A Nudgeathon for sexual health: co-designing HIV prevention strategies using behavioural economics

Left to Right: Associate Professor Dr. Jason Ong, Professor Ivo Vlaev, Associate Professor Eric Chow, Dr Umar Taj.

To achieve the UNAIDS goal to end the HIV/AIDS epidemic as a public health threat by 2030, action is needed to optimise the uptake of HIV testing and effective HIV prevention technologies, such as pre-exposure prophylaxis (PrEP) medication and treatment as prevention (TasP). Although significant gains in this area have been achieved globally, there is still a need to rethink how we target difficult-to-reach subpopulations. To this end, Associate Professor Dr Jason Ong, Research Fellow at the Melbourne Sexual Health Clinic, Monash University and Professor Daniel Read, Professor of Behavioural Science at the Warwick Business School are leading a team to investigate how successes in behavioural change from other disciplines may help to address the issue of controlling HIV using behavioural economics.

Behavioural economics is a discipline that studies how individuals make choices within complex contexts, blending insights from psychology and economics. Lessons from behavioural economics can be used to create environments that nudge people toward wiser decisions and healthier lives.

The team of researchers have identified challenges to control HIV that could be addressed by using behavioural economic theories. An example of these challenges includes how to improve PrEP medication uptake or regular HIV/STI testing for at-risk individuals where the costs are up front (taking a daily pill or making the time for HIV/STI testing) but the benefits are noticed much later (prevention of HIV or treatment of STIs). Much research has shown that in such situations, people often put too much weight on the immediate costs, and end up procrastinating – sometimes indefinitely.

Researchers at the Warwick Business School developed a crowd-sourcing event, known as a Nudgeathon, for creating behavioural economics solutions in a wide range of contexts. The event usually lasts one or two days and teams work intensively to solve one or a few precisely specified behavioural challenges. Teams of diverse stakeholders are created, including behavioural science experts, practitioners, and ’end users’. An ideal Nudgeathon team consists of a democratic problem solving entity that incorporates all relevant expertise and points of view. In this Nudgeathon, the team brought together 32 participants with varied skill sets. They devised a number of promising ‘nudges ’ or behavioural economics interventions.  These nudges included either improving HIV/STI testing or encouraging PrEP use among overseas-born males engaging in sexual activity with other males in Australia. The event focused on the sexual health needs of an overseas born group due to the significant rise in incident HIV in Australia amongst these men.

Throughout the event, many behavioural economic solutions were addressed including the following example - an email sent to all new international students advising them that most people want to be healthy and look after their own health (norms), containing information about how to navigate local health systems. They have all been given a free HIV self-testing kit (retail value $40) but have to pick it up within 7 days (incentive, loss aversion) from a trusted organisation (messenger).

Pleasingly, a post-event survey identified several key themes. Firstly, behavioural economics was a new concept for many participants who appreciated the opportunity to be equipped to use these economic tools in their ongoing work. Indeed, the Nudgeathon team emphasise that Nudgeathons are as much about ‘knowledge transfer’ as solving specific problems. Secondly, the diversity in the background and skill sets of the participants was seen as central to the legitimation of the Nudgeathon. Some participants also commented that the event was too short, and should be extended to fully understand the context and complexity of the behaviour to be changed. The team now plan to evaluate the identified nudges before taking the research to a wider audience, and to conduct further Nudgeathons to build on the insights already obtained.

If you would like to find out more about this project, please email Dr Jason Ong (jason.ong@monash.edu).

* Prof. Ivo Vlaev and Dr. Umar Taj from Warwick Business School, Associate Professor Eric Chow and Dr. David Lee from Melbourne Sexual Health Centre