Designing Resilience - Behavioral Science Meets Humanitarian Action with Britt Titus

[00:00:00] Adam Gamwell: Hello and welcome to This Anthro Life, a podcast about the little things we do as people that shape the course of humanity. I'm your host, Adam Gamwell. While most people probably don't like to think about their lives getting upended by disaster or emergency, COVID leveled the playing field just a little bit between those who typically have the privilege to avoid or mitigate disasters and those who don't. The pandemic also forced us to ask questions as a global society about how we respond to emergencies locally, regionally, nationally, or even across the world. But the pandemic is also just one of many ongoing challenges and crises that people are and have been facing for years. At the time of this recording, Syria and Turkey have just faced and are recovering from devastating earthquakes and a train derailment in East Palestine, Ohio has sparked massive fires, evacuations, led to toxic chemical spills and increasing health and safety concerns. So, in addition to raising awareness and consciousness, much of the difficult work that we have as people and organizations is in how we respond in moments of crisis. How do we know it works? How can we respond effectively? And will one type of aid be culturally appropriate if moved to another area? 

[00:01:07] One of the major organizations working on these questions is the International Rescue Committee. The IRC was founded at the call of Albert Einstein in 1933 and works in over 40 crisis-effective countries and in communities throughout Europe and the Americas to help people survive, recover, and rebuild their lives when disaster strikes. They do a ton of amazing work across fields like education, health, empowerment, and safety, and provide support for people that are suffering under issues like forced migration, war conflict, and natural disasters. Given the massive portfolio of projects they run and the increasing need for effective and appropriate response, I am very excited to be joined on the podcast by Brit Titus, a behavioral scientist at the IRC's Airbel Impact Lab. The lab is the research and innovation arm of the IRC. How cool is that? Brit has a unique background in humanitarian response and behavioral insights design. She's seen firsthand the importance of understanding people's behaviors, beliefs, and attitudes in emergency response as part of her work designing, testing, and scaling life-changing solutions for the communities that the IRC serves. We're gonna explore how we can move towards resilience in times of crisis, how to respond effectively, how to measure what works, and apply a design mindset to helping crisis response be more effective. We'll get into a ton of interesting areas and this is just the first of many conversations we'll be having on the podcast around how to build a more resilient world for ourselves and our neighbors. We'll dive into it right after a word from this episode's sponsor.

[00:02:53] Well, Britt, super excited to have you on the show today. Thank you so much for joining me. I think that the work that you're doing, I'm super excited to share it with the audience. And, you know, one of the big things that really surprised me when we got in contact was that there is this connection that we should be thinking more about that I think a lot of us may not around between behavioral insights and humanitarian action and this framework. So, one, I wanna welcome you to the show and thank you so much for joining me today. 

[00:03:21] Britt Titus: Thanks for having me. I'm really excited to be here.

[00:03:24] Adam Gamwell: Right on. Let's kind of break this idea down. You know, one of the things that the ways that we like to kind of kick things off is a bit of like your own superhero origin story, as it were. How did you find yourself intersecting these two areas of behavioral insights design and the humanitarian space?

[00:03:37] Britt Titus: That's a great question. When I was in my early twenties and left university, I entered into the world of the United Nations and humanitarian response work. So, started off my career working for the United Nations World Food Programme, which is the food arm of the UN and got thrown into a team that pretty much did just pure emergency response deployment. So, within my first year working there I was working, I was sent to Jordan and Lebanon for the regional Syria emergency. And then, a few months later I was shipped off to West Africa for the Ebola outbreak, which was back in 2014, if you can remember that. So, yeah. I think I really started my career kind of on the front lines of many of these kind of large global emergencies and learned a lot about how we do emergency response and how we've done emergency response for the last 50, 60 years. And, you know, what was always I think the most fascinating part for me was I guess the more anthropological one of why are people behaving the way they do? So, you know, during the Ebola outbreak was a great example of how important behavior and beliefs and attitudes were to the outcomes that we were seeing. So, for example, you know, there was a lot of fear, a lot of misinformation around Ebola and the disease and how it spread a lot of fear of the response teams, a lot of, you know, practices, for example, burial practices that were exacerbating the spread of the disease. And obviously, you know, those types of behaviors now seem very familiar with COVID. But at the time, you know, those were the parts that were most interesting to me. And, you know, we weren't, you know, as a global community really prepared to deal with the behavioral side of the response. You know, we were able to move food from place A to place B and set up large-scale, you know, bullet treatment units and hospitals. But the behavioral side of it was much more complex and arguably, you know, one of the most important parts of the response. And so, those were the parts that, you know, left me, you know, wondering and thinking, you know, how can we better respond to emergencies in the future, you know, all of which have a behavioral component. And so, after, you know, four or five years with the with that organization, went back to do my master's program and within a few days of starting the program, heard the term "behavioral science," which I had not really heard before, and thought, "Yes, that's it." That's what I've always been so interested in. I just didn't have the words to describe it. So, I took all the courses I could. Deep-dived right into it. And, you know, from then on was trying to figure out how I could combine these two areas. And lucky for me on that IRC, the International Rescue Committee, has a research and innovation team with a behavioral science component within it. And so, I applied and got the job and that was almost four years ago now. So, really, really lucky to be able to combine my two biggest kind of interests and passions into one role.

