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Wachner, Jonas, Marieke A. Adriaanse, and Denise T. D. De Ridder. "The effect of nudges on autonomy in hypothetical and real life settings." PLOS ONE 16, no. 8 (August 24, 2021): e0256124. http://dx.doi.org/10.1371/journal.pone.0256124.
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Nudges have repeatedly been found to be effective, however they are claimed to harm autonomy, and it has been found that laypeople expect this too. To test whether these expectations translate to actual harm to experienced autonomy, three online studies were conducted. The paradigm used in all studies was that participants were asked to voluntarily participate in a longer version of the questionnaire. This was either done in a hypothetical setting, where participants imagined they were asked this question, but did not answer it, and reported their expectations for autonomy; Or in an actual choice setting where participants answered the question and then reported their actual autonomy. The first study utilized the hypothetical setting and tried to replicate that laypeople expect nudges to harm autonomy with the current paradigm. A total of 451 participants were randomly assigned to either a control, a default nudge, or a social norm nudge condition. In the default nudge condition, the affirmative answer was pre-selected, and in the social norm nudge condition it was stated that most people answered affirmative. The results showed a trend for lower expected autonomy in nudge conditions, but did not find significant evidence. In Study 2, with a sample size of 454, the same design was used in an actual choice setting. Only the default nudge was found to be effective, and no difference in autonomy was found. In Study 3, Studies 1 and 2 were replicated. Explanation of the nudge was added as an independent variable and the social norm nudge condition was dropped, resulting in six conditions and 1322 participants. The results showed that participants indeed expected default nudges to harm their autonomy, but only if the nudge was explained. When actually nudged, no effect on autonomy was found, independent of the presence of an explanation.
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van Gestel, Laurens C., Marieke A. Adriaanse, and Denise T. D. de Ridder. "Who accepts nudges? nudge acceptability from a self-regulation perspective." PLOS ONE 16, no. 12 (December 3, 2021): e0260531. http://dx.doi.org/10.1371/journal.pone.0260531.
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Background Public acceptability of nudging is receiving increasingly more attention, but studies remain limited to evaluations of aspects of the nudge itself or (inferred intentions) of the nudger. Yet, it is important to investigate which individuals are likely to accept nudges, as those who are supposed to benefit from the implementation should not oppose it. The main objective of this study was to integrate research on self-regulation and nudging, and to examine acceptability of nudges as a function of self-regulation capacity and motivation. Method Participants (N = 301) filled in questionnaires about several components of self-regulation capacity (self-control, proactive coping competence, self-efficacy, perceived control and perceived difficulty) and motivation (autonomous motivation and controlled motivation). To evaluate nudge acceptability, we used three vignettes describing three types of nudges (default, portion size, and rearrangement) that stimulated either a pro-self behavior (healthy eating) or pro-social behavior (sustainable eating) and asked participants to rate the nudges on (aspects of) acceptability. Results Results revealed that there were substantial differences in acceptability between the three types of nudges, such that the default nudge was seen as less acceptable and the rearrangement nudge as most acceptable. The behavior that was stimulated did not affect acceptability, even though the nudges that targeted healthy eating were seen as more pro-self than the nudges targeting sustainable eating. From all self-regulation components, autonomous motivation was the only measure that was consistently associated with nudge acceptability across the three nudges. For self-regulatory capacity, only some elements were occasionally related to acceptability for some nudges. Conclusion The current study thus shows that people are more inclined to accept nudges that target behaviors that they are autonomously motivated for, while people do not meaningfully base their judgments of acceptability on self-regulatory capacity.
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Karlsen, Randi, and Anders Andersen. "Recommendations with a Nudge." Technologies 7, no. 2 (June 13, 2019): 45. http://dx.doi.org/10.3390/technologies7020045.
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In areas such as health, environment, and energy consumption, there is a need to do better. A common goal in society is to get people to behave in ways that are sustainable for the environment or support a healthier lifestyle. Nudging is a term known from economics and political theory, for influencing decisions and behavior using suggestions, positive reinforcement, and other non-coercive means. With the extensive use of digital devices, nudging within a digital environment (known as digital nudging) has great potential. We introduce smart nudging, where the guidance of user behavior is presented through digital nudges tailored to be relevant to the current situation of each individual user. The ethics of smart nudging and the transparency of nudging is also discussed. We see a smart nudge as a recommendation to the user, followed by information that both motivates and helps the user choose the suggested behavior. This paper describes such nudgy recommendations, the design of a smart nudge, and an architecture for a smart nudging system. We compare smart nudging to traditional models for recommender systems, and we describe and discuss tools (or approaches) for nudge design. We discuss the challenges of designing personalized smart nudges that evolve and adapt according to the user’s reactions to the previous nudging and possible behavioral change of the user.
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Wang, Xinghua, Guandong Song, and Xia Wan. "Who is Susceptible to Nudge? Nudge Susceptibility Clusters of Physical Activity in a College Setting." Technium Social Sciences Journal 37 (November 9, 2022): 800–807. http://dx.doi.org/10.47577/tssj.v37i1.7725.
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Currently, the settings of higher education system have made inactivity lifestyle already as social norms on campus. The World Health Organization encouraged to promote physical activity behaviors by setting-based approaches. Nudges could improve physical activity behaviors by changing college settings. However, not everyone could be “Nudgeable”. Finding the “High-Nudgeable” people would help the policymakers to understanding who can be nudged effective among the population. In the present study, we measured the susceptibility of physical activity nudges in a college setting by CPANSS. Based on the overall mean value of nudge susceptibility of five nudge types, we classified the degree of overall “Nudgeable” into “Low-Nudgeable”, “Medium-Nudgeable” and “High-Nudgeable” by a k-means non-hierarchical cluster analysis. This study conducted the target group index (TGI) to determine the demographic attributes (gender, major, and grade) of “High-Nudgeable” college students, and the findings indicated that individuals with following demographic attributes are nudgeable in a high level, which are female (TGI=124.29), be major in social science (TGI=105.02), medical (TGI=127.52) and sports (TGI=103.67), and in Grade 1 (TGI=118.88).
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Kawa, Christine, Wim H. Gijselaers, Jan F. H. Nijhuis, and Patrizia M. Ianiro-Dahm. "Are You “Nudgeable”? Factors Affecting the Acceptance of Healthy Eating Nudges in a Cafeteria Setting." International Journal of Environmental Research and Public Health 19, no. 7 (March 30, 2022): 4107. http://dx.doi.org/10.3390/ijerph19074107.
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Research has identified nudging as a promising and effective tool to improve healthy eating behavior in a cafeteria setting. However, it remains unclear who is and who is not “nudgeable” (susceptible to nudges). An important influencing factor at the individual level is nudge acceptance. While some progress has been made in determining influences on the acceptance of healthy eating nudges, research on how personal characteristics (such as the perception of social norms) affect nudge acceptance remains scarce. We conducted a survey on 1032 university students to assess the acceptance of nine different types of healthy eating nudges in a cafeteria setting with four influential factors (social norms, health-promoting collaboration, responsibility to promote healthy eating, and procrastination). These factors are likely to play a role within a university and a cafeteria setting. The present study showed that key influential factors of nudge acceptance were the perceived responsibility to promote healthy eating and health-promoting collaboration. We also identified three different student clusters with respect to nudge acceptance, demonstrating that not all nudges were accepted equally. In particular, default, salience, and priming nudges were at least moderately accepted regardless of the degree of nudgeability. Our findings provide useful policy implications for nudge development by university, cafeteria, and public health officials. Recommendations are formulated for strengthening the theoretical background of nudge acceptance and the susceptibility to nudges.
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Khadzhyradieva, Svitlana, Tetiana Hrechko, and Anatolii Savkov. "Behavioral Insights in Public Policy: Ukrainian Case." Public Policy And Administration 18, no. 1 (April 9, 2019): 85–99. http://dx.doi.org/10.5755/j01.ppaa.18.1.23130.
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The OECD has identified 196 teams within governments across the world, designed with the purpose of using behavioral insights to improve national administrations. Citizens of various societies support nudges and nudging. However, the determinants of the nudge approval level have not been studied so far. It is not known why some types of nudges are approved by citizens of different countries to a greater extent, and others are actively disapproved. The aim of this study is to reveal the approval level of using Behavioral insights in Public Policy. We have formulated the nudge approval determinants, have analyzed the influence of nudge approval determinants on nudge approval level in 15 countries. We report the results of nationally representative survey of nudge approval level in Ukraine. We have found governance, cultural and experience determinants of nudge approval. DOI: http://dx.doi.org/10.5755/j01.ppaa.18.1.23130
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Schnell, Av Alf Jørgen. "Nudge, nudge." Plan 53, no. 01 (April 6, 2021): 54–55. http://dx.doi.org/10.18261/issn1504-3045-2021-01-11.
