Persuading households to adopt safe, effective, and low-cost interventions to improve health is challenging. Door-to-door health campaigns, once a staple of public health practice in the US, are now rarely used. In developing countries, door-to-door campaigns remain vital for disease prevention and the dissemination of health-related products and services. Unfortunately, participation rates in such campaigns are often low, diminishing the effectiveness of low-cost, proven interventions. For example, current low household participation rates in the Chagas disease vector control program in Arequipa, Peru threaten Chagas control efforts in the region.
Previous work has revealed a quiet epidemic of Chagas in poorer communities in Arequipa, where more than 5% of children are infected. The overarching goal of this study is to develop and evaluate new interventions to increase participation in large-scale public health campaigns, such as vector control campaigns, where high rates of participation are required to achieve health gains. The interventions are based on recent discoveries from behavioral economics about the common cognitive biases and mental shortcuts that contribute to low uptake of life-saving measures.
This project ended May 2021
Abstract from Results paper:
Objective: To assess the efficacy of strategies informed by behavioural economics for increasing participation in a vector control campaign, compared with current practice. Design: Pragmatic cluster randomised controlled trial.
Setting: Arequipa, Peru. Participants: 4922 households.
Interventions: Households were randomised to one of four arms: advanced planning, leader recruitment, contingent group lotteries, or control.
Main outcome measures: Participation (allowing the house to be sprayed with insecticide) during the vector control campaign.
Results: In intent-to-treat analyses, none of the interventions increased participation compared with control (advanced planning adjusted OR (aOR) 1.07 (95% CI 0.87 to 1.32); leader recruitment aOR 0.95 (95% CI 0.78 to 1.15); group lotteries aOR 1.12 (95% CI 0.89 to 1.39)).
The interventions did not improve the efficiency of the campaign (additional minutes needed to spray house from generalised estimating equation regressions: advanced planning 1.08 (95% CI −1.02 to 3.17); leader recruitment 3.91 (95% CI 1.85 to 5.97); group lotteries 3.51 (95% CI 1.38 to 5.64)) nor did it increase the odds that houses would be sprayed in an earlier versus a later stage of the campaign cycle (advanced planning aOR 0.94 (95% CI 0.76 to 1.25); leader recruitment aOR 0.68 (95% CI 0.55 to 0.83); group lotteries aOR 1.19 (95% CI 0.96 to 1.47)).
A post hoc analysis suggested that advanced planning increased odds of participation compared with control among households who had declined to participate previously (aOR 2.50 (95% CI 1.41 to 4.43)).
Conclusions: Achieving high levels of household participation is crucial for many disease prevention efforts. Our trial was not successful in improving participation compared with the existing campaign. The trial highlights persistent challenges to field experiments as well as lessons about the intervention design process, particularly understanding barriers to participation through a behavioural lens.
Buttenheim AM, Castillo-Neyra R, Arevalo-Nieto C, Shinnick JE, Sheen JK, Volpp KG, Paz-Soldan V, Behrman JR, Levy MZ. Do Incentives Crowd Out Motivation? A Feasibility Study of a Community Vector-Control Campaign in Peru. Behavioral Medicine. 2021 Nov 2:1-9.
Buttenheim AM, Levy MZ, Castillo-Neyra R, McGuire M, Vizcarra AM, Riveros LM, Meza J, Borrini-Mayori K, Naquira C, Behrman J, Paz-Soldan VA. A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health. 2019 Dec;19(1):1-1.
Buttenheim AM, Paz-Soldán VA, Castillo-Neyra R, Vizcarra AM, Borrini-Mayori K, McGuire M, Arevalo-Nieto C, Volpp KG, Small DS, Behrman JR, Naquira-Verlarde C. Increasing participation in a vector control campaign: a cluster randomised controlled evaluation of behavioural economic interventions in Peru. BMJ global health. 2018 Oct 1;3(5):e000757.