Tuesday, July 09, 2013

Nudge Database VIII

This is Part 8 of the Nudge Database. 
Part I || Part II || Part III || Part IV || Part V || Part VI || Part VII || Part IX  || Part X || @Makeuya

Nudge: The authors looked at different ways to encourage employees (n=1299, 81% female, mean age 41) at a health care management and IT consulting company to complete Health Risk Assessments (HRAs); specifically examining whether a lottery is more effective than a direct payment of equivalent monetary value (i.e. a gift certificate). There was a control group in addition to these two treatment arms.  

The authors cite inspiration from the Dutch postal code lottery for their design, which incorporates regret aversion. In their lottery, employees were divided into teams of 4-8 and one team was randomly selected as the winner each week. Each member of the winning team who had completed the HRA prior to the time of the drawing would win $100. If at least 80% of the members of the team completed the HRA, the prize would increase to $125. 

Results showed significantly higher HRA completion for the lottery group (64%) than the gift certificate group (44%) and the control (40%). Effects were larger for lower-income employees. 

Tags: financial incentives / lotteries / health 

Source: Haisley et al. (2012), ‘The impact of alternative incentive schemes on completion of health risk assessments American Journal of Health Promotion

Nudge: This experiment (n=150) tested the impact of various notes on the likelihood of a person completing a survey. For those who received only the survey and cover page the completion rate was 36%, compared to 48% for those with a handwritten message on the front-page and 76% when the survey was accompanied by a hand-written post-it note.

Tags: salience 

Source: Garner (2005), ‘Post-It® note persuasion: a sticky influence’, Journal of Consumer Psychology

Nudge: The authors conducted a Safety Attitudes Questionnaire (SAQ) in eight hospitals participating in a trial of a WHO surgical safety checklist. Clinicians (n=281) in the pre-intervention phase had a mean SAQ score of 3.91 (1-5 scale where 5 represents better safety attitude) while the post-intervention group (n=257) had a statistically significantly different mean of 4.01. Improvements in postoperative outcomes were associated with improved perception of teamwork and safety climate among respondents, suggesting that changes in these may be partially responsible for the effect of the checklist. Clinicians held the checklist in high regard and 93.4% would want it used if they were undergoing surgery themselves.  

Tags: checklists / healthcare 

Source: Haynes et al (2011). ‘Changes in safety attitude and relationship to decreased postoperative morbidity and mortality following implementation of a checklist-based surgical safety intervention ', Quality Safety Health Care 

Nudge: The authors elicit subjects' beliefs about the likelihood that they will redeem a mail-in form. Expected redemption rates exceed actual redemption rates by 49 percentage points, meaning that subjects are overoptimistic about their likelihood of redemption. The authors conduct three treatments to reduce overoptimism; (1) informing subjects about a previous cohort's redemption rates, (2) reminding subjects about the redemption deadline and (3) reducing transaction costs (i.e. making it easier). 

Only the third nudge had any effect and it reduced overoptimism by one half. The third nudge increased redemption but had no effect on beliefs suggesting that weak cost-salience is the mechanism for overoptimism. 

Tags: over-optimism 

Source: Letzler & Tasoff (2013)Everyone Believes in Redemption: Nudges and Overoptimism in Costly Task Completion’, Working Paper.

Nudge: The author compared the effectiveness of a conventional informational poster intervention designed to increase condom use among gay men to a ‘self-justification’ intervention designed to bridge the hot-cold behavioral gap between acting in the throes of passion and later cool objectivity. Subjects in the latter group were sent a questionnaire which instructed them to recall as vividly as possible an unsafe (in terms of protection) sexual encounter they had previously engaged in and were asked to indicate which of a given list of possible self-justifications for having unsafe sex had been in their mind at the moment they decided not to use a condom. They were then how reasonable those justifications seemed now and to briefly justify those new responses.

The percentage of men in the ‘self-justification’ group subsequently differed dramatically in probability of reporting 2 or more acts of unsafe sex; 17% compared to 41% for the poster group and 42% for the control. 