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Khanal, Saval, Kelly Ann Schmidtke, Usman Talat, Asif Sarwar, and Ivo Vlaev. "Implementation and Evaluation of Two Nudges in a Hospital’s Electronic Prescribing System to Optimise Cost-Effective Prescribing." Healthcare 10, no. 7 (July 1, 2022): 1233. http://dx.doi.org/10.3390/healthcare10071233.
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Providing healthcare workers with cost information about the medications they prescribe can influence their decisions. The current study aimed to analyse the impact of two nudges that presented cost information to prescribers through a hospital’s electronic prescribing system. The nudges were co-created by the research team: four behavioural scientists and the lead hospital pharmacist. The nudges were rolled out sequentially. The first nudge provided simple cost information (percentage cost-difference between two brands of mesalazine: Asacol® and Octasa®). The second nudge provided information about the potential annual cost savings if the cheaper medication were selected across the National Health Service. Neither nudge influenced prescribing. Prescribing of Asacol® and Octasa® at baseline and during the implementation of the first nudge did not differ (at p ≥ 0.05), nor was there a difference between the first nudge and second (at p ≥ 0.05). Although these nudges were not effective, notable administrative barriers were overcome, which may inform future research. For example, although for legal reasons the cost of medicine cannot be displayed, we were able to present aggregated cost information to the prescribers. Future research could reveal more behavioural factors that facilitate medication optimisation.
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Kawa, Christine, Patrizia M. Ianiro-Dahm, Jan F. H. Nijhuis, and Wim H. Gijselaers. "Cafeteria Online: Nudges for Healthier Food Choices in a University Cafeteria—A Randomized Online Experiment." International Journal of Environmental Research and Public Health 18, no. 24 (December 8, 2021): 12924. http://dx.doi.org/10.3390/ijerph182412924.
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Many people do not consume as much healthy food as recommended. Nudging has been identified as a promising intervention strategy to increase the consumption of healthy food. The present study analyzed the effects of three body shape nudges (thin, thick, or Giacometti artwork) on food ordering and assessed the mediating role of being aware of the nudge. Students (686) and employees (218) of a German university participated in an online experimental study. After randomization, participants visited a realistic online cafeteria and composed a meal for themselves. Under experimental conditions, participants were exposed to one out of three nudges while choosing dishes: (1) thin body shape, (2) thick body shape, and (3) the Giacometti artwork nudge. The Giacometti nudge resulted in more orders for salad among employees. The thin and thick body shape nudges did not change dish orders. Awareness of the nudge mediated the numbers of calories ordered when using the Giacometti or thin body shape nudges. These findings provide useful insights for health interventions in occupational and public health sectors using nudges. Our study contributes to the research on the Giacometti nudge by showing its effectiveness when participants are aware (it is effective under conditions where it is consciously perceived).
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Jung, Janice Y., and Barbara A. Mellers. "American attitudes toward nudges." Judgment and Decision Making 11, no. 1 (January 2016): 62–74. http://dx.doi.org/10.1017/s1930297500007592.
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AbstractTo successfully select and implement nudges, policy makers need a psychological understanding of who opposes nudges, how they are perceived, and when alternative methods (e.g., forced choice) might work better. Using two representative samples, we examined four factors that influence U.S. attitudes toward nudges – types of nudges, individual dispositions, nudge perceptions, and nudge frames. Most nudges were supported, although opt-out defaults for organ donations were opposed in both samples. “System 1” nudges (e.g., defaults and sequential orderings) were viewed less favorably than “System 2” nudges (e.g., educational opportunities or reminders). System 1 nudges were perceived as more autonomy threatening, whereas System 2 nudges were viewed as more effective for better decision making and more necessary for changing behavior. People with greater empathetic concern tended to support both types of nudges and viewed them as the “right” kind of goals to have. Individualists opposed both types of nudges, and conservatives tended to oppose both types. Reactant people and those with a strong desire for control opposed System 1 nudges. To see whether framing could influence attitudes, we varied the description of the nudge in terms of the target (Personal vs. Societal) and the reference point for the nudge (Costs vs. Benefits). Empathetic people were more supportive when framing highlighted societal costs or benefits, and reactant people were more opposed to nudges when frames highlighted the personal costs of rejection.
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Lim, Kok Khiang, and Chei Sian Lee. "Acceptability of Nudge in Digital Learning Environment." Proceedings of the Association for Information Science and Technology 61, no. 1 (October 2024): 564–69. http://dx.doi.org/10.1002/pra2.1059.
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ABSTRACTDigital nudging is gaining traction in the educational domain to guide students' decision‐making processes and achieve desirable learning outcomes through subtle changes in the digital learning environment. From the information science perspective, these changes are realized through informational cues and human‐computer interface design to affect the influences. Studies have shown nudge effectiveness in influencing students' behaviors, but the extent to which digital nudging affects them and who is susceptible to nudges remains unclear. Although progress has been made in understanding nudge acceptability, research in the context of learning and students' characteristics, such as procrastination behavior, remains limited. To fill this gap, this study surveyed 305 university students to assess their nudge acceptability on two types of nudges: System 1, which involves automatic and intuitive processes, and System 2, which engages deliberate and reflective thinking. The results show that students, regardless of their procrastination tendencies, were receptive to nudges in supporting their learning. System 1 nudge was preferred due to its simplistic and straightforward intervention approach. The insights gained from this study contributed to the advancement of nudge research by demonstrating that students with various procrastination tendencies were receptive to nudging and guiding researchers in designing tailored nudges to maximize effectiveness.
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Takebayashi, Masaki, and Kurenai Takebayashi. "Control experiment for health center users to compare the usage of hand sanitizers through nudges during the COVID-19 pandemic in Japan." International Research Journal of Public and Environmental Health 8, no. 6 (November 29, 2021): 299–303. http://dx.doi.org/10.15739/irjpeh.21.032.
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To assess the effectiveness of promoting hand hygiene by nudges, the control experiment was conducted during the COVID-19 pandemic in Japan. Hand sanitizers were placed at entrances of health centers A (nudge group) and B (non-nudges/reference group). The users of each group were approximately 40 daily. In the nudge group, during week 1, the conventional notice was displayed. From weeks 2 to 4, sequential nudges based on the framework “MINDSPACE” were implemented: drawing an arrow on the floor towards a hand sanitizer, posting altruism messages, and providing trends in hand sanitizer usage. From weeks 5 to 8, no additional interventions were implemented. Until week 4, usage in the nudge group increased steeply. Although the gap narrowed after week 5, usage in the nudge group (1.7 times of week 1 usage) was higher than that in the reference group (1.4 times of week 1 usage) at week 8. The nudges cost 0.9 USD and were prepared within 3 hours. The series of nudges can be implemented with low cost and short preparation time, and the effect may last until week 8; these nudges will meet practitioners’ needs during the COVID-19 pandemic.
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Takvorian, Samuel U., Peter Gabriel, E. Paul Wileyto, Daniel Blumenthal, Sharon Tejada, Alicia B. W. Clifton, David A. Asch, et al. "Clinician- and Patient-Directed Communication Strategies for Patients With Cancer at High Mortality Risk." JAMA Network Open 7, no. 7 (July 1, 2024): e2418639. http://dx.doi.org/10.1001/jamanetworkopen.2024.18639.