[00:06:28] Adam Gamwell: Oh, that's super cool and that's it's great, I mean, so congratulations. It's been like about 10 years, right, working in the kind of humanitarian side of the world. It's so interesting to hear that, you know, when we are faced with crises and emergencies, it's one of these things that we it's a part of existence and a part of like having complex social lives. And so, even to hear the kind of example you were showing before around Ebola and how things like burial practices and how does local tradition align with, you know, regional health practices than international, you know, health practices and protocols and like when those align or misalign I think is, to your point, like one of the more fascinating and also like complex questions of how can we respond better, you know? This is interesting too 'cause this is something that we've actually seen in some consumer insights research from a different side of the field. But that like sustainability has been an important conversation on people's minds for a while in terms of how do we not, you know, derail the future's generation's ability to also live lives of abundance? But with things like the pandemic, the COVID pandemic, and then but then also thinking with Ebola too that there's been this interesting shift in the past year in terms of sentiment around the idea of moving towards resilience; that how do we design ways of being that we can bounce back, absorb, and deal with like the trauma and the kind of the disruptions that will inevitably occur. And COVID is kind of the first time the globe, you know, the world community had to try to think through this together. This is I think one of the interesting pieces that, you know, have you seen — this is a big question so let me know if it's too crazy — but like have you seen or how do we think about this in terms of like a slightly more localized. If we think about Ebola, it didn't really move beyond a regional area in Africa too much but then, you know, we have COVID that like — borders globally. Like is there a way to think about how do we think regionally but then also act globally or, you know, vice versa? Like understand that there's a global issue. What can we learn from regional responses? Or maybe that's a more concrete way to ask that question like is anything from the Ebola outbreak, any emergency and behavioral response, that that was applied how you would think about responding to COVID, for example, or a global pandemic?

[00:08:33] Britt Titus: Yeah, I mean I think there's a lot of overlaps. I mean, I think both are needed. You know, obviously things like misinformation, fear, social norms — all of these things play a big part into this. So, I think, you know, with both outbreaks we saw how fear, you know, ended up backfiring on people about how kind of panic behavior about misinformation and how that spreads and how that can kind of fuel a pandemic. So, I think there's a lot that we learned and about, you know, even specific things like contact tracing and how that works. But I think, you know, at the end of the day, you know, you do have to have a localized response and I think that was what was so complicated about the, you know, COVID pandemic was that you're not just looking at, you know, some behaviors. You're not just looking at, you know, the relationship between a population and their local government. You're looking at the relationship between the local population, their local government, the national government, and then what they're seeing online and what's being kind of spread around on social media. And so, I think, yeah, I think you have to do both. You have to go from bottom-up and top-down with, you know, with an emergency, you know, of these types of complexities. And I think that's where, you know, design and user-centered design and ethnography really comes into play here because, you know, I think traditionally, behavioral science has been a little bit more top-down in terms of trying to tweak or change, you know, one behavior here or two behaviors there. And for these kind of larger, more complex humanitarian crises, we see it's not just one behavior. There's many, many behaviors and there's many behaviors of the immediate population and then the health responders and then the local government and then humanitarians. And so, all of those behaviors are actually compounding on one another and influencing one another. And so, I think bringing in systems thinking, bringing in anthropology, ethnography, bringing in, you know, all of that on top of behavioral science I think is really needed when we kind of think about these very complex emergencies that go well beyond kind of specific borders, but are also, you know, incredibly contextual and locally driven.

[00:10:43] Adam Gamwell: Super well said. And always great that, you know, hear that systems thinking is not a word that we always hear. And so, it's like this I think really interesting and, you know, one of the fuzzier but I think what most interesting ways that we are seeing design and anthropology, you know, behavioral design and behavioral science begin to think towards an act towards, right, and that how do we draw the lines, right, the connections, the channels, the alignments between the local, you know, regional, national, global but then also, behavior, motivations, belief systems, you know, core values at play. And I mean this I think kind of answers the question I'm going to ask here in a second but also just this idea of like the challenge of how do we combine these like bringing a systems thinking format. So, one method that you kind of mentioned there that I want to think through is, you know, having some elements like design thinking or at least like a methodology, right? That's kind of like and how do we define a problem and then the kind of ideate it, prototype it, test it, you know, re-evaluate it and work with the community. And so, and that might be one of the answers but just thinking through this of like how can we help in order to get to that localized response I think is a brilliant way of thinking about this, right? We have the global. We have to then always have the emergency response be localized. Otherwise, it's decontextualized and won't stick, right, or could do harm, you know? So, is design thinking one of these methods? Like I'm curious like what the innovation arm at IRC uses or what else you use to kind of plug in to kind of get a sense of what it is that we're trying to solve for it locally.

