Morality in minimally deceptive environments.

Psychologists, economists, and philosophers have long argued that in environments where deception is normative, moral behavior is harmed. In this article, we show that individuals making decisions within minimally deceptive environments do not behave more dishonestly than in nondeceptive environments. We demonstrate the latter using an example of experimental deception within established institutions, such as laboratories and institutional review boards. We experimentally manipulated whether participants received information about their deception. Across three well-powered studies, we empirically demonstrate that minimally deceptive environments do not affect downstream dishonest behavior. Only when participants were in a minimally deceptive environment and aware of being observed, their dishonest behavior decreased. Our results show that the relationship between deception and dishonesty might be more complicated than previous interpretations have suggested and expand the understanding of how deception might affect (im)moral behavior. We discuss possible limitations and future directions as well as the applied nature of these findings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A field study of the impacts of workplace diversity on the recruitment of minority group members.

Increasing workplace diversity is a common goal. Given research showing that minority applicants anticipate better treatment in diverse workplaces, we ran a field experiment (N = 1,585 applicants, N = 31,928 website visitors) exploring how subtle organizational diversity cues affected applicant behaviour. Potential applicants viewed a company with varying levels of racial/ethnic or gender diversity. There was little evidence that racial/ethnic or gender diversity impacted the demographic composition or quality of the applicant pool. However, fewer applications were submitted to organizations with one form of diversity (that is, racial/ethnic or gender diversity), and more applications were submitted to organizations with only white men employees or employees diverse in race/ethnicity and gender. Finally, exploratory analyses found that female applicants were rated as more qualified than male applicants. Presenting a more diverse workforce does not guarantee more minority applicants, and organizations seeking to recruit minority applicants may need stronger displays of commitments to diversity.

Does Real Age Feedback Really Motivate Us to Change our Lifestyle? Results from an Online Experiment.

We set out to research the causal impact of Real Age feedback, a popular tool on health and lifestyle platforms, on health behaviors. We ran an online experiment where participants were randomly assigned a Real Age that differed in both direction (older or younger) and magnitude (much or slightly) from their passport age, or to a control condition where they received no Real Age feedback. We measured the impact of Real Age feedback on motivation to begin a healthier lifestyle, interest in taking a Real Age test, and percentage click-rate on an optional health link. We found that younger Real Age feedback was associated with higher interest. In addition, participants who received a slightly older Real Age were significantly less motivated to begin a healthier lifestyle compared to not only those who received a much younger or much older Real Age, but also to those in the control condition, suggesting a backfire effect. This effect remained even after accounting for participant health, demographics, and other psychological correlates to motivation. Real Age tests may backfire and demotivate people, and the positive effects they may have on psychological states may not outweigh the negative effects. Though promising, we caution using Real Age tests in their current form as stand-alone interventions to get people motivated.

The Association of Digital Health Application Use With Heart Failure Care and Outcomes: Insights From CONNECT-HF.

BACKGROUND: It is unknown whether digital applications can improve guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure trial (CONNECT-HF) included an optional, prospective ancillary study of a mobile health application among patients hospitalized due to HFrEF. Digital users were matched to nonusers from the usual-care group. Coprimary outcomes included change in opportunity-based composite HF quality scores and HF rehospitalization or all-cause mortality. Among 2431 patients offered digital applications across the United States, 1526 (63%) had limited digital access or insufficient data, 425 (17%) were digital users, and 480 (20%) declined use. Digital users were similar in age to those who declined use (mean 58 vs 60 years; P = 0.031). Digital users (n = 368) vs matched nonusers (n = 368) had improved composite HF quality scores (48.0% vs 43.6%; + 4.76% [3.27-6.24]; P = 0.001) and composite clinical outcomes (33.0% vs 39.6%; HR 0.76 [0.59-0.97]; P = 0.027). CONCLUSIONS: Among participants in the CONNECT-HF trial, use of digital applications was modest but was associated with higher HF quality-of-care scores, including use of GDMT and better clinical outcomes. Although cause and effect cannot be determined from this study, the application of technology to guide GDMT use and dosing among patients with HFrEF warrants further investigation.

Morality in the time of cognitive famine: The effects of memory load on cooperation and honesty.

