The Nudge Unit of the Ministry of Health (MOH) has produced this toolkit with the technical support of the World Bank. This paper opens with an overview of the application of behavioral science to public health policy, followed by a description of the IDEA framework.
A New Approach to Health Policy
This document will help behavioral science professionals in public health identify, diagnose, design, and implement behavioral interventions that contribute to a health plan. Public health is increasingly incorporating behavioral science into a variety of health outcomes to address pressing challenges.
The Behavioral Approach – IDEA Framework
At the World Bank, the Mind, Behavior, and Development Unit (eMBeD) leverages behavioral science to achieve its core goals of ending global poverty and increasing equality. Following the 2015 World Development Report on Mind, Society, and Behavior, 3 behavioral sciences were integrated into the design and implementation of World Bank projects.
Navigating the Toolkit
The following sections provide a detailed overview of the process, its steps and the respective recommended tools. This person also develops and supports the engagements with relevant stakeholders throughout the phases of the project.
Identifying and Defining Problems
Activities
At the end of Activity 1.4, you should have a list of assumptions about structural and behavioral barriers. At the end of Activity 1.6, you should have data and statistics about the challenge, the policy map, and information with evidence from the literature on the policy challenge.
Tools
Thirty percent of the population had a distorted view of their high cholesterol levels, with most underestimating their own risk while overestimating the risk of others. It focuses exclusively on describing the characteristics of stakeholders8 and helps uncover their interests and assess their influence on the problem at hand, looking at the three levels of influencing stakeholders: individual, community and organizational levels. Civil society is an important sector to take into account if the community or consumers are directly interested in the policy.
The policy map provides a visual depiction of the regulatory framework around policy challenges, including legislation, policies, regulations, and programs or projects to address them. Develop a template for the policy map by specifying critical information (eg, time frame, institution, description of objectives). In Saudi Arabia, a policy map helps identify all laws and regulations related to organ donation.
And it sets the stage for any data collection that will take place as part of the diagnostics (eg which region or time of year has the highest or lowest vaccination rates). Segment by population group to understand if there are differences in behavior/outcome associated with a particular group (ie, disaggregate by gender/region/etc. using crosstabs). A study by Christakis and Fowler (2007) followed more than 12,000 individuals over more than 30 years and found clear evidence of the spread of obesity through social ties.
Deep-Diving and Diagnosing Behavioral Barriers
Human-centered methods use the perspective of the target population to introduce a more realistic representation of the analysis. This activity outlines each step in the process people must follow to arrive at the desired behavior. In itself, this activity will expand the understanding of the problem from multidimensional perspectives, deepen and narrow the behavioral analysis.
This selection tends to be subjective, but can be informed by the relevance of the barrier. Also known as user journey or process flow, a behavioral process map provides a visual representation of each step in the decision-making process that leads to the behavior of interest and potential barriers from the perspective of the target population. Define a starting point of the decision-making process from the perspective of the target population (2 on Figure 2).
He does not know how to hand over the results of the analysis to the attending physician. 13 Based on the health policy challenge and context, the characteristics of the participants in each group are identified (for certain types of healthcare). Make a one-page note with research questions you can try to answer and details the process (requirements, steps, duration, number and type of interactions, language and style to use with the target group, paperwork) and the location and environment (remoteness , participant comfort, visual aids, availability of necessary resources and materials).
Surveys
Designing and Experimenting solutions 1. Activities
Thanks to the problem definition stage and the behavioral process map, you get a clearer understanding of the target group or population. The outcome variable must be measurable and identifiable so that the effect of the trial can be tested. At the end of activity 3.2, you should have a clear definition of the experiment goal and objective.
Although context matters, this exercise will provide critical insights and ideas for designing the specifics of the intervention. If randomization is not possible, there are other experimental and quasi-experimental techniques to isolate the effect of the intervention (See Tool L: Experimental design and Tool M: Quasi-experimental design). Pilot studies, like trial versions of the actual full study, help identify areas for improvement in design, process, measurement, and other aspects of the experiment.
