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1.
BMC Fam Pract ; 22(1): 253, 2021 12 22.
Artigo em Inglês | MEDLINE | ID: mdl-34937551

RESUMO

BACKGROUND: A minority of the U.S. population comprises a majority of health care expenses. Health system interventions for high-cost populations aim to improve patient outcomes while reducing costly over-utilization. Missed and inconsistent appointments are associated with poor patient outcomes and increased health care utilization. PEAK Health- Mount Sinai's intensive primary care clinic for high-cost patients- employed a novel behavioral economics-based intervention to reduce the rate of missed appointments at the practice. Behavioral economics has accomplished numerous successes across the health care field; the effect of a clinic-based behavioral economics intervention on reducing missed appointments has yet to be assessed. METHODS: This was a single-arm, pre-post trial conducted over 1 year involving all active patients at PEAK Health. The intervention consisted of: a) clinic signage, and b) appointment reminder cards containing behavioral economics messaging designed to increase the likelihood patients would complete their subsequent visit; appointment cards (t1) were transitioned to an identical EMR template (t2) at 6 months to boost provider utilization. The primary objective, the success of scheduled appointments, was assessed with visit adherence: the proportion of successful over all scheduled appointments, excluding those cancelled or rescheduled. The secondary objective, the consistency of appointments, was assessed with a 2-month visit constancy rate: the percentage of patients with at least one successful visit every 2 months for 1 year. Both metrics were assessed via a χ2 analysis and together define patient retention. RESULTS: The visit adherence rate increased from 74.7% at baseline to 76.5% (p = .22) during t1 and 78.0% (p = .03) during t2. The 2-month visit constancy rate increased from 59.5% at baseline to 74.3% (p = .01) post-intervention. CONCLUSIONS: A low-resource, clinic-based behavioral economics intervention was capable of improving patient retention within a traditionally high-cost population. A renewed focus on patient retention- employing the metrics described here- could bolster chronic care efforts and significantly improve the outcomes of high-cost programs by reducing the deleterious effects of missed and inconsistent appointments.


Assuntos
Agendamento de Consultas , Economia Comportamental , Instituições de Assistência Ambulatorial , Humanos , Cooperação do Paciente , Atenção Primária à Saúde , Sistemas de Alerta
2.
Vínculo ; 18(2): 1-12, jul.-dez. 2021. ilus
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1341801

RESUMO

trata-se de uma pesquisa bibliográfica exploratória que teve o objetivo de verificar quais foram os assuntos que estão relacionados com o dinheiro nos últimos 30 anos (1987 a 2017), pelas bases de dados Psychoinfo, Webscience, Lilacs e Scielo. Para a coleta de dados nas bases de dados foram utilizadas as palavras chaves: Family, Money e financial education. Na análise, foi realizada uma leitura exploratória, na qual entrou-se em contato com a totalidade do artigo, lendo passagens esparsas do resumo e do texto. Após, foi realizada a leitura seletiva para aprofundar mais nas partes que interessavam, e pôr fim a leitura analítica, que consistiu em ordenar e sumarizar as informações contidas no artigo. Foram coletados um total de 706 artigos nas quatro bases de dados citadas. Nos resultados foram identificadas 86 publicações de artigos nas 4 bases de dados na última década, em contrapartida entre os anos de 1987 a 1997 foram identificados um total de 76 artigos e entre 1998 a 2007, 180 artigos. Conclui-se que, a temática sobre dinheiro tem sido importante nas investigações cientificas principalmente na última década.


This is an exploratory bibliographic research that aimed to verify which subjects were related to money in the last 30 years (1987 to 2017), using the Psychoinfo, Webscience, Lilacs and Scielo databases. For the collection of data in the databases the keywords were used: Family, Money and financial education. In the analysis, an exploratory reading was carried out, in which the entire article was contacted, reading sparse passages from the abstract and the text. Afterwards, the selective reading was carried out to go deeper into the parts that were of interest, and put an end to the analytical reading, which consisted of ordering and summarizing the information contained in the article. A total of 706 articles were collected in the four databases cited. In the results, 86 publications of articles were identified in the 4 databases in the last decade, in contrast between the years 1987 to 1997, a total of 76 articles were identified and between 1998 and 2007, 180 articles. It is concluded that, the theme about money has been important in scientific investigations mainly in the last decade.


