A behavior design case study using BJ Fogg's Behavior design model to increase health care access

1. Behavior re-design for health
care access
CASE STUDY
JUNE 8, 2015
Alexandra Cristea
acristea@stanford.edu

2. 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 hospital
Increased maternal mortality risk
Delivery at Jacaranda
Excellent quality of care
Delivery at other private hospitals
Similar levels of care as Jacaranda
FREE $100 $1000< <
Alexandra Cristea – Stanford GSB

3. 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
Alexandra Cristea – Stanford GSB

4. 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
Alexandra Cristea – Stanford GSB

5. 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
Alexandra Cristea – Stanford GSB

6. Our clients had high motivation….
Find out more about BJ Fogg’s Behavior Model here: http://www.behaviormodel.org/
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…………..
Alexandra Cristea – Stanford GSB

7. … but low ability
Find out more about BJ Fogg’s Behavior Model here: http://www.behaviormodel.org/
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
Alexandra Cristea – Stanford GSB

8. New behavior-design challenge
HOW MIGHT WE
support expecting fathers to obtain the $100 necessary for the
delivery?
Alexandra Cristea – Stanford GSB

9. 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
Find out more about BJ Fogg’s Behavior Model here: http://www.behaviormodel.org/
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5
Alexandra Cristea – Stanford GSB

10. Behavior-design challenge #3
HOW MIGHT WE
Make the behavior of saving simpler?
~38 cents per day
= =
~1 soda per dayDue date = $100
1
Alexandra Cristea – Stanford GSB

11. 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/
Alexandra Cristea – Stanford GSB

12. MamaKiba: Mobile-based savings
platform
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
Alexandra Cristea – Stanford GSB

13. MamaKiba: Mobile-based savings
platform
Find out more about MamaKiba - Jacaranda Health’s Mobile Savings Platform - at jacarandahealth.org/innovation/
Deposited $10 at the
time of enrollment to
create success
momentum
2 Help people feel successful
*Effectively a marketing discount
to encourage saving
Alexandra Cristea – Stanford GSB

14. MamaKiba: Trigger design to increase
savings
Find out more about MamaKiba - Jacaranda Health’s Mobile Savings Platform - at jacarandahealth.org/innovation/
Reminder messages to
save small amounts
3 Trigger the right sequence of baby steps
Alexandra Cristea – Stanford GSB

15. MamaKiba: Trigger design to increase
savings
Find out more about MamaKiba - Jacaranda Health’s Mobile Savings Platform - at jacarandahealth.org/innovation/
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
Alexandra Cristea – Stanford GSB

16. MamaKiba: Identified optimal time for
trigger
Find out more about MamaKiba - Jacaranda Health’s Mobile Savings Platform - at jacarandahealth.org/innovation/
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
Alexandra Cristea – Stanford GSB

17. Success applying behavior design
principles
Find out more about MamaKiba - Jacaranda Health’s Mobile Savings Platform - at jacarandahealth.org/innovation/
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
Alexandra Cristea – Stanford GSB