[00:12:03] Britt Titus: Yeah, no. It's a really good question. And yes, we use a lot of design, user-centered design ethnography to really even define the problem, which I think is important. And I think, you know, one of the big challenges of applying behavioral science in these types of contexts is that, you know, the evidence base that we consider really universal is not universal. It's based in the Global North. It's, you know, most of the subjects are, as you know, you know, white university college students. While we, you know, we like to think that many of these behavioral science kind of concepts and principles are universal, there's a lot that we don't know and that really becomes very apparent in the types of contexts we're working in. For example, you know, behavioral science shows that, for example, you know, SMS messages are really effective at reminding people to do certain things. But what do you do when you are, you know, trying to design a reminder for a rural population in Mali who has a different conception of timekeeping or the population is illiterate or, you know, in Ethiopia where the population has been cut off from phone signal for the last two years. So, you know, it really forces us to be more innovative. It forces us to really be more humble, which I think is important and I'm really grateful for that. But in a lot of ways, it really it forces us to really use, you know, tools like design thinking to really start from what is the problem and is the problem what we think is the problem and what does the population we're designing for want and what do they think is the problem. And so, that I think, you know, the fact that we are designing for populations that we don't have much evidence about really makes design and user-centered design and ethnography incredibly important for our work. 

[00:13:40] And so, I can give an example of a project where this became really apparent. We have a really strong global body of evidence that social-emotional learning, which is a form of teaching children's social-emotional learning skills, has been very effective in the Global North in places like Massachusetts and even Brazil. Organizations like the IRC with partners have tried to implement the same types of learning programs in humanitarian contexts like Lebanon or Northeast Nigeria and have found almost zero results and almost no impact. So, you know, real head-scratcher why is this social-emotional learning, you know, pedagogy working so well for vulnerable students in the Global North and not working so well in a humanitarian context? And so, in order to understand, you know, why this was, you know, we kind of had a hypothesis that maybe these learning methods have not been properly contextualized for the population. Maybe they're too unfamiliar and too it's too contextual and so maybe we need to contextualize them. And two, you know, maybe teachers are just not using them in their classrooms. And so, what we did is we went and spoke to over a hundred teachers, parents, local government officials to try and understand what does social-emotional learning mean for them? How would they like their children to grow up to become good, successful adults that have good social skills and good emotional regulation skills, and what does that look like for them? And what was interesting is that we found that the skill areas that they were most interested in were things like discipline, respect, and tolerance, not things like emotional regulation and conflict resolution, which are the terms that we use as researchers. And when we really dove down into what it was that they were looking for with those skill areas, we found it was exactly the same things that we were trying to promote with the social-emotional learning. We were just calling it different things. When they said "discipline," they really meant the ability to focus on a task and for a child to be able to focus and see through an activity or a task, which is exactly what we had intended when we were developing these activities for students. And so, yeah. I think what really became apparent is after implementing that, it was that it worked. So, we completely reframed all of our activities to be in local terms, local words, promoting skills that the local community cared about and even changed some of the activities to really promote the things that they wanted to see their children learn. And we just ran a pilot study last year and found that this did increase teachers using these activities and they were highly motivated to use them, really excited about them, whereas previously we'd found that they weren't at all. And so, you know, one was the importance of finding out, you know, what do people want for their own children? What do people — how do they describe it in their own words, and what would they like to see? And then designing the program around that, of course, injecting the kind of evidence-based skill-building aspect into those activities but making sure that they were promoting and talking about things in the way that local teachers wanted to see things talked about and promoting things and outcomes that they've wanted for themselves. And so, not only is it, you know, important for, you know, dignity and local ownership and rights but it's also important for efficacy and for those activities to actually be effective at leading to outcomes that we care about.

[00:16:50] Adam Gamwell: We're gonna take a quick break. Just wanted to let you know that we're running ads to support the show now. We'll be right back back.

[00:17:01] No, but I think that's a really great point that so often from a social science perspective, we express concern that we are respecting the rights of locals, that we are using language in terms that matter to them, and that we're, you know, if we're implementing policy work, design programs, whatever it is that it's they're done in ways that are in alignment with what communities are looking for. But I think also to your point that the other side of this that's fundamentally important is that are the programs projects effective, right? Do they actually lead to desired outcomes, you know, for both community and for organizations that are helping implement them? And this is I think to me if I'm thinking through why we don't see more social scientists doing design work, is this half of it? Is that like it's there's not as there's not often as much about the evaluation assessment of a program itself, especially obviously coming from an academic study like typically people are there to just do studies. Not gonna ding on doing academic research but there is this interesting dichotomy that it is worth thinking about of what are the effects? There will be effects no matter what, if a researcher is doing research in a community. The question is how much do we own them as the researcher in terms of like are we owning up, you know, the effects that we are gonna have, whether we're there or not. 

[00:18:19] And this reminds me that, you know, I did my PhD research working with indigenous quinoa farmers in southern Peru also as part of an international organization that was helping design conservation mechanisms, like programs for how do we help implement and promote agrobiodiversity conservation for food scarcity and malnutrition and obviously to fight climate change. And so, it wasn't in emergency context and like the organization itself didn't also poise itself in a humanitarian. It was more carving research for development. But in a similar way, I hear there's an echo in terms of one of the big challenges that we faced was how do we talk with indigenous communities about what they actually want? What are they looking for when it comes to agricultural output and production, you know, nutrition within communities? But then also, some of these other areas like values, like respect from, you know, the regional communities, respect for land sovereignty, but then also respect for the kinds of food that I want to grow or my right to participate in the global market, you know? Again, like how do we balance these types of needs within also an organization's desire, you know, such as let's actually make a functional conservation program that's gonna help actually increase the output of agrobiodiverse quinoa. 

