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Remote work is here to stay

In response to the global COVID-19 pandemic, around March 2020, most companies across the U.S. required their office-based employees to work from home. While this shift provided new opportunities such as collaborations across time zones and allowing for flexible work hours, it also meant a drastic change for millions of employees. The boundary between work and life has become blurred and routines disrupted. 

Prior to the pandemic, there had been much concern over the lack of physical activity in the workplace. Shoulder stiffness, back pain, headaches — these are all common ailments resulting from prolonged sitting. Whereas the change in environment from office to home might bring the potential for positive changes in health behaviors, recent work suggests that those reporting working from home are in fact sitting more.

While many employees are starting to return to their physical offices, remote work is here to stay. Not only have employees voiced their preference of working from home at least a few times per week, many employers have either granted full choice with regards to work location or adopted a hybrid model. Therefore, it is important to find ways in which we can help this new and growing population of “hybrid-workers” reduce their sedentary behavior patterns and encourage more physical activity.

Surveying experts on remote work

Traditionally, efforts to encourage an active lifestyle among employees have relied on (mostly) in-person occupational health and wellness programs. While those are not only expensive, but also difficult to expand to the home environment of employees, we need to find new ways to effectively reach employees regardless of their work location.  

In a very real sense, most office workers are now experiencing a work environment that is very similar to that of the average MTurker.  

Yet, in order to generate ways to improve healthy work behaviors at home, we first need to understand employees’ environment and habits while working from home. Instead of surveying employees newly transitioned from the office to their home environment, we are able to draw upon results from a large survey that we distributed among Amazon Mechanical Turk (MTurk) workers who are experienced with working from home — they are individuals who do online tasks (like research studies or consumer surveys) from their personal computers. In a very real sense, most office workers are now experiencing a work environment that is very similar to that of the average MTurker.  

Thus, by surveying MTurkers, we gained valuable insights from their work experience that we can extrapolate to office-based employees now faced with a reality of a hybrid work model. 

Understanding the work environment 

The research was conducted between December 2019 and April 2020, and included over 2,000 MTurk workers between 20 and 77 years of age. The majority of respondents use MTurk for part-time work for approximately 11-20 hours per week, which equals to 2-3 hours per day, assuming a 5-day work week.  

When asked about their current working location, over 75% of participants reported that they are currently located at home, confirming that most MTurkers were already working from home pre-pandemic and thus are a valid population to draw inference from. 

Just like most other office-based employees, surveyed MTurkers all work on desktop or laptop computers. Almost all of the MTurkers indicated that they at least have some space to move around. This information is particularly important as it points out that employees do not face environmental constraints, but other constraints (most likely psychological constraints) that prevent them from moving sufficiently during the work day. 

Sedentary and break behaviors

On average, MTurkers spent approximately 5 and a half hours sitting during their workday. When zooming in on the average time different age groups spent sitting during the day, we found that younger adults tended to sit longer and the time spent sitting generally decreased as age increases.

Based on current activity guidelines, it is recommended to break-up sitting and to stand up and move around once every 30 – 60 minutes. From our study results, around 70% of the respondents self-report to adhere to this guideline.

When asking about the types of breaks MTurkers usually take, most of them had to do with meeting basic physical needs such as using the bathroom, or getting water and/or food. Only about 15% of the participants took breaks to go on a walk. Also, only one in four of the participants were actively aware of the health benefits of taking breaks.

Summary

The MTurk workforce provided us with a lot of insights into their work environment and habits while working from home, which we can use to inform future interventions to improve physical activity levels in all desk-based employees now confronted with the reality of a hybrid work model. 

While MTurk workers do have enough space to allow for movement, such as stretching, many do not break up their sitting bouts enough, which is particularly problematic among the younger workforce. When sitting is interrupted, it is mostly for physical needs; only few people use their break time to walk or engage in exercise, and only one-fourth of the participants were aware of the health benefits of taking breaks. 

Particularly striking is the fact that slightly more than 25% of participants reported spending time on the Internet when taking a break from their work, while only about 15% reported using that time to go on a walk. Whereas social media is certainly entertaining, there are ways in which we can transform that break into a healthier one: Break-up sitting and stand-up while scrolling through Facebook or imitating the latest dance on TikTok (just make sure you do it in a safe place where you can be distracted!)  

Particularly striking is the fact that slightly more than 25% of participants reported spending time on the Internet when taking a break from their work, while only about 15% reported using that time to go on a walk.

By making a connection between behaviors – social media use and standing up – we can piggy-back on existing habits to add a new, healthy behavior. If you get some water, use this time to go on a short walk. Any time you open social media, use that as a reminder to stand-up and stretch. These connections are also referred to as implementation intentions — the act of forming “if-then” plans, stating that if a certain situation occurs (e.g. if I’m taking a phone call), then I will respond in a certain way (e.g. then I will stand-up and walk around). Thus, implementation intentions help us remember to complete an activity by associating it with a typical daily habit. 

The other benefit of forming implementation intentions is that they are not environment dependent, meaning that they are ideal for employees working in the physical office some days of the week, and at home on other days. 

In addition to implementation intentions, other research we have conducted has shown that novel reminders to break up a work task can be effective in encouraging people to stand-up. Our research has shown that up to 86.8% of message recipients indeed follow the advice to break-up their sitting by taking a short break standing up. 

As many of us continue working from home or change to a part-time home/work schedule, it is important to develop habits of getting up and moving around periodically, regardless of where we are. Forming implementation intentions as well as thinking of novel and creative ways to remind colleagues or ourselves to stand up more frequently, are promising avenues to combat a lack of physical activity in the workplace. 

