TABLE 2.

How Behavioral Economics Can Explain and Facilitate Consumers’ Enrollment in the National DPP’s LCP

Awareness and Education (become aware of type 2 diabetes risk and decide to change behavior)Risk Assessment and Diagnosis (discover a National DPP LCP and are receptive to information about it)Enrollment (decide the program is a good fit now and enroll in an upcoming class)
Barriers (drop-off points)Do not feel an urgent need to actMisperceive type 2 diabetes risk and ability to change itLack social influenceDo not feel an urgent need to actMisperceive type 2 diabetes risk and ability to change itLack social influenceMisperceive that commitment costs outweigh program’s future benefitsLack social influenceMisperceive that commitment costs outweigh program’s future benefits
Behavioral economic conceptsAvailability bias,* salience, limited attentionLearned helplessness,§ ostriching,|| overconfidence, self-categorization#Social influence,** identity††Availability bias,* salience, limited attentionLearned helplessness,§ ostriching,|| overconfidence, self-categorization#Social influence,** identity††Loss-aversion,‡‡ present bias,§§ scarcity||||Social influence,** identity††Loss-aversion,‡‡ present bias,§§ scarcity||||
Possible solutionsPlanning prompts, promotion materials providing clear and actionable next steps, personalized promotion materials, built-in reminders, use of word-of-mouth referrals, physician referrals, provision of salient examples of successUse of word-of-mouth referrals, provision of program details from a trusted source, provision of salient examples of success, continued support by referrer, opportunities for mingling with program participantsConnecting participant with a lifestyle change coach, addressing questions about program details and costs, self-affirmation activities, opportunities for mingling with program participants
Stakeholder interventions (levels)LCPs (Family and Community, HCP, Health Care System)LCPs (Family and Community)
  • * Availability bias: propensity to overweigh the likelihood of an event happening based on how easily that event comes to mind.

  • Salience: the degree to which an item or choice stands out and captures our attention.

  • Limited attention: prevents us from weighing all options equally; thus, our choices become easily affected by which factors are most salient.

  • § Learned helplessness: the belief that one has little control over a situation and that no action can improve or change an outcome.

  • || Ostriching: “burying one’s head in the sand” when there is a possibility of bad news.

  • Overconfidence: being surer of one’s own beliefs, predictions, feelings, and abilities than an objective evaluation would warrant.

  • # Self-categorization: people innately understand themselves and others through categorical distinctions placing themselves in an “in group” among others with similar characteristics.

  • ** Social influence: when people they feel close to and trust, like friends, family, community members, and doctors, instruct them to take action, they usually listen.

  • †† Identity: people act on the basis of different group identities, which shift and can become more or less prominent at different moments and in different contexts.

  • ‡‡ Loss-aversion: the tendency to overweigh losses relative to gains of the same magnitude.

  • §§ Present bias: the idea that the impact of a choice or action we make or take now is really important.

  • |||| Scarcity: having a chronic lack of resources, which leads individuals to focus their attention on immediate needs as opposed to long-term ones.