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ImportanceSerious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion.ObjectiveTo test the independent and combined effects of clinician and patient nudges on SIC completion.Design, Setting, and ParticipantsA 2 × 2 factorial, cluster randomized trial was conducted from September 7, 2021, to March 11, 2022, at oncology clinics across 4 hospitals and 6 community sites within a large academic health system in Pennsylvania and New Jersey among 163 medical and gynecologic oncology clinicians and 4450 patients with cancer at high risk of mortality (≥10% risk of 180-day mortality).InterventionsClinician clusters and patients were independently randomized to receive usual care vs nudges, resulting in 4 arms: (1) active control, operating for 2 years prior to trial start, consisting of clinician text message reminders to complete SICs for patients at high mortality risk; (2) clinician nudge only, consisting of active control plus weekly peer comparisons of clinician-level SIC completion rates; (3) patient nudge only, consisting of active control plus a preclinic electronic communication designed to prime patients for SICs; and (4) combined clinician and patient nudges.Main Outcomes and MeasuresThe primary outcome was a documented SIC in the electronic health record within 6 months of a participant’s first clinic visit after randomization. Analysis was performed on an intent-to-treat basis at the patient level.ResultsThe study accrued 4450 patients (median age, 67 years [IQR, 59-75 years]; 2352 women [52.9%]) seen by 163 clinicians, randomized to active control (n = 1004), clinician nudge (n = 1179), patient nudge (n = 997), or combined nudges (n = 1270). Overall patient-level rates of 6-month SIC completion were 11.2% for the active control arm (112 of 1004), 11.5% for the clinician nudge arm (136 of 1179), 11.5% for the patient nudge arm (115 of 997), and 14.1% for the combined nudge arm (179 of 1270). Compared with active control, the combined nudges were associated with an increase in SIC rates (ratio of hazard ratios [rHR], 1.55 [95% CI, 1.00-2.40]; P = .049), whereas the clinician nudge (HR, 0.95 [95% CI, 0.64-1.41; P = .79) and patient nudge (HR, 0.99 [95% CI, 0.73-1.33]; P = .93) were not.Conclusions and RelevanceIn this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.Trial RegistrationClinicalTrials.gov Identifier: NCT04867850
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Richardson, Liz, and Peter John. "Co-designing behavioural public policy: lessons from the field about how to ‘nudge plus’." Evidence & Policy: A Journal of Research, Debate and Practice 17, no. 3 (August 1, 2021): 405–22. http://dx.doi.org/10.1332/174426420x16000979778231.
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Background: Behavioural public policies, known as nudges, suffer from lack of citizen consent and involvement, which has led to an argument for more reflective nudges, known as ‘nudge plus’.Aims and objectives: How can more citizen reflection be introduced in a way that is not itself top-down and paternalist in spite of good intentions? How might these ‘nudge pluses’ develop on the ground?Methods: This paper reports a mixed-methods case study.Findings: In the case study, there was an intervention that started off as a top-down nudge, using a randomised controlled trial. The nudge then evolved into a bottom-up initiative with citizen input aided by a design lab approach.Discussion and conclusion: One way to address tensions between top-down and bottom-up approaches is to let in the messiness and loss of direct control implied in a design lab, whereby nudge pluses might evolve naturally and without expert direction. The success of the eventual initiative points the way to more design-based nudge plus interventions. Nudge pluses may emerge naturally as a result of the evolutionary co-design process. There is potential for replication, with cross-fertilisation between different traditions by introducing behaviour change policies with a design-based approach.
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Nuckols, Teryl K., Peggy G. Chen, Kanaka D. Shetty, Harsimran S. Brara, Neel Anand, Nabeel Qureshi, David L. Skaggs, Jason N. Doctor, Joshua M. Pevnick, and Anne F. Mannion. "Surgical appropriateness nudges: Developing behavioral science nudges to integrate appropriateness criteria into the decision making of spine surgeons." PLOS ONE 19, no. 4 (April 19, 2024): e0300475. http://dx.doi.org/10.1371/journal.pone.0300475.
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Background Substantial variation exists in surgeon decision making. In response, multiple specialty societies have established criteria for the appropriate use of spine surgery. Yet few strategies exist to facilitate routine use of appropriateness criteria by surgeons. Behavioral science nudges are increasingly used to enhance decision making by clinicians. We sought to design “surgical appropriateness nudges” to support routine use of appropriateness criteria for degenerative lumbar scoliosis and spondylolisthesis. Methods The work reflected Stage I of the NIH Stage Model for Behavioral Intervention Development and involved an iterative, multi-method approach, emphasizing qualitative methods. Study sites included two large referral centers for spine surgery. We recruited spine surgeons from both sites for two rounds of focus groups. To produce preliminary nudge prototypes, we examined sources of variation in surgeon decision making (Focus Group 1) and synthesized existing knowledge of appropriateness criteria, behavioral science nudge frameworks, electronic tools, and the surgical workflow. We refined nudge prototypes via feedback from content experts, site leaders, and spine surgeons (Focus Group 2). Concurrently, we collected data on surgical practices and outcomes at study sites. We pilot tested the refined nudge prototypes among spine surgeons, and surveyed them about nudge applicability, acceptability, and feasibility (scale 1–5, 5 = strongly agree). Results Fifteen surgeons participated in focus groups, giving substantive input and feedback on nudge design. Refined nudge prototypes included: individualized surgeon score cards (frameworks: descriptive social norms/peer comparison/feedback), online calculators embedded in the EHR (decision aid/mapping), a multispecialty case conference (injunctive norms/social influence), and a preoperative check (reminders/ salience of information/ accountable justification). Two nudges (score cards, preop checks) incorporated data on surgeon practices and outcomes. Six surgeons pilot tested the refined nudges, and five completed the survey (83%). The overall mean score was 4.0 (standard deviation [SD] 0.5), with scores of 3.9 (SD 0.5) for applicability, 4.1 (SD 0.5) for acceptability, and 4.0 (SD 0.5), for feasibility. Conferences had the highest scores 4.3 (SD 0.6) and calculators the lowest 3.9 (SD 0.4). Conclusions Behavioral science nudges might be a promising strategy for facilitating incorporation of appropriateness criteria into the surgical workflow of spine surgeons. Future stages in intervention development will test whether these surgical appropriateness nudges can be implemented in practice and influence surgical decision making.
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Soon, Jason, Adrian C. Traeger, Adam G. Elshaug, Erin Cvejic, Chris G. Maher, Jenny A. Doust, Stephanie Mathieson, Kirsten McCaffery, and Carissa Bonner. "Effect of two behavioural ‘nudging’ interventions on management decisions for low back pain: a randomised vignette-based study in general practitioners." BMJ Quality & Safety 28, no. 7 (November 19, 2018): 547–55. http://dx.doi.org/10.1136/bmjqs-2018-008659.
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Objective‘Nudges’ are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions .MethodsAustralian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: ‘partition display’ nudge (low-value options presented horizontally, high-value options listed vertically) or ‘default option’ nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options.Results120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95%CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95%CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15; p=0.89).InterpretationA default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts.
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Raban, Magdalena Z., Gabriela Gonzalez, Amy D. Nguyen, Ben R. Newell, Ling Li, Karla L. Seaman, and Johanna I. Westbrook. "Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review." BMJ Open 13, no. 1 (January 2023): e062688. http://dx.doi.org/10.1136/bmjopen-2022-062688.
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ObjectivesAntibiotic prescribing in primary care contributes significantly to antibiotic overuse. Nudge interventions alter the decision-making environment to achieve behaviour change without restricting options. Our objectives were to conduct a systematic review to describe the types of nudge interventions used to reduce unnecessary antibiotic prescribing in primary care, their key features, and their effects on antibiotic prescribing overall.MethodsMedline, Embase and grey literature were searched for randomised trials or regression discontinuity studies in April 2021. Risk of bias was assessed independently by two researchers using the Cochrane Effective Practice and Organisation of Care group’s tool. Results were synthesised to report the percentage of studies demonstrating a reduction in overall antibiotic prescribing for different types of nudges. Effects of social norm nudges were examined for features that may enhance effectiveness.ResultsNineteen studies were included, testing 23 nudge interventions. Four studies were rated as having a high risk of bias, nine as moderate risk of bias and six as at low risk. Overall, 78.3% (n=18, 95% CI 58.1 to 90.3) of the nudges evaluated resulted in a reduction in overall antibiotic prescribing. Social norm feedback was the most frequently applied nudge (n=17), with 76.5% (n=13; 95% CI 52.7 to 90.4) of these studies reporting a reduction. Other nudges applied were changing option consequences (n=3; with 2 reporting a reduction), providing reminders (n=2; 2 reporting a reduction) and facilitating commitment (n=1; reporting a reduction). Successful social norm nudges typically either included an injunctive norm, compared prescribing to physicians with the lowest prescribers or targeted high prescribers.ConclusionsNudge interventions are effective for improving antibiotic prescribing in primary care. Expanding the use of nudge interventions beyond social norm nudges could reap further improvements in antibiotic prescribing practices. Policy-makers and managers need to be mindful of how social norm nudges are implemented to enhance intervention effects.
