Mbrella is a charitable organization devoted to helping impoverished Kenyan families buy health insurance. Mbrella connects donors with Kenyan mothers and employs a number of behavioral interventions meant to help the mother gain enough financial stability to be able to eventually, over time afford insurance for the family on her own. One such intervention is the Mbrella Calendar, which was designed with the help of CAH to leverage a number of behavioral insights. The calendar is meant to help Kenyan mothers overcome barriers such as lack of social support, an environment designed with temptation and instant gratification at its core, and the basic difficulty of keeping track of one’s progress, which can all derail good intentions.

View the Mbrella Calendar Here

In designing the calendar, we first wanted to tackle issues of social support. In order to do this, we sought to engender a sense of collective responsibility within the family. Typically, mothers are in charge of healthcare for the household, but fathers tend to be in charge of finances. Rather than putting all of the responsibility on one member of the family, we wanted the family to see itself as a group reaching towards a collective goal. At the very top of the calendar, we have “Team [family surname]’s Savings Calendar” written, where the family will write in their name. This is designed to encourage family members to think of this as a goal that the family will be pursuing as a unit. Also, at the top of the calendar, there is a story that outlines a hypothetical family’s savings journey with Mbrella – which demonstrates the importance of having the entire family save for health insurance.

Typically, mothers are in charge of healthcare for the household, but fathers tend to be in charge of finances.

The next design feature leverages prior work demonstrating that developing concrete plans leads to a higher likelihood of goal achievement. We have included boxes over the days of the week so that families can choose on which days they intend to save. Underneath the calendar itself, we have instructions for how to save for insurance using the mobile M-TIBA wallet (including the relevant account and phone numbers needed to save), and a way to keep track of savings using the calendar. Even something as simple as forgetting the account number can act as a significant barrier to action, so it is important to provide easily accessible reminders.

Finally, at the bottom of the calendar we have a gamified savings system that helps families track savings each month while also providing an element of fun. Football (soccer) is a very popular sport in Kenya, so we thought creating a tracking system that mimicked a football match could help to involve the children in the savings process. Hopefully, by involving the children, we can reinforce the value of saving for health insurance for the parents, and provide a model of savings behavior for those children as they grow up. Families are given a sheet of stickers with football stickers for each month that they need to save. One sticker represents 10 Kenyan Shilling. Each time they save, they add a football (or multiple footballs if they save more than 10 Shilling at a time) to the football field to track their progress from one end of the field to the goal. Along the way, we have added “defenders” that need to be avoided, which are pictures of temptations (e.g., clothes, fast food, soda) that Kenyans have reported wanting to cut down on to reduce spending.

On the sticker sheet, we have photos of each temptation, with a corresponding number of footballs that each temptation would cost. This should help members think in terms of health insurance savings when dealing with temptation. Reaching the goal means that a family has successfully saved for a month. If the family fails to reach their goal for a month, they will be given a fresh start when they flip the calendar to the next page. Fresh starts can provide a renewed motivation towards a goal, focusing them on the future rather than the past. Finally, whereas the football field acts as a short time-scale tracker and is meant to be the primary area of focus for the family, the sticker sheet also acts as a tracker towards the ultimate goal, as individuals can determine how far they need to go to reach their final goal by counting the number of stickers left on the sheet.

When it comes to helping families save for health insurance, Mbrella wants each of its interventions to tackle as many potential barriers as possible. The Mbrella calendar epitomizes this approach by providing solutions for socio-cultural and individual barriers. Whereas the calendar seeks to solve a number of problems, no one intervention can do it all. This is why Mbrella is rolling out several behavioral interventions over time which will be integrated with the calendar to help support the savings system set up by the calendar and tackle issues not accounted for by the calendar intervention. If you are interested in finding out more about the behavioral interventions being used by Mbrella, or if you like the idea of supporting families as they work towards being able to buy insurance on their own, please visit the Mbrella site.

Jonathan Corbin is a Senior Behavioral 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 him at jonathan.corbin@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.

The post The Mbrella Calendar: Helping Kenyan Families Track Their Savings for Health Insurance appeared first on Center for Advanced Hindsight.