Tags: sexual behavior / hot-cold gaps 

Source: Gold (1994), ‘Why we need to rethink Aids education for gay men’, AIDS Care 

Nudge: A field experiment in 31 primary schools in England & Wales tested the efficacy of incentives to encourage  healthy eating by schoolchildren (n=664). Children’s consumption patterns were monitored for 6 weeks and an intervention was carried out in 2/3rds of the schools for 4 weeks. Children who ate a portion of fruit & veg were rewarded with stickers and small gifts. At the end of the week the stickers could be exchanged for stationery or small toys. There were two incentive programs; (i) piece rate incentives where kids got an extra reward for choosing more than 4 pieces of fruit & veg and (ii) competitive incentives where kids got an extra reward if they received more stickers than their peers. 

The authors monitored consumption one week before the 4 week intervention, during the intervention itself, one week after and 6 months later. 

There were two main results. First, the incentives have heterogeneous effects, particularly by age and gender. Younger kids and girls are more responsive to competitive incentives, which are more effective overall. Piece rate incentives worked adversely on younger kids. Secondly, most of the effects were short-lived and did not persist once the incentives are removed. An important exception is that those kids from lower SES backgrounds do benefit from long-term effects, remaining 16% more likely to try fruit & veg after 6 months. 

Tags: incentives / healthy eating 

Source: Belot et al (2013), 'Changing Eating Habits: A Field Experiment in Primary Schools', Working Paper. 

Nudge: The authors use a randomized field experiment to test the efficacy of personalized information in letters sent to seniors for Medicare Part D prescription drug plans in the U.S. The control group was given the address of the Medicare Plan Finder website. The treatment group received a letter with personalized cost information; information which was readily available for free and widely advertised. This additional step—providing the information rather than having consumers actively access it—had an impact. Plan switching was 28% in the intervention group, versus 17% in the control group, and the intervention caused an average decline in predicted consumer cost of about $100 a year among letter recipients—roughly 5% of the cost in the comparison group. 

Tags: salience / healthcare 

Source: Kling et al (2012) 'Comparison Friction: Experimental Evidence from Medicare Drug Plans', Quarterly Journal of Economics.

Nudge: A RCT looked a situation where residential electricity customers saw price increases, with households in the treatment group receiving high-frequency information displays that give information about usage and prices. This lowering of information acquisition costs allows identification of the marginal information effect. Households only experiencing price increases reduce demand by 0-7% whereas those also exposed to information feedback reduce by 8-22%, depending on the amount of advance notice.  

Tags: energy usage 

Source: Jessoe & Rapson (2012) 'Knowledge is (Less) Power: Experimental Evidence from Residential Energy Use', NBER Working Paper. 

Nudge: This paper reviewed 7 recent studies on calorie labeling (of which 2 were considered good quality, 5 considered fair). Only two of the seven studies reported a statistically significant reduction in calories purchased among consumers using calorie-labeled menus. The current body of evidence suggests that calorie labeling does not have the intended effect of decreasing calorie purchasing or consumption. 

Tags: calorie labeling / food consumption 

Source: Swartz et al (2011), ‘Calorie menu labeling on quick-service restaurant menus: an updated systematic review of the literature’, International Journal of Behavioral Nutrition and Physical Activity  

Nudge: The authors examine the efficacy of shifting consumers towards zero calorie beverages. Three sites in the U.S. received 5 interventions in the period Oct 2009-May 2010; (1) a 10% discount on zero-calorie beverages, (2) the 10% discount + discount messaging, (3) messaging comparing calorie information of sugar beverages with zero-calorie alternatives, (4) messaging comparing exercise equivalent information and (5) messaging comparing both calorie and exercise equivalent information. The main outcome measure was daily sales of zero-cal and sugared beverages.  

Results failed to demonstrate a consistent effect across interventions. Treatments (2) and (3) had statistically significant effects: the former saw an increase in purchases of zero-cal beverages, the latter saw an increase in sugar-beverage sales.

Tags: beverage consumption / messaging 

Source: Jue et al (2012), ‘The impact of price discounts and calorie messaging on beverage consumption: a multi-site field study’, Preventative Medicine

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