Though human social interaction in general seems effortless at times, successful engagement in collaborative or exploitative social interaction requires the availability of cognitive resources. Research on Dual-Process suggests that two systems, the affective (non-reflective) and the cognitive (reflective), are responsible for different types of reasoning. Nevertheless, the evidence on which system leads to what type of behavioral outcome, in terms of prosociality, is at best contradicting and perplexing. In the present paper, we examined the role of the two systems, operationalized as working memory depletion, in prosocial decision-making. We hypothesize that the nature of the available cognitive resources could affect whether humans engage in collaborative or exploitative social interaction. Using Operation Span to manipulate the availability of working memory, we examined how taxing the cognitive system affects cooperation and cheating. In two experiments, we provide evidence that concurrent load, but not cumulative load is detrimental to cooperation, whereas neither concurrent nor cumulative load seems to affect cheating behavior. These findings are in contrast to several previous assumptions. We discuss limitations, possible explanations, and future directions.

Political coherence and certainty as drivers of interpersonal liking over and above similarity.

Affective polarization and political segregation have become a serious threat to democratic societies. One standard explanation for these phenomena is that people like and prefer interacting with similar others. However, similarity may not be the only driver of interpersonal liking in the political domain, and other factors, yet to be uncovered, could play an important role. Here, we hypothesized that beyond the effect of similarity, people show greater preference for individuals with politically coherent and confident opinions. To test this idea, we performed two behavioral studies consisting of one-shot face-to-face pairwise interactions. We found that people with ambiguous or ambivalent views were nonreciprocally attracted to confident and coherent ingroups. A third experimental study confirmed that politically coherent and confident profiles are rated as more attractive than targets with ambiguous or ambivalent opinions. Overall, these findings unfold the key drivers of the affability between people who discuss politics.

Moral responses to the COVID-19 crisis.

The COVID-19 pandemic has raised complex moral dilemmas that have been the subject of extensive public debate. Here, we study how people judge a set of controversial actions related to the crisis: relaxing data privacy standards to allow public control of the pandemic, forbidding public gatherings, denouncing a friend who violated COVID-19 protocols, prioritizing younger over older patients when medical resources are scarce, and reducing animal rights to accelerate vaccine development. We collected acceptability judgements in an initial large-scale study with participants from 10 Latin American countries (N = 15 420). A formal analysis of the intrinsic correlations between responses to different dilemmas revealed that judgements were organized in two dimensions: one that reflects a focus on human life expectancy and one that cares about the health of all sentient lives in an equitable manner. These stereotyped patterns of responses were stronger in people who endorsed utilitarian decisions in a standardized scale. A second pre-registered study performed in the USA (N = 1300) confirmed the replicability of these findings. Finally, we show how the prioritization of public health correlated with several contextual, personality and demographic factors. Overall, this research sheds light on the relationship between utilitarian decision-making and moral responses to the COVID-19 crisis.

Effect of a Hospital and Postdischarge Quality Improvement Intervention on Clinical Outcomes and Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction: The CONNECT-HF Randomized Clinical Trial.

Importance: Adoption of guideline-directed medical therapy for patients with heart failure is variable. Interventions to improve guideline-directed medical therapy have failed to consistently achieve target metrics, and limited data exist to inform efforts to improve heart failure quality of care. Objective: To evaluate the effect of a hospital and postdischarge quality improvement intervention compared with usual care on heart failure outcomes and care. Design, Setting, and Participants: This cluster randomized clinical trial was conducted at 161 US hospitals and included 5647 patients (2675 intervention vs 2972 usual care) followed up after a hospital discharge for acute heart failure with reduced ejection fraction (HFrEF). The trial was performed from 2017 to 2020, and the date of final follow-up was August 31, 2020. Interventions: Hospitals (n = 82) randomized to a hospital and postdischarge quality improvement intervention received regular education of clinicians by a trained group of heart failure and quality improvement experts and audit and feedback on heart failure process measures (eg, use of guideline-directed medical therapy for HFrEF) and outcomes. Hospitals (n = 79) randomized to usual care received access to a generalized heart failure education website. Main Outcomes and Measures: The coprimary outcomes were a composite of first heart failure rehospitalization or all-cause mortality and change in an opportunity-based composite score for heart failure quality (percentage of recommendations followed). Results: Among 5647 patients (mean age, 63 years; 33% women; 38% Black; 87% chronic heart failure; 49% recent heart failure hospitalization), vital status was known for 5636 (99.8%). Heart failure rehospitalization or all-cause mortality occurred in 38.6% in the intervention group vs 39.2% in usual care (adjusted hazard ratio, 0.92 [95% CI, 0.81 to 1.05). The baseline quality-of-care score was 42.1% vs 45.5%, respectively, and the change from baseline to follow-up was 2.3% vs -1.0% (difference, 3.3% [95% CI, -0.8% to 7.3%]), with no significant difference between the 2 groups in the odds of achieving a higher composite quality score at last follow-up (adjusted odds ratio, 1.06 [95% CI, 0.93 to 1.21]). Conclusions and Relevance: Among patients with HFrEF in hospitals randomized to a hospital and postdischarge quality improvement intervention vs usual care, there was no significant difference in time to first heart failure rehospitalization or death, or in change in a composite heart failure quality-of-care score. Trial Registration: ClinicalTrials.gov Identifier: NCT03035474.