Also, the participants or target audience that participated in the pilot study should not be considered part of the larger/actual experiment (Table 11). The experiment is carried out in this activity with close monitoring of data collection and research implementation. At the end of activity 3.8, you should have logs of monitoring and quality checks performed during implementation.
Tool k: co-creation design worksheet
Assessment: Feasibility and scalability
After you have finished analyzing the data and measured the effect of your intervention, you can perform other activities to determine whether and how to expand the intervention to other populations. Avoid such an outcome by performing heterogeneity checks, contrast your findings with other research that tested a similar intervention, and determine with peers and colleagues whether the intervention's results are likely to be replicated when grown. At the end of Activity 4.1, you should have decided whether the results of the intervention are generalizable to a larger population.
At the end of activity 4.2, you would have created a store of lessons learned and established which parts of the intervention need to be adapted for successful scale-up. At the end of activity 4.3 you should have a measurement and a comparison of your intervention's value for money. Considerations around budget, infrastructure, staff capacity and political will are essential to ensure proper scale-up and sustainability in time for the intervention.
At the end of activity 4.4, you should have mapped what kind of resources you possess to scale up and sustain the intervention in time. If you have determined that the intervention is generalizable to a wider population, that it is cost-effective, and that you have the necessary resources for successful scale-up and continuity, then you can develop recommendations, guidelines, and plans based on the evidence generated. . At the end of activity 4.4, you should have a roadmap for how to implement your intervention at scale.
Designing and Experimenting solutions
The main suggested behavioral strategies contained in the behavior map are to prepare the environment and create constant supervision. In addition, we proposed recruiting patients to remind healthcare professionals to perform hand hygiene as a way to reinforce the desired behavior. Hand hygiene is an ongoing problem in hospital care and we still need effective ways to improve it.
There are likely to be more costly approaches to forcing greater compliance with WHO hand hygiene guidelines, but evidence from behavioral science suggests that HCWs can potentially be nudged toward compliance by interventions. at a lower cost. Future experiments may focus on testing more attractive visual cues, as well as ways to train observers and collect data more reliably. This toolkit was an effort led by the Nudge Unit of the Ministry of Health (MOH) of Saudi Arabia and technical support from the World Bank.
It is intended to guide behavioral science practitioners, especially those in public health and other sectors, in identifying, diagnosing, planning, and implementing behavioral interventions. Aiming to shift behavioral science from an ad hoc and opportunistic response to policy problems to something systematically applied in programming and operations, this toolkit is available to all audiences for public use. The toolkit will be a key instrument for HNT in the Kingdom of Saudi Arabia to further expand the use of behavioral insights to address public health challenges.
Internal Flowchart to Prioritize Policy challenges at the HNT
2019 Testing the effectiveness of visual cues on healthcare workers' adherence to hand hygiene guidelines. Electronically from the national booking system Reminders The number of parents who have booked an appointment for their children at the student health screening clinics. 2021 To examine the effectiveness of the standard setting in children's attendance at well-baby clinics.
Patients were asked to tick the following three statements: (1) "I agree to my next virtual clinic visit", (2) "I will be notified of the date and time of my virtual visit" and (3) "I will attend my virtual appointment using the 'Sehhaty' app." Effect of segregation on food consumption: a randomized controlled trial 2022 To test the effectiveness of segregation on food consumption. Main Results of Promotion Strategy (*sig) 2019 To test the effectiveness of visual cues on health care workers' compliance with hand hygiene guidelines. 18% increase in intervention group* 2021 To examine the effectiveness of reminders to increase use of screening clinics.
9.4% increase post-intervention* 2021 To examine the efficacy of the default option in children's attendance at child welfare clinics. 17.6% improvement* 2021 To examine the effectiveness of five frameworks in encouraging citizens to receive the COVID-19 vaccine. Elicit the strategy of key outcomes (* sg) “I agree to have my next virtual clinic appointment”, (2) “I will be informed of the date and time of my virtual appointment”, and (3) “I will attend my virtual dating using 'Sehhaty' app.” 2022 To test the efficiency of partitioning in food consumption.
