1
|
Campos-Mercade P, Schneider FH. Monetary incentives for vaccination: effectiveness and unintended consequences. Clin Microbiol Infect 2024:S1198-743X(24)00164-2. [PMID: 38556210 DOI: 10.1016/j.cmi.2024.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/19/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Affiliation(s)
- Pol Campos-Mercade
- Department of Economics, Lund University and Institute for Future Studies, Lund, Sweden
| | - Florian H Schneider
- Department of Economics and Center for Economic Behavior and Inequality (CEBI), University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
2
|
Stevens J, Rausch J, Osuagwu N, Lutz R. Efficacy of Behavioral Economic Nudges to Assist Teen Mothers: the Healthy Adolescent Transitions Randomized Controlled Trial. Prev Sci 2024:10.1007/s11121-024-01660-3. [PMID: 38429618 DOI: 10.1007/s11121-024-01660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
Communities may often lack the resources to deliver intensive programs to assist teen mothers, and many eligible adolescents may decline participation in lengthy interventions. Therefore, alternative approaches involving less resource and time may be needed. Behavioral economics (BE) can inform the development of such novel interventions. BE often feature low-intensity approaches designed to "nudge" people to help them reach their long-term goals. Nudges can include giving reminders, making the desired behavior more convenient, and optimizing the verbal presentation of recommended options. Three hundred thirty-one American adolescents (ages 14 to 19) who were 22 to 35 weeks pregnant were enrolled in the present trial. One hundred sixty-six participants were randomly assigned to the intervention condition featuring a three-month BE intervention delivered by a registered nurse and social worker. The remaining 165 youths were assigned usual care. Surveys were completed at baseline, 3 months, 12 months, and 18 months. Data collection occurred from 2017 to 2021. Qualitative feedback indicated that the BE intervention was well-received by adolescents. However, there were no significant differences between the intervention and control groups at any time point regarding repeat pregnancy, contraceptive usage, financial literacy, school completion, job attainment, HPV vaccinations, nicotine usage, perception of having a medical home, urgent care/ED usage, and nutritional intake (all p > .05). Our findings suggest that a BE-based intervention may not be sufficient to facilitate change for teen mothers. Future programs should consider lasting longer, featuring a higher dose, and/or incorporating systems-level changes. This trial was prospectively registered (NCT03194672 clinicaltrials.gov).
Collapse
Affiliation(s)
- Jack Stevens
- Nationwide Children's Hospital, NEOB 3rd Floor, Columbus, OH, 43205, USA.
- Department of Pediatrics, Ohio State University, Columbus, OH, USA.
| | - Joseph Rausch
- Nationwide Children's Hospital, NEOB 3rd Floor, Columbus, OH, 43205, USA
- Department of Pediatrics, Ohio State University, Columbus, OH, USA
| | - Ngozi Osuagwu
- OhioHealth Research and Innovation Institute, Columbus, OH, USA
- Ohio University Heritage College of Osteopathic Medicine, Columbus, OH, USA
| | - Robyn Lutz
- OhioHealth Research and Innovation Institute, Columbus, OH, USA
| |
Collapse
|
3
|
Boz-Yılmaz HZ, Boduroglu A. Understanding patterns of accumulation: Improving forecast-based decisions via nudging. Mem Cognit 2024:10.3758/s13421-024-01519-6. [PMID: 38270777 DOI: 10.3758/s13421-024-01519-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2024] [Indexed: 01/26/2024]
Abstract
In this study we investigated challenges associated with comprehension of graphical patterns of accumulation (Experiment 1) and how to improve accumulation-based reasoning via nudging (Experiment 2). On each trial participants were presented with two separate graphs, each depicting a linear, saturating, or exponential data trajectory. They were then asked to make a binary decision based on their forecasts of how these trends would evolve. Correct responses were associated with a focus on the rate of increase in graphs; incorrect responses were driven by prior knowledge and beliefs regarding the context and/or selective attention towards the early phases of the line trajectories. To encourage participants to think more critically and accurately about the presented data, in Experiment 2, participants completed a nudge phase: they either made a forecast about a near horizon or read particular values on the studied trajectories prior to making their decisions. Forecasting about how the studied trajectories would progress led to improvements in determining expected accumulation growth. Merely reading values on the existing trajectory did not lead to improvements in decision accuracy. We demonstrate that actively asking participants to make specific forecasts prior to making decisions based on the accumulation trajectories improves decision accuracy.
