Reorienting Behavioral Interventions: Integrating Spatiotemporal Methods and Behavioral Economic Principles to Strengthen Context Specific Interventions

Abstract

Cardiovascular diseases (CVD) are a leading cause of death worldwide yet are largely preventable through lifestyle modification targeting risk factors such as physical inactivity, unhealthy diets, obesity, high blood pressure, smoking, high cholesterol, and harmful use of alcohol. Behavioral interventions have proven effective at managing CVD risk factors and preventing repeat cardiac events; however, the effectiveness of behavioral interventions is challenged by limited maintenance of behavior change, lack of spatiotemporal contexts influencing day-to-day activities, and limited understanding of decisions patients make as part of their daily routines. The aim of this study is to investigate how theoretical and methodological principles of health geography and behavioral economics can be used to strengthen interventions. This study used a two-phased, mixed-methods research design guided by adapted geo-ethnography techniques and in-depth interviews. In phase one, adapted geo-ethnography techniques were used with a customized digital mapping tool to gather detailed descriptions about the timing and location of patient day-to-day routines. In phase two, qualitative methods were used to gather in-depth descriptions about facilitators and barriers to increasing physical activity (PA) and what context specific behavioral economic strategies could be used to influence decisions about engaging in PA. Data were gathered from one cardiac intervention program from June to September 2021. A total of 29 individuals (19 men and 10 women) between the ages of 45 to 81 referred to the program after a cardiac event participated. Patients exceeded minimum guidelines for daily PA by walking in their neighborhood but were sedentary for long periods of time watching television at home. Patients had capability and were motivated for PA but were challenged to identify opportunities to adapt sedentary routines and increase PA. Behavioral economic principles including disrupting default routines, increasing commitments, changing the messenger, and introducing incentives were identified as potentially useful strategies to improve decisions for increasing PA. This thesis makes several contributions including the coupling of spatiotemporal contexts and behavioral economic principles to conceptualize a new understanding of data collection tools to measure and report contexts of patient behaviors and strategies for tailoring interventions to improve decisions for modifying behaviors.