Se trata de una investigación bibliográfica exploratoria que tuvo como objetivo verificar qué temas estaban relacionados con el dinero en los últimos 30 años (1987 a 2017), utilizando las bases de datos Psychoinfo, Webscience, Lilacs y Scielo. Para la recogida de datos en las bases de datos se utilizaron las palabras clave: Familia, Dinero y educación financiera. En el análisis se realizó una lectura exploratoria, en la que se contactó con todo el artículo, leyendo escasos pasajes del resumen y del texto. Posteriormente, se realizó la lectura selectiva para profundizar en las partes que eran de interés, y poner fin a la lectura analítica, que consistió en ordenar y resumir la información contenida en el artículo. Se recogieron un total de 706 artículos en las cuatro bases de datos citadas. En los resultados se identificaron 86 publicaciones de artículos en las 4 bases de datos en la última década, en contraste entre los años 1987 a 1997 se identificaron un total de 76 artículos y entre 1998 y 2007, 180 artículos. Se concluye que el tema del dinero ha sido importante en las investigaciones científicas principalmente en la última década.


Assuntos
Psicologia/economia , Família , Economia , Economia Comportamental , Administração Financeira
3.
Curr Cardiol Rep ; 23(11): 153, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34599461

RESUMO

PURPOSE OF REVIEW: Behavioral economics represents a promising set of principles to inform the design of health-promoting interventions. Techniques from the field have the potential to increase quality of cardiovascular care given suboptimal rates of guideline-directed care delivery and patient adherence to optimal health behaviors across the spectrum of cardiovascular care delivery. RECENT FINDINGS: Cardiovascular health-promoting interventions have demonstrated success in using a wide array of principles from behavioral economics, including loss framing, social norms, and gamification. Such approaches are becoming increasingly sophisticated and focused on clinical cardiovascular outcomes in addition to health behaviors as a primary endpoint. Many approaches can be used to improve patient decisions remotely, which is particularly useful given the shift to virtual care in the context of the COVID-19 pandemic. Numerous applications for behavioral economics exist in the cardiovascular care delivery space, though more work is needed before we will have a full understanding of ways to best leverage such applications in each clinical context.


Assuntos
COVID-19 , Economia Comportamental , Comportamentos Relacionados com a Saúde , Humanos , Pandemias , SARS-CoV-2
4.
PLoS One ; 16(10): e0257320, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34634064

RESUMO

Rates of chronic pain and daily opioid use are higher among veterans relative to civilian populations. Increasing physical activity can reduce pain severity and decrease opioid use among patients with chronic pain. Behavioral economic strategies can improve physical activity levels but have been undertested in veterans with chronic pain. The objective of this study was to evaluate if a financial incentive combined with a loss aversion component-a "regret lottery" in which veterans could win money if they met a set goal or told how much they could have won had they met their goal-would increase physical activity levels among veterans with chronic pain. A 12-week single-blinded randomized controlled trial (ClinicalTrials.gov: NCT04013529) was designed. Veterans with chronic pain (N = 40) receiving care at a specialty pain clinic were eligible for participation, and were randomly assigned (1:1) to either (a) activity trackers and daily text message reminders to increase physical activity ("control arm"), or (b) the same plus a weekly regret lottery ("intervention arm"). For those in the intervention arm, participants who met their activity goal, had a chance to win a small ($30) or large ($100) gift card incentive; those who did not meet their goals were informed of what they would have won had they met their goal. The primary outcome, physical activity, was measured using self-reported physical activity and step counts using activity trackers. Secondary outcomes included changes in physical function, chronic pain severity, depression and opioid use. The sample was primarily white, male and disabled, with an average age of 57 years. No between-arm differences were noted for physical activity, physical function, chronic pain severity, depression or opioid use. Regret lottery-based approaches may be ineffective at increasing physical activity levels in veterans with chronic pain. Trial Registry: NCT04013529.