[00:19:28] And so, it is always this tension to kind of think between these two pieces that I think is also getting this really fascinating arena and that like the IRC itself like, I mean, this is every kind of project, you know? For me, this was my first time doing that kind of work where it was like stepping out of the academic shell and into then, you know, more what I think of as design anthropology but also it's interventionist work, right? And so, making sure that we pay attention to both what we're inputting into it for communities and what they want and then also what's gonna be gotten out of it. And I do remember like one of the hardest things that, you know, a farmer told me towards the end of the program, he's like just don't forget about us when you leave. And always remembering that there's a human there, right? Like whenever we're doing these kinds of these projects too that there's people on the other side of it. And that sounds weird to say that, right, because it's like, of course, you know, there's people there. But, you know, that's one of these interesting questions of like how do we, again, just thinking about the impact that we have when we're parts of and interact with communities and like we're there to ultimately, you know, create change with them and like what does sustainability mean? Like how do we create that lasting change besides not just forgetting, right, not disappearing? So, I think it's a challenge. 

[00:20:32] I like and I appreciate what you're hearing on your side too of that this idea of what's the right kind of assessment to do, you know? How do we know if something is working? And so, I'm curious to kind of hear a bit about that, whether it's like with the SEL program I think is SEL program is interesting and this idea of are we seeing an uptick in adoption of different kinds of methods that teachers are using? You know, is that something that we think through? Like as we think about user-centered design, you know, how do we get a sense of is something achieving the goals that we want? Like an uptick in adoption could be one of them. Are there other ways that you use to measure this idea of impact? 

[00:21:05] Britt Titus: Yeah, I mean, I think there's so many ways and yeah, I think, you know, as behavioral scientists, we, you know, we're mainly looking for behavioral outcomes, right? So, are teachers using the activities, you know? Are parents changing their kind of feeding behaviors of children for malnutrition programs? Are, you know, farmers changing their farming practices? So, I think that's obviously the, you know, the focus of a lot of our work is, you know, did we see a change in the behavior? And then ultimately, obviously we're looking for a change in the humanitarian outcomes. So, reduction in malnutrition or improvement in education outcomes, so social-emotional learning in that case or things like that. But I think, you know, as we've said, I don't think that that is exclusive to looking at, you know, other things like, you know, desirability, you know, and how much does the population actually want the solution and how much can we make sure that we're, you know, instead of doing a client satisfaction survey at the end of our big, you know, impact evaluation, you know, bringing that early on to the beginning of the program and finding out, you know, co-designing our solutions or co-designing even our behavioral interventions or our nudges with the community so that we're already, you know, thinking about even, you know, as we're thinking about impact, we're also thinking about how desirable is this for the population? How feasible is it for them to do this on a regular basis for a sustainable period of time, right? Because for many of these more complex, you know, issues that we're dealing with in these humanitarian contexts, we're not just trying to see a one-off behavior, like switching from not being an organ donor to being an organ donor. We're looking for like a consistent behavior over time. For these teachers, it's changing their teaching behaviors every day for the rest of their career by incorporating these new types of activities, you know? And for every, you know, most of the programs we have, it's these ongoing new behaviors that need to be, you know, need to be implemented for a long time. And for most of our populations that we're working with, you know, we know that they're already, you know, experiencing, you know, mental scarcity, cognitive scarcity. They're already, you know, extremely overloaded with what they're being asked to do. Many of them are experiencing trauma or the effects of trauma. And so, asking populations to do more things, to do more activities and more tasks on top of what they already do is also already a huge ask. And so, I think through using design in addition to behavioral science, we also make sure that the solutions that we're building actually fit into people's lives and meet people where they are, rather than trying to build, you know, some new set of behaviors or some completely different kind of system on top of what they already do that we expect them to do, you know, for months and years to come. So, I think, you know, feasibility and desirability, again, we we're probably not going to be looking at those from a quantitative perspective when we're designing a program. But I think, you know, really looking to the importance of design research and, you know, formative qualitative research as we're designing the program to make sure we're designing for that even at the same time as or even before we're looking, you know, at impact I think is absolutely critical.

[00:24:12] Adam Gamwell: I really like the way that you said that too in that especially if we're seeing populations in the humanitarian and/or emergency context that if cognitive overload is already a part of their daily norm, then, you know, asking them to do something new almost guarantees failure or just like a very, very uphill battle, right, to get anything to even change. And I think a point that you made before that was really interesting is when you were trying to think through the goals, like what are the values that communities already have in this context of things like discipline, for example, and recognizing that like there's a goal that you had around focus and those are actually pointing us towards the same kind of thing — the ability to kind of follow through on a task. And recognizing that actually like there isn't a huge difference, right, like actually the fundamental like underlying thing itself is actually similar, which is very cool. 

