HARVARD GAZETTE ARCHIVES

James Choi gives a presentation last Friday at a conference exploring small, inexpensive, and noncoercive psychological and sociological interventions that can have a dramatic effect on human behavior. (Staff photos Stephanie Mitchell/Harvard News Office)

For many of us, the gap between what we know is good for us and what we actually do yawns wide. This disconnect has long confounded social scientists, who have traditionally plied us with information - those terrifying pictures of crumbling teeth not flossed - or financial incentives, such as an employer's match of retirement funds.

A Harvard-sponsored conference Friday (Nov. 14) convened a multidisciplinary group of social scientists to explore whether there might not be easier, more effective ways to align our intentions with our actions. Called "Small Interventions with Large Effects: The Psychological Foundations of Effective Policies," the daylong conference was sponsored by the Center for Basic Research in the Social Sciences (CBRSS) at Harvard.

Research from the fields of economics, social psychology, and public health showed how psychological changes could affect sexual health, retirement savings, marketing, and sustainable public health in developing nations. "These interventions are by and large noncoercive and tend to be very effective," said David Laibson, professor of economics at Harvard and conference organizer. "The question we want to ask is, Are these psychologically styled interventions important elements to be added to our arsenal of policy interventions?" The answer turned out to be a qualified "yes."

Changing sexual behavior

Rochelle Shain, a professor of obstetrics and gynecology at the University of Texas and director of an STD intervention project there, discussed how she and a team of researchers found that a behavioral intervention carefully designed to be relevant to the background of their clients - Mexican-American and African-American women in San Antonio - resulted in lower STD infection rates.

"Sexual behavior is really tough to change," she said. "It involves a host of factors that are much more in-depth than just the sexual act," including intimacy, sexual support, and sometimes economic support.

Trained as an anthropologist, Shain spent 18 months gathering ethnographic data from her subjects. "We needed to understand where people were coming from, what they did, what were the strengths of the culture that we were dealing with that we could build on," she said. "We try to take belief patterns that already exist in the culture and actually [adapt] them to other things."

Rochelle Shain (left) gives her presentation as David Laibson listens from the audience.

She cited the Mexican-American value of protecting one's family, and the importance of survival by one's wits and an emphasis on cleanliness among African Americans as behaviors on which the intervention built. When African Americans told researchers about the concept of not eating or drinking "behind" - not sharing glasses or food - they extended it to not having sex "behind," or not sharing sex partners.

Tapping this information, Shain and her researchers designed a nonjudgmental intervention that showed the subjects that they were at disproportionately high risk for contracting STDs or AIDS, taught preventive methods like abstinence and mutual monogamy, coached them on positive relationship skills and condom use, and provided resources not only for health care but also for education, housing, and employment.

The results were encouraging: the study group had lower rates of infection than the control group - 17 percent versus almost 26 percent. "Giving people information doesn't work," said Shain. "You have to really get involved with their belief systems, what they do, in order to actually motivate change."

Making active decisions

James Choi, a graduate student in Harvard's department of economics, presented research on retirement savings that might have hit the audience of academics closer to home. In a study co-authored by Laibson, he proposed an "active decision" model to enrollment in a company's 401(k) plan that proved a practical alternative to effective but paternalistic default options.

Research indicates that making enrollment in a company 401(k) plan the default option - so that employees had to actively opt out of the plan if they did not want to participate - boosted enrollment. In one company he studied, however, it also clustered employees' contribution rates at the default savings rate of just 3 percent. "It seemed the path of least resistance - for example, defaults - has an enormous influence on people's actions and decisions," he said. "The downside of this is that defaults have undesirable herding effects."

Choi and his colleagues studied a company that, for a certain time period, required employees to make an active decision regarding their retirement savings: They were told that they must actively choose either to enroll in or decline the company's 401(k) plan.

The researchers found that the active decision model not only boosted employee participation rates over a model in which the default is nonenrollment, it also increased the average rate of savings. "This 'active decision' regime provides a neutral middle ground that avoids the paternalism of a one-size-fits-all default election," Choi wrote.

Just give a man the fish

Not everyone found success with small psychological interventions, however. Research by Michael Kremer, the Gates Professor for Developing Societies in the Department of Economics, and Ted Miguel, assistant professor of economics at the University of California, Berkeley, showed that for treating intestinal worms among Kenyan schoolchildren, giving the man the proverbial fish was more cost-effective than giving him fishing lessons.

In a paper called "The Illusion of Sustainability," the researchers poked holes in the ideologically popular notion that local ownership and self-sustainability is preferable when providing relief aid in developing communities. The motivations for economic sustainability, which has gained traction among nongovernmental organizations working in the developing world, are sound: They aim to perpetuate the relief after foreign aid withdraws, and they push local communities toward independence and self-reliance.

"A lot of us look at this evolution [toward sustainability] somewhat skeptically," said Miguel. "Our point in this paper is ... that a lot of the claims made about the sustainability literature and its potential to rapid development are really overstated."

The researchers studied a deworming program in schools in a poor, rural area of Kenya, where intestinal worms constitute a serious and widespread public health problem. They compared treating the infected children with inexpensive, effective drugs with four sustainable approaches to deworming: health education, a cost-sharing model that shifted a small percentage of the cost of drugs onto families, requesting a verbal commitment from the children, and improving water and latrine facilities.

"All four of those seem to do much worse than the policy of simply having external donors give deworming drugs to the school and basically placing the drugs in kids' mouths," said Miguel. From the high cost of education and water and latrine improvements to the low effectiveness of the cost-sharing and verbal commitments, the researchers concluded that in this instance, sustainability was not a worthy alternative to the donor-funded drug treatment.

"Deworming drugs cost 49 cents per child per year. It's pretty hard to beat that, in terms of cost-effectiveness," he said. "Count after count, it looks like this sustainable approach was not sustainable at all."