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 country settings, door-to-door campaigns remain vital for disease prevention and 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. Chagas, a devastating insect-borne disease affecting than 8 million people, is one of the principal infectious causes of morbidity and mortality in the Americas. Previous work has shown 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. The interventions include responsive scheduling with advance commitment;neighbor recruitment;and contingent group lotteries. Advance commitments and lotteries both counter present bias-the common tendency to heavily weight immediate costs and benefits relative to future ones when making decisions. Neighbor recruitment leverages the power of social norms to change behavior.
The aims of the study are to: (1) Determine the rate of participation under these three behavioral economic interventions in a vector control campaign;(2) Measure the comparative cost- effectiveness of the behavioral economic interventions;and (3) Assess the impact of each behavioral economic intervention on participation in subsequent public health campaigns. The study is uniquely positioned to both strengthen Chagas disease control efforts in the Americas, and to contribute to a general understanding of behavioral economics interventions across a wide range of health topics where uptake at the household level is critical, including bed bug control, fire safety and poisoning prevention.

Public Health Relevance

Vector-transmitted illness is common in many parts of the world, causing considerable disease burden in affected populations. Effective vector control requires high rates of household participation in campaigns to eliminate disease-carrying insects from homes. This study evaluates whether interventions informed by behavioral economics (including responsive scheduling with advance commitment, neighbor recruitment, and contingent group lotteries) can increase households participation in vector control campaigns.

National Institute of Health (NIH)
Research Project (R01)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Clark, Rebecca L
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University of Pennsylvania
Biostatistics & Other Math Sci
Schools of Medicine
United States
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