Discussions about health insurance reform have recently occupied brilliant minds around the world. Last month, Ting Jiang, Principal of the global team, gave a talk about the role of behavioral technology in health insurance innovation and reform at the China International Health Insurance & Health Financing Innovation Forum in Shanghai. Ting described behavioral tech as akin to financial technology (fintech), which refers to new technology that seeks to improve and automate financial services. “Behavioral tech,” on the other hand, can be used to refer to new technology that improves and automates human participation (i.e., behavioral uptake) in products, services, and programs.

She stated that systematic application of behavioral tech could be the next breakthrough of innovation in healthcare, and an opportunity that one should not miss. She pointed out that the emphasis of any public debate so far is too much on who is paying and how to increase the ability to pay, and too little on how to reduce cost by using policies and infrastructural supports to promote health. The cumulative cost of chronic disease in middle- and low-income countries is expected to increase to $11.2 trillion by 2030. Speeding up the development of new medicines and medical treatment needs to go hand in hand with the development of behavioral treatment to curb the rapid increase of chronic diseases caused mainly by lifestyle choices. In other words, unlocking human potential to prevent unnecessary illness can and will help save healthcare.

For more on behavioral tech and product examples of behavioral tech created by our own lab, be on the lookout for Ting’s blog post in next month’s newsletter. And if you think behavioral uptake is one of your core challenges, get in touch with one of the CAH principals! There’s a chance we could help you apply behavioral tech to solve your problem.

Ting Jiang is Principal of Global 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 t.jiang@duke.edu

Ciara Lutz 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 ciara.lutz@duke.edu

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Global team members Ting Jiang, Jan Willem Lindemans, and Rebecca Kelley attended the 8th Games for Health Europe conference in Eindhoven, the Netherlands between October 8-9. The largest conference on games for health in Europe, it brings together medical professionals, academics, and game developers from the field of applied health games to discuss using game technologies to improve health and the delivery of healthcare.

Ting Jiang, Principal of CAH’s Global Health and Development team, gave the opening keynote about the important role that behavioral science can play in creating more impactful games and gamification features, especially for health-related behavioral change. In her talk, Ting used the example of designing a game aimed at increasing medication adherence and explained that a behavioral diagnosis is necessary to determine the extent to which non-adherence is caused by: lack of intention vs. intention-behavior gap, social vs. individual factors, and system II (deliberative) vs. system I (automatic) thinking.

(Photo: “Happy Money” game playtest in Kibera)

Ting noted that applying behavioral science tools early in the game development process leads to more accurate identification and measurement of behavioral change progress and permits experimentation aimed at identifying the most effective game components. She also gave examples of games developed by CAH, including the board game “Happy Money,” which is designed to help individuals with low income make better daily spending and saving decisions, in order to reduce deaths from lack of health financing for curable diseases. “Bill Thrill,” a cashier training game funded by the Joep Lange Institute, is another example of how games can be used to promote effective behavioral change. After identifying a core behavioral barrier of health clinic cashiers shying away from the use of a new digital transaction platform, the team gamified this real-life challenge to improve cashiers billing skills and increase their professional pride, with the aim of increasing behavioral uptake of the new platform and self-efficacy.

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Together with the Joep Lange Institute and the Amsterdam Health and Technology Institute (AHTI), the Global team hosted a workshop titled “A healthier, wealthier Africa: Behavioural science, digital innovation, and beyond” on August 8th, at Strathmore University.

The workshop speakers brought a range of experiences in entrepreneurship, academia, experimental design, and change leadership to talks and a panel exploring what behaviorally informed-solutions for financial inclusion, wellness, and poverty alleviation can look like now and in the future.

The event built on increasing recognition of the importance of embedding behavioural science into designing for impact, and was an example of how international partnerships are approaching conversations around innovations in fighting poverty and healthcare financing.

Dan Ariely commented about this event:

“In general we make lots of attempts to try and get people to behave in a way that is in their own long term best interests, but when we make these attempts without understanding the true nature of human behaviour, these attempts are very likely to fail. This is the same for human beings across the world, from East Africa to Europe or the US. What behavioural economics gives us is a true foundation to understanding what really drives behaviour. With plans for Universal Health Coverage, Kenya is at an important juncture in making progress toward health and wellness. When we create interventions with behavioural economics incorporated, we are much more likely to succeed, so I’m excited about the conversations happening in Nairobi and across the continent, now and into the future.”

The following are 4 key takeaways from the presentations:

• Behavioral Science has the potential to bridge the intention-behavior gap.