The post Helping Remote Employees Towards a Healthier Lifestyle Some Insights from MTurkers appeared first on Center for Advanced Hindsight.

(Image Credit: WABE.org)

As March comes to close, we feel like it is appropriate to look back at Women’s History Month by celebrating influential women in the social sciences. It started in 1978 as a week celebration in Santa Rosa, California by the Education Task Force of the Sonoma County Commission. Today, it’s a national annual celebration due to its importance and popularity. Given that we live in a patriarchal society, it’s easy for women and their contributions to be easily overlooked or diminished. Therefore, it’s important for women’s achievements, leadership, courage, and strength to be given a space to be recognized and celebrated as much as men’s. Women’s History Month is used as a month to celebrate the accomplishments that women contributed to American history. These accomplishments can be seen in every aspect of American life. 

Women in social science have affected much of the modern world, including the way we approach ­research here at The Center for Advanced Hindsight. At our lab, our goal is to use behavioral science to make people happier, healthier, and wealthier. We would like to highlight a few among many women that have contributed in a way that reflects our goal. These women are Mamie Phipps Clark and Gertrude Cox.

Mamie Phipps Clark

Mamie Phipps Clark was born on October 18, 1917. She received her Bachelor’s and Master’s degrees in Psychology from Howard University. Mamie Clark is known for studying the development of self-consciousness in African American children. It all started with her master’s thesis, “The Development of Consciousness in Negro Pre-School Children.” This study consisted of Mamie showing young Black children two identical dolls, with the exception of one doll being White and the other being Black. The children were asked a series of questions pertaining to which doll they wanted to play with, which one was nice, and which doll looked like them. Her study showed that the majority of the Black children preferred to play with the White doll, stated that the white doll was nicer, and that it resembled them the most. She later met her husband, Kenneth Clark, and they continued this line of work together. Their findings indicate that Black children become aware of their racial identity around three years old and that segregation can have a negative effect on one’s self-image.

This research was so significant that it played a major role in the Brown vs Board of Education case. This court case argued to end racial segregation in schools. Clark’s study was used in this argument to show that segregation had harmful effects on children, and it was instrumental in the Supreme Court’s ruling that racial segregation in U.S schools was unconstitutional. In all, Mamie Clark’s work has paved the way for society to understand self-concept among minorities.

Mamie’s Clark work is important because it enables us to understand the mental well-being among minorities and how society can influence or affect it. Check out these scientists below to see how they are currently contributing to our understanding of racial identity among minorities: Erin Cooley of Colgate University, Carla Hunter of The University of Illinois, and Janet Helms of Boston College.

Gertrude Cox

Gertrude Cox was born on January 13, 1900. She received a Bachelor’s degree in Mathematics and Master’s degree in Statistics from Iowa State. Gertrude Cox is known for an array of accomplishments. For example, she founded one of the first statistics departments at North Carolina State College (later renamed North Carolina State University) in 1941. Years later, she became the first woman to be elected to the International Statistical Institute (1949). In 1950, she co-authored one of the most well-known statistical books, Experimental Designs.

In this book, Cox emphasized that researchers should be involved in all aspects of research; from the planning stages to analyzing the data to randomizing when possible. Also, she pioneered the use of blocks. Blocks are essentially similar groups within a study (e.g., grouping by gender). Randomizing within a block helps to remove variability. Today, Cox’s book is still in print, and her principles are continued to be used among scientists.

Cox’s work is important because she paved the way for women to be in roles that women had not previously inhabited. Being a pioneer in this respect allowed Cox to use her strengths to promote the use of statistics and build a statistical empire. For example, Cox played a major role in funding the Research Triangle Institute (RTI) in North Carolina. RTI’s goal is to improve the human condition through science-based solutions. Today, RTI has more than 25 offices across the United States. Check out more about RTI here.

Mamie Phipps Clark and Gertrude Cox are among many that have broken barriers to conduct research that has paved the way for modern society. As humans, we tend to not like change and continue with the way things currently are (i.e., status quo). However, Mamie Phipps Clark, Gertrude Cox, and others challenged this status quo despite facing discrimination and many obstacles. They used their intelligence in a way that has paved the way for all in the science realm. Though our list doesn’t represent all women in the social science field, one should interpret this blog as a stepping stone to uncover more fascinating women that have broken many barriers in this field.

Shanta Ricks is a researcher at the Center for Advanced Hindsight at Duke University, an applied behavioral science research lab that helps people be happier, healthier, and wealthier. You can reach her at shanta.ricks@duke.edu

References

Notices of the American Mathematical Society, Volume 66, Number 3, Retrieved from https://www.ams.org/journals/notices/201903/rnoti-p317.pdf  

Retrieved from https://encyclopediaofarkansas.net/entries/mamie-katherine-phipps-clark-2938/

Retrieved from https://womenshistorymonth.gov/about/ 

Retrieved from : https://www.lib.ncsu.edu/archivedexhibits/cox/career.html 

The post Breaking the Status Quo: Women who changed Science appeared first on Center for Advanced Hindsight.

First, a little about our partner. Centene is a diverse, multi-national healthcare enterprise which works with government sponsored healthcare programs, focusing on under-insured and uninsured individuals, to provide a wide range of services and health insurance coverage. Since its inception in 1984, Centene has grown to become a Fortune 500 company that services 32 states in the US and 3 international markets, managing care for over 15 million members. Check out Centene’s Facebook page if you want to learn more about their initiatives. As part of their innovative mission, Centene has partnered with the Center for Advanced Hindsight (CAH) to utilize behavioral science techniques to continue improving their services for the health and wellbeing of their members.  