[00:24:56] Britt Titus: I think that's really important because sometimes I think, yeah, we think that these that asking the population what they want is mutually exclusive with, you know, having impact on the outcomes that we care about. But I think often, you know, we lose sight of the fact that these populations want the same things, right? Mothers and fathers also want to reduce their child's likelihood of developing severe malnutrition. Parents and teachers also want their children to develop strong social-emotional learning skills. It's just that often we're saying different things and we're using these terms and framings and ways of talking about it that are completely unfamiliar and then just expecting or hoping that the population learns about the way we talk about it or developing these very expensive trainings so we can, you know, tell them about how important these social-emotional learning skills are. But if we instead invest in finding out what they think is important and trying to map that to the evidence, I think that we, you know, we can achieve both. People can have, you know, programs that actually fit their lives and what their goals are for themselves and their children and they can and we can make sure that there's the evidence-based, you know, component of it so that we're using tools that are, you know, evidence-backed and we know that it's going to lead to some kind of change, you know? And for terms like discipline, it's really hard because, you know, in the US, there's like a really negative connotation around the word "discipline," which might feel more oppressive or more not something you want to see in a classroom but, you know, I think, you know, going one step further to asking, you know, the people we're speaking to, what do you mean by discipline? What does it look like if you see discipline in your classroom? And finding out that it was exactly the same as, you know, many of these, you know, more, you know, scientific and research-based terms that we've been using. It's just that we are using different framings for them. I think was a very obvious but also took us a long time to get there. And also to socialize that even within our own, you know, Global North base, you know, research colleagues is that discipline isn't this scary negative term in the context that we're speaking about. It means something that is actually really, really positive and really deferring to the local population to guide us there was I think really important to the success of that project. 

[00:27:05] Adam Gamwell: That idea too I think that the question of framing, right, is such an important piece that recognizes both. Like what are the what's the, I don't know, you know, linguistic or technical baggage that we bring to the table, as it were, and then also but what do community members also bring in and their bags also? And so, learning to communicate at the level of frames, you know, I think is something that is such a fundamentally important part of doing effective design. And also, I really the other thing that you said there too that has gotten me thinking is this idea of also how do we socialize that back to our research communities, right? So, they wouldn't say, wait a minute, discipline. You can't do that. We don't do that here, you know? It's like actually, no. Here's like there's a universal that we're actually leaning more into — or a larger, I don't know if it's universal — but a larger desire that we see parents and teachers looking for for their kids to succeed in the classroom and in life and how can we help that be that facilitated in this way? So, I think that's an interesting piece too. I mean, has that been a particular challenge or is that a focus for your team also to think about how do we then re-socialize back to the community? I mean, I know that there's been some interesting publications that even you put around this project too, you know, in peer-reviewed journals too, which is important. So, again, thinking about like where are we circulating the knowledge that we're creating locally as well as then and amongst other like global communities. So, how has that process looked in terms of re-sharing information or learnings elsewhere?

[00:28:21] Britt Titus: Yeah, I mean it's definitely a process and I think, you know, in the kind of team that we have, which is fantastically interdisciplinary at the at IRC’s Airbel Impact Lab, which is our research and innovation so it houses our BI team, our human-centered design team, our strategy team so we have many disciplines. And so, what's been really interesting is that we really saddle that we're really in that kind of middle space between, you know, pure academic research 'cause we have an amazing team of researchers on our team and then we have our designers on our team and behavioral scientists. And so, you know, being able to communicate to kind of a research audience about why we do this more kind of qualitative design-based research is not always that straightforward, right, because typically our research, you know, colleagues and the research community are looking for representative samples and looking at impact across a large number of people and typically, it tends to be more quantitative. And so, you know, a lot of what we, you know, end up doing, at least at the beginning of a project at the project inception is a lot more of this, you know, speaking to 12 teachers and finding out, you know, what is their lived reality? What does their day look like? Can we shadow them? Can we find out what it looks like to be in their shoes for a day? And there's not a lot of kind of easy ways of kind of making that make sense in a traditional research perspective. And the same vice versa: making sense of these kind of outcome-based, you know, objectives, which are also incredibly important because we do want to create breakthrough solutions that do, you know, make headway on things like malnutrition and education and help. And so, making that make sense to our teams that are trying to just understand how the population lives and what, you know, their beliefs are and what they desire and what they want for themselves, you know, being in between those different types of disciplines is fascinating and it's definitely something that's an ongoing process. But what has been interesting is, for example, publishing the results of, for example, this study that I just mentioned and publishing the results of this approach to program design has been really interesting. And, you know, I hope to see more of that in the literature in addition to our RCTs and our impact evaluations because, you know, the problem is that, you know, we don't have a lot of research and evidence out there about, for example, the behaviors of teachers on social-emotional learning or the behaviors of parents in Mali about malnutrition. And so, I think it's really important that we find ways of publishing more of that, even if it's not an impact evaluation because, as I'm sure you can imagine, impact evaluations are also, you know, 10 times more challenging to implement in humanitarian context, where populations are on the move and we have access constraints and conflict going on potentially. So, we don't always have the ability to even run an impact evaluation even if we wanted to and publish on that. You know, I hope my hope is for the future that we see more design research, ethnography, this type of work about populations, you know, published and shareable, not to explain how an entire general population believes in things and acts but to give us better insight into, yeah, the lived reality of this type of population so that we can better design programs and services that meet their needs and help us achieve these outcomes.