Assuntos
Dor Crônica/terapia , Exercício Físico , Dor Crônica/epidemiologia , Gerenciamento Clínico , Economia Comportamental , Feminino , Monitores de Aptidão Física , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Recompensa , Veteranos
5.
Implement Sci ; 16(1): 90, 2021 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-34563227

RESUMO

BACKGROUND: Serious illness conversations (SICs) are an evidence-based approach to eliciting patients' values, goals, and care preferences that improve patient outcomes. However, most patients with cancer die without a documented SIC. Clinician-directed implementation strategies informed by behavioral economics ("nudges") that identify high-risk patients have shown promise in increasing SIC documentation among clinicians. It is unknown whether patient-directed nudges that normalize and prime patients towards SIC completion-either alone or in combination with clinician nudges that additionally compare performance relative to peers-may improve on this approach. Our objective is to test the effect of clinician- and patient-directed nudges as implementation strategies for increasing SIC completion among patients with cancer. METHODS: We will conduct a 2 × 2 factorial, cluster randomized pragmatic trial to test the effect of nudges to clinicians, patients, or both, compared to usual care, on SIC completion. Participants will include 166 medical and gynecologic oncology clinicians practicing at ten sites within a large academic health system and their approximately 5500 patients at high risk of predicted 6-month mortality based on a validated machine-learning prognostic algorithm. Data will be obtained via the electronic medical record, clinician survey, and semi-structured interviews with clinicians and patients. The primary outcome will be time to SIC documentation among high-risk patients. Secondary outcomes will include time to SIC documentation among all patients (assessing spillover effects), palliative care referral among high-risk patients, and aggressive end-of-life care utilization (composite of chemotherapy within 14 days before death, hospitalization within 30 days before death, or admission to hospice within 3 days before death) among high-risk decedents. We will assess moderators of the effect of implementation strategies and conduct semi-structured interviews with a subset of clinicians and patients to assess contextual factors that shape the effectiveness of nudges with an eye towards health equity. DISCUSSION: This will be the first pragmatic trial to evaluate clinician- and patient-directed nudges to promote SIC completion for patients with cancer. We expect the study to yield insights into the effectiveness of clinician and patient nudges as implementation strategies to improve SIC rates, and to uncover multilevel contextual factors that drive response to these strategies. TRIAL REGISTRATION: ClinicalTrials.gov , NCT04867850 . Registered on April 30, 2021. FUNDING: National Cancer Institute P50CA244690.


Assuntos
Neoplasias , Assistência Terminal , Comunicação , Economia Comportamental , Feminino , Humanos , Neoplasias/terapia , Cuidados Paliativos
6.
J Neurosci ; 41(43): 8963-8971, 2021 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-34544831

RESUMO

Standard economic indicators provide an incomplete picture of what we value both as individuals and as a society. Furthermore, canonical macroeconomic measures, such as GDP, do not account for non-market activities (e.g., cooking, childcare) that nevertheless impact well-being. Here, we introduce a computational tool that measures the affective value of experiences (e.g., playing a musical instrument without errors). We go on to validate this tool with neural data, using fMRI to measure neural activity in male and female human subjects performing a reinforcement learning task that incorporated periodic ratings of subjective affective state. Learning performance determined level of payment (i.e., extrinsic reward). Crucially, the task also incorporated a skilled performance component (i.e., intrinsic reward) which did not influence payment. Both extrinsic and intrinsic rewards influenced affective dynamics, and their relative influence could be captured in our computational model. Individuals for whom intrinsic rewards had a greater influence on affective state than extrinsic rewards had greater ventromedial prefrontal cortex (vmPFC) activity for intrinsic than extrinsic rewards. Thus, we show that computational modeling of affective dynamics can index the subjective value of intrinsic relative to extrinsic rewards, a "computational hedonometer" that reflects both behavior and neural activity that quantifies the affective value of experience.SIGNIFICANCE STATEMENT Traditional economic indicators are increasingly recognized to provide an incomplete picture of what we value as a society. Standard economic approaches struggle to accurately assign values to non-market activities that nevertheless may be intrinsically rewarding, prompting a need for new tools to measure what really matters to individuals. Using a combination of neuroimaging and computational modeling, we show that despite their lack of instrumental value, intrinsic rewards influence subjective affective state and ventromedial prefrontal cortex (vmPFC) activity. The relative degree to which extrinsic and intrinsic rewards influence affective state is predictive of their relative impacts on neural activity, confirming the utility of our approach for measuring the affective value of experiences and other non-market activities in individuals.


