In behavioral science, the term nudge refers to any aspect of decision architecture that predictably alters people’s behavior to improve
the chooser’s own welfare without forbidding or significantly ...restricting their choices. Its promoters invoke libertarian paternalism,
which means, on the one hand, that the behavior of the individual is guided without counting on his autonomy, but, on the other
hand, that this form of influence does not reach the point of restricting freedom of choice when it is manifest. This paper analyzes
the role of nudges in the field of health policies. A cognitive analysis of these nudges is carried out and are distinguished the clinical
nudges (those that take place within the healthcare professional and patient relationship) from the public health nudges (specific
to public health policies). The ethical aspects of both categories of nudge will be analyzed to point out some of their virtues and the
ethical challenges they face. This study focuses in particular on public health nudges, to consider whether it is reasonable, and with
what limits, their implementation in health crises (for example, pandemics). Analyzing that public policies face the dilemma between
preserving freedom at the expense of health or, on the contrary, prioritize health to the point of limiting freedom. It is raised whether
in this context greater restrictions on individual freedoms should be allowed (for example, through mandatory lockdowns and
quarantines, imposed vaccinations, forced tests) or whether to use nudges as an intermediate solution and less harmful to individual
rights to promote health measures.
En ciencias del comportamiento, la expresión nudge (del inglés, empujón, codazo) se refiere a cualquier aspecto de la arquitectura de
la decisión que altera predeciblemente la conducta de las personas en su propio beneficio sin prohibir o restringir de forma significativa
sus opciones. Sus promotores invocan el paternalismo libertario para justificarlo, lo que significa que se promueve el beneficio
del individuo sin contar con su autonomía, pero sin llegar al punto de coartar la libertad de elección cuando ésta es manifiesta. En
este trabajo se analiza el papel de los nudges en el ámbito de las políticas de salud. Se lleva a cabo un análisis cognitivo de ellos y
se distinguen los nudges clínicos (aquellos que tienen lugar en el seno de la relación sanitario-paciente) de los nudges salubristas
(específicos de políticas de salud pública). Se analizan los aspectos éticos de ambas categorías para señalar algunas de sus virtudes y
los retos éticos que plantean. El estudio se centra, de manera particular, en los nudges salubristas, para considerar si es razonable, y
con qué límites, su implementación en crisis sanitarias (por ejemplo, pandemias), donde las políticas públicas se enfrentan al dilema
entre preservar la libertad a costa de la salud pública o, por el contrario, priorizar ésta hasta el punto de limitar aquélla. Se plantea si
en este contexto se deberían permitir mayores restricciones de las libertades individuales (por ejemplo, mediante confinamientos y
cuarentenas obligatorias, vacunación impuesta, etc.) o bien utilizar nudges como una salida intermedia y menos lesiva de derechos
individuales para promover medidas sanitarias.
We examine framing effects in nudging honesty, in the spirit of the growing norm-nudge literature, by utilizing a high-powered and pre-registered study. Across four treatments, participants received ...one random truthful norm-nudge that emphasized ‘moral suasion based on either what other participants previously did (empirical message) or approved of doing (normative message) and varied in the framing (positive or negative) in which it was presented. Subsequently, participants repeatedly played the ‘mind game’ in which they were first asked to think of a number, then rolled a digital die, and then reported whether the two numbers coincide, in which case a bonus was paid. Hence, whether or not the report was truthful remained unobservable to the experimenters. We find compelling null effects with tight confidence intervals showing that none of the norm-nudge interventions worked. A follow-up experiment reveals the reason for these convincing null-effects: the information norm-nudges did not actually change norms. Notably, our secondary results suggest that a substantial portion of individuals misremembered norm-nudges such that they conveniently supported deviant behavior. This subset of participants indeed displayed significantly higher deviance levels, a behavior pattern in line with literature on motivated misremembering and belief distortion. We discuss the importance of this high-powered null finding for the flourishing norm-nudge literature and derive policy implications.
Should Governments Invest More in Nudging? Benartzi, Shlomo; Beshears, John; Milkman, Katherine L. ...
Psychological science,
08/2017, Volume:
28, Issue:
8
Journal Article
Peer reviewed
Open access
Governments are increasingly adopting behavioral science techniques for changing individual behavior in pursuit of policy objectives. The types of "nudge" interventions that governments are now ...adopting alter people's decisions without coercion or significant changes to economic incentives. We calculated ratios of impact to cost for nudge interventions and for traditional policy tools, such as tax incentives and other financial inducements, and we found that nudge interventions often compare favorably with traditional interventions. We conclude that nudging is a valuable approach that should be used more often in conjunction with traditional policies, but more calculations are needed to determine the relative effectiveness of nudging.
