Intervention (Hidden)
“Línea 155” is a hotline managed by the National Government of Colombia to orient women victims of violence to available support services. Since the beginning of its operations, the goal of “Línea 155” has been to help women victims of violence access the medical, legal, and psychosocial assistance services offered by the State. To this end, operators provide contact information (address, telephone number, etc.) about the most accessible and appropriate services according to the caller’s requirements and needs. Operators do not offer psychological or legal assistance but refer callers to complementary specialized services. The “Línea 155” also does not handle emergencies. If the caller is in an emergency, they are automatically directed to the national emergency line (“Línea 123”), which has action protocols for these situations.
In its original service protocol, “Línea 155” contemplated one task: providing contact information for victim support services. Once operators provided the information, calls ended, and operators had no further contact with the caller. “Línea 155” decided to change its service protocol to provide greater support to callers in their search for institutional help and to generate information to monitor the hotline’s operation. Under the new protocol, operators will give the contact information for victim support services and, before finishing the call, ask callers if they wish to be recontacted. If callers want to be recontacted, two recontact calls will be made: a first call (one week after the initial call) to reorient the caller to the available support services and a second call (two weeks later) to ask if she has been able to access the referred service (or another service) and, if she has not, the reason for not doing so.
The intervention evaluated in this study is the reorientation (or follow-up) call made one week after the victim contacted “Línea 155”.
The follow-up call is structured as follows: First, the operator must establish if the victim is safe and has enough time and privacy to talk. Once this is verified, the operator indicates to the respondent they are reaching out to follow up on the call received the week before. The operator also tells the victim that her safety is their priority and praises her decision to call “Línea 155” in search of orientation. Then, the operator asks if the respondent accessed the referred support services. If the victim has accessed them, the operator again congratulates her for the steps taken, emphasizes “Línea 155”’s commitment to her safety, and asks if she needs further guidance. If the victim has not accessed the services, the operator helps the victim plan how and when to access the referred services safely. Finally, the operator highlights again the importance of the steps taken and emphasizes the potential benefits of getting help.
The follow-up call uses behavioral strategies to help the victims overcome potential barriers to accessing victim services:
Implementation intentions involve making concrete plans (specify when, where and how) to help people achieve a goal. Different types of implementation intentions include barrier management, planning where/when/how, if-then plans, action and coping plans (Gollwitzer & Sheeran, 2006). There is evidence of the impact of implementation intentions on protective behaviors. For example, women who were asked in a survey to decide where and when they would perform breast self-examination were 4.5 times more likely to do so (Belanger-Gravel, Godin, & Amireault, 2011). The follow-up calls leverage implementation intentions as “Línea 155” operators will support users in developing a plan about when, where, and how to access support services.
Reciprocity refers to the social norm obliging repayment of favors, gifts, invitations, etc. and the shunning of those who freeload (Cialdini, 2007). There is strong evidence that people are more likely to follow through with behaviors if they feel others are invested in the outcome of such behavior (Regan, 1971). For example: reciprocity framings have been shown to increase organ donorship (Behavioural Insights Team, 2013) and job-search actions (Sanders & Kirman, 2014). Follow-up calls leverage the concept of reciprocity as receiving a call from the “Línea 155” can generate a bond between the caller and the hotline – users perceive the operators’ interest in their health, thereby feeling that other people are invested in the outcome of their behaviors.
The endowment effect shows how people prefer avoiding losses to acquiring similar gains, as people demand far more to give up something they already possess than they would pay to acquire it (Kahneman, Knetsch, & Thaler, 1991). In this sense, the endowed progress effect means that when people perceive any progress towards a given goal, even if small, they will be more motivated to complete remaining steps to reach the goal than they would be if they didn’t perceive themselves to have made progress. The follow-up calls make the progress towards the goal of getting help salient by highlighting how users have already completed the first and most significant step - making the initial call to the hotline.
The sunk cost fallacy tells us that people are likely to continue a course of action in order to justify a previously invested resource, even if the costs now outweigh the benefits (Arkes & Blumer, 1985). In contexts of domestic violence, it is important to highlight the future consequences of an action in a positive way, removing the attention we place on past costs, and avoiding the feeling of regret. Sunk cost rationalizations may act as a barrier to actions that may disrupt a relationship into which a survivor has invested significant time, energy, and other resources. Evidence shows that presenting the positive consequences of an action has worked well in contexts of violence (Behavioural Insights Team, 2022). The follow-up calls aim to demystify sunk costs. Operators will recognize and validate this barrier while also making the opportunity cost of not taking action salient and prompting users to imagine a future scenario in which they have seeked help and found safety.