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Karlsen, Randi, and Anders Andersen. "The Impossible, the Unlikely, and the Probable Nudges: A Classification for the Design of Your Next Nudge." Technologies 10, no. 6 (October 22, 2022): 110. http://dx.doi.org/10.3390/technologies10060110.
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Nudging provides a way to gently influence people to change behavior towards a desired goal, e.g., by moving towards a healthier or more environmentally friendly lifestyle. Personalized and context-aware digital nudging (named smart nudging) can be a powerful tool for efficient nudging by tailoring nudges to the current situation of each individual user. However, designing smart nudges is challenging, as different users may need different supports to improve their behavior. Determining the next nudge for a specific user must be done based on the user’s current situation, abilities, and potential for improvement. In this paper, we focus on the challenge of designing the next nudge by presenting a novel classification of nudges that distinguishes between (i) nudges that are impossible for the user to follow, (ii) nudges that are unlikely to be followed, and (iii) probable nudges that the user can follow. The classification is tailored to individual users based on user profiles, current situations, and knowledge of previous behaviors. This paper describes steps in the nudge design process and a novel set of principles for designing smart nudges.
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Thunström, Linda. "Welfare effects of nudges: The emotional tax of calorie menu labeling." Judgment and Decision Making 14, no. 1 (January 2019): 11–25. http://dx.doi.org/10.1017/s1930297500002874.
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AbstractTraditionally, information has been assumed to never harm consumers, a notion recently challenged. Salience nudges have been argued to evoke negative emotions, therefore acting as “emotional taxes”. I design a hypothetical restaurant meal experiment to analyze the emotional and short-term consumer welfare impact of a calorie salience nudge (calorie menu labeling) – a policy implemented nationwide in the U.S. in 2018. I find that a calorie salience nudge may act as an emotional tax, but only for some – there is considerable heterogeneity in the emotional response to the nudge. In particular, the nudge emotionally taxes people with low eating self-control, while it emotionally subsidizes those with higher levels of eating self-control. It therefore emotionally taxes the “right” people. However, people with lower levels of self-control may experience fewer benefits from the nudge – the nudge causes them to adjust their high calorie meal consumption by less than do those with higher self-control. It is therefore unsurprising that consumers with lower self-control attach a lower (a negative) value to the calorie salience nudge. Overall, the calorie salience nudge positively affects consumer welfare, although heterogeneity over consumers is substantial – the consumer value ranges from positive to negative. I find no distributional effects over income from the calorie salience nudge.
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Hansen, Pelle Guldborg. "The Definition of Nudge and Libertarian Paternalism: Does the Hand Fit the Glove?" European Journal of Risk Regulation 7, no. 1 (March 2016): 155–74. http://dx.doi.org/10.1017/s1867299x00005468.
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In recent years the concepts of ‘nudge’ and ‘libertarian paternalism’ have become popular theoretical as well as practical concepts inside as well as outside academia. But in spite of the widespread interest, confusion reigns as to what exactly is to be regarded as a nudge and how the underlying approach to behaviour change relates to libertarian paternalism. This article sets out to improve the clarity and value of the definition of nudge by reconciling it with its theoretical foundations in behavioural economics. In doing so it not only explicates the relationship between nudges and libertarian paternalism, but also clarifies how nudges relate to incentives and information, and may even be consistent with the removal of certain types of choices. In the end we are left with a revised definition of the concept of nudge that allows for consistently categorising behaviour change interventions as such and that places them relative to libertarian paternalism.
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Kasdan, David Oliver. "Do Koreans like being nudged? Survey evidence for the contextuality of behavioral public policy." Rationality and Society 32, no. 3 (July 1, 2020): 313–33. http://dx.doi.org/10.1177/1043463120937832.
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This study explores the nuances of South Koreans’ approval for nudge policies by replicating a survey conducted in global nudge research, and then extending the analysis and discussion with greater detail about the context. The traditions, culture, and development of Korea have contributed to a distinct behavioral bias profile that must be integrated into approaches for nudge policy design and implementation. This article proposes the qualities of such a profile from the survey results, as well as the prospect that Koreans are more receptive to information nudges that engage analytic reflection. The findings show significantly lower nudge policy approval rates for Koreans in contrast to Americans and other Western countries. This serves to support previous calls for further research about the generalizability of nudge approaches by contributing evidence to the importance of context for identifying and leveraging behavioral biases in the application of policy. The research offers insights into the Korean context that may be used for nudge policies in Korea and other Eastern contexts.
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Takvorian, Samuel U., Alicia BW Clifton, Peter Edward Gabriel, E. Paul Wileyto, David A. Asch, Alison M. Buttenheim, Katharine A. Rendle, et al. "Patient- and clinician-directed implementation strategies to improve serious illness communication for high-risk patients with cancer: A cluster-randomized pragmatic trial." Journal of Clinical Oncology 41, no. 16_suppl (June 1, 2023): 1514. http://dx.doi.org/10.1200/jco.2023.41.16_suppl.1514.
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1514 Background: Early serious illness conversations (SICs) elicit patients’ values, goals, and care preferences and have been shown to improve outcomes and reduce end-of-life healthcare utilization for patients with cancer. However, most patients with cancer die without a documented SIC. Given prior evidence that strategies informed by behavioral economics (“nudges”) increase SIC rates, our objective was to test the independent and additive effects of clinician- and patient-directed nudges to increase SIC completion. Methods: We conducted a 2 × 2 factorial, cluster-randomized pragmatic trial (NCT04867850) to test the effects of nudges to clinicians, patients, or both, compared to usual care, on SIC completion. Usual care was an active control consisting of clinician-directed text messages sent before routine clinic sessions, identifying patients at high risk of 6-month mortality as predicted by a validated machine-learning prognostic algorithm. The clinician nudge additionally included weekly peer comparisons on clinician-level SIC completion rates. The patient nudge consisted of a patient-facing message sent electronically before an index clinic visit, asking a 3-question survey designed to prime patients for an SIC with their oncology team. Participants included medical/gynecologic oncologists and advanced practice providers (APPs) within a large academic health system and their high-risk patients. We independently randomized oncologist/APP clusters and patients to receive nudges vs. usual care. The primary outcome was a documented SIC in the electronic health record within 6 months of enrollment. Using a Cox proportional hazards model with cluster robust standard errors, we performed a time-to-event analysis and tested for heterogeneity of effect across prespecified subgroups. Results: From September 2021 to March 2022, the study accrued 4,450 patients (median age 67, 52.9% female, 17.3% Black, 2.7% Hispanic) seen by 166 clinicians across 4 hospitals and 6 community sites, randomized to clinician nudge (n=1,179), patient nudge (n=997), both (n=1,270), or active control (n=1,004). Overall patient-level rates of 6-month SIC completion were: 11.5% (clinician nudge), 11.5% (patient nudge), 14.1% (both), and 11.2% (active control). Compared to the active control, participants in the combination nudge arm were more likely to engage in SICs (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.00-2.40), whereas those in the clinician (HR 0.95, 95% CI 0.64-1.41) and patient (HR 0.99, 95% CI 0.73-1.33) nudge arms were not. There was no effect heterogeneity across age and race subgroups. Conclusions: Clinician- and patient-directed nudges may be synergistic in promoting serious illness communication at scale and equitably in routine cancer care. Effects on end-of-life care among decedents are forthcoming. Clinical trial information: NCT04867850 .
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SUNSTEIN, CASS R. "Nudges that fail." Behavioural Public Policy 1, no. 1 (May 2017): 4–25. http://dx.doi.org/10.1017/bpp.2016.3.
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AbstractWhy are some nudges ineffective, or at least less effective than choice architects hope and expect? Focusing primarily on default rules, this essay emphasizes two reasons for this. The first involves strong antecedent preferences on the part of choosers. The second involves successful “counternudges,” which persuade people to choose in a way that confounds the efforts of choice architects. Nudges might also be ineffective, and less effective than expected, for five other reasons: (1) some nudges produce confusion in the target audience; (2) some nudges have only short-term effects; (3) some nudges produce “reactance” (though this appears to be rare); (4) some nudges are based on an inaccurate (though initially plausible) understanding on the part of choice architects of what kinds of choice architecture will move people in particular contexts; and (5) some nudges produce compensating behavior, resulting in no net effect. When a nudge turns out to be insufficiently effective, choice architects have three potential responses: (1) do nothing; (2) nudge better (or differently); and (3) fortify the effects of the nudge, perhaps through counter-counternudges, or perhaps through incentives, mandates, or bans.
