APRIL 2018
The Healthy Nudge
Welcome to The Healthy Nudge . Each month, we'll get you up to speed on the latest developments in policy-relevant health behavioral economics research at CHIBE. Want more frequent updates? Follow us on Twitter @PennCHIBE and visit our website .
Boosting Cardiac Care
Cardiac rehabilitation has been shown to reduce rates of death and readmissions, and to improve quality of life, in patients with heart disease. A recent CHIBE study found that a simple EHR nudge can increase referral rates to cardiac rehab from 12 to 75% following a serious cardiac event.
Patient-Centered Design for Value-Based Cancer Treatment
In a recent Health Affairs blog post, CHIBE Associate Director Jalpa Doshi, PhD writes that "given the highly individualized nature of decisions involving life-threatening conditions such as cancer, it is imperative that cancer value frameworks accommodate individual patient preferences."
Applying Behavioral Science to Alcohol-Impaired Driving
Earlier this year, CHIBE Affiliated Faculty Kit Delgado, MD, MS contributed to a report as part of the National Academies of Sciences, Engineering, and Medicine Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities. "People who frequently drink and drive are also poor planners, which may explain the tendency to not plan a ride in advance. That means policies to make transportation alternatives other than driving the default option when drinking are key," said Delgado, in an accompanying op-ed.
Blog Spotlight
How can state vaccine exemption laws leverage behavioral economics to increase coverage and reduce the spread of infectious disease? Alison Buttenheim, PhD, MBA reviews key principles in a recent blog post.
Work-in-Progress Seminar:
Visceral Decision Making: Evidence from the Field
Thomas Chang, PhD
Assistant Professor of Finance and Business Economics, University of Southern California Marshall School of Business
04/12 @ Noon
251 Biomedical Research Building
In The News
People Can't Be Educated Into Vaccinations, But Behavioral Nudges Help, Study Finds

Access to Real-time Genetic Testing Data Impacts Prescriber Behavior following Minimally Invasive Stent Procedure

Rehab after Heart Attack: How Hospitals Can Make Sure it Happens

How to Put Behavioral Economics to Work for More Effective Patient Engagement

How Brands Can Use Psychology to Improve Marketing Techniques

‘No Educational Advantage’ from Grueling Intern Shifts

EMR Alert System, Training Boosts Cardiac Rehab Referrals from 12% to 75%

Survey Finds Reducing Stigma Attributed to Alzheimer's Is Vital to Prevention Research

UPenn Study Provides Insight into How Consumers Use Wearable Devices in Relation to Health

Businesses Levy Employee Tobacco Surcharges, Don’t Aid In Ending Use  
 CHIBE Profile
CHIBE Affiliated Faculty Gretchen Chapman, PhD aims to illuminate the psychological processes underlying decision making through in order to improve the design of theoretically-motivated, policy-relevant interventions to facilitate healthy and prosocial behavior.
What have you learned from your research on vaccine uptake and prosocial motives? 
Vaccination is an inherently prosocial decision because the person who gets vaccinated benefits not only herself but also her social contacts. For example, an effective way to protect young infants who are too young for certain vaccinations is through cocooning, or the vaccination of those around them. Unfortunately, there is not a lot of evidence that prosocial motives drive vaccination behavior. There are some laboratory and hypothetical scenario studies showing that prosocial messaging increases vaccination intention, but no field studies demonstrating that prosocial interventions affect vaccination behavior.
What questions does your current work using lottery incentives seek to answer?
Our recently-funded Roybal field study compared different types of incentives for flu vaccination. Some university employees were offered a $5 gift card for getting vaccinated (a direct incentive). Others were offered a $5 gift card for answering a few quick questions after they got vaccinated (an indirect incentive). A control group was not offered any incentive. Even though both the direct and indirect incentive groups received the gift card only after vaccinating, we predicted that the indirect incentive would be more effective in motivating vaccination because participants would not view it as payment for a behavior they should be doing anyway and because the payment for effort ratio would seem more appealing ($5 for just a few questions). The objective vaccination rates in the three study groups, however, was essentially identical (about 18% in each of the three groups).

Do you think your work on vaccine uptake could be useful in the context of this year’s difficult flu season? 
The 2017-18 flu season has been challenging because the flu vaccine was not very effective. This posed difficulties in convincing individuals to vaccinate this year (although the vaccine was less effective than typical, it was still more effective than not vaccinating), and it may have repercussions that continue into subsequent years. One feature of behavioral economics interventions for behavior change (e.g, health defaults or incentives) is that the effects are often short-lived -- once the intervention is removed, the behavior change does not persist. At the same time, there is every reason to expect that these types of interventions would be just as effective next year (following this year's difficult flu season) as they would in any other year.
Are there other kinds of behavioral economic approaches that you think would be worth investigating specifically to motivate flu vaccine uptake?
My collaborators Noel Brewer, Alexander Rothman, Julie Leask, and Allison Kemp, and I published a paper "Increasing Vaccination: Putting Psychological Science Into Action, " in which we review the interventions that have the most empirical support for increasing vaccination uptake and conclude that, surprisingly, the strongest evidence supports impacting vaccination directly by leveraging, but not trying to change, what people think and feel. Specifically, the most effective vaccination interventions build on the favorable intentions that people already have, employing behavioral strategies to:
-          Facilitate action by providing patients with reminders and prompts
-          Reduce barriers by setting default orders and appointments
-          Shape behavior by developing incentives, sanctions, and requirements
This conclusion is quite consistent with behavioral economics research and the type of interventions often researched at CHIBE.
New Publications

The Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania conducts behavioral economics research aimed at reducing the disease burden from major U.S. public health problems. Originally founded within the Leonard Davis Institute of Health Economics , our mission is to inform health policy, improve healthcare delivery and increase healthy behavior.
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