We study the effects of two exogenous modifications in the Swedish pension system application form nudging individuals towards a fixed-term payout. Meanwhile, the set of available options and the ...default option—life annuity—were unchanged during the period under study. We examine the effects on individuals’ payout decisions and the spillover effects on labour supply and other pensions using a difference-in-difference framework and detailed administrative data on actual payout decisions and a wide range of individual-level outcomes. Each modification increased the demand for the nudged payout by around 30 percentage points. The first modification also induced individuals to work less.
Individuals with low socioeconomic position (SEP) often make poor food choices, preferring high-density fast foods that provide sufficient energy at a minimal cost over healthy foods, as fruits and ...vegetables. Increasing evidence reveals that the traditional view of food choice as a perfectly rational and deliberate process does not reflect reality, in which habits and heuristics strongly impact decisions.
Applying PRISMA guidelines, the current systematic review provides an updated evaluation of the effectiveness of nudges (changes in the choice architecture) in promoting healthy/decrease unhealthy food purchases, choices, and intake among socioeconomically disadvantaged individuals.
Forty-one articles, including forty-three empirical studies (as two articles included two empirical studies each) were analyzed. Extending previous results based on studies performed only in real-life food purchasing scenarios this review reveals high effectiveness of nudges among low SEP individuals.
Indeed, only 12% of hypothetical and 28% of real-setting studies showed no efficacy. Nevertheless, due to the extreme variability in measurements, these outcomes urge scholars to establish specific and consistent outcome criteria to robustly determine the effectiveness of nudge interventions.
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•41 articles, including 43 studies conducted between 2018 and 2023, were analyzed.•22 articles tested a single nudge, 12 multiple nudges, 7 compared different ones.•40% of cognitive nudge interventions were effective.•75% of affective and 61% of behavioral studies had a positive effect.•12% of hypothetical and 28% of real-setting studies showed no efficacy.
Food production significantly impacts Earth's systems and accounts for approximately a quarter of all greenhouse gas emissions. To create a more sustainable food system, scientific evidence ...emphasizes replacing consumption of certain types of protein with high environmental impact such as beef and pork, with protein with less-impact alternatives such as fish or vegetable protein. This study evaluates a nudge intervention at a medium sized grocery store designed to increase purchases of fish. Alongside it also examines other relevant factors influencing protein choice, such as values, attitudes, habits, demographics and price. To assess the nudge's impact a natural field experiment was designed, and the effect was measured by observing changes in sales of fish (over 59,000 items sold over 143 days). Additionally, data was collected from a selected sample of customers (N = 147) to further explore protein choice determinants. The results fail to demonstrate a significant effect of the nudge intervention. Instead, values, habits, attitudes and price significantly influence protein selection. These findings underscore the complexity of shopping decisions and how nudge interventions are not always easy to implement, adding important null findings to the available literature. Policy implications and possible improvements are discussed, emphasizing the need to account for habits and habit-breaking when designing interventions that aim to steer similar shopping decisions.
Over the past decade, choice architecture interventions or so-called nudges have received widespread attention from both researchers and policy makers. Built on insights from the behavioral sciences, ...this class of behavioral interventions focuses on the design of choice environments that facilitate personally and socially desirable decisions without restricting people in their freedom of choice. Drawing on more than 200 studies reporting over 450 effect sizes (
= 2,149,683), we present a comprehensive analysis of the effectiveness of choice architecture interventions across techniques, behavioral domains, and contextual study characteristics. Our results show that choice architecture interventions overall promote behavior change with a small to medium effect size of Cohen's
= 0.45 (95% CI 0.39, 0.52). In addition, we find that the effectiveness of choice architecture interventions varies significantly as a function of technique and domain. Across behavioral domains, interventions that target the organization and structure of choice alternatives (decision structure) consistently outperform interventions that focus on the description of alternatives (decision information) or the reinforcement of behavioral intentions (decision assistance). Food choices are particularly responsive to choice architecture interventions, with effect sizes up to 2.5 times larger than those in other behavioral domains. Overall, choice architecture interventions affect behavior relatively independently of contextual study characteristics such as the geographical location or the target population of the intervention. Our analysis further reveals a moderate publication bias toward positive results in the literature. We end with a discussion of the implications of our findings for theory and behaviorally informed policy making.