The goal of Centene’s visit to CAH was to get a glimpse of how we conduct research using the principles of behavioral science and to share ideas that align with their research interests going forward in order to maximize impact. To this end, we created two days of talks, activities, and discussions around some of the research we’ve conducted, highlighting major factors that contribute to health-related behaviors and some of the difficulties people face when making decisions about their health. 

 The visit began with Dan Ariely, a founder of the Center for Advanced Hindsight, and Professor of Psychology and Behavioral Economics at Duke University, providing an overview of behavioral economics and the science behind behavior change. Dan discussed the two main concepts of friction and fuel, and how these two forces interact in one’s environment to affect the likelihood of engaging in any specific health behavior. As an example, friction is anything that makes a behavior, like eating healthy, more difficult to do. Friction can manifest in many ways, like not having the healthy foods at eye level in the refrigerator, or not having those foods already prepared and ready for consumption. By removing friction associated with engaging in healthy behaviors, while also increasing friction associated with unhealthy habits, Dan discussed how research shows dramatic improvements in various health-related behaviors. In discussing the other main concept of fuel, which is the various ways in which we can boost health behaviors through incentives, Dan discussed reward schemes available that impact people’s success. For example, sometimes offering monetary incentives are less effective than providing social support. 

(Dan Ariely sharing his experiences with behavioral science approaches to healthcare)

After Dan’s opening talk, a few of us researchers at CAH gave presentations to discuss the various projects we were conducting that were relevant to Centene’s mission. These included both patient-side and provider-side interventions. On the patient side, our first talks provided an overview of the various digital tools for behavior change and apps for improving disease management. These are hot topics in behavioral science due to the dramatic increase in telehealth and digital health apps available in today’s market, as well as the great potential for these tools to transform the healthcare world and to reach many people who may not otherwise receive healthcare aid. 

Other talks discussed the barriers and potential solutions around getting people to adhere to taking their medications on time and as directed. Taking medication is often a reminder of illness, which can lead to avoidance. This can be counteracted by helping patients add visible reminders to their environment and having them think about how taking medication relates to larger goals, like spending time with one’s family.

Finally, we discussed some fascinating research uncovering a relatively novel concept of breaking points, which are moments in people’s lives where the stressors become too great and lead to unhealthy behaviors. Someone trying to adhere to a diet, for example, may decide to eat pizza one day when they’ve experienced a lot of stress, thereby breaking their diet behavior. These breaking points have shown to be a major contributor to overall breaks in healthy behavior goals, and can sometimes derail a person completely from their initial health plan. 

(Jenna Clark (Senior Behavioral Researcher on the Health Team) presenting breaking points research)

In addition to talks given by our behavioral scientists, Karyn Quinn, Senior Director at Centene, gave a talk covering behavioral science successes at Centene in the previous year, as well as goals for the upcoming year. The partnership between Centene and CAH focuses on three fundamental elements of care — appropriate utilization of health services, managing chronic illness, and every day health behaviors to improve mental and physical well-being. For appropriate utilization, she discussed materials meant to help decrease unnecessary Emergency Room usage by giving people the necessary information to make an informed decision while also providing them with alternate defaults to the ER (e.g., a nurse hotline or an urgent care facility.) For chronic illness, she presented work that Centene has done to encourage those with chronic illnesses to take part in their free care management phone service. Finally, she discussed how flyers that took a social norms approach to promoting the importance of flu shots (e.g., “You’d do anything to protect your baby, right? So be among the millions of moms who will get a flu shot this year.”), outperformed other flyer types. Finally, Karyn focused on future directions, aiming at a large-scale intervention to help improve physical and mental well-being.

During the workshop, we also focused on provider behavior. Two talks focused on physician behavior, demonstrating how physicians can fall prey to the same types of biases (e.g., anchoring, framing) as non-physicians, and how even though physicians have greater knowledge regarding health as compared to non-physicians, they tend to make similar decisions in the health-care context. These talks reinforced the importance of designing a healthcare environment that helps both physicians and patients avoid predictable errors in decision-making. 

We took a break from the talks to work together on an activity where we showed the Centene folks how to improve the quality and formatting of a customer feedback survey. Oftentimes, these forms can be challenging for customers to fill out, as they may ask confusing questions, or format the questions in an unnecessarily complicated way. When surveys are not constructed to be easy to read and answer, it creates friction, which inevitably reduces the likelihood that a client will complete it. We chose a form that had been used in a previous survey to edit together and, working in small groups, came up with a variety of solutions for improving the overall quality of the survey. A few things that stood out, from a behavioral science perspective, were the framing of the questions, the need for personalization wherever possible, and taking care in formatting Likert-style questions. When we finished, our new form looked like it had gotten a makeover, and everyone was energized to begin the final presentations.  

(Nina Bartmann (Senior Behavioral Researcher with the Health Team) showing how to make a good questionnaire)

After the talks for the day finished, we ended the day’s activities with a scavenger hunt where we had set up a handful of tables displaying a few hands-on interventions from previous research as well as some prototypes meant for future testing. One example of a physical intervention was an alarm clock with wheels that rolls away when the alarm goes off — forcing you to get out of bed to turn the alarm off. More recent prototypes focused on areas more relevant to Centene, such as reducing unnecessary Emergency Room visits and improving workplace health by reducing the amount of time individuals stay seated in meetings (as these interventions are still in development, we will go into more detail about these physical interventions in future blog posts).

 Although the behavioral sciences have provided us with many tools for solving big problems, these tools cannot be implemented in a vacuum. This is why it is so crucial to have partners who are willing to take the time to supply their expertise and provide a concrete context for the environments in which the problems we collectively would like to solve exist. Our workshops provide a space for these discussions to take place, where we can really zero-in on the most important problems and develop behavioral science-informed approaches to solve them.

