Nudging Vaccination in Latin America: Insights from Three Field Experiments in Behavioral Economics

In this dissertation, I address the impact of various principles of behavioral economics on vaccination rates and attitudes toward vaccines in Latin America with an experimental economics methodology. Each experiment was implemented with government entities in the respective study locations. With the insights generated by these studies, I seek to provide evidence-based recommendations to aid governments in optimizing resource allocation toward effective health promotion. In chapter one, I test the effect of norm nudges on increasing HPV vaccinations for parents of girls and adolescents in Bogota, Colombia, where only a minority of the population is vaccinated against HPV. Norm nudges provide social information describing the prevalence of a behavior and/or its degree of social approval. I use a text message campaign to target parents with daughters between 9 and 17 years old who need the first dose of the HPV vaccine. I compare five norm nudges, a control group, an experimental control group, and a policy control group. Two norm nudges contain social information communicating how other people’s behavior is changing over time, i.e., dynamic norm nudges. The results are based on actual HPV vaccinations from administrative data from the Secretariat of Health in Bogota. The results find that the trending norm, one of the two dynamic designs, increases average vaccination by 1.39 percent compared to the control group vaccination rate of 5.57 percent. It represents a difference in HPV vaccination rate equivalent to 25 percent compared to the control group. This study contributes to the growing literature on the applications of dynamic norm nudges on behavior change. In chapter two, I examine the effectiveness of dynamic norm nudges on increasing second-dose HPV vaccinations for trendsetters. I follow the definition of trendsetters by Bicchieri and Funcke (2018). They define trendsetters as the initiators of norm abandonment. In this context, trendsetters are parents who vaccinated their daughters with the first-dose HPV vaccine between 2017-2020. The results are based on actual HPV vaccinations from administrative data from the Secretariat of Health in Bogota. The paper tests three variations of dynamic norm nudges that include trending norms, qualitative dynamic norms, and quantitative dynamic norms. Contrary to chapter one, the results indicate that dynamic norms do not increase second-dose HPV vaccination rates of trendsetters. However, injunctive norms have a statistically significant marginal increase in second-dose HPV vaccinations of 5.22 percent compared to the control average of 15.2 percent. This difference is equivalent to a 34 percent difference. The study contributes to the literature on the effect of norm nudges on minority behaviors and identifies the elements that make dynamic norm nudges effective in this context. In addition, the study contributes to the literature on the specific conditions under which norm nudges are effective. In chapter three, I test the hypothesis that online interventions grounded in the principles of behavioral economics, that is, nudges, impact COVID-19 vaccine attitudes. I test the hypothesis with a field experiment in cooperation with the government of Guanajuato, Mexico. Contrary to public health communications interventions, the behavioral economics approach assumes that individuals suffer from limited attention and cognitive resources that constrain information processing. This study’s approach uses elements of gamification, heuristics, altruism, and framing to support the visual and message intervention to simplify the cognitive processing of information, thereby making information more salient. The results show that the online behavioral intervention has a positive effect on vaccine attitudes of 0.207 points on a 9-point scale from 1-9, where 1 is completely against, and 9 is completely in favor of the vaccine. Since recent studies show that vaccine attitudes have declined, low-cost interventions like the one studied in this chapter may hold the promise of containing a continued decline.

Author

• Martinez Villarreal, Deborah

• Behavioral Economics
• Latin America
• nudge
• RCT
• social norms
• vaccination

Identifier

hdl:1920/14024

OAI identifier oai:identifier

oai:MARS:1920/14024