,Bradleyetal2001)• Povertyassociatedwithlaggeddevelopmentofskills(Waldfogel andWashboork 2011,Schady etal.2015,Rubio-Codina etal.2015)• Heckman (2006)argues that the lackof early stimulation is more importantthan the lackof economic resources indetermining the developmentalgaps inearly childhood.

The recent findings ofbehavioral economicsinthe context ofparenthood• Toalarge extent,parentalinterventions have been designedassuming that individuals act rationally (Gen- netian etal.,2017)• Many parentaldecisions canbedifficult toanalyze andunderstandthrough the lens ofthe rational model

BiasesandnudgesassociatedwithTIMEPREFERENCES

• Parentalinvestmentinvolvesmakingintertemporalchoices• Intangiblefuturebenefitsvs.immediategratification• Myopicdecisions

Presentbias

• Poorpeopleinvestless• Higherpresentopportunitycosts• Discountratesarehigher

Povertyanddiscountrate

• Commitments(writingdownshorttermgoals;Gine,KarlanandZinman2010).• Reminders(YorkandLoeb2014)• Immediatebenefitsorshorttermgoals(Fryeretal.2015;monetaryincentives

Nudges

BiasesandnudgesassociatedwithFRAMING

• ComplexityofparentingmayoverwhelmparentsInattention,

decisionfatigue

•Stressthatarisesfromfinancialproblems,socialisolationandpovertycanreduceself-controlandconsumecognitiveresources

• Bandwidth,cognitiveperformanceandfinancialpriming(Manietal2013)

Bandwidthandpoverty

•Automaticmode• Parentsreproduceparentingpatternsoftheirparents• Changeiscognitivelycostly

Statusquobias

•Reminders (Bryanetal.2010)• Decomposing complex tasks into simpler ones (Mayeretal.2018,YorkandLoeb 2014)• Relaxedenvironment• Defaultoptions

Nudges

BiasesandnudgesassociatedwithSOCIALNORMS

• Self-esteemandself-confidenceaboutparenting• Trustintheirabilitytoinfluencetheirchild’strajectories• Benabou andTirole (2002):complementationbetweenskillsandeffort(overoptimism aboutone’sskillscanleadtomoreeffort)

Positiveidentity

• Whatareotherparentsdoing?ReferencepointsPeerinfluence

• Positivefeedback• Motivationaltestimonies• Peersupporttomotivatepositiveidentities(Lavecchia etal2014)• Increasethesalienceofpositiveidentities(Gennetian etal.,2017)

Nudges

Previousliterature

• YorkandLoeb(2014):ReadyforK!3weeklytextmessagestoencourageliteraryactivities• Parentsreadmore• Childliteracydevelopmentincreasesby0.3std.dev

• Doss etal.(2017):Ready forK!• Olderchildren;messages differentiated according tochild development• OriginalReady forKhad no results;differentiated programincreased reading

• Meuwissen etal.(2017):Text2Learn• 12weeks txt messages

• Mayeretal.(2018):tablet with reading materials+6weeks text messages• Reminders• Goals• Social gratification inthe formof congratulations

TheCrianzaPositiva Program(CP)

CrianzaPositiva:PromotingandStrengtheningParentalCompetenciesforaStrongInfantDevelopment

Program´sobjectives

Improveparentingpractices• Promotesensitivityandreflection• Strengthenfamily’sattachment• Incentivizeparentalinvestment,throughtheidentificationofresourcesandstrengthsathomeandthecommunity

Contributetoclosetheskillsgap• Nurturethedevelopmentofcognitiveandsocioemotionalskills• Preventdelays,healthproblems,negligenceandchildabuse

CrianzaPositiva’s structure

5Homevisits

Textandvoicemessages(6months)

CPgroupworkshops(8weeklysessions,2.5hs each)


5Homevisits

Txtandvoicemessages(6months)


• Heavilystructured,intensive,experiential,group-based• Aimedatchangingmentalmodelsandofferingparentsopportunitiestolearnandpracticeparentalcompetences

• 4competences:affective,protective,formative,reflective• Seekstointegrateworkshopcontentstoparents’lifehistories• Attachmenttheory(Main1991,Fonagy1991),theoryofthemind(BaronCohen1995),ecological

