Dr. Alison Buttenheim is a professor in the Department of Family and Community Health at Penn Nursing and in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine. She also serves as Penn LDI’s Director of Engagement. 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 Scientific Director, Center for Health Incentives and Behavioral Economics (CHIBE), 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.
HIV testing coverage in sub-Saharan Africa is lower among men than women. We investigated the impact of a peer-delivered U = U (undetectable equals untransmittable) message on men’s HIV testing uptake through a cluster randomized trial with individual mobile clinic days as a unit of randomisation.
On standard of care (SOC) days, peer promoters informed men about the availability of HIV testing at the mobile clinic. On intervention days, peer promoters delivered U = U messages. We used logistic regression adjusting for mobile clinic location, clustering by study day, to determine the percentage of invited men who tested for HIV at the mobile clinic.
Peer promoters delivered 1048 invitations over 12 days. In the SOC group, 68 (13%) of 544 men invited tested for HIV (3, 4.4% HIV-positive). In the U = U group, 112 (22%) of 504 men invited tested for HIV (7, 6.3% HIV-positive). Men in the U = U group had greater odds of testing for HIV (adjusted odds ratio = 1.89, 95% CI 1.21-2.95; p = 0.01).
Tailored, peer-delivered messages that explain the benefits of HIV treatment in reducing HIV transmission can increase men’s HIV testing uptake.
(September 2019). A behavioral design approach to improving a Chagas disease vector control campaign in Peru. BMC Public Health. 19(1272).
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.
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.
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.
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.