Behavior design for better health care access

Behavior re-design for health care accessCASE STUDY

JUNE 8, 2015

Alexandra [email protected]

The need: increase patient numbers for network of maternity hospitals

Jacaranda Health provides high-quality, yet affordable maternity care to women in peri-urban, low-income areas of Nairobi.

Delivery at a public hospitalIncreased maternal mortality risk

Delivery at JacarandaExcellent quality of care

Delivery at other private hospitalsSimilar levels of care as Jacaranda

FREE $100 $1000< <

Alexandra Cristea – Stanford GSB

Behavior design challenge: how might more patients deliver with Jacaranda Health?

Client interviews:

I wanted to come to deliver at JH but I

couldn’t!

I want to come to deliver at JH! I love the quality of care!

Why not?!?!?

When the moment came, my husband took me to a public hospital. JH was too

expensive.

Before delivery After delivery


The father to be is the decision-maker for the mother’s health care

In our patients’ culture, the father-to-be is little involved in the antenatal care process

His main responsibility is to pay for the delivery

and all the costs thereafter

Faces a myriad of competing financial priorities

The father-to-be

Does not experience our services

Is the financial decision-maker

Is strapped for cash


A behavior occurs when motivation, ability and trigger converge

Find out more about BJ Fogg’s Behavior Model here: http://www.behaviormodel.org/

One-time desired behavior:

Mother-to-be (JH antenatal care client)

to deliver at Jacaranda Health

Trigger:

Mother-to-be goes into labor


Our clients had high motivation….


Motivation=high: Desire to deliver with Jacaranda Health

All surveys and mystery shoppers showed that client satisfaction and trust were high

Quality of care…..

Bedside manner…

Cleanliness………

Respect…………..


… but low ability


Ability = low due to financial constraints

Mothers told us that lack of cash on hand at the moment of the delivery led expecting fathers to decide to take their partners to deliver elsewhere

Desired behavior failsDesired behavior


New behavior-design challenge

HOW MIGHT WE

support expecting fathers to obtain the $100 necessary for the delivery?


Applications of behavior design principles

Make the behavior simpler

Help people feel successful in the desired behavior

Trigger the right sequence of baby steps

Use snap-testing

Put hot triggers in the path of motivated people who have the ability


1

2

3

4

5


Behavior-design challenge #3

HOW MIGHT WE

Make the behavior of saving simpler?

~38 cents per day¿ ¿

~1 soda per dayDue date = $100

1


MamaKiba: Mobile-based savings platform

Mobile-based savings platform

+Reminder messages to save small amounts

Find out more about MamaKiba - Jacaranda Health’s Mobile Savings Platform - at jacarandahealth.org/innovation/




Behavior simple and natural: clients already

used to saving with mPesa

To make it even simpler: automatic

enrollment at time of mother’s first visit

1 Make it simpler




Deposited $10 at the time of enrollment to

create success momentum

2 Help people feel successful

*Effectively a marketing discountto encourage saving


MamaKiba: Trigger design to increase savings


Reminder messages to save small amounts

3 Trigger the right sequence of baby steps


MamaKiba: Trigger design to increase savings


4 Use snap-testing

Snap testing: test many super low-resolution versions of the product to gain feedback

Informally tested a lot of versions of the reminder messages with any young male could encounter who was an expecting father, a recent father, or knew a young father including

Cab drivers Security guards

Or anyone who would speak to us


MamaKiba: Identified optimal time for trigger


5 Put hot triggers in the path of motivated people who have the ability

Our snap tests revealed the insight that the best time for the reminder messages was

~at the end of the month ~

when people were usually getting paid and had a

higher ability to save


Success applying behavior design principles


Tripled the number of fathers who were saving small amounts with the mobile platform and who were able to deliver with Jacaranda Health

Great application of behavior design

Many more next steps to increase the ability of our clients to deliver with


Health & Medicine

Behavior design for better health care access