Collapse
Affiliation(s)
| | - Aysecan Boduroglu
- Department of Psychology, Koc University, 34450 Sarıyer, Istanbul, Turkey.
| |
Collapse
|
4
|
Allard A, Armond ACV, Goddiksen MP, Johansen MW, Loor H, Schöpfer C, Varga O, Clavien C. The quizzical failure of a nudge on academic integrity education: a randomized controlled trial. Res Integr Peer Rev 2023; 8:15. [PMID: 38031137 PMCID: PMC10688455 DOI: 10.1186/s41073-023-00139-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Studies on academic integrity reveal high rates of plagiarism and cheating among students. We have developed an online teaching tool, Integrity Games ( https://integgame.eu/ ), that uses serious games to teach academic integrity. In this paper, we test the impact of a soft intervention - a short quiz - that was added to the Integrity Games website to increase users' interest in learning about integrity. Based on general principles of behavioral science, our quiz highlighted the intricacy of integrity issues, generated social comparisons, and produced personalized advice. We expected that these interventions would create a need for knowledge and encourage participants to spend more time on the website. METHODS In a randomized controlled trial involving N = 405 students from Switzerland and France, half of the users had to take a short quiz before playing the serious games, while the other half could directly play the games. We measured how much time they spent playing the games, and, in a post-experimental survey, we measured their desire to learn about integrity issues and their understanding of integrity issues. RESULTS Contrary to our expectations, the quiz had a negative impact on time spent playing the serious games. Moreover, the quiz did not increase participants' desire to learn about integrity issues or their overall understanding of the topic. CONCLUSIONS Our quiz did not have any measurable impact on curiosity or understanding of integrity issues, and may have had a negative impact on time spent on the Integrity games website. Our results highlight the difficulty of implementing behavioral insights in a real-world setting. TRIAL REGISTRATION The study was preregistered at https://osf.io/73xty .
Collapse
Affiliation(s)
- Aurélien Allard
- iEH2-Institute for Ethics History Humanities, University of Geneva, Geneva, Switzerland.
| | | | - Mads Paludan Goddiksen
- Department of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Céline Schöpfer
- iEH2-Institute for Ethics History Humanities, University of Geneva, Geneva, Switzerland
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Christine Clavien
- iEH2-Institute for Ethics History Humanities, University of Geneva, Geneva, Switzerland
| |
Collapse
|
5
|
McCarthy AM, Fernandez Perez C, Beidas RS, Bekelman JE, Blumenthal D, Mack E, Bauer AM, Ehsan S, Conant EF, Wheeler BC, Guerra CE, Nunes LW, Gabriel P, Doucette A, Wileyto EP, Buttenheim AM, Asch DA, Rendle KA, Shelton RC, Fayanju OM, Ware S, Plag M, Hyland S, Gionta T, Shulman LN, Schnoll R. Protocol for 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. Implement Sci 2023; 18:65. [PMID: 38001506 PMCID: PMC10668465 DOI: 10.1186/s13012-023-01323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Increased breast density augments breast cancer risk and reduces mammography sensitivity. Supplemental breast MRI screening can significantly increase cancer detection among women with dense breasts. However, few women undergo this exam, and screening is consistently lower among racially minoritized populations. Implementation strategies informed by behavioral economics ("nudges") can promote evidence-based practices by improving clinician decision-making under conditions of uncertainty. Nudges directed toward clinicians and patients may facilitate the implementation of supplemental breast MRI. METHODS Approximately 1600 patients identified as having extremely dense breasts after non-actionable mammograms, along with about 1100 clinicians involved with their care at 32 primary care or OB/GYN clinics across a racially diverse academically based health system, will be enrolled. A 2 × 2 randomized pragmatic trial will test nudges to patients, clinicians, both, or neither to promote supplemental breast MRI screening. Before implementation, rapid cycle approaches informed by clinician and patient experiences and behavioral economics and health equity frameworks guided nudge design. Clinicians will be clustered into clinic groups based on existing administrative departments and care patterns, and these clinic groups will be randomized to have the nudge activated at different times per a stepped wedge design. Clinicians will receive nudges integrated into the routine mammographic report or sent through electronic health record (EHR) in-basket messaging once their clinic group (i.e., wedge) is randomized to receive the intervention. Independently, patients will be randomized to receive text message nudges or not. The primary outcome will be defined as ordering or scheduling supplemental breast MRI. Secondary outcomes include MRI completion, cancer detection rates, and false-positive rates. Patient sociodemographic information and clinic-level variables will be examined as moderators of nudge effectiveness. Qualitative interviews conducted at the trial's conclusion will examine barriers and facilitators to implementation. DISCUSSION This study will add to the growing literature on the effectiveness of behavioral economics-informed implementation strategies to promote evidence-based interventions. The design will facilitate testing the relative effects of nudges to patients and clinicians and the effects of moderators of nudge effectiveness, including key indicators of health disparities. The results may inform the introduction of low-cost, scalable implementation strategies to promote early breast cancer detection. TRIAL REGISTRATION ClinicalTrials.gov NCT05787249. Registered on March 28, 2023.