In our hospital, the Infection Control Team (ICT) evaluates patients who test positive for the hepatitis virus during preoperative and preadmission tests (the hepatitis virus round), and adds ...referral requests to a hepatologist to the electronic medical records of these patients. A review after 1 year of this practice confirmed that number of referrals provided by non-hepatology specialty physicians was low, especially among short-stay inpatients. Therefore, we requested referrals using the nudge method in year 2 of the initial infection control training session. This increased the referral consultation rate for short-term hospitalization from 14.3% (3/21) before ICT referral to 31.6% (6/19) in the 1st year and 66.7% (8/12) in the 2nd year (vs. before the start, p<0.01). Thus, the nudge method is effective in promoting voluntary behavior change and can increase rates of referred consultations.
We aimed to assess the clinical effects of dietary education intervention utilizing the nudge strategy in individuals with type 2 diabetes mellitus (T2DM).
The global prevalence of T2DM and its ...associated complications presents a significant health challenge. While the benefits of dietary education intervention for blood glucose management are widely acknowledged, patients often struggle to adhere to dietary recommendations. The implementation of the nudge strategy may offer a promising solution to change unhealthy dietary behavior and enhance diabetes control among individuals with T2DM.
This is a sub-study within a broader cluster-randomized trial that evaluated the effects of nudge-based dietary education and traditional dietary education intervention. Measurements of HbA1c, fasting blood glucose (FBG), body mass index (BMI), blood lipid levels, blood pressure, dietary behavior, and diabetes distress were assessed at baseline and 3 months after the intervention in 147 individuals with T2DM from six primary care practices in Beijing, China.
All outcome measurements were complete at two time points for 134 participants. Results showed that compared to the control group, the intervention group achieved a significantly greater reduction in HbA1c, FBG, BMI, total cholesterol, low-density lipoprotein cholesterol, blood pressure, total energy intake, carbohydrate intake, fat intake, and protein intake and had lower diabetes distress. The intervention group also maintained HDL-C levels and had a significantly greater increase in vegetable intake, while changes in triglycerides were similar in the two groups .
The present study provides evidence that nudge strategy-based dietary education intervention is effective in improving blood glucose, BMI, blood lipid levels, and blood pressure and facilitating changes in patients' dietary behavior and diabetes distress. These findings suggest that implementing nudge strategies can contribute to the optimization of T2DM dietary management and overall patient well-being.
Graphical Abstract
Graphical Abstract
Schematic of a future learning health system with nudge, clinical decision support systems (CDSS), and artificial intelligence-powered analyses forming core ...parts of the learning cycle. Nudges within the CDSS can be used to either promote better adherence of guideline-directed therapy or test new hypotheses whenever there is clinical equipoise, identified through variation in clinical practice owing to the lack of robust evidence in that context. Although a simple A vs. B randomized controlled trial choice has been presented (fluid restriction vs. standard of care), multiple arms and an adaptive design could be built. Clinical outcomes could include patient-reported outcome measures. The presentation of nudges can be adjusted as new clinical insights are generated either within the local system or externally through data linkage. ACEi, angiotensin-converting enzyme inhibitor; GDT, guideline-directed therapy.
Abstract
The increasing volume and richness of healthcare data collected during routine clinical practice have not yet translated into significant numbers of actionable insights that have systematically improved patient outcomes. An evidence-practice gap continues to exist in healthcare. We contest that this gap can be reduced by assessing the use of nudge theory as part of clinical decision support systems (CDSS). Deploying nudges to modify clinician behaviour and improve adherence to guideline-directed therapy represents an underused tool in bridging the evidence-practice gap. In conjunction with electronic health records (EHRs) and newer devices including artificial intelligence algorithms that are increasingly integrated within learning health systems, nudges such as CDSS alerts should be iteratively tested for all stakeholders involved in health decision-making: clinicians, researchers, and patients alike. Not only could they improve the implementation of known evidence, but the true value of nudging could lie in areas where traditional randomized controlled trials are lacking, and where clinical equipoise and variation dominate. The opportunity to test CDSS nudge alerts and their ability to standardize behaviour in the face of uncertainty may generate novel insights and improve patient outcomes in areas of clinical practice currently without a robust evidence base.
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