Principal of Global Health and Development, Ting Jiang, gave examples of how behavioral science can save lives by enabling practitioners to make more accurate problem diagnoses and apply BE informed interventions that bridge the gap between intention and behavior.

• Digital Innovation can help improve the mental health of a population

With lack of access, price, and stigma as the leading roadblocks to accessing mental health services in Kenya, Alex Royea gave an excellent presentation on how Amka Life is using bots to make mental health services more accessible. You can read more on this from his presentation:  Using Bots and Tech to Scale Mental Health Solutions.

• Experimental design is extremely important to Behavioral Science

David Clarance painted a clear picture of the importance of testing Behavioral Science solutions based on previous research. You can read more on this from his presentation: Experiment Design in Practice.

• Implementing sustainable healthcare solutions in action

Access Afya runs low-cost, affordable clinics within Nairobi tailored for the global mass market. The organization also sells health subscriptions to factories and schools. On the other hand, ahti supports entrepreneurs, both start-ups and scale-ups, to generate solutions for better health, care, and costs by providing hands-on mentorship and access to their extensive network of healthcare institutions. You can read more on these in Melissa Menke’s and Laurens Van Hoorn’s presentations.

The post Can We Create a Healthier, Wealthier Africa with Behavioural Science? appeared first on Center for Advanced Hindsight.

In our last post, we told you about a behavioral intervention that our Global Health and Development team developed that was tested by our partners, the Joep Lange Institute and PharmAccess Foundation.

In this intervention, a few different types of calendars were given to people attending medical camps (where they received free medical care) in Nairobi, Kenya. The goal of this intervention was to increase health savings on a mobile wallet that is locked for health expenses – the M-Tiba platform.*

One challenge for M-Tiba users is that they fail to deposit after signing up, even though most users strongly agree that saving for health is very important.

Figure 1: The story calendar

Our partners tested CAH-created calendars – some used storytelling (Figure 1) and goal-setting and planning (Figure 2). Based on a previous predicting game, we already knew that the storytelling calendar led to greater savings compared to the control calendar. We asked you to guess whether the storytelling or goal-setting calendar would lead to greater health savings on the M-Tiba platform.

Figure 2: The goal-setting calendar

Only 29% of you correctly predicted that the goal-setting calendar led to greater savings compared to the storytelling calendar, and that this difference was not significant. As you might recall from our last post, 7.5% of those who received the storytelling calendar saved at least once, compared to 0% of those who received the control calendar. Of those who received the goal-setting calendar, however, 12.8% saved at least once.

Moreover, men and women seem to have different expenses in mind to cut down on:

Figure 3: Unnecessary spending reported by women (left) and men (right). The size of each word indicates the number of times each word was reported.

Although the “story editing” approach leveraged by the storytelling calendar effectively increased savings, goal-setting was just as effective. While the storytelling calendar may have led people to change the narratives they usually tell themselves about saving, the goal-setting and planning calendar forced users to interact with the calendar more often.

Since a simple M-Tiba branded calendar did not increase saving, it is possible that users did not actively engage with this calendar as much as they did with the other two. It is conceivable that including a story or asking people to write down a savings goal served as more engaging reminders, making M-Tiba users more likely to save.

Figure 4: The control calendar

If you missed last month’s predicting game, or would like to try your hand at a predicting game that has nothing to do with calendars, check out this month’s game:

Another way in which we can try to increase savings is by sending SMS reminders. This month, we are asking you to guess which of three SMS reminders led to the greatest savings in M-Tiba. The three messages, always sent on Saturdays, were:

Control: Remember to save as little as 10/- today!

Social Proof: Remember to save as little as 10/- today. Every Saturday, thousands of M-PESA users save in M-TIBA.

Voucher: Remember to save as little as 10/- today to get a voucher of 500/-. Extra bonus for Savings on Saturdays this month.

Which of these three SMS reminders led to the greatest savings? Make your guess via this link. If you guess correctly, your foresight could win you a free e-book!

We would also like to congratulate Patrick, the lucky winner of our last predicting game! A free ebook copy of Dollars and Sense has been sent to you a via email.

* M-Tiba is digital health platform that includes a wallet on a mobile phone containing specified entitlements for healthcare. Users can use this wallet to save (for their family’s health), get insurance, receive money from more affluent relatives elsewhere in the country, from donors, and even from individuals in other countries willing to donate directly for health (remittances).

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