Assuntos
Comportamento de Escolha/fisiologia , Economia Comportamental , Modelos Neurológicos , Córtex Pré-Frontal/fisiologia , Recompensa , Adulto , Tomada de Decisões/fisiologia , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Córtex Pré-Frontal/diagnóstico por imagem , Adulto Jovem
7.
PLoS One ; 16(8): e0254867, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34351921

RESUMO

Eye-tracking is becoming an increasingly popular tool for understanding the underlying behavior driving human decisions. However, an important unanswered methodological question is whether the use of an eye-tracking device itself induces changes in participants' behavior. We study this question using eight popular games in experimental economics chosen for their varying levels of theorized susceptibility to social desirability bias. We implement a simple between-subject design where participants are randomly assigned to either a control or an eye-tracking treatment. In seven of the eight games, eye-tracking did not produce different outcomes. In the Holt and Laury risk assessment (HL), subjects with multiple calibration attempts demonstrated more risk averse behavior in eye-tracking conditions. However, this effect only appeared during the first five (of ten) rounds. Because calibration difficulty is correlated with eye-tracking data quality, the standard practice of removing participants with low eye-tracking data quality resulted in no difference between the treatment and control groups in HL. Our results suggest that experiments may incorporate eye-tracking equipment without inducing changes in the economic behavior of participants, particularly after observations with low quality eye-tracking data are removed.


Assuntos
Economia Comportamental , Tecnologia de Rastreamento Ocular , Calibragem , Feminino , Jogo de Azar , Teoria do Jogo , Humanos , Masculino , Análise de Regressão , Risco , Confiança , Adulto Jovem
8.
Drug Alcohol Depend ; 227: 108919, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34340160

RESUMO

BACKGROUND: The marijuana purchase task (MPT) is a commonly used behavioral economic measure of relative cannabis value (i.e. demand) that presents specific methodological concerns due to non-standardized measurement, variability in modality of use, and evolving legalization policies. Refinement of the task is critical to improve task ecological validity and accurate measurement of cannabis demand. The present study examined the construct validity of an adaptive MPT that allowed for participant selection of their preferred cannabis-based product and unit of measurement and the effect of next-day responsibilities on demand. METHODS: Participants reporting at least monthly cannabis use (N = 186, 40.3 % women, Mage = 33.59) were recruited via Amazon Mechanical Turk and completed the original MPT and our adaptive form with 2 next-day responsibilities scenarios (no responsibilities vs. morning job interview) for each MPT. Cannabis use motives, problems, and risk for cannabis use disorder were also assessed. RESULTS: Cannabis demand was sensitive to next-day responsibility, with higher hypothetical consumption observed in the no responsibilities condition. Responsibility-related decreases in Omax (F(1,185) = 4.83, p = .029, η2p = .03) were significantly greater on the adaptive MPT than the original MPT. Demand indices derived from the adaptive MPT were significantly correlated with cannabis problems (rbreakpoint = .19, rPmax = 0.18, relasticity=-0.18) and motives (rrange=-.32-.25), and demand metrics from the original MPT. CONCLUSIONS: Results provide preliminary support for the construct validity of an adaptive MPT and suggest that early-morning work responsibilities may reduce cannabis demand. Continued research is needed to further refine this task and determine implications for cannabis use disorder intervention and prevention approaches.


