Unpacking Peer Conversations in a Virtual Communitiy for Diabetes Self-Management Education and Support: Behavior Science and Linguistics Perspective

Diabetes is a chronic disease that can be effectively managed and controlled using strategies such as self-management education and ongoing support. Virtual environments offer innovative and realistic settings where patients can achieve self-management education and obtain ongoing self-management support from peers and healthcare professionals. Transcribed real-time conversations in an innovative virtual community were analyzed using qualitative and linguistic analysis. These virtual interactions were manually coded to identify embedded behavior change techniques and linguistic features. Results showed 13 behavior change techniques were manifested. Further, language differences were observed between behavior change techniques and social support types. Our research can provide valuable insights into the design of effective digital health interventions that maximize sustained use of virtual environments, subsequently impacting self-management of chronic conditions such as diabetes.

Using Behavior Science to Maximize Human Performance

Authors use behavior science to help organizations maximize human performance through a cost-effective and sustainable approach. Such approach is based on transformational leaders and employees’ engagement, so they embrace a humanized management system by conviction, not by imposition. This paper shows how to use organizational psychology principles in real case applications, resulting in holistic business improvements, including financial, safety and service quality performance. The authors developed the Engineering Human Performance (EHP) methodology, by improving the Behavior Engineering Methodology (Lopez, et. al., 2020) to help organizations achieve outstanding and sustainable levels of human performance. Over the last ten years, this methodology was successfully applied to more than 50 business processes in an oilfield services company. The EHP four-stages process uses frontline employees’ wisdom to identify sources of behavioral variance, measure adherence to expected behaviors and formulate changes to the operational context to pursue high levels of procedural adherence, sustainably. EHP incorporated statistic models to demonstrate its significant impact to business results, using a fit-for-purpose digital platform. A combination of a coaching program for managers to embrace a leading with purpose approach (Sinek, 2020), and workshops with the front-line associates, generate a healthy flow of communication across the organization. The leading with purpose program improves managers’ leadership by voluntarily selecting and engineering transformational behaviors they adapt and adopt to improve the effectiveness of their leadership style. The impact of the program is measured for statistical significance by applying the Multi-Factor Leadership Questionnaire (Boss, Avolio, 1996) before the coaching program starts, and 90 days after the last session. Workshops with front-line associates use scientific principles to understand the sources of behavioral variance and formulate intervention plans that drive procedural adherence by conviction, not by imposition. An innovative element of EHP is the ‘behavior empowerment center (BEC)’. The BEC coordinates the systematic measurement of adherence to critical behaviors in the front-line, captures and verifies statistical significance of the data, analyzes trends, and prepares reports depicting the levels of behavioral adherence, so crews receive soon, certain, and positive feedback on a regular basis. This feedback loop elicits levels of adherence above 90%, sustainably, and eliminates losses associated to behavioral variance. The BEC uses a unique digital platform designed to bring consistency to the feedback loop to front-line employees and managers. A case study is used to exemplify how EHP is being applied by a major rig company, to improve human performance in workover operations. The paper illustrates the remarkable results of the leading with purpose program and describes the Stages 1 (select processes that are causing loss), 2 (behavior analysis), 3 (baseline and intervention) and Stage 4 (scale-up) of the EHP methodology. Authors consider that EHP offers an innovative, and cost-effective approach to helping organizations maximize human performance, in a systematic and sustainable manner. The application of the methodology shall not be limited to the oil and gas industry, as the focus on incorporating the human factor to inconsistently applied processes is affecting many industries, if not all. The main challenge faced by authors in the implementation of the methodology is management commitment. Some managers expect improvement programs to bring immediate results, which could undermine the sustainability of the benefits. EHP grants sustainable improvements, provided the organization is committed to scale-up the program until results are significant. Achieving these milestones require time (from 6 months to 2 years), resources, and persistency. The leading with purpose program has proven effective in getting the proper levels of management commitment, to support EHP and deliver outstanding results. The paper shows a statistically significant improvement in the leadership style of the management team and how it is helping the business of the case-study company. As for the way forward, authors are exploring options to incorporate artificial intelligence into the behavioral measurement, not to replace the face-to-face interactions, but to increase the accuracy of the behavioral measurement and speed up the feedback loop.

Promoting the adoption of local governmental policy on the reimbursement of chronic disease medicines (PAPMed): study protocol of a field-based cluster randomized trial in rural Nantong, China

Background Among rural Chinese patients with non-communicable diseases (NCDs), low socioeconomic status increases the risk of developing NCDs and associated financial burdens in paying for medicines and treatments. Despite the chronic disease medicine reimbursement policy of the local government in Nantong City, China, various barriers prevent patients from registering for and benefitting from the policy. This study aims to develop a behavior-science based intervention program for promoting the adoption of the policy and to evaluate the effectiveness of the program compared with usual practices. Methods Barriers and opportunities affecting stakeholders in adopting the policy were identified through contextual research and summarized through behavior mapping. The intervention targets these barriers and opportunities through behavior science theories and will be evaluated through a 6-month cluster randomized controlled trial in Tongzhou District, Nantong, China. A total of 30 villages from two townships are randomized in a 1:1 ratio to either the intervention or the control arm (usual practices). Village doctors in the intervention arm (1) receive systematic training on policy details, registration procedures, and intervention protocol, (2) promote the policy and encourage registration, (3) follow-up with patients in the first, third and sixth month after the intervention, and (4) receive financial incentives based on performance. The primary outcome is policy registration rate and the secondary outcomes include the number of patients registering for the policy, medical costs saved, frequency of village doctor visits, and health conditions such as blood pressure and glucose levels. Discussion This study is one of very few that aims to promote adoption of NCDs outpatient medication reimbursement policies, and the first study to evaluate the impact of these policies on patients’ financial and physical wellbeing in China. The simple, feasible, and scalable intervention is designed based on the theories of behavior science and are applicable to similar low-income regions nationwide where outpatient medical costs remain a financial burden for patients. Trial registration: ClinicalTrials.gov, NCT04731194, registered on 29 January 2021, https://clinicaltrials.gov/ct2/show/NCT04731194?term=PAPMed&draw=2&rank=1; Chinese Clinical Trial Registry, ChiCTR2100042152, registered on 14 January 14 2021, http://www.chictr.org.cn/showproj.aspx?proj=65987.

Advocating for the use of Restorative Justice Practices: Examining the Overlap Between Restorative Justice and Behavior Analysis

Broadly defined, Restorative Justice (RJ) is a set of procedures based in Indigenous peacemaking practices that reduces recidivism and guides the effective reparation of harm. RJ practices provide harm-affected parties an opportunity for engagement in the resolution process, which theoretically enhances community well-being. RJ practices overlap significantly with behavior-analytic principles. Implementing RJ practices from a context-focused, appetitive-based approach that focuses on classes of behaviors may address harmful behaviors within police organizations. RJ practices may also facilitate changes in contexts that support behaviors valued by the community. The current review discusses criminal and Restorative Justice, RJ processes and practices, the effectiveness of RJ in various contexts, how RJ overlaps with behavior-analytic principles and existing behavior science models more generally, research suggestions, and recommendations for behavior analysts implementing RJ within police organizations and communities to address officer misconduct.