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Alison Buttenheim

Assistant Professor | Medical Ethics & Health Policy, Nursing

Dr. Alison Buttenheim is an Associate Professor of Nursing and Health Policy. She received the Patricia Bleznak Silverstein and the Howard A. Silverstein Term Endowed Professorship in Global Women’s Health and is a Senior Fellow at the Leonard Davis Institute of Health Economics. She is also the Associate Director, Center for Health Incentives and Behavioral Economics and the Associate Director of the National Clinician Scholars Program.

Her research addresses persistent behavior change challenges in public and global health. Using the techniques and frameworks of behavioral economics, Alison designs, trials, and scales innovative interventions in the areas of vaccine acceptance, smoking cessation, reproductive health, cancer prevention, and vector control.

A recognized evaluation expert, Alison has consulted on several impact evaluation studies in international settings, including village midwife and microfinance programs in Indonesia, school feeding schemes in Laos, and improved sanitation in urban Bangladesh.

Selected Publications

Alison ButtenheimMichael Z. LevyRicardo Castillo-NeyraMolly McGuireAmparo M. Toledo VizcarraLina M. Mollesaca RiverosJulio MezaKatty Borrini-MayoriCesar NaquiraJere R. BehrmanValerie A. Paz-Soldan

(September 2019). A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health. 19(1272).

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. The behavioral design offered us a broader range of strategies and approaches that are typically used in vector control campaigns.

Conclusions

Careful attention to how behavioral design may affect the 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.

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