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Emmanuel, Anton. "Nudge nudge, wink wink." Clinical Medicine 19, no. 4 (July 2019): 265. http://dx.doi.org/10.7861/clinmedicine.19-4-265.
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Kawa, Christine, Patrizia M. Ianiro-Dahm, Jan F. H. Nijhuis, and Wim H. Gijselaers. "Effects of a Nudging Cue Targeting Food Choice in a University Cafeteria: A Field Study." Healthcare 11, no. 9 (May 3, 2023): 1307. http://dx.doi.org/10.3390/healthcare11091307.
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Many students approaching adulthood often choose high-calorie food products. Concurrently, health interventions applied during this life phase can potentially lead to a healthier lifestyle. Nudge health interventions in experimental cafeteria settings have been found to improve eating behavior effectively, yet research in real-world settings is lacking. Accepting nudges as health interventions impacts nudge effectiveness. The present study applies a pretest–posttest design for a period of three consecutive weeks (no nudge, nudge, no nudge), testing the effectiveness of the so-called Giacometti cue on the number of calories purchased in a real-world cafeteria. Students were exposed to the nudge during the intervention week when entering the cafeteria and when choosing their meals. After purchasing a meal, their choice was recorded, and they completed a questionnaire. The Giacometti cue immediately reduced the number of calories purchased (comparing weeks one and two). After nudge removal, an effect was identified, increasing the number of calories purchased (comparing weeks two and three). Contrary to expectations, higher nudge acceptance resulted in more calories purchased. Neither awareness of the nudge’s presence when buying food nor the interaction between acceptance and awareness played a role. We explore potential explanations for the Giacometti cue’s effects.
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Mistura, Matheus, Nicole Fetterly, Ryan E. Rhodes, Dona Tomlin, and Patti-Jean Naylor. "Examining the Efficacy of a ‘Feasible’ Nudge Intervention to Increase the Purchase of Vegetables by First Year University Students (17–19 Years of Age) in British Columbia: A Pilot Study." Nutrients 11, no. 8 (August 2, 2019): 1786. http://dx.doi.org/10.3390/nu11081786.
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In the transition from high school to university, vegetable consumption tends to deteriorate, potentially influencing immediate and longer-term health outcomes. Nudges, manipulation of the environment to influence choice, have emerged as important to behavior change goals. This quasi-experimental pilot study examined the impact of a contextually feasible evidence-informed nudge intervention on food purchasing behavior of older adolescents (1st year students) in a university residence cafeteria in British Columbia, Canada. A co-design process with students and staff identified a student relevant and operationally feasible nudge intervention; a placement nudge, fresh vegetables at the hot food table, combined with a sensory and cognitive nudge, signage encouraging vegetable purchase). Using a 12-week single-case A-B-A-B design, observations of the proportion of vegetables purchased were used to assess intervention efficacy. Data analysis included visual trend inspection, central tendency measures, data overlap, variability and latency. Visual trend inspection showed a positive trend when nudges were in place, which was more apparent with female purchases and during the first intervention (B) phase. However, further analysis showed lack of baseline stability, high variability across phases and overlapping data, limiting efficacy conclusions. Menu choices, staff encouragement, term timing and student finances are other potential influences. Further ‘real world’ nudge research is needed.
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Zimmermann, Verena, and Karen Renaud. "The Nudge Puzzle." ACM Transactions on Computer-Human Interaction 28, no. 1 (February 2021): 1–45. http://dx.doi.org/10.1145/3429888.
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Nudging is a promising approach, in terms of influencing people to make advisable choices in a range of domains, including cybersecurity. However, the processes underlying the concept and the nudge’s effectiveness in different contexts, and in the long term, are still poorly understood. Our research thus first reviewed the nudge concept and differentiated it from other interventions before applying it to the cybersecurity area. We then carried out an empirical study to assess the effectiveness of three different nudge-related interventions on four types of cybersecurity-specific decisions. Our study demonstrated that the combination of a simple nudge and information provision, termed a “hybrid nudge,” was at least as, and in some decision contexts even more effective in encouraging secure choices as the simple nudge on its own. This indicates that the inclusion of information when deploying a nudge, thereby increasing the intervention’s transparency, does not necessarily diminish its effectiveness. A follow-up study explored the educational and long-term impact of our tested nudge interventions to encourage secure choices. The results indicate that the impact of the initial nudges, of all kinds, did not endure. We conclude by discussing our findings and their implications for research and practice.
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Vande Velde, Fiona, Hans J. Overgaard, and Sheri Bastien. "Nudge strategies for behavior-based prevention and control of neglected tropical diseases: A scoping review and ethical assessment." PLOS Neglected Tropical Diseases 15, no. 11 (November 1, 2021): e0009239. http://dx.doi.org/10.1371/journal.pntd.0009239.
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Background Nudging, a strategy that uses subtle stimuli to direct people’s behavior, has recently been included as an effective and low-cost behavior change strategy in low- and middle- income countries (LMIC), targeting behavior-based prevention and control of neglected tropical diseases (NTDs). The present scoping review aims to provide a timely overview of how nudge interventions have been applied within this field. In addition, the review proposes a framework for the ethical consideration of nudges for NTD prevention and control, or more broadly global health promotion. Methods A comprehensive search was performed in several databases: MEDLINE, PsycINFO, and Embase (Ovid), Web of Science Core Collection, CINAHL, ERIC and Econ.Lit (EBSCO), as well as registered trials and reviews in CENTRAL and PROSPERO to identify ongoing or unpublished studies. Additionally, studies were included through a handpicked search on websites of governmental nudge units and global health or development organizations. Results This scoping review identified 33 relevant studies, with only two studies targeting NTDs in particular, resulting in a total of 67 nudge strategies. Most nudges targeted handwashing behavior and were focused on general health practices rather than targeting a specific disease. The most common nudge strategies were those targeting decision assistance, such as facilitating commitment and reminder actions. The majority of nudges were of moderate to high ethical standards, with the highest standards being those that had the most immediate and significant health benefits, and those implemented by agents in a trust relationship with the target audience. Conclusion Three key recommendations should inform research investigating nudge strategies in global health promotion in general. Firstly, future efforts should investigate the different opportunities that nudges present for targeting NTDs in particular, rather than relying solely on integrated health promotion approaches. Secondly, to apply robust study designs including rigorous process and impact evaluation which allow for a better understanding of ‘what works’ and ‘how it works’. Finally, to consider the ethical implications of implementing nudge strategies, specifically in LMIC.
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Tafur Gómez, Jorge Andrés, and Jhully Paulin Martínez Giraldo. "Students' perception of the application of nudges." Tendencias 25, no. 2 (July 1, 2024): 190–218. http://dx.doi.org/10.22267/rtend.242502.259.
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In this research it was examined how students of two private institutions perceive the nudges. Although the nudge theory has gained considerable popularity in international research, as it is reflected on recent articles in international magazines, it does not count on the recognition or implementation in a local context. In that way, with the developed research, knowledge is generated with regard to the population object of study and it is an important test about the possible implementations of deliberative and non-deliberative nudges in public policies. The methodology used is a quantitative approach, descriptive method, snowball probabilistic sample technique and the test was carried out through chi square to determine gender perception. The results gotten showed that students are receptive to the use of nudge tool in their daily contexts. In conclusion, there is acceptance of the use of deliberative nudges and there is a little distrust of non-deliberative nudges, likewise, it is exposed that nowadays the nudge tool is discussed in top level international universities; nevertheless, in the Latin American context, its formulation is minimal.
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Wang, Xinghua, Guandong Song, and Xia Wan. "Measuring “Nudgeability”: Development of a Scale on Susceptibility to Physical Activity Nudges among College Students." Behavioral Sciences 12, no. 9 (September 1, 2022): 318. http://dx.doi.org/10.3390/bs12090318.
