Simplification
Making information salient and clear visible to individuals around the moment of decision.

One well-established tool in behavioral economics is simplification. Individuals make better decisions when the information available to them is less complex (Gigerenzer & Gaissmaier, 2011). However, just filtering information through the use of heuristics can lead to suboptimal choices (Iyengar & Lepper, 2000). Simplification is about It can help decision-makers to overcome limited attention, as well as status quo bias by lowering the cognitive costs of adopting new information.

The advantages of simplicity in messaging and design have been appreciated in the field of development.

  • In South Africa, one study finds that simplifying the decisions around interest rates and loans—by reducing the number of combinations of interest rates and loan tenures—led to a large increase in uptake. It was just as effective in promoting adoption as a 2.3 percentage point reduction in the interest rate offered to households (Bertrand et al., 2009).

In the context of health, it is clear that simplifying, streamlining, and removing unnecessary steps and requirements can increase the likelihood of making a healthy decision.

  • In Morocco nearly seventy percent of households signed up for piped water when they received help with the administrative steps needed to obtain a connection. This compares with just ten percent of those who were not provided with assistance (Devoto et al., 2011).

Similarly, providers must operate under uncertain conditions, often with little information and significant time constraints. Under these circumstances, diagnosis and treatment can be improved through the use of tools that provide clear and salient information to guide provider decision-making. Recent studies suggest that clinicians are more accurate when they use a decision making shortcut, or filter information, relative to when all information is available (Marewski & Gigerenzer, 2012; Gigerenzer & Brighton, 2009).

Accessible, salient patient counseling aids can also improve care quality, by reducing provision of inaccurate information, or preventing providers from denying service to particular patient populations (Tavrow, 2010).

  • A Cochrane review of health decision aids finds that simpler materials are more effective than complicated materials in improving the knowledge and empowerment of patients.
  • Similarly, communication on the relative effectiveness of different contraceptives was more comprehensible to patients than information on absolute effectiveness of each method (Steiner et al., 2003; O’Connor et al., 2009).

The WHO Global Handbook for Family Planning Providers offers simplified guidance that emphasizes two features found important to women: effectiveness and side effects.

  • Counseling materials emphasize relative effectiveness, visually ranking methods from most to least effective, and include information on side effects; this presentation has been shown to improve patient comprehension of methods (WHO, 2011a).
  • There is also experimental evidence that simplifying and streamlining counseling about contraceptive adoption (Steiner et al., 2006: WHO, 2011a) improves access.

Just as with the bank loans and interest rates, reducing the number of options facing a decision-maker can improve the take up of a product or service. It is important to note here that choice simplification does not necessarily mean reducing the choices or information available to a woman; interventions may be designed to make choices easier without compromising a woman’s full and informed choice.

Simplification through Task Shifting
The WHO has endorsed task-shifting strategies that authorize non-physician providers to deliver essential services. These providers, including midwives, nurses and community based health extension workers, are often closer to rural and marginalized communities (WHO, 2008).  A review of the literature suggests that task shifting can mitigate workforce shortages and inadequate provider skill mix (Fulton et al., 2011). It also has the potential to improve health outcomes. Because task-shifting requires fewer trained providers to carry out complex functions, it typically involves a streamlining of services, eliminating medically unnecessary regulations that complicate and lengthen time to obtaining services or products. This can improve clinical decision-making. Task-shifting also restructures the provider-client encounter, aiming to maximize clarity and utility for the client. Often services are integrated, which further simplifies patient and provider decision-making, by reducing the need for referrals and associated follow-ups.

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