Assuntos
Cannabis , Alucinógenos , Adulto , Comportamento do Consumidor , Economia Comportamental , Humanos , Motivação
9.
PLoS One ; 16(8): e0255515, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34384100

RESUMO

Liquid markets are driven by information asymmetries and the injection of new information in trades into market prices. Where market matching uses an electronic limit order book (LOB), limit orders traders may make suboptimal price and trade decisions based on new but incomplete information arriving with market orders. This paper measures the information asymmetries in Bitcoin trading limit order books on the Kraken platform, and compares these to prior studies on equities LOB markets. In limit order book markets, traders have the option of waiting to supply liquidity through limit orders, or immediately demanding liquidity through market orders or aggressively priced limit orders. In my multivariate analysis, I control for volatility, trading volume, trading intensity and order imbalance to isolate the effect of trade informativeness on book liquidity. The current research offers the first empirical study of Glosten (1994) to yield a positive, and credibly large transaction cost parameter. Trade and LOB datasets in this study were several orders of magnitude larger than any of the prior studies. Given the poor small sample properties of GMM, it is likely that this substantial increase in size of datasets is essential for validating the model. The research strongly supports Glosten's seminal theoretical model of limit order book markets, showing that these are valid models of Bitcoin markets. This research empirically tested and confirmed trade informativeness as a prime driver of market liquidity in the Bitcoin market.


Assuntos
Comércio/tendências , Economia Comportamental , Administração Financeira/estatística & dados numéricos , Investimentos em Saúde/economia , Marketing/economia , Modelos Econômicos , Humanos
10.
Artigo em Inglês | MEDLINE | ID: mdl-34360222

RESUMO

The situation of labour inclusion of people with disabilities in Spain is still too negative, in spite of the different efforts carried out by public and private sector. Previous research points to social discrimination as one of the main causes of the situation. Ilunion Hotels is one of the most important hotel companies in Spain focused on labour inclusion of people with disabilities. The objective of this paper is to explore the social inclusion case of Ilunion Hotels of the Costa del Sol, the actions that they have developed to improve the labour integration of this collective, based on a behavioral economics theoretical model (with a high relevance of the influence of social stigma, stress theories and coping to stress responses). We look into the specific situation of two of the three hotels developed as Special Employment Centres (sheltered employment contexts defined by Spanish legislation) and the possible impact of their Support Units for Professional Activity. Case study methodology is considered the most appropriate, according to the research objective, supported by semi-structured interviews with the hotel managers. The results show that, although Special Employment Centres are effective in improving labour integration in the short term and could contribute to change the long-term social perspectives about workers with disabilities, they could be also reinforcing the social stigma existing in the ordinary market.


Assuntos
Pessoas com Deficiência , Economia Comportamental , Economia , Emprego , Humanos , Espanha , Recursos Humanos
11.
J Neurosci ; 41(40): 8403-8413, 2021 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-34413207

RESUMO

Decision-making not only requires agents to decide what to choose but also how much information to sample before committing to a choice. Previously established frameworks for economic choice argue for a deliberative process of evidence accumulation across time. These tacitly acknowledge a role of information sampling in that decisions are only made once sufficient evidence is acquired, yet few experiments have explicitly placed information sampling under the participant's control. Here, we use fMRI to investigate the neural basis of information sampling in economic choice by allowing participants (n = 30, sex not recorded) to actively sample information in a multistep decision task. We show that medial frontal cortex (MFC) activity is predictive of further information sampling before choice. Choice difficulty (inverse value difference, keeping sensory difficulty constant) was also encoded in MFC, but this effect was explained away by the inclusion of information sampling as a coregressor in the general linear model. A distributed network of regions across the prefrontal cortex encoded key features of the sampled information at the time it was presented. We propose that MFC is an important controller of the extent to which information is gathered before committing to an economic choice. This role may explain why MFC activity has been associated with evidence accumulation in previous studies in which information sampling was an implicit rather than explicit feature of the decision.SIGNIFICANCE STATEMENT The decisions we make are determined by the information we have sampled before committing to a choice. Accumulator frameworks of decision-making tacitly acknowledge the need to sample further information during the evidence accumulation process until a decision boundary is reached. However, relatively few studies explicitly place this decision to sample further information under the participant's control. In this fMRI study, we find that MFC activity is related to information sampling decisions in a multistep economic choice task. This suggests that an important role of evidence representations within MFC may be to guide adaptive sequential decisions to sample further information before committing to a final decision.


