Behavioral Economics and Social and Behavior

Change Communication at CCP

16 Feb 2017
Written by: admin
Behavioral economics is a rapidly growing area of study rooted in
psychology, economics and behavioral sciences. A driving force behind the
growth of behavioral economics has been its recent application to behaviors
that affect health.

The standard economic model assumes that people always make decisions
and act based on rational thinking. However, most people know from their
own experiences that this is not always the case. Research shows that people
often make irrational choices, sometimes against their best interest.

The Johns Hopkins Center for Communication Programs (CCP) has more than
30 years of experience in strategic social and behavior change
communication (SBCC) and has used behavioral economics (BE) concepts
over the past decades to influence how and why people make choices that
affect their own health and well being and that of their families and
communities.

BE elements can add benefit in understanding how people think, decide and
act when developing SBCC programs. Below are examples of CCP SBCC
campaigns that illustrate the four core BE concepts.

Four Core Concepts and CCP Examples in Action

1. Priming/Framing: Framing (and a corollary, priming) refers to characterizing a
choice situation in a way that suggests how an audience should think about it. The
frame that is introduced first primes the audience to think about the issue through that
frame or lens rather than some other perspective.
The language used to describe a set of choices can shape people’s
decision-making. People make default (“gut” reaction, quick) decisions
and can be more motivated by emotional messages with immediate
benefit.

Project Example: Communication for Healthy Living’s Mabrouk campaign

Location: Egypt
Communication for Healthy Living (CHL) was an integrated health
communication program in Egypt funded by the United States Agency
for International Development (USAID) led by CCP in partnership with
the Egyptian government. The project prioritized contraceptive use as
a primary behavioral goal, but framed it within a cycle of family health
 behaviors, celebrating marriage (Mabrouk!—Congratulations!) as the
entry point for the communication strategy.

The signature theme that branded all CHL messages and activities and
primed an overarching healthy family mindset was “Sahetak…
Sarwetak” (Your Health…is Your Wealth).

Within that larger frame, messaging focused on the benefits of the

following lifestage behaviors:

o longer birth spacing results in better maternal and child health;

o immunization and breastfeeding improve the mental and physical development of

infants;

o avoidance of secondhand smoke reduces cardiovascular disease and cancer risk, and

so on.

CHL positioned each behavior as an informed choice that people make

in order to protect their greatest asset—good health—a deeply held
value that emerged strongly in pre-campaign formative research.

2. Commitment devices/Reminders: These are items (like texts or SMSs) that remind

us of a commitment we made. Behavioral economics posits that people make
decisions automatically, by using mental shortcuts. Commitment devices and
reminders can help decrease the cognitive burden required to sequence or complete a
complex task. Pre-committing to a particular decision can help people align their
actions with their preferences.
Project Example: Tanzania Capacity and Communication Project’s
Wazazi Nipendeni SMS campaign
Location: Tanzania
Wazazi Nipendeni (“Love me, Parents”) is a national safe motherhood
social and behavior change communication (SBCC) campaign in
Tanzania and part of the Tanzania Capacity and Communication
Project (TCCP). TCCP was a USAID-funded project led by CCP in
partnership with Media for Development International (MFDI) and the
Tanzania Communication and Development Center (TCDC).
All Wazazi Nipendeni media encourages listeners and viewers to send
a free text message to a dedicated short-message-service (SMS)
number to receive more information on healthy pregnancy. A set of
initial introductory questions allows users to register as pregnant
women, mothers of newborns, birth supporters, or general
information seekers, and establish the date of pregnancy or age of the
newborn, where relevant. Users then receive information, tips, and
reminders timed to the week/month of pregnancy or age of the baby.
Subscribers receive an average 3-4 messages/week across a number of
safe motherhood topic areas.  
 From November 2012 to the end of September 2016, a total of
1,507,828 users had enrolled in the service.  Nearly 113 million text
messages have been sent to registrants.

3. Heuristics (Scripts): A heuristic is a mental script or guide that simplifies decision-

making or judgments. These rule-of-thumb strategies shorten decision-making time
and allow people to function without constantly stopping to think about their next
course of action. One way that communication can affect heuristics is through
modeling behavior so that people can have a mental image of how to do something
without having to think about it.
 Project Example: Suaahara’s Bhanchhin Aama campaign
Location: Nepal
The Bhanchhin Aama (“Mother says”) communication platform
integrated social and behavior change communication (SBCC)
messages and activities about nutrition with hygiene/sanitation,
agriculture and health services promotion at all levels. The campaign
was part of Suaahara, a USAID-funded integrated nutrition project led
by Save the Children and supported by CCP.

The campaign was centered on the positive mother-in-law ‘Bhanchhin

Aama’ who modeled how to be a supportive mother-in-law in a way
that was credible, authentic and persuasive. She showed new ‘scripts’
of how to have positive conversations with daughters-in-law on issues
that had formerly been less common. Mothers-in-law were inspired to
become more like the Bhanchhin Aama.

Exposure to all program activities (vs. no exposure) had a 2.5 times

greater likelihood of receiving support from one’s husband or other
family member for work often assigned to women.

4. Behavioral Defaults: Behavioral defaults refers to what some research calls a

“nudge,” a simple change in a situation that makes one choice more likely than
another.
A default is the option an individual will receive if he or she does not
make an active choice. In behavioral economics, the default is often
something that an external entity such as a government agency or
company has implemented in order to maximize (optimally) the
welfare of the group. The system is setup so that the person will
automatically receive the default unless they ‘opt out’. For example,
countries, whose default is that people will be organ donors, though
they can ‘opt out’, have much higher rates of organ donation than
other countries.

Project Example: MyChoice
Location: Indonesia
 MyChoice is a four-year Bill & Melinda Gates Foundation-funded
project in Indonesia led by CCP with partners Jhpiego and JSI.

One of MyChoice’s key objectives is to increase the number of clients

who adopt family planning after childbirth by improving facility
readiness to provide contraceptive methods. MyChoice worked closely
with the Indonesian national family planning board, BKKBN, to develop
Balanced Counseling Strategy plus postpartum family planning
(BCS+PPFP).

BCS+PPFP is an opt-out family planning counseling for postpartum

uptake provided to clients delivering in 44 facilities across four
provinces. It uses a client-centered design, wherein the provider uses
counseling cards and initiates the counseling by asking the client or
couple questions about their fertility desires and breastfeeding
intentions. Based on the client or couple’s responses, the provider
explains the family planning methods that best meet their needs
before discharge from the postpartum ward.

Between August and October 2016, more than half of women who
received BCS+PPFP adopted postpartum family planning prior to
discharge, an increase from previous months.

Conclusion
SBCC professionals worldwide have used these concepts over the past
decades to influence how and why people make choices which affect their
own health and well being and that of their families and communities.  As the
field of behavioral economics grows, these specialists will benefit from the
latest research and future findings to public health campaigns. Stay connected
to CCP’s work by signing up to our mailing list here.
This post was written by Caroline Jacoby, Tina Dickenson, Alice Payne Merritt and
Susan Leibtag.

Accessed on March 14, 2018