Title
A behavioral design approach to improving a Chagas disease vector control campaign in Peru
Date Issued
18 September 2019
Access level
open access
Resource Type
journal article
Author(s)
Buttenheim A.M.
McGuire M.
Toledo Vizcarra, Amparo
Mollesaca Riveros, Lina
Meza, Julio
Behrman J.
Perleman School of Medicine of the University of Pennsylvana
Perleman School of Medicine of the University of Pennsylvana
Tulane University School of Public Health and Tropical Medicine
Tulane University School of Public Health and Tropical Medicine
Publisher(s)
BioMed Central Ltd.
Springer Nature
Abstract
Background: Individual behavior change is a critical ingredient in efforts to improve global health. Central to the focus on behavior has been a growing understanding of how the human brain makes decisions, from motivations and mindsets to unconscious biases and cognitive shortcuts. Recent work in the field of behavioral economics and related fields has contributed to a rich menu of insights and principles that can be engineered into global health programs to increase impact and reach. However, there is little research on the process of designing and testing interventions informed by behavioral insights. Methods: In a study focused on increasing household participation in a Chagas disease vector control campaign in Arequipa, Peru, we applied Datta and Mullainathan's "behavioral design" approach to formulate and test specific interventions. In this Technical Advance article we describe the behavioral design approach in detail, including the Define, Diagnosis, Design, and Test phases. We also show how the interventions designed through the behavioral design process were adapted for a pragmatic randomized controlled field trial. Results: The behavioral design framework provided a systematic methodology for defining the behavior of interest, diagnosing reasons for household reluctance or refusal to participate, designing interventions to address actionable bottlenecks, and then testing those interventions in a rigorous counterfactual context. Behavioral design offered us a broader range of strategies and approaches than are typically used in vector control campaigns. Conclusions: Careful attention to how behavioral design may affect internal and external validity of evaluations and the scalability of interventions is needed going forward. We recommend behavioral design as a useful complement to other intervention design and evaluation approaches in global health programs.
Volume
19
Issue
1
Language
English
OCDE Knowledge area
Tecnología médica de laboratorio (análisis de muestras, tecnologías para el diagnóstico) Ingeniería médica
Scopus EID
2-s2.0-85072389925
PubMed ID
Source
BMC Public Health
ISSN of the container
1471-2458
DOI of the container
10.1186/s12889-019-7525-3
Sponsor(s)
The authors thank members of the Chagas Disease Working Group in Arequipa who contributed to and facilitated this work, including Fernando Malaga, Andy Catacora, Karina Oppe, and Juan Cornejo del Carpio. We also acknowledge support from Claudia Arevalo and Jenni Peterson. We gratefully acknowledge the invaluable contributions of the Ministerio de Salud del Perú (MINSA), the Dirección General de Salud de las Personas (DGSP), the Estrategia Sanitaria Nacional de Prevención y Control de Enfermedades Metaxenicas y Otras Transmitidas por Vectores (ESNPCEMOTVS), the Dirección General de Salud Ambiental (DIGESA), the Gobierno Regional de Arequipa, the Gerencia Regional de Salud de Arequipa (GRSA), the Pan American Health Organization (PAHO/ OPS) and the Canadian International Development Agency (CIDA). Recently, the vector control campaign in Arequipa has suffered from declining rates of participation, threatening efforts to eliminate vector-borne Chagas disease [26] and ultimately the success of the Southern Cone Initiative. Given the low participation rates in the spray campaign in the Mariano Melgar district of Arequipa in 2012–2013, there was mutual interest between the Ministry of Health and our research team in increasing household participation in future efforts in other districts. We adopted a behavioral design framework to guide these efforts. Following formative and pilot work [27, 28] and an initial grant submission (2011–2013), the project was awarded a five-year extramural grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development in early 2014 (R01HD075869). We gleaned additional insights through analysis of several important structural, political, and financing factors that have influenced the design and implementation of the local campaign since its initiation. In the early years, the campaign received technical support from the Pan American Health Organization (PAHO) and financial support from the Canadian International Development Agency (CIDA) [34]. This support allowed for significant investments in campaign promotion via radio ads and murals. In 2002, Peru’s Ley Orgánica de los Gobiernos Regio-nales transferred numerous functions, including many related to health, to regional governments [35]. The transfer was completed in 2006. Around this time the funding for the campaign was diverted from one regional office (the regional office of the Ministry of Health) to another (the Red de Salud Arequipa-Caylloma). A gap in funding in 2009 prevented the purchase of insecticide and paused the campaign [36, 37]. The bulk of the campaign promotion is now carried out through megaphoning and household visits. Over time, the geographic focus of the campaign has shifted from primarily poor, recently established communities (pueblos jovenes) to districts with greater economic and social heterogeneity. Vector infestation patterns are also more heterogeneous in the more urban districts [38–40]. Participation in poorer neighborhoods is generally higher than in wealthier and more established areas of the city.
Sources of information: Directorio de Producción Científica Scopus