Generating Buy-In from Participants

Because one of the objectives of the HAT program is to help adolescents learn new skills to lead healthier lives, participants are presented with an array of options for changes they can make to their immediate environment. When done correctly, this method can be effective in helping them make lasting behavior changes. The following key principles to keep in mind can help HAT providers know the best way to approach the goal-setting opportunity with each participant.

Variety, Defaults, and Anchoring

Most people like options, but too much variety often leads people to walk away from the choice and lose their sense of ownership. Thus, it can be very useful for HAT providers to have pre-determined, or default, sets of goals for the participants. Of course, participants can modify these lists as they please. An important feature of these lists is that they act as an anchor, or baseline. Participants are likely to refer to these initial lists as they consider their own goal options (if they wish to modify the default lists).

Attribution

Lasting change requires commitment. People are more likely to commit to a certain behavior when they feel a sense of ownership. This is why each participant chooses their own areas of behavior change within the program’s framework.

Framing

Is the glass half empty, or half full? The way a person perceives the context of any situation greatly influences decisions that are made. If HAT providers can present the goals in an appealing way, participants are more likely to take ownership. Since the participants are teenage mothers, positive messaging will be most effective. For example, instead of telling them that drinking sugary beverages can have long-term health consequences, present the benefits of drinking something like milk, water, or juice without added sugar.

Scarcity

Many adolescent mothers face what research has referred to as “income scarcity.’’ In addition, many people also deal with “time scarcity” because they have too many things to do and not enough time to do them. Scarcity often leads to “tunnel vision” so that all cognitive resources are devoted to overcoming the negative effects of scarcity. If this is the case, people will be less committed to the other goals they make. Participants in the HAT program may be focused on eating from meal to meal, or making sure rent is covered rather than food preparation, savings, or obtaining a primary care provider while they are healthy. Enrollment in SNAP, WIC, and other assistance programs for which they qualify can help reduce income scarcity. If they can be defaulted into these programs, i.e., automatically enrolled, then they do not have to take the steps to complete the appropriate paperwork.

Nudges

A nudge is any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives (Thaler and Sunstein, 2008). To count as a mere nudge, the intervention must be easy and cheap. Nudges are not mandates. For example, putting fruit at eye level counts as a nudge, while banning junk food does not. Perhaps the most frequently used nudge is the setting of defaults, which are pre-set courses of action that take effect if nothing is specified by the decision maker.