Assuntos
Comportamento de Escolha/fisiologia , Economia Comportamental , Estimulação Luminosa/métodos , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/fisiologia , Recompensa , Adolescente , Adulto , Feminino , Previsões , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
PLoS One ; 16(8): e0255333, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34437562

RESUMO

BACKGROUND: The field of behavioural economics holds several opportunities for integrated fisheries management and conservation and can help researchers and managers alike understand fisher behaviour and decision-making. As the study of the cognitive biases that influence decision-making processes, behavioural economics differentiates itself from the classical field of economics in that it does not assume strictly rational behaviour of its agents, but rather looks for all mechanisms that influence behaviour. This field offers potential applications for fisheries management, for example in relation to behavioural change, but such applications require evidence of these mechanisms applied in a fisheries context. Thus, we have developed a systematic literature review protocol focusing on the primary question: "Which behavioural economics mechanisms influence fisher behaviour?" The aim is to provide a comprehensive overview of these different mechanisms and how they have been applied in the study of fisher behaviour. METHODS AND EXPECTED OUTPUTS: The review protocol was developed in close collaboration with the International Council for the Exploration of the Sea (ICES) Working Group on Maritime Systems (WGMARS). WGMARS members were therefore considered the key stakeholders for this study, and were consulted to develop a suitable systematic review question and methodology. Three academic databases will be searched using a customized Boolean keyword search string. Research articles deemed eligible for inclusion in the systematic review are those that studied the influence of behavioural-economics mechanisms on the behaviour of marine fishers in any location, and at any scale. Insights from this literature will be collated in order to provide an overview of the relevant behavioural-economics mechanisms and actions, how effective these mechanisms are and at what scale, geographic region and in which fisheries sector they have been applied. Any fisheries management implications identified by the studies under review will also be outlined. Finally, it will be recorded whether or not ethical considerations were made in the reviewed literature, so that in the discussion it will be possible to reflect on the ethics of conducting behavioural-economics research and policy actions in a fisheries context.


Assuntos
Conservação dos Recursos Naturais/métodos , Pesqueiros/economia , Tomada de Decisões , Economia Comportamental , Atividades Humanas , Humanos
15.
Hastings Cent Rep ; 51(4): 7-8, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34255366

RESUMO

One of the biggest policy interventions during the last year of the COVID-19 pandemic was the Coronavirus Aid, Relief, and Economic Securities Act, instituting a novel form of economic relief similar to a universal basic income. The economic impact payments, colloquially known as "stimulus checks," were distributed based on the socioeconomic status of American citizens and legal residents and provided much-needed financial aid. However, the distribution of these payments paid little attention to other important factors that might determine the economic security of said individuals, such as race and gender. This article calls for policy-makers to pay particular attention to how structural inequity and discrimination based on identity could affect the efficacy of proposed policies and demonstrate an ethic of care informed by an understanding of intersectionality.


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Efeitos Psicossociais da Doença , Economia Comportamental/estatística & dados numéricos , Financiamento da Assistência à Saúde/ética , Comportamentos Relacionados com a Saúde/ética , Acesso aos Serviços de Saúde/economia , Humanos , Nações Unidas , Estados Unidos
16.
Implement Sci ; 16(1): 72, 2021 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-34266468