[00:31:50] Adam Gamwell: Yeah, and especially kind of combining those pieces together, right, where we have the combination of a representative and helpful portrait of what one's lived experience is like with the kind of impact either assessment and, you know, and or just kind of how we design something for and around that, around this and with these belief systems, you know? It's a great point. I mean, this is a kind of a literature that we don't see really and so, it this is a really interesting point of like this is the first time I think on the show that we've discussed like a new type of literature that we could put together. There's some more design work, you know? 

[00:32:21] Britt Titus: There you go. 

[00:32:22] Adam Gamwell: But that's really interesting to think about, you know? 'Cause especially to your point if we're in like a humanitarian and/or emergency context, like there's not even always time to do this kind of like longer impact assessment, especially long like one over that's long-term, right? I'm checking back in a year later. It's like you can't. Like the population has moved, right, the entire context has re-changed again. That's a really fascinating question of like, I mean, how do we, yeah, how do we how might we design impact assessments in a way that can respond quicker but still have like evidence-based impact, right? So, we can say, this worked, this didn't work. I think it's a really fascinating question. I mean, is this something that y'all have started diving into? Is it something that you've seen so far? Or there's are we inventing something?

[00:33:00] Britt Titus: Great question. That's exactly what we're thinking about all the time. So, if you or any of your listeners have solutions in this space, do send me a note. But yeah, I mean, I think, you know, one is obviously coming back again it sounds like I'm advocating for design a lot but, you know, the iterative nature of design is incredibly helpful in these types of contexts because they do change, they do shift, you know, they are very dynamic, right? And so, being able to have an approach where you can iterate, where you can respond, you can make changes, you can kind of start with a small number of people and work your way up to a larger number of people as you get more confident in your solutions and feel like you're designing something that's actually meeting the needs of the population and likely to achieve the outcome that you're looking for. That type of approach I think is really helpful, especially in dynamic changing shifting context and humanitarian context. So, we do do a lot of prototyping, iterative testing in our work. And at the same time, you know, there are a lot of people who are starting to advocate for the use of kind of adaptive RCTs, where you kind of have stage approaches and other forms of kind of, you know, traditional research methods that you can shift or adapt so that they do take account of changing shifting dynamics and so you can learn from one round and then make changes and then implement it again. And so, I do think that across the board, we just have to find more ways of this form of iterative testing. And I think that that can come at all stages of the project lifecycle from the beginning, where you might be doing prototyping, all the way through to the end, where you might be, you know, wanting to roll out a large impact evaluation to be able to include moments of iteration within that. And, you know, also, you know, using qualitative and ethnographic methods during, you know, for example, an impact evaluation so you can learn why something's working and not working and you can shift it based on that. I think, you know, I think that will be the future of this space. So, I think that, you know, we don't have, you know, too many, too many examples of this in the literature but they are, you know, popping up more and more and so we are really interested in learning from other people about how they've done that. And in the meantime, we continue to use prototyping and iterative testing as well as behavioral experimentation. So, we do still, for example, run, you know, A/B tests. We do still try and run, for example, lab in the field experiments and, of course, you know, the researchers in our team do, you know, run impact evaluations where it is possible and where it is relevant. So, you know, that is happening and I think it's just a matter of time before we start kind of seeing these more adaptive iterative approaches at all stages of the project life cycle becoming the norm. 

[00:35:49] Adam Gamwell: Yeah, that's an a really exciting idea. And because you have me thinking that typically, we tend to think about, you know, we've even said this a couple times in this conversation that like, you know, your ethnography or qual tends to come at the front end, right, of a project but they kind of use it as like the definitional stage but then it seems to like then shift over to more quant typically when you get towards the, you know, re-evaluation and some iteration too, I suppose. And so, I think that's I think one right there is a fascinating point of like what does it look like to implement more ethnographic or qual approaches across the project lifecycle so that it's can reinform like how we are evaluating what, you know, what's happening. Would it stick, you know, and measure for change, right? And to understand that it like as is organic, like how would that, what that'd look like. And even this like lab in the field A/B testing stuff too. I mean, one example that I cheated in and also checked out some of the talks that you've done around the InforMH thing with a trauma group in terms of a talk you gave about that project. And so, if folks have not checked that video out, which you totally should, I'll link it in the notes. One thing that you mentioned in that video that I'd love to hear a little bit about is like, again, some ways that you did some testing in terms of getting communities in Jordan around kind of destigmatizing mental health and how do we get people to actually approach when they need to get help. What does it look like? And so one of the things you mentioned in the video you did was testing different behavioral mechanisms to get people to see what would be most appropriate? When would I reach out for help using social media, using SMS text messages, and things like that? So, not to put you on a memory spot of remembering that entire project but just part o, I think something, you know, or it could be this project or something else but this idea of like using some of these kind of A/B test or like lab in the field behavioral switches to kind of see what works as it's happening.