• Nudges:Initialcontract,taskmagnet,diploma


5Homevisits




5Homevisits



Hypotheses:1) Presentbiasaffectsparentalinvestment,andislargerinpoorerhouseholds2) Parentingiscomplex:inattentionanddecisionfatigueaffectthequalityand

quantityofparentalinvestment3) Parentsreproducehabits,changeiscostly4) Poorparentshavenegativeidentitiesabouttheirparentalefficacy


5Homevisits



Hypotheses:1) Presentbiasaffectsparentalinvestment,andislargerinpoorerhouseholds2) Parentingiscomplex:inattentionanddecisionfatigueaffectthequalityand

quantityofparentalinvestment3) Parentsreproducehabits,changeiscostly4) Poorparentshavenegativeidentitiesabouttheirparentalefficacy

•Textandaudiomessages:3weeklymessagesduring24weeks


5Homevisits




5Homevisits



•5homevisits,aimedathighriskfamilies• Coordinationwithlocalresources• Content:Sensitiveobservation,interpretation,response,commitment•Twofacilitatorsperhousehold,1.5hourseachsession

CPImplementation• 2016:DesignandpilotofCPworkshopin2CAIFpreschoolcenters• 2017:• Trainingof97CAIFworkers• Workshopimplementedin23CAIFcentersand521families.• Designoftextandaudiomessagesandhomevisitingmodule

• 2018:• Trainingof90workersin21CAIFcenters• January-June:textandaudiomessages• Workshopimplementationin21newCAIFcenters(400families).• Pilotingofhomevisitingmodulein2CAIFcenters

Designofvoiceandtextmessages

• Baselinesurvey:• Identifybehavioralbiasesintheanalyzedcommunity• 41CAIFcenters,453families• 10%ofCAIFcentersinthecountry

Surveyinstruments

• Sociodemographiccharacteristics• Frecuencyofparentalinvolvmentinphysicalgameswiththechild(8items),childcare(8items),stimulatingactivities(5items),socializingactivities(9items)• PSOC(ParentingSenseofCompetenceScale,Johnston&Mash1989):efficacyandcontrolabilityofparentalpractices• PSI/SF(TheParentingStressIndex- ShortForm,Abidin1995):parentaldiscomfortwithparentingrole,disfunctional interaction,difficultchild• MCQ(MonetaryChoiceQuestionnaire,Kirbyetal.,1999:Timepreferences

Variable Mean StddevRespondentismotherofthechild 0,88 0,32Respondentisfatherofthechild 0,06 0,24Mother'sage 29,46 6,51Mother'syearsofeducation 9,95 3,32Mother finishedmiddleschool 0.65 0.48Motherworksfulltime 0,373 0,48Fatherworksfulltime 0,84 0,37Childisaboy 0,53 0,50Ageinmoths 20,94 5,78Childisbeingbreastfed 0,38 0.49Childwasbornpremature 0,11 0,31Childhassiblings 0,52 0,50

Childliveswithbiologicalfatherandmother 0,81 0,39

Childliveswithmotheronly 0,17 0,38Householdreceivescashtransfers 0,66 0,47

Between10and50booksinthehousehold 0,37 0,48

Householdexperiencedanegativeshockinpast12months 0,58 0,50Householdhasatleastoneunsatisfiedbasicneed(non-decoroushhld,lackofbasicelementsofcomfort) 0,30 0,46

