Changing ingrained attitudes, perceptions and cultural norms that lead to harmful behavior can be one of the trickiest challenges in public health. There are varying disciplines that attempt to examine why social and behavioral change can be so difficult to accomplish. One of those fields, Health Economics, examines how to design incentives to motivate people to take care of themselves. Dr. Antonio Trujillo, co-director of Health Systems Program’s Master of Health Science (MHS) in Health Economics academic program, spearheads a study in Peru that attempts to understand why people with diabetes fail to take care of themselves over and over again.

In collaboration with the Center of Excellence in Chronic Diseases (CRONICAS) in Peru, Dr. Trujillo’s study looks at the role group incentives play in promoting healthier behavior, specifically, how we can use the combination of cooperation and group monetary rewards to encourage people with diabetes to take care of themselves. Past studies have examined the use of individual monetary incentives to accomplish certain outcomes when trying to change behavior; however, individual cash rewards have increasingly been found to work short-term but not in the long run. In addition to a lack of long-term success for consistent healthy behavior, they are often infeasible and unaffordable to scale-up to larger projects and studies, and frequently face rejection from the general public who are opposed to paying individuals to take care of themselves.

This Health Systems Program project examines the viability of a mixed-incentive study that combines both group motivation and monetary reward. Using a teamwork approach, there are two participants: one patient implements the suggested lifestyle changes while their partner, designated as a “motivator,” encourages them to stick to the new regimen. If the person implementing the suggested changes makes the goal, then they both get rewarded. The aim of the design is to foster cooperation and synergies between participants. The use of social networks and personal connections establishes a more meaningful tie to the healthier routine.

Challenges to introducing behavior change over the long haul still persist and a big part of Dr. Trujillo’s work is understanding these challenges and how best to mitigate them. One such challenge touches upon one of the basic fundamentals of public health - people in many areas of the world lack the information and knowledge, access to primary care and insurance, and do not have the income to support a steady upkeep of their health. These obstacles persist across all geographic areas, and failures to take care of diabetes are similar in both the U.S. and Peru. Dr. Trujillo and the Health Systems Program wish to see gains happen across all different types of behaviors, starting with designing better programs to address chronic disease; however, in order to achieve that, it’s necessary to help people develop a habit of taking care of themselves – all around the world.