Heterogeneity in banker culture and its influence on dishonesty.

The social sciences are going through what has been described as a 'reproducibility crisis'1,2. Highly influential findings derived from accessible populations, such as laboratories and crowd-sourced worker platforms, are not always replicated. Less attention has been given to replicating findings that are derived from inaccessible populations, and recent high-profile replication attempts explicitly excluded such populations3. Pioneering experimental work4 offered a rare glimpse into banker culture and found that bankers, in contrast to other professionals, are more dishonest when they think about their job. Given the importance of the banking sector, and before academics or policy-makers rely on these findings as an accurate diagnosis of banking culture, an exploration of their generalizability is warranted. Here we conduct the same incentivized task with bankers and non-bankers from five different populations across three continents (n = 1,282 participants). In our banker studies in the Middle East and Asia Pacific (n = 148 and n = 620, respectively), we observe some dishonesty, although-in contrast to the original study4-this was not significantly increased among bankers primed to think about their work compared to bankers who were not primed. We also find that inducing non-banking professionals to think about their job does not have a significant effect on honesty. We explore sampling and methodological differences to explain the variation in findings in relation to bankers and identify two key points. First, the expectations of the general population regarding banker behaviour vary across jurisdictions, suggesting that banking culture in the jurisdiction of the original study4 may not be consistent worldwide. Second, having approached 27 financial institutions, many of which expressed concerns of adverse findings, we expect that only banks with a sound culture participated in our study. The latter introduces possible selection bias that may undermine the generalizability of any similar field study. More broadly, our study highlights the complexity of undertaking a high-fidelity replication of sensitive, highly publicized fieldwork with largely inaccessible populations resulting from institutional and geographical barriers. For policy-makers, this work suggests that caution should be exercised in generalizing the findings of the original study4 to other populations.

Encouraging the resumption of economic activity after COVID-19: Evidence from a large scale-field experiment in China.

As the COVID-19 pandemic comes to an end, governments find themselves facing a new challenge: motivating citizens to resume economic activity. What is an effective way to do so? We investigate this question using a field experiment in the city of Zhengzhou, China, immediately following the end of the city's COVID-19 lockdown. We assessed the effect of a descriptive norms intervention providing information about the proportion of participants' neighbors who have resumed economic activity. We find that informing individuals about their neighbors' plans to visit restaurants increases the fraction of participants visiting restaurants by 12 percentage points (37%), among those participants who underestimated the proportion of neighbors who resumed economic activity. Those who overestimated did not respond by reducing restaurant attendance (the intervention yielded no "boomerang" effect); thus, our descriptive norms intervention yielded a net positive effect. We explore the moderating role of risk preferences and the effect of the intervention on subjects' perceived risk of going to restaurants, as well as the contrast with an intervention for parks, which were already perceived as safe. All of these analyses suggest our intervention worked by reducing the perceived risk of going to restaurants.

A user-centred implementation strategy for tuberculosis contact investigation in Uganda: protocol for a stepped-wedge, cluster-randomised trial.

BACKGROUND: Tuberculosis(TB) is among the leading causes of infectious death worldwide. Contact investigation is an evidence-based, World Health Organisation-endorsed intervention for timely TB diagnosis, treatment, and prevention but has not been widely and effectively implemented. METHODS: We are conducting a stepped-wedge, cluster-randomised, hybrid Type III implementation-effectiveness trial comparing a user-centred to a standard strategy for implementing TB contact investigation in 12 healthcare facilities in Uganda. The user-centred strategy consists of several client-focused components including (1) a TB-education booklet, (2) a contact-identification algorithm, (3) an instructional sputum-collection video, and (4) a community-health-rider service to transport clients, CHWs, and sputum samples, along with several healthcare-worker-focused components, including (1) collaborative improvement meetings, (2) regular audit-and-feedback reports, and (3) a digital group-chat application designed to develop a community of practice. Sites will cross-over from the standard to the user-centred strategy in six, eight-week transition steps following a randomly determined site-pairing scheme and timeline. The primary implementation outcome is the proportion of symptomatic close contacts completing TB evaluation within 60 days of TB treatment initiation by the index person with TB. The primary clinical effectiveness outcomes are the proportion of contacts diagnosed with and initiating active TB disease treatment and the proportion initiating TB preventative therapy within 60 days. We will assess outcomes from routine source documents using intention-to-treat analyses. We will also conduct nested mixed-methods studies of implementation fidelity and context and perform cost-effectiveness and impact modelling. The Makerere School of Public Health IRB(#554), the Uganda National Council for Science and Technology(#HS1720ES), and the Yale Institutional Review Board(#2000023199) approved the study and waived informed consent for the main trial implementation-effectiveness outcomes. We will submit results for publication in peer-reviewed journals and disseminate findings to local policymakers and representatives of affected communities. DISCUSSION: This pragmatic, quasi-experimental implementation trial will inform efforts to find and prevent undiagnosed persons with TB in high-burden settings using contact investigation. It will also help assess the suitability of human-centred design and communities of practice for tailoring implementation strategies and sustaining evidence-based interventions in low-and-middle-income countries. TRIAL REGISTRATION: The trial was registered(ClinicalTrials.gov Identifier NCT05640648) on 16 November 2022, after the trial launch on 7 March 2022.

