A Behavioral Economics Toolkit: The Case of HPV Vaccination in Colombia

"Although behavioral economics interventions are low-cost, designing and testing them requires a rigorous methodology."

With the tools and insights that psychology offers, behavioural economists evaluate ways to correct some of our irrational tendencies or biases to help us make better choices that improve our well-being and, therefore, society's welfare. This toolkit outlines an intervention designed to increase human papillomavirus (HPV) vaccination rates in Bogota, Colombia, by following the steps of the Inter-American Development Bank (IDB) Behavioral Economics Group methodology: define, diagnose, design, and test. The guide explains why they chose the population they intervened in, the behavioural barriers they found, and the designs that proved helpful for this intervention. This toolkit also aims to give practitioners and policymakers the tools to design interventions informed by behavioural economics to increase HPV vaccinations in their area.

The toolkit describes the process and lessons learned from the Bogota HPV project in each of the four steps:

1. Define
   • 1.2 Understand context
   • 1.3 Define intended population and desired behaviour
2. Diagnose
   • 2.1 Identify behavioural barriers
   • 2.2 Check validity of barriers in the field (e.g., via interviews)
   • 2.3 Select behavioural barriers to tackle
3. Design
   • 3.1 Identify potential solutions
   • 3.2 Design treatments
   • 3.3 Design evaluation strategy, outcome indicators, and methodology
4. Test
   • 4.1 Pilot intervention
   • 4.2 Implement intervention and evaluate results
   • 4.3 Scale up (when applicable)

In brief, the American Cancer Society and the Liga Colombiana Contra el Cáncer, two organisations with a mission to eradicate cancer, recruited the IDB Behavioral Economics Group to be part of a team devoted to addressing the challenge of record-low HPV vaccination rates in Bogotá, Colombia. They strengthened the team by creating a coalition with the Colombian Government and the Behavioral Government Lab at Universidad del Rosario. The team then worked with insurance companies, health authorities, and physicians to obtain a detailed picture of the process and a comprehensive list of potential barriers at each moment of decision and moment of action. Once they created a list of hypothesised behavioural barriers, they developed an instrument to interview people in the field to validate the hypotheses.

The interviews revealed, for example, the existence of an availability bias. The media phenomenon sparked by an incident in which several minors from the municipality of Carmen de Bolívar said the HPV vaccine caused them to faint is easily remembered and has been assimilated into the country's culture. Thus, the availability bias is present in parents' belief that side effects are more likely than they are in reality. Related to salience, parents are unsure when they should vaccinate their daughters, so they wait for doctors to recommend the vaccine. However, all interviewed doctors report that sometimes they do not have time to talk about the vaccine during their appointments because they usually face more urgent issues.

Once the team had narrowed down some themes that summarised the barriers and contextual features they found in the field, it was time to design the intervention. Considering the relevance and scalability of the intervention, they chose the text messaging channel for messages designed with behavioural economics principles. As detailed in the toolkit, this behavioural intervention reached thousands of parents and helped advance HPV vaccination in Bogotá in a cost-effective manner.

Lessons learned from this experience include:

• Diagnosing the challenges that prevent parents from getting their girls vaccinated is essential, keeping in mind that vulnerable populations may require special attention.
• When there are safety concerns around a vaccine, it is vital to show a consistent stance among different stakeholders to reassure individuals of the veracity of the information.
• Personalising and signing messages may be as important as the message itself.
• For the second dose of the vaccine, all parents may need is a simple reminder.

The final section of the resource invites the reader to think like a behavioural economist and build their own HPV case.