Collapse
Affiliation(s)
- Anne Marie McCarthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | | | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin E Bekelman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Daniel Blumenthal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Mack
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna-Marika Bauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Ehsan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily F Conant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carmen E Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Linda W Nunes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Gabriel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Abigail Doucette
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Sue Ware
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Martina Plag
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Hyland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tracy Gionta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Robert Schnoll
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
6
|
Symecko H, Schnoll R, Beidas RS, Bekelman JE, Blumenthal D, Bauer AM, Gabriel P, Boisseau L, Doucette A, Powers J, Cappadocia J, McKenna DB, Richardville R, Cuff L, Offer R, Clement EG, Buttenheim AM, Asch DA, Rendle KA, Shelton RC, Fayanju OM, Wileyto EP, Plag M, Ware S, Shulman LN, Nathanson KL, Domchek SM. Protocol to evaluate sequential electronic health record-based strategies to increase genetic testing for breast and ovarian cancer risk across diverse patient populations in gynecology practices. Implement Sci 2023; 18:57. [PMID: 37932730 PMCID: PMC10629034 DOI: 10.1186/s13012-023-01308-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/29/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Germline genetic testing is recommended by the National Comprehensive Cancer Network (NCCN) for individuals including, but not limited to, those with a personal history of ovarian cancer, young-onset (< 50 years) breast cancer, and a family history of ovarian cancer or male breast cancer. Genetic testing is underused overall, and rates are consistently lower among Black and Hispanic populations. Behavioral economics-informed implementation strategies, or nudges, directed towards patients and clinicians may increase the use of this evidence-based clinical practice. METHODS Patients meeting eligibility for germline genetic testing for breast and ovarian cancer will be identified using electronic phenotyping algorithms. A pragmatic cohort study will test three sequential strategies to promote genetic testing, two directed at patients and one directed at clinicians, deployed in the electronic health record (EHR) for patients in OB-GYN clinics across a diverse academic medical center. We will use rapid cycle approaches informed by relevant clinician and patient experiences, health equity, and behavioral economics to optimize and de-risk our strategies and methods before trial initiation. Step 1 will send patients messages through the health system patient portal. For non-responders, step 2 will reach out to patients via text message. For non-responders, Step 3 will contact patients' clinicians using a novel "pend and send" tool in the EHR. The primary implementation outcome is engagement with germline genetic testing for breast and ovarian cancer predisposition, defined as a scheduled genetic counseling appointment. Patient data collected through the EHR (e.g., race/ethnicity, geocoded address) will be examined as moderators of the impact of the strategies. DISCUSSION This study will be one of the first to sequentially examine the effects of patient- and clinician-directed strategies informed by behavioral economics on engagement with breast and ovarian cancer genetic testing. The pragmatic and sequential design will facilitate a large and diverse patient sample, allow for the assessment of incremental gains from different implementation strategies, and permit the assessment of moderators of strategy effectiveness. The findings may help determine the impact of low-cost, highly transportable implementation strategies that can be integrated into healthcare systems to improve the use of genomic medicine. TRIAL REGISTRATION ClinicalTrials.gov. NCT05721326. Registered February 10, 2023. https://www. CLINICALTRIALS gov/study/NCT05721326.
Collapse
Affiliation(s)
- Heather Symecko
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Robert Schnoll
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin E Bekelman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Daniel Blumenthal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna-Marika Bauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Gabriel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Leland Boisseau
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Abigail Doucette
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Jacquelyn Powers
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacqueline Cappadocia
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle B McKenna
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Richardville
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Cuff
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ryan Offer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth G Clement
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - E Paul Wileyto
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Martina Plag
- Center for Healthcare Transformation and Innovation, Penn Medicine, Philadelphia, PA, USA
| | - Sue Ware
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Katherine L Nathanson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Susan M Domchek
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Basser Center for BRCA, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA.