Sociodemographiccharacteristics,N=453

01234567

Physicalgames Homecare Stimulatingactivities

Socialactivities

Frequencyofparentalinvolvementandunsatisfiedbasicneedsinthehousehold

0 1 2ormore

0

1

2

3

4

5

6

7

Physicalgames Homecare Stimulatingactivities Socialactivities

Frequencyofparentalinvolvementandnumberofnegativeshocksinpast12months

0 1 2ormoreshocks

0

1

2

3

4

5

6

7

Physicalgames Homecare Stimulatingactivities Socialactivities

Frequency ofparentalinvolvment andmother's education

Primary Middleschool Highschool

01234567

Physicalgames Homecare Stimulatingactivities

Socialactivities

Parentalinvolvement.by recepient ofgovernmentassistance

Receivesgovtassistance Nogovtassistance

Parentalinvolvementandpoverty

Physicalgames

Stimulatingactivities

Homecare Socialactivities

Discountrate 0.00 -0.12** -0.05 -0.02

PSI -0.19*** -0.18*** -0.13** -0.05PSOC 0.14** 0.14*** 0.05 0.17***

Presentbias

Physicalgames



Discountrate 0.00 -0.12** -0.05 -0.02

PSI -0.19*** -0.18*** -0.13** -0.05PSOC 0.14** 0.14*** 0.05 0.17***

Inattention,decisionfatigue

Physicalgames



Discountrate 0.00 -0.12** -0.05 -0.02

PSI -0.19*** -0.18*** -0.13** -0.05PSOC 0.14** 0.14*** 0.05 0.17***

Parentalidentity,self-efficacy

Timediscountrate PSOC PSI

Mother’syrseducation -0.005** 0.468** -0.575(0.002) (0.182) (0.527)

Motherworks 0.001 -0.444 -4.222(0.014) (1.159) (3.477)

Fatherworks 0.015 -0.327 -11.603(0.025) (1.933) (7.439)

Childlivesw/bothparents -0.027 -0.682 -10.561**(0.020) (1.647) (4.957)

Negativeshock12mo 0.003 -1.952 7.971**(0.014) (1.192) (3.412)

Atleast2u.basicneeds 0.022 0.931 5.924(0.024) (1.994) (5.586)

Gov’tassistance 0.010 0.535 7.852**(0.016) (1.352) (3.905)

Childismale 0.003 -1.250 -0.304(0.013) (1.100) (3.196)

Child<18months -0.010 -2.463* 4.162(0.016) (1.385) (3.773)

1stchild -0.014 -0.280 -3.804(0.018) (1.583) (4.319)

Constant 0.127*** 62.506*** 90.280***(0.040) (3.300) (11.705)

Designofvoiceandtextmessages

• Baselinesurvey:• Identifybehavioralbiasesintheanalyzedcommunity• 41CAIFcenters,453families• 10%ofCAIFcentersinthecountry

• Designofvoiceandtextmessages• 3weeklymessages• Message1:Reminderofaparentalcompetenceanditsbenefits• Message2:Decompositionofparentaltasksintosimpleones• Message3:Reinforcementofpositiveidentity

Week Topic Parentalcompetence1 Sensitive observation AFFECTIVE23 Expressions ofaffection/sensitive approach AFFECTIVE45 Safetyandprotection athome PROTECTIVE67 The importance ofroutines PROTECTIVE89 Self-caring for caring REFLECTIVE1011 Language:Speaking tothe baby FORMATIVE1213 Language: Reading FORMATIVE1415 Freeplay FORMATIVE1617 Relieving tensions REFLECTIVE/SELF-CARE1819 Learninghowtocalmonself REFLECTIVE/SELF-CARE2021 Parentalinvolvement ALL COMPETENCES2223 Reflectionaboutparenting REFLECTIVE2425 Closingmessage

Structureofvoiceandtextmessages

Barrier Type of message to address this barrier ExamplePresent bias and timeinconsistency

1) Messages that underscore the benefits ofparenting practices

2) Reminders about the importance ofparenting practices

3) Reminders of personal committmentsregarding parenting practices

Children’s brains are like sponges, they absorb everything: thesounds, the pitches of voices, the language they listen to. Themore words your child listens to at this stage, the more he/shewill develop his/her language. It is therefore very important thatyou speak to your baby, this will impact heavily on his/her abilityto learn.

Complexityofparentalrole,inattention,decisionfatigue

1) Messages that facilitate the execution oftasks by offering concrete suggestions.

2) Messages that highlight relieve stressthrough breathing and relaxationtechniques

Talk to your baby while you are washing him or changing hisdiapers. Look him in the eye when you speak to him. When yourbaby tries to respond, don’t interrupt him and do not getdistracted. Your baby needs to know you are listening.