Developing Workshops to Enhance Hope Among Patients With Metastatic Breast Cancer and Oncologists: A Pilot Study.

PURPOSE: Hope is a modifiable entity that can be augmented. We evaluated the feasibility, acceptability, and efficacy of a short intervention to increase hopefulness in patients with advanced breast cancer and oncologists. METHODS: We enrolled eligible participants to two cohorts: one for patients with metastatic breast cancer and one for medical, radiation, or surgical oncologists. The intervention, a half-day hope enhancement workshop, included groups of 10-15 participants within each cohort. Participants in both cohorts completed preworkshop, postworkshop, and 3-month evaluations, which included the Adult Hope Scale (AHS), Herth Hope Index (HHI), and Patient-Reported Outcomes Measurement Information System-Global Health (PROMIS-GH) measures in patients, and the AHS, HHI, and a burnout self-assessment tool in physicians. RESULTS: We consented 13 patients and 26 oncologists for participation in the workshop and 76.9% (n = 10) of consented patients and 100% (n = 26) of consented physicians participated. Postworkshop, all participants planned to incorporate what they learned into their daily lives. In patients, AHS scores increased from preworkshop to postworkshop, and the mean change of 5.90 was significant (range 0-15, SD: 4.7, t = 3.99, P = .0032). HHI scores also increased, although the mean change was not significant. AHS and HHI scores did not significantly change in oncologists from preworkshop to postworkshop. At 3 months, less than half of the participants responded to the evaluation. CONCLUSION: We found that conducting a hope-enhancement workshop for patients with metastatic breast cancer and oncologists was feasible, generally acceptable to both populations, and associated with increased hopefulness in patients. Next steps should focus on confirming this effect in a randomized study and maintaining this effect in the postworkshop interval.

Replicating and extending the effects of auditory religious cues on dishonest behavior.

Although scientists agree that replications are critical to the debate on the validity of religious priming research, religious priming replications are scarce. This paper attempts to replicate and extend previously observed effects of religious priming on ethical behavior. We test the effect of religious instrumental music on individuals' ethical behavior with university participants (N = 408) in the Czech Republic, Japan, and the US. Participants were randomly assigned to listen to one of three musical tracks (religious, secular, or white noise) or to no music (control) for the duration of a decision-making game. Participants were asked to indicate which side of a vertically-bisected computer screen contained more dots and, in every trial, indicating that the right side of the screen had more dots earned participants the most money (irrespective of the number of dots). Therefore, participants were able to report dishonestly to earn more money. In agreement with previous research, we did not observe any main effects of condition. However, we were unable to replicate a moderating effect of self-reported religiosity on the effects of religious music on ethical behavior. Nevertheless, further analyses revealed moderating effects for ritual participation and declared religious affiliation congruent with the musical prime. That is, participants affiliated with a religious organization and taking part in rituals cheated significantly less than their peers when listening to religious music. We also observed significant differences in cheating behavior across samples. On average, US participants cheated the most and Czech participants cheated the least. We conclude that normative conduct is, in part, learned through active membership in religious communities and our findings provide further support for religious music as a subtle, moral cue.

It's how you say it: Systematic A/B testing of digital messaging cut hospital no-show rates.