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Background: The current college lifestyle create more opportunities for students to develop unhealthy behaviors, especially physical inactivity. Nudging could be an effective tool to improve physical activity behaviors by changing college settings. One-nudge-fits-all leads to ineffective nudges, so it is necessary to develop a reliable and valid instrument capable of measuring the “nudgeability” of physical activity nudges for college students, which is for a higher level of nudge efficacy. Method: Developing the College Physical Activity Nudges Susceptibility Scale (CPANSS) that integrated the nudge method with the Likert scale, which is the first attempt to measure the susceptibility to nudges directly by a scale. There are four steps for developing CPANSS, including Scale Dimensions, Item Generation, Exploratory Factor Analysis (n = 294), and Confirmatory Factor Analysis (n = 293) with appropriate procedures. Results: The five-factor 21-item CPANSS with good reliability and validity fitted the data reasonably well. Conclusion: The CPANSS was to provide a new tool for policymakers to design effective nudges in changing and promoting physical activity in college settings, and to provide a method for scholars to promote other healthy behaviors for different target groups.
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Tanaka, Rie. "Nudge for Environmental Restructuring in Diabetes Self-Management: Comment on Existing Systematic Reviews." Health Services Insights 16 (January 2023): 117863292311743. http://dx.doi.org/10.1177/11786329231174337.
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Diabetes self-management education and support are necessary for all people living with diabetes, but its accessibility is limited worldwide. Nudge strategies have been proposed as an environmental outreach for diabetes management. This article provides further insights regarding environmental restructuring nudges into the cumulative evidence on diabetes self-management interventions from existing systematic reviews that classified primary trials using the behavior change technique taxonomy (BCTTv1). Among the 137 relevant articles searched through the bibliographic databases until 2022, three systematic reviews were scrutinized. Environmental restructuring nudges have been tested in interpersonal communications for diabetes self-management. Although nudge-based techniques were used with other types of behavior techniques in various trial contexts, the independent effects of social restructuring nudges were not denied in previous meta-analyses. Environmental restructuring nudges may be feasible in diabetes management, but they are still controversial with internal and external validation. Considering care accessibility for diabetes management, social restructuring nudges applied to healthcare providers are expected to complement healthcare systems. For future implementation, the rationale for the practice should be explicit in the conceptualization and evidence synthesis of diabetes-specific nudge interventions based on global sources.
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Fedoruk, Kelly, James Xie, Ellen Wang, Cedar Fowler, Edward Riley, and Brendan Carvalho. "Effect of an electronic medical record nudge to improve quality improvement program tracking of neuraxial catheter replacements in obstetric patients." BMJ Open Quality 12, no. 4 (October 2023): e002240. http://dx.doi.org/10.1136/bmjoq-2022-002240.
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BackgroundMonitoring complications associated with medical procedures requires reliable and accurate record keeping. Nudge reminders executed by way of electronic medical record (EMR) alerts influence clinician behaviour. We hypothesised that the introduction of an EMR nudge would improve documentation of replaced neuraxial blocks by obstetric anaesthesiologists at our institution.MethodsWe developed an EMR nudge that would alert the physician to a replaced neuraxial block if two or more neuraxial procedure notes in a single patient encounter were detected. The nudge encouraged physicians to document neuraxial block replacements in our institution’s quality improvement database. We assessed the rate of physician adherence to replaced neuraxial block charting prior to the introduction of the nudge (January 2019–September 2019) and after the implementation (October 2019–December 2020).Results494 encounters during the chart review period, January 2019–December 2020, required a neuraxial block replacement, representing an actual neuraxial replacement rate of 6.3% prior to the introduction of the nudge in October 2019. This rate was largely unchanged (6.2%) after the introduction of the nudge (0.1% difference, 95% CI: −0.0119 to 0.0099). Prior to the introduction of the nudge, the proportion of correctly charted failed/replaced blocks in our quality improvement database was 80.0%, and after nudge introduction, the rate was 96.2% (p value <0.00001, OR=6.32, 95% CI: 3.15 to 12.66). A p-chart of the monthly adherence rate demonstrated sustained improvement over time.ConclusionsEMR nudge technology significantly improved adherence with quality metric monitoring of neuraxial catheter replacement in obstetric patients. The results imply that data collection for quality metric databases of neuraxial block failures and replacements that rely on clinician memory without a nudge are likely under-reporting neuraxial block failures and replacements. This study supports widespread implementation of nudges in EMRs to improve quality metric reporting.
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Parashar, Dr Suhasini. "The Economic Behavior Theory -The Nudge Theory : An Appraisal." INTERNATIONAL JOURNAL OF TRANSFORMATIONS IN BUSINESS MANAGEMENT 12, no. 01 (2022): 053–63. http://dx.doi.org/10.37648/ijtbm.v12i01.003.
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The behavioral economics is making a significant impact on economic theory and economic policy. Behavioral economics with intuitive appeal, seeks to work with human limitations. Nudge theory becomes an important aspect to study about behavioral economics, political theory and behavioral sciences, as ways to influence the behavior and decision-making of groups or individuals. Nudge theory explains consumer behavior can be influenced by small suggestions and positive views. Nudges decrease low market performance, save the Government money, encourage the actions and help to increase the efficiency of resource use and their effect. Nudge helps to choose an option socially desirable beneficial for better public healthcare, civic sense and social harmony. Humans being need encouragement or intervention as nudge to do what is best for the country or society at large .
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Teichman, Doron, and Eyal Zamir. "Nudge Goes International." European Journal of International Law 30, no. 4 (November 2019): 1263–79. http://dx.doi.org/10.1093/ejil/chaa007.
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Abstract This article introduces the concept of nudge – low-cost behaviourally informed modes of regulation that influence people’s decisions without limiting their choice set – into the behavioural analysis of international law. It sketches out the pathways through which nudges might influence the behaviour of countries, and highlights the normative implications associated with utilizing these regulatory tools in the international arena. That done, the article presents numerous case studies that demonstrate how nudges such as defaults, goals and rankings are integrated into the international legal terrain.
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Entwistle, Tom. "Why nudge sometimes fails: fatalism and the problem of behaviour change." Policy & Politics 49, no. 1 (January 1, 2021): 87–103. http://dx.doi.org/10.1332/030557320x15832072208458.
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Nudge presumes that decision-making is guided by intuitive biases and heavily influenced by the environment in which choices are made. However, critics argue that in place of the quick thinking envisaged by nudge behaviour change reflects deeper and broader thought processes. One of these patterns of thinking ‐ fatalism ‐ has been identified across health and allied disciplines as key to explaining the reason why many people ignore authoritative advice. Insights drawn from a critical review of the fatalism literature explain why nudges sometimes fail. While a fatalist mindset seems to make some of us more susceptible to nudges, it prompts others to respond to nudges in surprising and dysfunctional ways.
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, Spinnbarkeit. "Nudge nudge, say no more…" Faculty Dental Journal 7, no. 2 (April 2016): 92. http://dx.doi.org/10.1308/rcsfdj.2016.92.
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Gupta, Aashray K., Joshua G. Kovoor, and Stephen Bacchi. "Nudge Theory Can Be Used to Optimise Cardiac Surgery Inpatient Management." Journal of Cardiac Surgery 2023 (April 15, 2023): 1–3. http://dx.doi.org/10.1155/2023/7291773.
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Nudge theory has influenced the behaviour of millions of individuals across the world; however, the potential power of this approach has yet to be fully utilised in the field of inpatient cardiac surgery. The nudge theory also presents multiple nonalert choice architecture modifications that may be employed. Choice architecture is already influencing decisions made in hospitals every day, whether it has been deliberately designed to promote beneficial behaviours or not. Decision making for cardiac surgery inpatients is already subject to inherent choice architectures, which may be amenable to nudges. The types of choices to which nudges may be employed in the inpatient surgical setting are numerous and may be relevant to medical officers, nursing staff, allied health staff, and patients. Through the strategic development and robust evaluation of choice architecture modification, using the principles of the nudge theory, further optimisation of cardiac surgery inpatient management may be achieved.
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Moreira, Caritsa Scartaty, Rossana Guerra de Sousa, Orleans Silva Martins, and Andson Braga de Aguiar. "Nudge: Empurrando para longe o gerenciamento de resultados." Revista de Contabilidade e Organizações 17 (December 31, 2023): e214068. http://dx.doi.org/10.11606/issn.1982-6486.rco.2023.214068.