Negative identity 1) Messages that strengthen parental self-efficacy and empowerement2) Messages that show that feeling stressedout or underconfident is normal, and thatparents do overcome it

There is no one that wants as much for your baby as you do.Think about one or two moments in the past days in which youfelt you really contributed towards his/her wellbeing.Trust yourself and continue seeking more of these momentsduring the week.

Status quo bias 1) Messagess suggesting concrete activities2) Messages reminding benefits of parental

involvement

The more you speak to your baby, the better will his languagedevelop and the more he will learn. Today and in the followingdays, remember and repeat this thought: ”I take advantage of allthe moments with my baby to speak to him.”

0 20 40 60 80 100 120 140 160 180 200

Devotemoretimetoobservemybabysensitively,sothatIcanunderstandhimbetter

Hugmybabymoreoften,showherhowmuchIloveherwithwarmgesturesandwords

Devotemoretimetoplaywithmybaby

Devotemoretimetoreadandsingtomybaby

Talkmoretomybaby

Makemyhomeasaferplaceformybaby

Createmoreroutinestohelpmybabyfeelsafe

Seeksometimeformyself

Commitmentsmadebyparentsattheendoftheworkshop

Somelessonsfromtheimplementationofvoiceandtextmessages• Poorfamilieschangemobilenumbersveryfrequently• Sendmessagestomorethanonefamilymember• Explorehowmanyparentsarenotgettingthemessagesandtrytofindalternativewaysofcontactingthem(Trivia:42%)

• Toofewmessagesmaynotdothework,buttoomanymaylosesaliency• Parentswantfeedback• Makethemessagesaspersonalaspossible• Child’snameandgender• Previouspersonalcommitments

Evaluation

• August2017:baselinesurveyin41CAIFcenters(430evaluations=255treated+175controls).• December2018• August-Oct2018:1yearfollowupsurveyaprox700families• Evaluationdesign:• Workshop:Diferenceindifferencewithmatching• Textandaudiomessages:RandomAssignment

Preliminaryresults:facilitators’feedbackontheworkshop

45% 86%

92% 63%

82% 71%

83% 87%

53% 62%

84% 77%

15% 46%

83%

CPatiendeunanecesidadinsatisfechadelasfamiliasFamiliasrecepctivasdelprogramaCPMovilizaciónpositivadelasfamiliasMovilizacionesdemasiadofuertes

EducadorescómodosalmanejarlasreaccionesdelasfamiliasFamiliascómodasconelcambiocontinuodeactividades

SeajustólapropuestadeacuerdoainquietudesFamiliassatisfechasconeltaller

FamiliaspracticarondurantelasemanaFamiliascompartieronenlacasa

CPgenerarácambiosenlacrianzaCPlogróqueconozcamásalasfamilias

LasupervisiónapoyóCPseinterpusoconotrasactividadesdelCAIF

BuenapoyodelequipoCP

Preliminaryresults:feedbackfromfamilies

96%

98%

99%

97%

48%

76%

96%

92%

93%

95%

92%

90%

Laimplementaciónfueorganizadayordenada

Elmaterialentregadofueútil

Lasexplicacionesdelosfacilitadoresfueronclaras

Losfacilitadoresestuvierondisponibles

Elsepararmedemihijomeresultódifícil

Eltranscursodelostalleresfacilitósepararmedemihijo

Lassesionespermitieronconocermásalosdemáspadres

Elprogramaseajustóalasnecesidadesdemihijo

Elprogramamedioinformaciónquenosabía

Elprogramamerefrescóinformaciónqueyasabía

Elprogramameayudóaconocermásamihijo

Elprogramacolmómisexpectativas

Otherbehavioraleconomicconceptsappliedtoeducation• Lavecchia etal(2014)• Educationpoliciesshould• Makelearningopportunitieseasier• Remindstudentsoflong-termgoals• Teachstrategiestodevelopself-control• Encourageyouthtotakeprideintheirowndevelopment

Thankyou

Documents

Behavioral Economics, Health and Education...2. Nudges: Behavioral Economics offers a menu of cost-effective tools to help individuals optimize decision-making 3. Behavioral Economics