Failure to attend hospital appointments has a detrimental impact on care quality. Documented efforts to address this challenge have only modestly decreased no-show rates. Behavioral economics theory has suggested that more effective messages may lead to increased responsiveness. In complex, real-world settings, it has proven difficult to predict the optimal message composition. In this study, we aimed to systematically compare the effects of several pre-appointment message formats on no-show rates. We randomly assigned members from Clalit Health Services (CHS), the largest payer-provider healthcare organization in Israel, who had scheduled outpatient clinic appointments in 14 CHS hospitals, to one of nine groups. Each individual received a pre-appointment SMS text reminder five days before the appointment, which differed by group. No-show and advanced cancellation rates were compared between the eight alternative messages, with the previously used generic message serving as the control. There were 161,587 CHS members who received pre-appointment reminder messages who were included in this study. Five message frames significantly differed from the control group. Members who received a reminder designed to evoke emotional guilt had a no-show rates of 14.2%, compared with 21.1% in the control group (odds ratio [OR]: 0.69, 95% confidence interval [CI]: 0.67, 0.76), and an advanced cancellation rate of 26.3% compared with 17.2% in the control group (OR: 1.2, 95% CI: 1.19, 1.21). Four additional reminder formats demonstrated significantly improved impact on no-show rates, compared to the control, though not as effective as the best performing message format. Carefully selecting the narrative of pre-appointment SMS reminders can lead to a marked decrease in no-show rates. The process of a/b testing, selecting, and adopting optimal messages is a practical example of implementing the learning healthcare system paradigm, which could prevent up to one-third of the 352,000 annually unattended appointments in Israel.

Signing at the beginning versus at the end does not decrease dishonesty.

Honest reporting is essential for society to function well. However, people frequently lie when asked to provide information, such as misrepresenting their income to save money on taxes. A landmark finding published in PNAS [L. L. Shu, N. Mazar, F. Gino, D. Ariely, M. H. Bazerman, Proc. Natl. Acad. Sci. U.S.A. 109, 15197-15200 (2012)] provided evidence for a simple way of encouraging honest reporting: asking people to sign a veracity statement at the beginning instead of at the end of a self-report form. Since this finding was published, various government agencies have adopted this practice. However, in this project, we failed to replicate this result. Across five conceptual replications (n = 4,559) and one highly powered, preregistered, direct replication (n = 1,235) conducted with the authors of the original paper, we observed no effect of signing first on honest reporting. Given the policy applications of this result, it is important to update the scientific record regarding the veracity of these results.

The Effect of a Priest-Led Intervention on the Choice and Preference of Soda Beverages: A Cluster-Randomized Controlled Trial in Catholic Parishes.

BACKGROUND: Latin America ranks among the regions with the highest level of intake of sugary beverages in the world. Innovative strategies to reduce the consumption of sugary drinks are necessary. PURPOSE: Evaluate the effect of a one-off priest-led intervention on the choice and preference of soda beverages. METHODS: We conducted a pragmatic cluster-randomized trial in Catholic parishes, paired by number of attendees, in Chimbote, Peru between March and June of 2017. The priest-led intervention, a short message about the importance of protecting one's health, was delivered during the mass. The primary outcome was the proportion of individuals that choose a bottle of soda instead of a bottle of water immediately after the service. Cluster-level estimates were used to compare primary and secondary outcomes between intervention and control groups utilizing nonparametric tests. RESULTS: Six parishes were allocated to control and six to the intervention group. The proportion of soda selection at baseline was ~60% in the intervention and control groups, and ranged from 56.3% to 63.8% in Week 1, and from 62.7% to 68.2% in Week 3. The proportion of mass attendees choosing water over soda was better in the priest-led intervention group: 8.2% higher at Week 1 (95% confidence interval 1.7%-14.6%, p = .03), and 6.2% higher at 3 weeks after baseline (p = .15). CONCLUSIONS: This study supports the proof-of-concept that a brief priest-led intervention can decrease sugary drink choice. CLINICAL TRIAL INFORMATION: ISRCTN, ISRCTN24676734. Registered 25 April 2017, https://www.isrctn.com/ISRCTN24676734.

Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure: Rationale and design of CONNECT-HF.