[00:37:32] Britt Titus: Absolutely, yeah. So, the context of that project is in Jordan in the Middle East and it's a mental health project. And it really came about because we know from reports that I think, you know, well over, you know, 57% of the population are experiencing some form of distress and are in need of mental health support but only 5% of people in the country have ever sought out mental health support in their lives. So, there's this huge gap between need and people actually accessing the support. And we know that one of the main reasons is demand so demand due to lack of demand rather due to stigma, you know, negative social norms around seeking mental health support for especially for a lot of men as will not be surprising. There's this sense that if you admit that you have a mental health problem, then you are weak or there's something wrong with you. And so, we really wanted to look at this project to try and understand, you know, a little bit more in depth why people are not seeking out these services and then, you know, how can we encourage people to seek out services where they need them? 

[00:38:41] And so, we did a lot of design research and co-creation with the population, with communities in Jordan, and we learned a lot. Some of the things we learned, for example, was that, you know, people, you know, really responded well, which is not surprising, to normalizing language. So, things like, you know, the last few years have been really difficult for all of us, especially with COVID. More and more people in Jordan are experiencing, you know, distress and challenges and more people are seeking out support more than ever, which is true. So, really talking about how things are shifting in Jordan and how mental health support-seeking is really increasing even in Jordan, even if it's small. And at the same time, we also heard other things. People really responded well if they heard that an expert or a professional was really endorsing this program or that there were professionals who were behind this program and behind this mental health support. And we heard a lot of other kind of insights but there were a few things that were starting to come to the fore as like these are really the things that might really help people feel confident and feel trusting of seeking out this mental health support. 

[00:39:49] And so, we wanted to run an A/B test to see, okay, we have these strong hypotheses about what might work, what type of language, what type of framing, what type of messenger or influencer might be kind of most effective at encouraging people to seek out mental health support. But we don't know what's actually going to work because sometimes, you know, people in a focus group, some people would say one thing and other people would say, no, I wouldn't really trust this if just some other guy said that he was using it or if just because other people are using it doesn't mean that I'm gonna use it. And so, you know, and both of these kind of ideas were strongly backed by the behavioral science evidence. And so, we wanted to do an A/B test on Facebook and Jordan is a great place to run an A/B test because, you know, the majority of the population uses WhatsApp and Facebook. That's not the case for many of the populations that we work with but it is the case in Jordan. And so, we ran a Facebook A/B test where we had two different versions of our a kind of advertisement for our program where people could click through to get more information to receive, you know, content and information about mental health and also, you know, information about seeking out those services. So, call, you know, a button to call a hotline and other forms of support. So, we ran this A/B test with these two different versions — one talking about how this is expert-backed, you know, professionals in Jordan are saying that this is really useful, which is true that you know this based on data and evidence. And then, we had another version of it, which was talking about how other people in Jordan are starting to do this more. We're seeing small changes in the population overall who are starting to seek out mental health support and really normalizing it. And so, we ran this campaign for under two weeks even. We reached about 400,000 people on Facebook and we wanted to see which one led to more click-throughs to the website and which one would lead to more clicks. For example, once they got to the website to call the mental health hotline that we had partnered with. 

[00:41:44] And so, we ran it and we found that the peer-based or peer-supported option, which was option B, worked more. We had 33% more unique visitors to the website and more people calling the hotline and people spending more time on the webpage once they got there from that one, which was really interesting. So, from being able to do that A/B test, we were able to kind of test these two strong hypotheses we had about what would really motivate people to, you know, follow through with seeking out care. And then, we are able to use that type of framing and language now throughout our entire program. So, from the moment you see the kind of invitation to join the program through to, you know, halfway through the program, the way that we reach out to that the population and talk to them, we are now embedding this kind of, you know, there are other people out there in Jordan who are starting to look at this. Here's testimonials from them. Here's what they say about it. Here's what, you know, how they've changed their behavior. That's now the kind of way that we're talking about and informing the program design. So, that A/B test really allowed us to really test those strong hypotheses and figure out which one would be more effective.

[00:42:49] Adam Gamwell: Right on. No, that's great to hear and like that this kind of concrete example, I was excited to hear about in, you know, especially as our listeners, whether they're social scientists who are interested in social science or behavioral design, you know, coming out from a couple different angles, you know, this is a good example of how we can apply literal like a you might come from user experience like UX like an A/B testing of like what's gonna get click-throughs that we typically think about only in the context of, you know, I don't know, I'm trying to get Shopify to work better, right? But realistically, like we can also, again, think about these in the context of mental health, you know, seeking help and in different ways. And so, I think this is a really helpful example of recognizing that, you know, a lot of what we've been talking about too is actually how design can give us some mechanisms. It's rich to think about where we could plug in more qualitative research. And then, this side of it is like also how we can then take what might be a qualitative approach or like how do we get people to think about this but then applying a design tool that feels like it's comes from somewhere else that actually is quite helpful for them to say here's actually some, you know, also some quantitative numerical data that will then show us we've pulled the qual of why people care and then we put some numbers behind it. So, it's like really cool to see how these pieces can align together to give us a bigger story.