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Esta pesquisa teve por objetivo verificar os efeitos da utilização dos nudges na redução do gerenciamento de resultados. O estudo se classificou como um experimento do tipo entre sujeitos (between-subject). A amostra foi composta por 40 contadores. Para a análise e interpretação dos dados, utilizou-se de estatísticas descritivas, Análise de Variância, Modelo de Equações Estruturais e testes de médias. Os resultados evidenciaram três achados principais, demonstrando suporte para as hipóteses desenvolvidas. Primeiro, o nível de gerenciamento de resultados dos profissionais contábeis é menor na presença do que na ausência de nudges; segundo, o nível de gerenciamento de resultados dos profissionais contábeis é menor na presença do que na ausência de nudge injuntivo emitido pelo líder; e terceiro, que não existe diferença no nível de gerenciamento de resultados dos profissionais contábeis quando o nudge descritivo é emitido pelo líder, em comparação à ausência de nudge.
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Mack, Elizabeth, Daniel Blumenthal, Claudia Fernandez Perez, Rinad Beidas, Justin Bekelman, David A. Asch, Anna-Marika Bauer, et al. "Abstract A136: Design and interim review of a pragmatic stepped wedge cluster randomized clinical trial testing behavioral economic implementation strategies to increase supplemental breast MRI screening among patients with extremely dense breasts." Cancer Epidemiology, Biomarkers & Prevention 33, no. 9_Supplement (September 21, 2024): A136. http://dx.doi.org/10.1158/1538-7755.disp24-a136.
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Abstract INTRODUCTION Supplementing routine screening mammography with breast MRI can significantly increase cancer detection among women with extremely dense breasts, but breast MRI is not widely utilized. At Penn Medicine in 2021, only 8% of women with extremely dense breasts completed supplemental breast MRI screening, with even lower completion among Black women (3%). METHODS We designed a pragmatic trial to evaluate whether sending “nudges” (messages informed by behavioral economics) promoting breast MRI to patients, clinicians, or both increases breast MRI utilization among women with extremely dense breasts. Given baseline inequities, we also sought to assess whether nudges could reduce racial differences in MRI screening rates. This trial is being performed in a state with newly mandated insurance coverage for supplemental MRI screening for patients with extremely dense breasts. Patients aged 40-74 with extremely dense breasts reported on non-actionable mammograms are identified and independently randomized to receive a patient nudge or not. Patient nudges are delivered via text message following confirmation of identify and interest. Prior to launching the trial, rapid cycle approaches (RCAs) tested a set of messages in a diverse patient sample to optimize and de-risk nudge content. Clinicians receive nudges embedded within the mammogram report or through electronic health record in-basket messages. The primary outcome of the trial is ordering and/or scheduling of breast MRI within 6 months of a mammogram. Enrollment numbers and preliminary data on the implementation of the trial has been collected. RESULTS In 8 months, 990 women with extremely dense breasts have been enrolled. The study population currently includes 618 White women, 170 Black women, and 202 women of other races. In total, 36% of women in the patient nudge arm opted to receive the nudge. Patient nudge reception was 35% for White patients and 38% for Black patients. Additionally, 18% of women in the patient nudge arm opted out of receiving the nudge, with 18% of White patients and 22% of Black patients declining the nudge. The provider nudge was successfully delivered 97% of the time. Overall, MRIs have been ordered for about 22% of patients across all study arms. When stratified by race, the order rate was 25% for White patients compared to 16% for Black patients. While follow-up periods have not been completed for many patients, MRIs have been scheduled for 13% of all patients. CONCLUSIONS Despite laws mandating insurance coverage of supplemental screening and emerging evidence of the benefits of supplemental breast MRI for women with extremely dense breasts, there is still inequity in utilization. This trial aims to determine whether nudges can help reduce this existing inequity. Our early results suggest that patient acceptance of text message nudges was similar for White and Black patients. We eagerly await full analyses to determine the efficacy of nudges in increasing uptake and in improving equity of MRI screening among women with extremely dense breasts. Citation Format: Elizabeth Mack, Daniel Blumenthal, Claudia Fernandez Perez, Rinad Beidas, Justin Bekelman, David A. Asch, Anna-Marika Bauer, Alison M. Buttenheim, Emily F. Conant, Abigail Doucette, Oluwadamilola M. Fayanju, Peter Gabriel, Carmen Guerra, Linda W. Nunes, Martina Plag, Katharine A. Rendle, Rachel C. Shelton, Lawrence Shulman, Sue Ware, Bernadette C. Wheeler, Paul Wileyto, Robert Schnoll, Anne Marie McCarthy. Design and interim review of a pragmatic stepped wedge cluster randomized clinical trial testing behavioral economic implementation strategies to increase supplemental breast MRI screening among patients with extremely dense breasts [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A136.
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Mackay, Mary, Satoshi Yamazaki, Sarah Jennings, Hugh Sibly, Ingrid E. van Putten, and Timothy J. Emery. "The influence of nudges on compliance behaviour in recreational fisheries: a laboratory experiment." ICES Journal of Marine Science 77, no. 6 (February 22, 2019): 2319–32. http://dx.doi.org/10.1093/icesjms/fsz020.
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Abstract Non-compliance is a tenacious problem in recreational fisheries management, posing a risk to marine conservation and socio-ecological systems by, for example, undermining management efforts and creating conflict between resource user groups. In fisheries management, deterrence-based approaches have traditionally been used to tackle non-compliance. However, enforcement is often limited in recreational fisheries and an alternative approach is needed to improve compliance. In this paper, we explore the lessons from behavioural economics and apply nudge theory as the basis of alternative management approaches. Nudge theory argues that through positive reinforcement or indirect suggestion, voluntary compliance can be achieved. We test the influence of a nudge, based on a descriptive social norm, through an economic laboratory experiment in a recreational fisheries context. Our results show that the presence of this nudge can increase compliance behaviour by 10%. We find that a nudge was more effective when deterrence is low, but its effects become weaker when deterrence is already high. We also find heterogeneity across individual’s responses to the nudge and risk preferences significantly related to compliance behaviour. Nudges based on social norms have the potential to complement traditional deterrence methods and could prove successful as a cost-effective compliance tool in the marine environment.
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Balconi, Michela, Carlotta Acconito, Katia Rovelli, and Laura Angioletti. "Influence of and Resistance to Nudge Decision-Making in Professionals." Sustainability 15, no. 19 (October 5, 2023): 14509. http://dx.doi.org/10.3390/su151914509.
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This study investigated how professionals’ decision-making is influenced by nudging and their resistance to such a form of conditioning. A total of 61 professionals performed a nudge task in which three different scenarios related to wellbeing and sustainable behaviours were presented to the participants under boosted and soft nudge conditions. After the presentation of each scenario, participants were required to decide between two options of choice: one choice was more nudge-induced, the other was not. Electrophysiological (EEG), autonomic, behavioural, and self-report data were collected to determine the correlates of resistance with nudge conditions. The findings showed that professionals’ resistance to nudging is high and not influenced by boosted or soft nudges. Also, while the generalized increase in EEG delta, theta, and beta power localized and lateralized in the right temporoparietal regions can lay the foundation of “the neural architecture” of resistance to nudging, the significant increase in SCR for the boosted compared to soft condition highlighted the pivotal role of this marker as the only indicator that differentiates the two nudge conditions. Overall, evaluating the correlates of the resistance to nudge can be useful to render professionals aware of the explicit and implicit factors to be strengthened to resist to such form of conditioning.
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Roach, Jason, Kevin Weir, Paul Phillips, Karen Gaskell, and Miles Walton. "Nudging down theft from insecure vehicles. A pilot study." International Journal of Police Science & Management 19, no. 1 (December 26, 2016): 31–38. http://dx.doi.org/10.1177/1461355716677876.
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This report presents the preliminary findings of a pilot study to reduce thefts from cars committed against insecure vehicles, using the behavioural insights or ‘nudge approach’. The recipients of the ‘nudges’ were potential victims of theft from insecure vehicles living in high rate areas for this crime, where a bespoke leaflet campaign was developed to nudge vehicle owners into thinking more carefully when leaving their vehicles unattended, particularly when left on their driveways overnight. Although somewhat tentative at this stage, the preliminary findings indicate that the percentage of thefts committed against insecure vehicles in the two treatment areas was reduced significantly when compared with the two control group areas where no nudge interventions were introduced. This demonstrates that if appropriate nudges (grounded in psychological theory) are coupled with and delivered by appropriate messengers, the prosocial behavioural change can be encouraged which can lead to a reduction in criminal behaviour and opportunities for crime.