Many therapies have been shown to improve outcomes for patients with heart failure (HF) in controlled settings, but there are limited data available to inform best practices for hospital and post-discharge quality improvement initiatives. The CONNECT-HF study is a prospective, cluster-randomized trial of 161 hospitals in the United States with a 2×2 factorial design. The study is designed to assess the effect of a hospital and post-discharge quality improvement intervention compared with usual care (primary objective) on HF outcomes and quality-of-care, as well as to evaluate the effect of hospitals implementing a patient-level digital intervention compared with usual care (secondary objective). The hospital and post-discharge intervention includes audit and feedback on HF clinical process measures and outcomes for patients with HF with reduced ejection fraction (HFrEF) paired with education to sites and clinicians by a trained, nationally representative group of HF and quality improvement experts. The patient-level digital intervention is an optional ancillary study and includes a mobile application and behavioral tools that are intended to facilitate improved use of guideline-directed recommendations for self-monitoring and self-management of activity and medications for HFrEF. The effects of the interventions will be measured through an opportunity-based composite score on quality and time-to-first HF readmission or death among patients with HFrEF who present to study hospitals with acute HF and who consent to participate. The CONNECT-HF study is evaluating approaches for implementing HF guideline recommendations into practice and is one of the largest HF implementation science trials performed to date.

Reaching Consensus in Polarized Moral Debates.

The group polarization phenomenon is a widespread human bias with no apparent geographical or cultural boundaries [1]. Although the conditions that breed extremism have been extensively studied [2-5], comparably little research has examined how to depolarize attitudes in people who already embrace extreme beliefs. Previous studies have shown that deliberating groups may shift toward more moderate opinions [6], but why deliberation is sometimes effective although other times it fails at eliciting consensus remains largely unknown. To investigate this, we performed a large-scale behavioral experiment with live crowds from two countries. Participants (N = 3,288 in study 1 and N = 582 in study 2) were presented with a set of moral scenarios and asked to judge the acceptability of a controversial action. Then they organized in groups of three and discussed their opinions to see whether they agreed on common values of acceptability. We found that groups succeeding at reaching consensus frequently had extreme participants with low confidence and a participant with a moderate view but high confidence. Quantitative analyses showed that these "confident grays" exerted the greatest weight on group judgements and suggest that consensus was driven by a mediation process [7, 8]. Overall, these findings shed light on the elements that allow human groups to resolve moral disagreement.

The Limits of Cognitive Reappraisal: Changing Pain Valence, but not Persistence, during a Resistance Exercise Task.

Physiological discomfort is commonly cited as a barrier for initiating and persisting with exercise. Although individuals may think of physiological discomfort as determined by physical sensations, it can also be influenced by cognitive and emotional factors. We explored the impacts of interpreting the purpose of pain as a sign of muscle building (helpful) vs. a sign of muscle tearing and possible injury (harmful) and tested the effect of cognitive reappraisals, or shifting interpretations of pain, on exercise persistence and the subjective experience of discomfort during exercise. Seventy-eight participants were randomized to listen to voice recordings that framed exercise-related pain as helpful vs. harmful before participating in a standard muscular endurance test using the YMCA protocol. Although the two experimental groups did not differ in the overall number of resistance training repetitions achieved, participants who were asked to think about the benefits (rather than the negative consequences) of pain reported less negative pain valence during exercise. Thus, the experience of pain was influenced by appraisals of the meaning of pain, but differences in pain valence did not impact exercise persistence. Theoretical implications and applications for affect-based exercise interventions are discussed.

Human decision-making biases in the moral dilemmas of autonomous vehicles.

The development of artificial intelligence has led researchers to study the ethical principles that should guide machine behavior. The challenge in building machine morality based on people's moral decisions, however, is accounting for the biases in human moral decision-making. In seven studies, this paper investigates how people's personal perspectives and decision-making modes affect their decisions in the moral dilemmas faced by autonomous vehicles. Moreover, it determines the variations in people's moral decisions that can be attributed to the situational factors of the dilemmas. The reported studies demonstrate that people's moral decisions, regardless of the presented dilemma, are biased by their decision-making mode and personal perspective. Under intuitive moral decisions, participants shift more towards a deontological doctrine by sacrificing the passenger instead of the pedestrian. In addition, once the personal perspective is made salient participants preserve the lives of that perspective, i.e. the passenger shifts towards sacrificing the pedestrian, and vice versa. These biases in people's moral decisions underline the social challenge in the design of a universal moral code for autonomous vehicles. We discuss the implications of our findings and provide directions for future research.