Global Behaviors, Perceptions, and the Emergence of Social Norms at the Onset of the COVID-19 Pandemic.

We conducted a large-scale survey covering 58 countries and over 100,000 respondents between late March and early April 2020 to study beliefs and attitudes towards citizens' and governments' responses at the onset of the COVID-19 pandemic. Most respondents reported holding normative beliefs in support of COVID-19 containment measures, as well as high rates of adherence to these measures. They also believed that their government and their country's citizens were not doing enough and underestimated the degree to which others in their country supported strong behavioral and policy responses to the pandemic. Normative beliefs were strongly associated with adherence, as well as beliefs about others' and the government's response. Lockdowns were associated with greater optimism about others' and the government's response, and improvements in measures of perceived mental well-being; these effects tended to be larger for those with stronger normative beliefs. Our findings highlight how social norms can arise quickly and effectively to support cooperation at a global scale.

Potential follow-up increases private contributions to public goods.

People contribute more to public goods when their contributions are made more observable to others. We report an intervention that subtly increases the observability of public goods contributions when people are solicited privately and impersonally (e.g., mail, email, social media). This intervention is tested in a large-scale field experiment (n = 770,946) in which people are encouraged to vote through get-out-the-vote letters. We vary whether the letters include the message, "We may call you after the election to ask about your voting experience." Increasing the perceived observability of whether people vote by including that message increased the impact of the get-out-the-vote letters by more than the entire effect of a typical get-out-the-vote letter. This technique for increasing perceived observability can be replicated whenever public goods solicitations are made in private.

Cooperate without looking: why we care what people think and not just what they do.

Evolutionary game theory typically focuses on actions but ignores motives. Here, we introduce a model that takes into account the motive behind the action. A crucial question is why do we trust people more who cooperate without calculating the costs? We propose a game theory model to explain this phenomenon. One player has the option to "look" at the costs of cooperation, and the other player chooses whether to continue the interaction. If it is occasionally very costly for player 1 to cooperate, but defection is harmful for player 2, then cooperation without looking is a subgame perfect equilibrium. This behavior also emerges in population-based processes of learning or evolution. Our theory illuminates a number of key phenomena of human interactions: authentic altruism, why people cooperate intuitively, one-shot cooperation, why friends do not keep track of favors, why we admire principled people, Kant's second formulation of the Categorical Imperative, taboos, and love.

Powering up with indirect reciprocity in a large-scale field experiment.

A defining aspect of human cooperation is the use of sophisticated indirect reciprocity. We observe others, talk about others, and act accordingly. We help those who help others, and we cooperate expecting that others will cooperate in return. Indirect reciprocity is based on reputation, which spreads by communication. A crucial aspect of indirect reciprocity is observability: reputation effects can support cooperation as long as peoples' actions can be observed by others. In evolutionary models of indirect reciprocity, natural selection favors cooperation when observability is sufficiently high. Complimenting this theoretical work are experiments where observability promotes cooperation among small groups playing games in the laboratory. Until now, however, there has been little evidence of observability's power to promote large-scale cooperation in real world settings. Here we provide such evidence using a field study involving 2413 subjects. We collaborated with a utility company to study participation in a program designed to prevent blackouts. We show that observability triples participation in this public goods game. The effect is over four times larger than offering a $25 monetary incentive, the company's previous policy. Furthermore, as predicted by indirect reciprocity, we provide evidence that reputational concerns are driving our observability effect. In sum, we show how indirect reciprocity can be harnessed to increase cooperation in a relevant, real-world public goods game.

Policy makers believe money motivates more than it does.

To motivate contributions to public goods, should policy makers employ financial incentives like taxes, fines, subsidies, and rewards? While these are widely considered as the classic policy approach, a substantial academic literature suggests the impact of financial incentives is not always positive; they can sometimes fail or even backfire. To test whether policy makers are overly bullish about financial incentives, we asked county heads, mayors, and municipal government representatives of medium-to-large towns in Germany to predict the effects of a financial incentive on COVID-19 vaccination, and tested the exact same incentive in a field experiment involving all 41,548 inhabitants (clustered in 10,032 addresses) of the German town of Ravensburg. Whereas policy makers overwhelmingly predict that the financial incentive will increase vaccination-by 15.3 percentage points on average-the same financial incentive yielded a precisely estimated null effect on vaccination. We discuss when financial incentives are most likely to fail, and conclude that it is critical to educate policy makers on the potential pitfalls of employing financial incentives to promote contributions to public goods.

A user-centred implementation strategy for tuberculosis contact investigation in Uganda: Protocol for a stepped-wedge, cluster-randomised trial.