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Georgiou, Panayiota. "Nudging As a Public Policy Tool: Exploring the Relationship Between Nudge and the Ability of Citizens for Rational Thought and Choice." HAPSc Policy Briefs Series 3, no. 1 (June 29, 2022): 23–30. http://dx.doi.org/10.12681/hapscpbs.30982.
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This paper presents a theoretical analysis of the use of nudge as a tool of governments in influencing people’s behaviour. It captures the emergence of nudge as a policy making tool and its meaning within the context of policy interventions. Then, the different conditions under which nudge effectively leads to citizens’ loss of their ability for choice and thought are examined, which are (i) referring to the choice of architects promoting their own interests, (ii) unconscious nudging, (iii) overuse of nudging and (iv) the issue of who gets nudged and its associated implications. To conclude, the summative assessment of nudge’s role in negatively influencing citizens’ ability for choice and rational thought while also providing comments for future analysis is also discussed. Overall, this paper critically examines the use of nudge as a policy tool for governments, adding to the existing public management and policy literature.
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Straßheim, Holger. "John, Peter (2018). How Far to Nudge? Assessing Behavioural Public Policy. Cheltenham (New Horizons in Public Policy), UK/Northampton, MA, USA: Edward Elgar. 173 Seiten. ISBN: 9781786430564." der moderne staat – Zeitschrift für Public Policy, Recht und Management 12, no. 1-2019 (June 24, 2019): 227–31. http://dx.doi.org/10.3224/dms.v12i1.16.
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In the past decade, interventions informed by behavioural economics and psychology have spread across jurisdictions and policy areas. Worldwide, more than one hundred organizations and networks are developing and implementing nudges and other behavioural tools. After an initial phase of curiosity, attention is now shifting to the varieties of behavioural public policy, its institutional and cultural embeddedness, its impact and limitations. In his most recent book, Peter John explores some of the crucial questions related to this next phase of nudge. He discusses the role of nudge units, the limitations of behavioural approaches and the ethics of nudge. Most importantly, John proposes a deliberative and reflective version of nudging, nudge plus. Readers might miss an in-depth discussion of pressing problems such as the globalizing influence of behavioural expertise, the imperialism of evidence hierarchies and the political repercussions of nudging. Despite these deficits, the book will inspire both further research and critical debates.
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Bonell, Chris, Martin McKee, Adam Fletcher, Andrew Haines, and Paul Wilkinson. "Nudge smudge: UK Government misrepresents “nudge”." Lancet 377, no. 9784 (June 2011): 2158–59. http://dx.doi.org/10.1016/s0140-6736(11)60063-9.
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Lemken, Dominic, Ainslee Erhard, and Simone Wahnschafft. "A choice architect’s guide to the (autonomous) galaxy: a systematic scoping review of nudge intrusiveness in food choices." Humanities and Social Sciences Communications 11, no. 1 (August 12, 2024). http://dx.doi.org/10.1057/s41599-024-03555-8.
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AbstractIn seeking to uphold consumer autonomy in the design and implementation of nudge interventions, choice architects must concern themselves with preserving both the availability of options made to consumers (freedom of choice), and the capacity of consumers to deliberate and choose (agency) Several studies aim to examine the extent to which nudges truly uphold autonomy; however, most examine self-reported perceived intrusiveness on autonomy, rather than considering autonomy from the perspective of how nudges are designed. Leveraging a systematic scoping review of nudges related to food choice (N = 146), a common policy arena for nudge interventions, we develop a typology of three mechanisms of nudge design that, when not considered, could unduly intrude upon autonomy: (1) the effort to opt out, delineated along economic and physical sub-dimensions; (2) affective influence, such as social reference messaging and emotional appeals; and (3) non-transparency, including of the nudge itself and of non-nudged alternative options. We discuss how each mechanism manifested in reviewed studies, and ultimately offer possible criteria that can be used to evaluate nudge intrusiveness along each mechanism. This typology can support choice architects to discern how nudges might better protect consumer autonomy, and ultimately uphold it in pursuit of behavior change. Our scoping review further provides empirical support for the concept of resistible yet effective nudges.
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Van Rookhuijzen, Merije, Emely De Vet, and Marieke A. Adriaanse. "The Effects of Nudges: One-Shot Only? Exploring the Temporal Spillover Effects of a Default Nudge." Frontiers in Psychology 12 (September 13, 2021). http://dx.doi.org/10.3389/fpsyg.2021.683262.
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Nudges, such as defaults, are generally found to be effective in guiding immediate behavioural decisions. However, little is known about whether the effect of a nudge can be lasting, meaning that it spills over to subsequent similar choices without the presence of a nudge. In three experiments, we explored the temporal spillover effects of a default nudge. The results of Experiments 1 (N = 1,077) and 2 (N = 1,036) suggest that nudging participants into completing a longer questionnaire affected their decision for the same behaviour a day later without the presence of a nudge. However, nudging participants into a healthier food choice in Experiment 3 (N = 969) did not result in such a temporal spillover effect. The results indicated that participants' change in attitude towards the nudged behaviour may partly explain the temporal spillover effects. These findings suggest that for some, but not all behaviours, default nudges may have the potential to yield temporal spillover effects and warrant a further investigation of boundary conditions and facilitators of the spillover effects of nudges.
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de Ridder, Denise, Floor Kroese, and Laurens van Gestel. "Nudgeability: Mapping Conditions of Susceptibility to Nudge Influence." Perspectives on Psychological Science, August 23, 2021, 174569162199518. http://dx.doi.org/10.1177/1745691621995183.
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Nudges are behavioral interventions to subtly steer citizens’ choices toward “desirable” options. An important topic of debate concerns the legitimacy of nudging as a policy instrument, and there is a focus on issues relating to nudge transparency, the role of preexisting preferences people may have, and the premise that nudges primarily affect people when they are in “irrational” modes of thinking. Empirical insights into how these factors affect the extent to which people are susceptible to nudge influence (i.e., “nudgeable”) are lacking in the debate. This article introduces the new concept of nudgeability and makes a first attempt to synthesize the evidence on when people are responsive to nudges. We find that nudge effects do not hinge on transparency or modes of thinking but that personal preferences moderate effects such that people cannot be nudged into something they do not want. We conclude that, in view of these findings, concerns about nudging legitimacy should be softened and that future research should attend to these and other conditions of nudgeability.
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Dyck, Bruno, Chi Liao, and Rajesh V. Manchanda. "Putting people and planet ahead of profits: Nudges in Investor Profile Questionnaires." Journal of Business, Ethics and Society II, no. II (October 20, 2022). http://dx.doi.org/10.61781/2-1ii2022/1bmlm.
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In light of the increasing concern about social and ecological crises facing humankind, this experimental study uses nudge theory to examine whether Investor Profile Questionnaires can be redesigned so that retail investors are nudged towards investments that place social and ecological returns ahead of financial returns, and away from investments that (merely) seek to maximize financial returns. Contrary to our predictions, our findings indicate that adding sustainability-oriented awareness and attitudinal nudges to Investor Profile Questionnaires did not result in participants decreasing the proportion of funds they invested in business-as-usual firms that focus primarily on maximizing financial returns. However, as predicted, the awareness and attitudinal nudges did increase the proportion of funds invested in firms that compromise financial returns in order to optimize social and ecological well-being. Moreover, investors’ attitudes towards sustainable investing were more positive after they received an action nudge versus (merely) an awareness nudge. Implications are discussed.
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Öztürk, Alperen, and Korhan Arun. "Nudge theory on intrapreneurship: a conceptual view." Journal of Entrepreneurship in Emerging Economies, May 21, 2024. http://dx.doi.org/10.1108/jeee-09-2023-0355.
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Purpose This study aims to discuss appropriate individual, organizational and macroleveled conditions when it is desired to foster intrapreneurship with nudge techniques. Design/methodology/approach Conceptual paper. Findings This paper aims to provide theoretical framework on the relationship between nudges approach and intrapreneurship and offer measurable propositions at different level of analysis for future research. Originality/value At the individual level it is theorized that nudges techniques on intrapreneurship will work when: “agents are aware of being nudged”, “choice architect is a well-recognized leader”, “perception of meaningful work is high” and “agents had former experience about being nudged”. At the organizational level it is claimed that the “number”, “type” and “frequency” of nudges plays the prominent role. Lastly, at the macrolevel it is postulated that “cultural adjustments”, “providing education” and “forming networks” sets the ground for pushing masses to intrapreneurial activities via nudges.