This stealth data is then compared with what is recorded by trained enumerators when they observe the clinician treating patients. The Tanzania’s study trick was to use patient recall interviews, conducted soon after the clinic visit, to reconstruct the actions of the clinicians and specifically their adherence to proper medical protocols. The challenge in measuring the Hawthorne effect is that we need to also have “stealth” data on subject behaviors when they are not aware of observation.
With respect to behavior of health providers in developing countries, one of the more extensive studies in understanding the Hawthorne effect was conducted in the Arusha region of Tanzania and resulted in a series of papers by Kenneth Leonard and Melkiory Masatu.
(It’s a fairly nascent literature, and at the bottom of this post we list the papers that we have found.) This is a hard question to get at, but some inventive studies, at times utilizing new technology, have given us some fascinating results. My colleague Brinda Gokul and I recently reviewed the health economics and public health literature that explicitly study the effect in the general field of health. Yet only a handful of studies have attempted to identify and measure the Hawthorne effect.
Clearly any effect magnitude, and indeed whether the effect arises at all, depends on the study context including the type of behavior observed.
So the Hawthorne effect may present a challenge to the validity of causal inference (when agents respond to the knowledge they are being studied rather than respond to the changed environment as a result of the intervention) or may present a challenge to the accuracy of measurement (when the fact of observation alters the behavior measured). The conclusion: productivity was not being affected by the changes in workplace conditions but instead by the self-knowledge of workers that they were under observation. Indeed it became apparent that whenever a change was implemented, such as a change in work hours, productivity improved for a period of time. It turned out that worker productivity improved when the lighting was increased, but also improved when the lighting was dimmed. The term originates from the Western Electric Company’s Hawthorne Works Plant in Chicago where, in the late 1920s and early 1930s, researchers tried to study the effects of altered workplace lighting on worker productivity. Hence for the effect to exist it is necessary for the subjects to realize they are under observation. The Hawthorne effect refers to study participants’ alteration of behavior solely as a result of being observed (rather than as a result of the intervention). But if this is a new concept, let’s quickly review the definition and history of the Hawthorne effect: Many who work on impact evaluation are familiar with the concept of the Hawthorne effect and its potential risk to the accurate inference of causal impact. This post is co-authored with Brinda Gokul