Are you interested in the partnership on health and healthcare? Contact Becky Reeves, Senior Behavioral Researcher, at rebecca.rayburnreeves@duke.edu 

Is your organization in any other way interested in CAH Health? Contact Jan Willem Lindemans, Principal, at jan.lindemans@duke.edu

The post Behavioral Science Workshop: Working with Centene to Improve Patient Care appeared first on Center for Advanced Hindsight.

This post originally appeared on the Pattern Health blog.

The holiday season is upon us, whether you’re ready for it or not. Many people overeat in the holiday season (all those leftover treats at home, cookies in the office, how could you resist?!) And — no surprise — it shows up in our waistlines. People tend to gain weight each holiday season and on average, an additional pound lingers by the time March rolls around (Yanovski et al., 2000).

Say that, hypothetically, you’d like to avoid that seasonal gain this year. Seems like a nice long-term goal. And a good one to think about with Thanksgiving right around the corner. You might wonder what the best way is to ensure that you keep off those extra pounds.

Long-term goals are made up of many short-term goals

First, think of this long-term (or “superordinate”) goal as the outcome of a series of short-term goals (or “sub-goals”). And this isn’t unusual; any project is made up of smaller steps. Think about what it takes to plan a conference or wedding, or build a house — all these big projects are made up of smaller projects. It’s the same for your weight. To reach your long-term goal of maintaining your weight from now until the flowers start to bloom, you’ll need to succeed at a series of short-term goals; many days of healthy eating and exercise. You’ll have to avoid overeating, and exercise the recommended amount (say, a total of 150 minutes a week, or 5 days of 30-minute bouts).

So there are really two types of goals at play here. Your long-term goal, or the outcome, is to not gain weight, and your short-term goal is the behavior, or what you need to do in order to get there. But which of these types is more helpful for you to focus on as you try to reach your goals?

The post To Achieve Goals, Focus on Behavior appeared first on Center for Advanced Hindsight.

(Image credit: Vicky Tran)

Imagine something that makes you excited to get out of bed and start your day. It guides your everyday behaviors and gives your life a sense of meaning and security. This “something” is called purpose. When someone has a purpose, they have life-long goals that are meaningful to them and are motivated to engage in activities that align with these goals. Purpose can be different for each person. For example, purpose can come from one’s religion, job, personal achievements, leisure activities, or relationships. Regardless of the source, researchers are beginning to take notice of purpose and how it not only influences our everyday decisions but the decisions when it comes to our health as well.

When people act in accordance with their purpose, they tend to do well within their day-to-day lives. They report eating healthier (1), exercising (2), and taking advantage of preventative health care services (3). When it’s time for a good night’s rest, those with purpose tend to report fewer sleep disturbances and being more relaxed (4). Beyond the way purpose influences our day-to-day activities, those with a purposeful life tend to have lower risks for strokes (5), Alzheimer’s and cardiovascular diseases (6). They also tend to live longer! (7)

Considering that purpose is associated with positive health outcomes, researchers are now testing hypotheses for why this relationship exists (e.g., mechanisms). Purpose in life is likely to lead to positive health behaviors because maintaining a healthy lifestyle is likely to be an important component to carrying out one’s purpose. Thus, one with purpose develops a positive orientation towards their health (8) and becomes invested in their health (9). Since one’s health becomes a priority, the individual experiences less conflict (10) when it comes to choosing between engaging in a healthy behavior or a conflicting unhealthy behavior.

Purpose may also operate by making barriers to achieving one’s goals appear less daunting. A recent paper by Burrow, Patrick, and Sumner (2018) (11) demonstrated that when asked to estimate the steepness of a hill and the amount of effort needed to ascend, individuals who scored higher on a measure of purpose had a smaller relationship between overestimation of steepness and amount of effort needed to climb. Burrow et al. also experimentally manipulated the salience of one’s purpose by having some participants write about their purpose while others wrote about the last movie they saw. Those who wrote about purpose also demonstrated a decoupling between overestimation of the slope and effort. These results suggest that if you want to motivate yourself to get healthier, don’t just consider the immediate benefits of a healthy lifestyle, but also think about how your health contributes toward achieving your overall purpose. In couching smaller health goals in the context of your larger purpose, you may just discover that those health challenges that you once saw as impossibly steep mountains may begin to appear more manageable.

Apart from the motivational elements of purpose, the skills one uses when living their purpose can also contribute to a healthy lifestyle. When an individual has a strong sense of purpose, they use their skills and talents to engage in easy or hard activities that align with their purpose. For the difficult activities, the individual is building self-efficacy (e.g., one’s belief that they can successfully tackle a challenge by using their skills and talent) while engaging in these activities. For example, let’s say someone’s purpose is to be a school teacher. This purpose helps them organize their life around goals associated with achieving their purpose. So along with planning for their next week of lessons, they will also feel empowered to tackle other challenges, like planning their week’s activities in a way that allows them to get enough sleep and exercise.

Currently, the majority of the research on purpose in life and health is correlational so we cannot be sure whether having purpose leads to a healthier lifestyle or if it is the other way around. The good news is that here at the Center for Advanced Hindsight, we are currently exploring whether there’s a causal relationship between purpose in life and health behaviors. We will do so by first understanding how to increase purpose in life. Research has shown that feeling like you belong (12), being in a positive mood (13), engaging in prosocial behavior (14), and having a cohesive narrative about one’s life (15) can increase one’s purpose in life. What all of these variables have in common is the feeling of self-transcendence (e.g., contributing or being apart of something larger than the self). As humans, we all have a biological need of wanting social relationships. One way of feeling belonged to a group is to engage in prosocial behaviors (e.g., donating or giving lunch to the homeless). When someone engages in these activities, they are putting their needs to the side and are influencing others lives in a positive manner. In effect, this may put the individual in a good mood because they know that they are changing someone’s life for the better. We are currently running studies to integrate these methods of increasing purpose in life by exploring self-transcendence values effects on purpose in order to foster positive health behaviors.