RESUMO

BACKGROUND: Routine evidence-based tobacco use treatment minimizes cancer-specific and all-cause mortality, reduces treatment-related toxicity, and improves quality of life among patients receiving cancer care. Few cancer centers employ mechanisms to systematically refer patients to evidence-based tobacco cessation services. Implementation strategies informed by behavioral economics can increase tobacco use treatment engagement within oncology care. METHODS: A four-arm cluster-randomized pragmatic trial will be conducted across nine clinical sites within the Implementation Science Center in Cancer Control Implementation Lab to compare the effect of behavioral economic implementation strategies delivered through embedded messages (or "nudges") promoting patient engagement with the Tobacco Use Treatment Service (TUTS). Nudges are electronic medical record (EMR)-based messages delivered to patients, clinicians, or both, designed to counteract known patient and clinician biases that reduce treatment engagement. We used rapid cycle approaches (RCA) informed by relevant stakeholder experiences to refine and optimize our implementation strategies and methods prior to trial initiation. Data will be obtained via the EMR, clinician survey, and semi-structured interviews with a subset of clinicians and patients. The primary measure of implementation is penetration, defined as the TUTS referral rate. Secondary outcome measures of implementation include patient treatment engagement (defined as the number of patients who receive FDA-approved medication or behavioral counseling), quit attempts, and abstinence rates. The semi-structured interviews, guided by the Consolidated Framework for Implementation Research, will assess contextual factors and patient and clinician experiences with the nudges. DISCUSSION: This study will be the first in the oncology setting to compare the effectiveness of nudges to clinicians and patients, both head-to-head and in combination, as implementation strategies to improve TUTS referral and engagement. We expect the study to (1) yield insights into the effectiveness of nudges as an implementation strategy to improve uptake of evidence-based tobacco use treatment within cancer care, and (2) advance our understanding of the multilevel contextual factors that drive response to these strategies. These results will lay the foundation for how patients with cancer who smoke are best engaged in tobacco use treatment and may lead to future research focused on scaling this approach across diverse centers. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04737031 . Registered 3 February 2021.


Assuntos
Neoplasias , Tabaco , Economia Comportamental , Humanos , Neoplasias/terapia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Fumaça , Uso de Tabaco
17.
PLoS Comput Biol ; 17(7): e1009213, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34270552

RESUMO

Reward prediction errors (RPEs) and risk preferences have two things in common: both can shape decision making behavior, and both are commonly associated with dopamine. RPEs drive value learning and are thought to be represented in the phasic release of striatal dopamine. Risk preferences bias choices towards or away from uncertainty; they can be manipulated with drugs that target the dopaminergic system. Based on the common neural substrate, we hypothesize that RPEs and risk preferences are linked on the level of behavior as well. Here, we develop this hypothesis theoretically and test it empirically. First, we apply a recent theory of learning in the basal ganglia to predict how RPEs influence risk preferences. We find that positive RPEs should cause increased risk-seeking, while negative RPEs should cause risk-aversion. We then test our behavioral predictions using a novel bandit task in which value and risk vary independently across options. Critically, conditions are included where options vary in risk but are matched for value. We find that our prediction was correct: participants become more risk-seeking if choices are preceded by positive RPEs, and more risk-averse if choices are preceded by negative RPEs. These findings cannot be explained by other known effects, such as nonlinear utility curves or dynamic learning rates.


Assuntos
Modelos Psicológicos , Recompensa , Assunção de Riscos , Adolescente , Adulto , Aprendizagem por Associação/fisiologia , Gânglios da Base/fisiologia , Biologia Computacional , Simulação por Computador , Corpo Estriado/fisiologia , Tomada de Decisões , Dopamina/fisiologia , Economia Comportamental , Feminino , Humanos , Aprendizagem/fisiologia , Funções Verossimilhança , Masculino , Memória/fisiologia , Reforço Psicológico , Incerteza , Adulto Jovem
18.
J Exp Anal Behav ; 116(2): 149-165, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34227121

RESUMO

Condom use substantially reduces unwanted pregnancies and sexually transmitted infections. While condom availability is a significant public health priority, effects of condom availability constraints remain relatively under-researched. The limited research on condom availability suggests two major barriers to use: (1) effort/costs and (2) delay to access. To date, we are aware of no study that explores both demand for and discounting of condom availability; the focus of this study was to account for condom decisions using a reinforcement pathology framework. This study used a condom purchase task and the Sexual Delay Discounting Task to quantify behavioral economics of condom use. Low sexual discounting was associated with higher willingness to engage unprotected sex. Demand metrics suggest participants indicating abstinence at condom breakpoint were willing to pay nearly double for condoms relative to individuals indicating unprotected sex at breakpoint. Finally, we grouped participants into reinforcement pathology risk groups based on their discounting and demand indices; these groups significantly differed in self-reported number of sexual partners, unprotected sexual partners, and Sexual Desire scores. This study demonstrates the value of behavioral economic approaches to public health concerns, and further underscores the translational benefits of quantitative metrics to shed novel light on risky health decisions.