Background Tuberculosis (TB) is among the leading causes of infectious death worldwide. Contact investigation is an evidence-based, World Health Organisation-endorsed intervention for timely TB diagnosis, treatment, and prevention but has not been widely and effectively implemented. Methods We are conducting a stepped-wedge, cluster-randomised, hybrid Type III implementation-effectiveness trial comparing a user-centred to a standard strategy for implementing TB contact investigation in 12 healthcare facilities in Uganda. The user-centred strategy consists of several client-focused components including 1) a TB-education booklet, 2) a contact-identification algorithm, 3) an instructional sputum-collection video, and 4) a community-health-rider service to transport clients, CHWs, and sputum samples, along with several healthcare-worker-focused components, including 1) collaborative improvement meetings, 2) regular audit-and-feedback reports, and 3) a digital group-chat application designed to develop a community of practice. Sites will cross from the standard to the user-centred strategy in six, eight-week transition steps following a randomly determined site-pairing scheme and timeline. The primary implementation outcome is the proportion of symptomatic close contacts completing TB evaluation within 60 days of TB treatment initiation by the index person with TB. The primary clinical effectiveness outcomes are the proportion of contacts diagnosed with and initiating active TB disease treatment and the proportion initiating TB preventative therapy within 60 days. We will assess outcomes from routine source documents using intention-to-treat analyses. We will also conduct nested mixed-methods studies of implementation fidelity and context and perform cost-effectiveness and impact modelling. The Makerere School of Public Health IRB (#554), the Uganda National Council for Science and Technology (#HS1720ES), and the Yale Institutional Review Board (#2000023199) approved the study with a waiver of informed consent for the main trial implementation-effectiveness outcomes. We will submit trial results for publication in a peer-reviewed journal and disseminate findings to local shareholders, including policymakers and representatives of affected communities. Discussion This pragmatic, quasi-experimental implementation trial will inform efforts to find and prevent undiagnosed persons with TB in high-burden setting using contact investigation. It will help assess the suitability of human-centred design and communities of practice for tailoring implementation strategies and sustain evidence-based interventions in low-and-middle-income countries. Trial registration number ClinicalTrials.gov Identifier: NCT05640648.

Can digital adherence technologies reduce inequity in tuberculosis treatment success? Evidence from a randomised controlled trial.

INTRODUCTION: Tuberculosis (TB) is a global health emergency and low treatment adherence among patients is a major barrier to ending the TB epidemic. The WHO promotes digital adherence technologies (DATs) as facilitators for improving treatment adherence in resource-limited settings. However, limited research has investigated whether DATs improve outcomes for high-risk patients (ie, those with a high probability of an unsuccessful outcome), leading to concerns that DATs may cause intervention-generated inequality. METHODS: We conducted secondary analyses of data from a completed individual-level randomised controlled trial in Nairobi, Kenya during 2016-2017, which evaluated the average intervention effect of a novel DAT-based behavioural support programme. We trained a causal forest model to answer three research questions: (1) Was the effect of the intervention heterogeneous across individuals? (2) Was the intervention less effective for high-risk patients? nd (3) Can differentiated care improve programme effectiveness and equity in treatment outcomes? RESULTS: We found that individual intervention effects-the percentage point reduction in the likelihood of an unsuccessful treatment outcome-ranged from 4.2 to 12.4, with an average of 8.2. The intervention was beneficial for 76% of patients, and most beneficial for high-risk patients. Differentiated enrolment policies, targeted at high-risk patients, have the potential to (1) increase the average intervention effect of DAT services by up to 28.5% and (2) decrease the population average and standard deviation (across patients) of the probability of an unsuccessful treatment outcome by up to 8.5% and 31.5%, respectively. CONCLUSION: This DAT-based intervention can improve outcomes among high-risk patients, reducing inequity in the likelihood of an unsuccessful treatment outcome. In resource-limited settings where universal provision of the intervention is infeasible, targeting high-risk patients for DAT enrolment is a worthwhile strategy for programmes that involve human support sponsors, enabling them to achieve the highest possible impact for high-risk patients at a substantially improved cost-effectiveness ratio.

Don't get it or don't spread it: comparing self-interested versus prosocial motivations for COVID-19 prevention behaviors.

COVID-19 prevention behaviors may be seen as self-interested or prosocial. Using American samples from MTurk and Prolific (total n = 6850), we investigated which framing is more effective-and motivation is stronger-for fostering prevention behavior intentions. We evaluated messaging that emphasized personal, public, or personal and public benefits of prevention. In initial studies (conducted March 14-16, 2020), the Public treatment was more effective than the Personal treatment, and no less effective than the Personal + Public treatment. In additional studies (conducted April 17-30, 2020), all three treatments were similarly effective. Across all these studies, the perceived public threat of coronavirus was also more strongly associated with prevention intentions than the perceived personal threat. Furthermore, people who behaved prosocially in incentivized economic games years before the pandemic had greater prevention intentions. Finally, in a field experiment (conducted December 21-23, 2020), we used our three messaging strategies to motivate contact-tracing app signups (n = 152,556 newsletter subscribers). The design of this experiment prevents strong causal inference; however, the results provide suggestive evidence that the Personal + Public treatment may have been more effective than the Personal or Public treatment. Together, our results highlight the importance of prosocial motives for COVID-19 prevention.