We hypothesize that those who reflected and wrote about self-transcendence values will report higher purpose in life and greater intentions to exercise.

We are testing whether values will increase one’s sense of purpose by having participants either write about the importance of self-transcendence values (helping others) or non-self transcendence values (activities aim at focusing on the self). Participants in the control condition will complete the same task as the treatment groups but instead their writing task will focus on writing about factors that influence the weather and how they influence the weather. Participants will then complete a few scales assessing their purpose in life and intentions to exercise within the next month. We hypothesize that those who reflected and wrote about self-transcendence values will report higher purpose in life and greater intentions to exercise. We suspect that self-transcendence values will enable the individual to understand that they are a part of and contributing to something that is bigger than the self. Therefore, these individuals will engage in positive health behaviors in order to further contribute to something beyond their needs. Besides increasing purpose through values we also plan to design studies to further increase purpose in life through goal setting and social inclusion.

As mentioned, we are not only finding additional ways to increase purpose in life but we are also incorporating questions that will assess one’s intent to exercise. Previous research has successfully increase purpose in life but unfortunately there aren’t any studies that measures one’s intent to engage in health behaviors as an outcome of having a higher purpose . We intend to fill this research gap and if we find a causal relationship between purpose in life and health behaviors, our next step includes understanding the mechanism between this relationship.

Current research on purpose and health has shown promising results. There is still much work to be done — purpose is deeply personal, expansive, multi-faceted, and abstract. However, these things that make purpose such a challenging area of research are also the things that make it such an important one. Purpose provides clarity, meaning, and direction for our lives. It may help us to see obstacles as surmountable. Rather than intervening at the level of individual health behaviors, we may see a bigger benefit in putting the work in to build (and support) environments that foster purpose.

Check out the infographic below that provides a brief summary of the purpose in life and health research.

Shanta Ricks is a researcher at the Center for Advanced Hindsight at Duke University, an applied behavioral science research lab that helps people be happier, healthier, and wealthier. You can reach her at shanta.ricks@duke.edu

Is your organization in any other way interested in health research with CAH? Contact Jan Willem Lindemans, Principal, at jan.lindemans@duke.edu.

References:

(1) Steger, M. F., Fitch-Martin, A., Donnelly, J., & Rickard, K. M. (2014). Meaning in life and health: Proactive health orientation links meaning in life to health variables among American undergraduates. Journal of Happiness Studies, 58(3), 583–597.

(2) Hooker, S. A., & Masters, K. S. (2016b). Purpose in life is associated with physical activity measured by accelerometer. Journal of Health Psychology, 21, 962–971.

(3) Kim  E.S., Strecher, V.J, Ryff, C.D. (2014). Purpose in life and use of preventive health care services.  Proc Natl Acad Sci U S A, 111, 16331-16336

(4) Kim  E.S, Hershner, S.D, Strecher, V.J. (2015).Purpose in life and incidence of sleep disturbances.  J Behav Med, 38,:590-597

(5) Kim  E.S., Sun, J.K., Park, N., Peterson, C. (2013). Purpose in life and reduced incidence of stroke in older adults: “The Health and Retirement Study”.  J Psychosom Res, 74, 427-432

(6) Czekierda, K., Banik, A., Park, C. L., & Luszczynska, A. (2017). Meaning in life and physical health: Systematic review and meta-analysis. Health Psychology Review, 11, 387-418

(7) Czekierda, K., Banik, A., Park, C. L., & Luszczynska, A. (2017). Meaning in life and physical health: Systematic review and meta-analysis. Health Psychology Review, 11, 387-418

(8) Steger, M. F., Fitch-Martin, A., Donnelly, J., & Rickard, K. M. (2014). Meaning in life and health: Proactive health orientation links meaning in life to health variables among American undergraduates. Journal of Happiness Studies, 58(3), 583–597.

(9) Holahan, C., Holahan, C., Velasquez, K., Jung, S., North, R., Pahl, S. (2011). Purposiveness and leisure-time physical activity in women in early midlife. Women and Health, 51, 661-675

(10)  Kang, Y., Strecher, V.J., Kim, E., & Falk, E.B. (2019). Purpose in life and conflict-related neural responses during health decision-making. Health Psychology, 38, 545-552

(11) Burrow, A. L., Hill, P. L., & Sumner, R. (2016). Leveling mountains: Purpose attenuates links between perceptions of effort and steepness. Personality and Social Psychology Bulletin, 42(1), 94–103

(12) Lambert, N. M., Stillman, T. F., Hicks, J. A., Kamble, S., Baumeister, R. F., & Fincham, F. D. (2013). To belong is to matter: Sense of Belonging enhances meaning in life. Personality and Social Psychology in Bulletin, 39. 1418-1427.

(13) Hicks, J. A., & King, L. A., Krull, J.L., & Del Gaiso, A.K.(2006). Positive affect and the experience of meaning in life. Journal of Personality and Social psychology, 9-, 176-179

(14) Tongeren, D. R. V., Green, J. D., Davis, D. E., Hook, J. N., and Hulsey, T. L. (2016). Prosociality enhances meaning in life. J. Posit. Psychol. 11, 225–236.