[00:44:01] Britt Titus: Absolutely, yeah, and definitely, yes. The quantitative definitely comes very much in handy, as I'm sure you know. You know, we have many instances where people want to believe that one thing is going to influence them more or they like the idea that they would be associated with an expert or, you know, with a professional, which may very well be true but actually when push comes to shove, the thing that actually will move behavior could be something else. And so, you know, we have to look at not just what people say, you know, what people tell us, you know, in this formative design research but also what they do. And that, you know, obviously is really well measured by kind of quantitative methods as well. And so, I think, you know, really combining, you know, what people say they do, they feel, all of that together, using, you know, mixed methods is something that we really try to do and not just focus on one or the other so that we, yeah, we're able to kind of measure multiple different aspects of people's lived realities and what drives them. 

[00:44:55] Adam Gamwell: Right on. So this, I mean, the Airbel Center for Innovation and Research seems like such a cool, interesting, fun place to be to do work. I mean, it sounds like very hard work but, I mean, like at the same time like such an interesting, intellectually rich, and exciting place. And so, if folks are learning about this for the first time, you know, I'm curious like how could they either get involved, learn more, be able to dive in, you know? We'll definitely put links to the site, your site, and bio, and things like that in the show notes. But, you know, folks are now saying, oh, wow! I wanna know more about this. I wanna be involved in this kind of work. I've never I didn't realize I could plug in like behavioral design and humanitarian work together. How can folks find out more?

[00:45:34] Britt Titus: Yeah. Well, I think the first thing is our website. We have a lovely website, which is airbel.rescue.org, and I'm sure you'll link it. So, there you can see kind of the portfolio of different work that we do. There's a lot of the studies, some of the studies I've mentioned are listed there. You also will see a kind of list of everyone on the team, not just me and not just the behavioral science team, but also the designers, the researchers, the academics, the strategists are all there as well so there might be also other people that are of interest. And there's a blog where we try and kind of provide updates and kind of thought pieces about the different types of work we're doing and many of the themes we've talked about today are all there. So, definitely, definitely check it out. And, yeah, there's also a kind of way of kind of getting in touch with us if any of that is of interest. You can send us a note through the website. 

[00:46:23] Adam Gamwell: Right on. So and of course just echoing this point that the team is built and made of so many different kinds of thinkers, strategists, designers, researchers, academics. So, if folks are interested that it's also just great to recognize too this is a very multidisciplinary interdisciplinary team. And so, folks of all ilks and all stripes with different specializations, you know, different kind of project management skills, different ways of looking at design, the whole shebang. So, this is a very cool family, as it were, of researchers doing good, which always makes me excited and happy. So, really excited to share this with our listeners. And so, I don't know if parting advice is the right term but just, you know, as we're thinking about what would come next, you know, what are you thinking about? What's getting you excited about this field, this combination of, I was gonna say combination, what is it? Taco Bell and Pizza Hut, which is not at all we're talking about. Sorry. Talked about that earlier this week. Combination between, you know, behavioral design and human humanitarian work. What gets you excited about that? Where are we going in this field and what are you hopeful for?

[00:47:21] Britt Titus: I think a lot of the topics that we've talked about that you've brought up, Adam, have been really very, very top of mind for our team — kind of how do we incorporate more kind of user-centered design and human-centered design into, you know, wider research projects. How do we incorporate more iteration and adaptive kind of methods and systems thinking into these approaches? And I think finally, you know, something that I'm really interested in is, you know, we don't know a lot about the intersection of conflict, trauma, and decision-making. And something that I'm really interested in I know a lot of my colleagues in this field are interested in is a gap that exists, which is we don't know about the unique psychologies which exist and the decision-making and impacts on decision-making that happen when people are in situations of displacement, conflict, and crisis. And so, I think if we are better able to understand how and why people behave the way they do, especially in emergency context, I think we'll be able to better design programs and services for them during the times that they're in those situations. So, I think that's something that is exciting for me. And yeah, I hope that we'll be able to really start diving into better understanding the communities that we're serving so that we can, yeah, better design solutions for them. So, I think that's one exciting area. So, again, if anyone out there is working on that, please let us know.

[00:48:49] Adam Gamwell: Right on. You heard it, folks. Britt, thank you so much for joining me today on the podcast. It has been really great to talk with you. Really excited about the work that you're doing. I think it's super important, very impactful, and awesome to see such such, you know, well-thought-out programs, processes, and like just going through that process has been really, really insightful and enlightening so thank you so much for sharing with us. 

[00:49:08] Britt Titus: Thanks for having me. Thanks for the great questions.

[00:49:11] Adam Gamwell: Many thanks once again to Britt Titus of the International Rescue Committee for sharing her process around designing more effective crises response. You can check out her work and the portfolio of the Airbel Impact Lab in the show notes. And as always, I want to hear from you. We can think about questions like what strategies could be implemented to ensure that emergency responses are effective in addressing the behavioral components of different kinds of crises and what role can behavioral science play in helping to create sustainable solutions for future generations as we face different kinds of emergencies. As always, get in touch with me over email or comment on our Substack newsletter or hit me up on LinkedIn or Twitter. I always like getting in touch with you. Thanks so much for tuning in. As always, I'm your host, Adam Gamwell, and we'll see you next time. You're listening to This Anthro Life.