Assuntos
Preservativos , Desvalorização pelo Atraso , Economia Comportamental , Humanos , Sexo Seguro , Comportamento Sexual
19.
Contemp Clin Trials ; 107: 106483, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34129953

RESUMO

Physical inactivity post-stroke can negatively impact long-term health outcomes and contribute to cardiovascular deconditioning, muscle loss, and increased risk for recurrent stroke. The limited number of interventions designed to improve daily physical activity post-stroke have lacked precision in step goals, are resource intensive, and difficult to scale. The purpose of the Leveraging Insights from Behavioral Economics to Improve Mobility for Adults with Stroke (BE Mobile) trial is to examine the preliminary effectiveness of a novel gamification with social incentives intervention for improving physical activity post-stroke. This trial includes adults who have experienced an ischemic or hemorrhagic stroke ≥3 months prior to the time of recruitment who are randomized to a control or gamification arm. All participants receive a Fitbit Inspire 2 wearable device to quantify daily steps and complete a 2-week baseline run-in period followed by an 8-week intervention period. All participants select a daily step goal and the gamification arm is enrolled in a game with loss-framed points and levels to help participants achieve their daily step goal. Participants in the gamification arm also select a support partner who receives weekly updates on their progress in the game. The primary outcome is change in daily steps from baseline during the intervention period. The secondary outcome is difference in the proportion of days participants achieved their daily step goal. Results from this trial will inform future, larger studies that leverage insights from behavioral economics to help improve daily physical activity post-stroke. Trial registration: NCT #04607811.


Assuntos
Economia Comportamental , Acidente Vascular Cerebral , Adulto , Exercício Físico , Monitores de Aptidão Física , Humanos , Motivação
20.
Wiad Lek ; 74(5): 1125-1129, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34090276

RESUMO

OBJECTIVE: The aim: To determine the level of public awareness of COVID-19 and information needs, as well as level of public confidence in both official information on COVID-19 and to develop recommendations for communication policy on longer-term awareness in pandemic settings COVID-19, using principles of behavioral economics. PATIENTS AND METHODS: Materials and methods: 4 focus group interviews were conducted in residents of Ukraine, with a total quantity of 48 people aged 16-70 years questioned and an anonymous questionnaire was conducted in 1,700 respondents, representing the adult population aged 18 years and older from all over Ukraine. The representative error of the study with probability of 0.95 does not exceed 4%. The processing of questionnaires was carried out by SDU Center of Social Researches (SDUCSR) employees, using the OSA program. RESULTS: Results: 28.5% of respondents believe that politicians and media underestimate the danger of the COVID-19 epidemic, while other 28.1% believe that politicians and media adequately assess its danger. 18.9% of respondents are sure that the danger is exaggerated. As much as 24.5% of Ukrainian respondents could not decide on such assessment. The most common sources of information about disease/treatment are Internet and social media. Traditional media and relatives/acquaints who endured the COVID-19 also gain population`s confidence. A family doctor is the least popular source of information. 42.1% of respondents do not trust official information on the number of infected people and severity of the disease, and another 40% are not sure whether they should trust or not. Only 17.9% of respondents trust official information. CONCLUSION: Conclusions: Within informing the society about public health in conditions of a COVID-19 pandemic it is better to provide communication strategy for various target audiences: for youth which is inclined to underestimate threats of epidemic and obtains information on social networks; for people of a retirement age (as risk group) who lack information because they use only traditional media (mainly TV); for women who need psychological support to decrease in level of stress in the family more often and also to overcome the negative post-stressful situations (connected with the death of the family/relatives); for men who are inclined to neglect their own health, etc.; for the people who have endured COVID-19 to prevent possible reinfection in them.


Assuntos
COVID-19 , Economia Comportamental , Adolescente , Adulto , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2 , Ucrânia
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