(15) Chippendale, T., & Boltz, M. (2015). Living Legends: Effectiveness of a program to enhance sense of purpose and meaning in life among community-dwelling older adults. American Journal of Occupational Therapy, 69(4), 1-11.

The post Unlocking a Healthy Lifestyle: Purpose in Life as a Key appeared first on Center for Advanced Hindsight.

CAH’s World team is very excited to announce its newest partnership with Zilveren Kruis. With 5 million insured persons in The Netherlands, Zilveren Kruis is not only the largest health insurance company of the Netherlands but also of Europe as a whole.

To kick off this new collaboration, Dan Ariely and researchers of CAH’s World team conducted a workshop with Zilveren Kruis in the Netherlands on January 11th, 2019 to introduce behavioral economics principles and to brainstorm about areas where Zilveren Kruis can leverage behavioral economics to improve health and vitality in the workplace. These workplaces are interesting labs for research: it is an environment which can be changed and controlled quite well and there are social groups who can stimulate each other.

Programs aimed at improving health have traditionally intervened in people’s lives by providing information and education. On the whole, these programs have been ineffective at helping people make better health decisions. Therefore, most behavioral scientists agree that an increase in knowledge alone doesn’t change behavior. Instead, many behavioral scientists believe that behavior change happens as a result of a change in people’s environments.

Using the three B’s approach – identify key Behaviors, then reduce Barriers and amplify Benefits – workshop attendees were introduced to the behavior mapping exercise.

Step 1: Identify “key behaviors”
When we’re trying to change user behavior, we need to get very specific about the exact behaviors we want our users to perform. These “key behaviors” are the actions the ideal user would take. This is where the behavioral map comes into the picture. We listed key behaviors at the top of the behavioral map in the workshop. Key behaviors are not general behaviors which are hardly actionable like eating better. Rather, they are specific behaviors, such as eating a healthy lunch.

Step 2: Identify barriers
To build the map, the attendees of the workshop where challenged to visualize the users’ daily routine and think about whether there are barriers that would prevent users from performing any of the key behaviors. These barriers are written on post-it notes and placed under the relevant key behavior. After placing all of the barriers on the map, one needs to consolidate and classify each barrier as either “social” or “individual”. For example, a lack of proper footwear (e.g., high heels) is an individual barrier, whereas having colleagues who don’t walk is a social barrier.

Step 3: Identify potential interventions

Next, one needs to identify ways to eliminate all possible sources of friction and ways to encourage the desired behaviors. Attendees leveraged newly learned principles like loss aversion, social proof, self-herding etc. and created a list of potential interventions for testing.

Step 4: Test

The goal of the mapping process is to identify:

1. areas where you need to gather further evidence
2. areas where you are ready to run an experiment
3. areas where you are ready to apply ideas to product development

During the workshop, behavior maps were developed for three target health behaviors: taking 20-minute naps, eating healthy lunches, and going on lunch walks. Participants learned to appreciate the importance of being specific, concrete and detailed when attempting to encourage desired behaviors. After the behavioral mapping exercise, each mapping group presented the primary barriers and proposed interventions to Dan Ariely and the CAH team. We were impressed by the workshop attendees’ insights.

One of the proposed interventions aimed to overcome the negative connotations of napping at work. The concept was nappiness, a combination of napping and happiness. Nappiness would include a scheduled midday resting period for all employees. Relaxing music, horizontal chairs, dimmed lights, and blankets would provide additional comfort, communicating that midday napping is not only normal, but expected.

When it comes to preparing healthy lunches, a lack of time seems to be the main barrier. One group proposed a buddy system to overcome this barrier. Employees would pair up and take turns preparing a healthy lunch for themselves and their buddy. Hence, the buddy system not only overcomes the barrier of limited time , but it also creates accountability: If you don’t prepare a lunch, your buddy will have to go hungry that day.

Another group made use of a public leaderboard to encourage regular lunch walks. Employees would place a sticker on the leaderboard each time they take a walk. In addition, team managers should invite their team for lunch walks to signal the importance of these walks.

Two key lessons that we recommend everyone keeps in mind when mapping their own behavior journey are:

1. Do not put all of your faith in logic, reason, and providing information. Most things in life are more difficult than they appear. People are more triggered by what they feel and see than by facts.
2. There are individual and social elements to behaviors and their corresponding barriers and benefits. These often need different approaches.

Overall, it was a highly successful workshop. We are very excited to start this new collaboration with Zilveren Kruis in creating sustainable health behavior change to improve health and vitality in the workplace. Stay tuned for updates on our upcoming field experiments!

Are you interested in this partnership? Contact Nina Bartmann, researcher and Zilveren Kruis Partnership Lead at the Center for Advanced Hindsight at Duke University, an applied behavioral science research lab that helps people be happier, healthier, and wealthier. You can reach her at nina.bartmann@duke.edu.

Is your organization interested in CAH World? Contact Jan Lindemans, Principal of CAH World, jan.lindemans@duke.edu.

The post Happiness + Naps = Nappiness! appeared first on Center for Advanced Hindsight.

By Aline Holzwarth

I recently had a friction-filled experience when I tried to make an appointment for a routine physical exam. It’s been a while since I’ve had my annual exam, as my previous doctor moved away in 2015 and I haven’t gotten it together enough to find a new primary care physician. (I know! Shame on me.) Finally I had a few extra hours this past weekend, and instead of using them to catch up on email I decided to take care of my preventive health needs.

So I launched myself into the research stage. I downloaded an app (very popular, highly rated, I’m sure you’ve heard of it) that provided me with information that could only be completely inaccurate (locating no doctors within 20 miles or so, despite the fact that I live in an area densely packed with medical care).

I turned to google to ask how to find a doctor, which pulled up a nifty “Find a Doctor” page. But with every answer came a new question, and I quickly found myself flooded with a deluge of information to compare but no great way to compare it. I resisted making a spreadsheet and instead opened up browser tabs for the eligible doctors, starting with 39 physicians and ultimately narrowing down to only three. To narrow my search down to three, I had to figure out where the various doctor’s offices are and how close they are to my work and home, whether their hours accommodate a 9-to-5 working schedule with night and weekend availability (none do), whether they take my insurance (surprisingly difficult to confirm), whether the cost is any different to go to a family medicine center near my house (I’m still not entirely sure), what the difference is between internal and family medicine (not much, I think?), and which physician is best for my particular needs.

By the time I had narrowed my options down to three doctors, I was exhausted and ready to quit. So I watched the short videos taken of each physician and chose the one who mentioned her collaborative problem-solving approach with patients. But mostly, she seemed nice. Note: Sometime in the future we should talk about System 1 decision-making.

Ready to get this over with and return to my weekend chores, I moved on to the action stage. Now all I had to do was make an appointment with my chosen physician. New questions arrived: First, of course, How do I make an appointment? Can I do it online immediately, or do I have to call someone? If I have to call someone, can I do it right now (remember, it’s the weekend) or do I have to wait until a weekday during work hours?

After hours spent researching physicians and finding the answers to my questions, I still didn’t have an appointment. I was left with the option to send a message requesting an appointment (no, I was not able to schedule online) or call in later when the office is open (I know myself well enough to not rely on that — after all, it did take me four years to put any effort into finding a new primary care doctor.)

Now here I am, hoping that someone will see my appointment request and reach out to me. It might not be hyperbole to say that if I don’t get a scheduling call or email, I might never go to the doctor again.

All this is to say that small barriers are a BIG deal. One tiny little step can be *the step* that prevents someone from achieving their desired health behavior. Even something as small as mental effort (deciding, what kind of doctor do I want?), or something that needs to be looked up (I have to input my health insurance number? I guess I’ll have to find my card), or too many fields in a form (I have to enter my address AGAIN?) — all these steps are friction, and they each decrease the chance that you’ll find a doctor.

Small barriers are a BIG deal. One tiny little step can be *the step* that prevents someone from achieving their desired health behavior.

These are exactly the kinds of barriers we’re talking about in the Friction and Fuel Framework (which you can read a bit about here, and download below).

The post Making a doctor’s appointment should be easy. (It isn’t.) appeared first on Center for Advanced Hindsight.

By Aline Holzwarth

Human behavior is anything but simple, and for that exact reason I believe that oversimplifications can be useful in the first step of designing for behavior change. When it comes down to it, there’s a lot of human behavior that we can explain in terms of two simple forces: Friction and Fuel.

There’s a metaphor that Dan Ariely uses that I think is very nice, and that’s of a rocket ship. It would work just as well with a plane or a car, but let’s face it — you can’t beat a rocket on the cool-meter. For a rocket ship to fly through space, it needs to not only bypass atmospheric friction and avoid debris, but also consume fuel to propel itself up and out of the atmosphere. Too much friction, and it won’t fly. Not enough fuel, and it won’t fly either.

Too much friction, and it won’t fly. Not enough fuel, and it won’t fly either.

Ok, you get the metaphor. How do these two forces, friction and fuel, play out in healthcare?

Friction in Healthcare

In healthcare, frictions are anything that get in the way of performing that positive health behavior, from the feeling of exhaustion that always arrives when it’s time to exercise to that application form you have to fill out to opt in to your health savings account. Technology can go a long way to decrease friction, removing steps like filling out forms by hand and mailing them, or bringing the doctor to you through your smartphone instead of having to make an appointment, take off time from work, and get to the clinic.

If we return to the rocketship example, we can think about gravity as an important type of friction. The gravity of our lives — the thing that is always there and keeping us steady and stable — that’s the status quo. We can move against the status quo, but it takes some effort. Just like gravity, the status quo may be an invisible force, but it’s deceivingly powerful. One way to combat the status quo is to add fuel.

Fuel in Healthcare

Fuel is anything that makes a positive health behavior more appealing, from the gamification of un-fun procedures to delivering incentives (rewards, discounts, and so on) contingent on good behavior (like the WellnessWins rewards program from WeightWatchers). Fuel doesn’t have to come in the form of tangible rewards like baseball hats and travel shoe bags, and in fact the joy of playing a game can be even more motivating than winning a prize. For example, one study (Kumar, Wentzell, Mikkelsen, Pentland & Laffel, 2004) used a guessing game to incentivize diabetic children to better manage their condition (“try and predict your next blood glucose measurement!”).

Personally, there’s nothing that gets me moving like a good old fashioned competition. But if competition’s not your thing, try temptation bundling (Milkman, Minson & Volpp, 2013) where you pair “want” activities (like listening to an addictive audiobook) with “should” activities (like exercise). If you only allow yourself to consume The Hunger Games while on the treadmill, you’ll be much more likely to get to the gym.

These are just a few examples of friction and fuel in healthcare, but we’ve added a lot more to the comprehensive Friction and Fuel Framework, which we’ll share with you if you trudge through a bit of friction and share your email address with us (don’t worry, we promise not to do anything evil with it).

Behavioral science is incredibly complex, but the reality is that it’s possible to use these two simple concepts of friction and fuel to make a big difference in behavior change. You can decrease friction and add fuel to make desired behaviors simple, salient and appealing — and, importantly, more likely to actually happen.

Find the Fuel and Friction Framework here.

References

1. Kumar, V. S., Wentzell, K. J., Mikkelsen, T., Pentland, A., & Laffel, L. M. (2004). The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. Diabetes technology & therapeutics, 6(4), 445-453.
2. Milkman, K. L., Minson, J. A., & Volpp, K. G. (2013). Holding the Hunger Games hostage at the gym: An evaluation of temptation bundling. Management science, 60(2), 283-299.

The post Decrease friction and add fuel for health behavior change appeared first on Center for Advanced Hindsight.

By Aline Holzwarth

The post Make plans, not resolutions appeared first on Center for Advanced Hindsight.

A version of this post originally appeared on the Envolve Blog.

The holiday season is a beloved time across America when we fill our houses with family, friends and laughter, and fill our bellies with meals, drink and dessert. By January 1, reality sets in along with a few unwanted extra pounds.

The end of the holiday season offers us a chance to make up for our overindulgences in the form of a New Year’s resolution. Among the 44 percent of the U.S. population that make resolutions, “be a better person,” “lose weight” and “exercise more” were the most popular in 2018.

Despite our intentions, almost 30 percent of New Year’s resolvers give up in just two weeks. Six months later, that number shoots up to more than 50 percent.

Behavioral scientists call this problem the intention-behavior gap. And it turns out to be a pretty big gap.

Why Is It So Hard to Keep Our Resolutions?

The New Year is a monumental moment, and we strive to make monumental changes. In doing so, we display an optimism bias — we’re overly optimistic about our chance of success. As a result, we set vague, unachievable goals — a recipe for failure.

Even the smallest roadblocks make it less likely that that we’ll enact our resolutions. This is known as friction costs, which refers to our tendency to be deterred by seemingly small barriers.

Adding to the challenge is a phenomenon known as ego depletion. Ego depletion suggests that our willpower gets tired the more we use it. A single act of self-control now leaves us even more susceptible to temptation later.

With our self-control depleted, we find it almost impossible to resist that delicious chocolate cake. For this, we can thank present bias, the tendency to choose immediate rewards over our long-term goals. Present bias works hand in hand with our (lack of) self-control, and together, they send us down a slippery slope.

You promised to cut back on sweets, but a single bite of chocolate cake can’t hurt, right? The what-the-hell effect describes how a small step off track can cause us to spiral out of control. Because once you have one bite, you might as well have another. And now that you’ve had two, well, what the hell … 

This Time Can Be Different

I’ll admit, the situation looks pretty dire. To keep our New Year’s resolutions, we’re up against a formidable team of behavioral biases and fallacies, each conspiring to get us to give up on exercise, eat more junk food, and leave our resolutions behind.

But there’s good news. Behavioral science has discovered the strategies that can make this New Year’s different than the rest.

• Step #1: Make it SMART

To accomplish your resolution, you’ll need to overcome the optimism bias. Try making a SMART resolution. Revise your resolution until you can answer yes to the following:

Is your resolution as specific as possible? Can you measure your progress? How achievable is it? Is it relevant to your life goals? Do you have a time limit?

My SMART resolution: To run a half marathon by June.

• Step #2: Break It Down and Build It Up 

Reducing friction costs requires making it as easy as possible to achieve your resolution. To do this, break your resolution down into smaller “sub-resolutions,” like running for 20 minutes on Saturday.

This sub-resolution may seem small, but that’s the point. Small goals lead to small wins, small wins build momentum, and momentum is crucial for long-term success.

Still, sustaining momentum requires making progress. Once you successfully complete your sub-resolution, try making it a little bit harder next week. Keep adjusting to keep your sub-resolution challenging, but still achievable.

This week’s sub-resolution: To run for 20 minutes on Saturday.

• Step #3: Find Your Opportunity

Now that you have a sub-resolution in place, you’ll need to make a plan. “Opportunity plans,” or when-then plans, map out exactly when, where and how you’ll act. By planning in advance, they also lessen your chance of succumbing to ego depletion and present bias.

To make your opportunity plan, use the “when-then” formula to decide when and where you’ll do your sub-resolution.

My opportunity plan: When it is 10 a.m. on Saturday, then I will run for 20 minutes around my neighborhood. 

• Step #4: Overcome Your Obstacles

A simple plan can also stop the what-the-hell effect in its tracks. “Obstacle plans,” or if-then plans, let us decide how we’ll behave when a challenging obstacle arises.

To make your obstacle plan, identify an internal obstacle to carrying out your opportunity plan. Then, decide on one behavior to overcome that obstacle.

To make your obstacle plan, use the “if-then” formula.

My obstacle plan: If I feel too tired to run, then I will play some music to wake me up and get moving.

The Year Ahead

Achieving your New Year’s resolution won’t be easy. Behavioral biases and fallacies leave us overly optimistic, easily deterred, tired and feeling a lack of control. But with the help of a few simple strategies tested by behavioral science, you can turn your resolution into reality. Here’s to the New Year, and each one that comes after it. Because this time really will be different.

Jonathan Cloughesy is a behavioral scientist in the Better Living and Health Group at the Center for Advanced Hindsight at Duke University. He is a recent graduate of the University of California Santa Barbara, where he studied biopsychology and applied psychology. He is interested in the design and evaluation of scalable interventions that promote health behavior.

The Envolve Center for Health Behavior Change™ is a partnership between the Brown School at Washington University in St. Louis, The Center for Advanced Hindsight at Duke University and Centene Corporation. The Envolve Center advances life-centric health research to improve lives so that communities can thrive.

The post Why This New Year’s Will Be Different: How Behavioral Science Can Help You Keep Your Resolution appeared first on Center for Advanced Hindsight.