| |
Collapse
|
7
|
Caso G, Rizzo G, Migliore G, Vecchio R. Loss framing effect on reducing excessive red and processed meat consumption: Evidence from Italy. Meat Sci 2023; 199:109135. [PMID: 36796286 DOI: 10.1016/j.meatsci.2023.109135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/14/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
A reduction of meat consumption is crucial for addressing public health problems, especially in industrialized countries. Among low-cost interventions, emotionally provocative health-information strategies could be effective options in fostering meat reduction. Through an online experimental survey, administrated to a quota-based national sample (N = 1142), this study analysed the profile of Italians consuming red/processed meat above World Health Organization (WHO) recommended amounts. Via a between-subjects design, the research tested whether two health frame-nudges (societal impact and individual impact of over consumption) persuaded these individuals to reduce future meat consumption. Results showed that adhering to an omnivore diet, higher consumption of meat than peers, household size (larger) and positive moral perception of meat consumption increased the likelihood of overconsumption. In addition, both nudges proved to be effective in positively impacting future intentions to reduce meat consumption among individuals exceeding WHO recommended amounts. The two frame-nudges were more effective among females, respondents with children in the household and individuals with a low health status perception.
Collapse
Affiliation(s)
- Gerarda Caso
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 96, Portici, Naples 80055, Italy.
| | - Giuseppina Rizzo
- Department of Agricultural, Food and Forest Sciences, University of Palermo, Viale delle Scienze, Building 4, Palermo 90128, Italy.
| | - Giuseppina Migliore
- Department of Agricultural, Food and Forest Sciences, University of Palermo, Viale delle Scienze, Building 4, Palermo 90128, Italy.
| | - Riccardo Vecchio
- Department of Agricultural Sciences, University of Naples Federico II, Via Università 96, Portici, Naples 80055, Italy.
| |
Collapse
|
8
|
Poch M, Aldao C, Godo-Pla L, Monclús H, Popartan LA, Comas J, Cermerón-Romero M, Puig S, Molinos-Senante M. Increasing resilience through nudges in the urban water cycle: An integrative conceptual framework to support policy decision-making. Chemosphere 2023; 317:137850. [PMID: 36657572 DOI: 10.1016/j.chemosphere.2023.137850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 11/28/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Relevant challenges associated with the urban water cycle must be overcome to meet the United Nations Sustainable Development Goals (SDGs) and improve resilience. Unlike previous studies that focused only on the provision of drinking water, we propose a framework that extends the use of the theory of nudges to all stages of the overall urban water cycle (drinking water and wastewater services), and to agents of influence (citizens, organizations, and governments) at different levels of decision making. The framework integrates four main drivers (the fourth water revolution, digitalization, decentralization, and climate change), which influence how customers, water utilities and regulators approach the challenges posed by the urban water cycle. The proposed framework, based on the theory of nudges first advanced by the Nobel Prize in behavioral economics Richard H. Thaler and Cass R. Sunstein (Thaler and Sunstein, 2009), serves as a reference for policymakers to define medium- and long-term strategies and policies for improving the sustainability and resilience of the urban water cycle. Finally, we provide new insights for further research on resilience approaches to the management of the urban water cycle as an element to support the more efficient formulation of policies.
Collapse
Affiliation(s)
- Manel Poch
- LEQUIA. Institute of the Environment, Universitat de Girona, C/ Maria Aurèlia Capmany, 69, 17003, Girona, Spain.
| | - Carolina Aldao
- Faculty of Tourism, Universitat de Girona, Plaça Josep Ferrater i Móra, 1, 17004, Girona, Spain
| | - Lluís Godo-Pla
- LEQUIA. Institute of the Environment, Universitat de Girona, C/ Maria Aurèlia Capmany, 69, 17003, Girona, Spain; Createch Drinking Solutions, Costa d'en Paratge St. 22, E1 08500 Vic, Barcelona, Catalonia, Spain
| | - Hèctor Monclús
- LEQUIA. Institute of the Environment, Universitat de Girona, C/ Maria Aurèlia Capmany, 69, 17003, Girona, Spain
| | - Lucia Alexandra Popartan
- LEQUIA. Institute of the Environment, Universitat de Girona, C/ Maria Aurèlia Capmany, 69, 17003, Girona, Spain
| | - Joaquim Comas
- LEQUIA. Institute of the Environment, Universitat de Girona, C/ Maria Aurèlia Capmany, 69, 17003, Girona, Spain; ICRA-CERCA. Catalan Institute for Water Research, Emili Grahit 101, 17003, Girona, Spain
| | | | - Sebastià Puig
- LEQUIA. Institute of the Environment, Universitat de Girona, C/ Maria Aurèlia Capmany, 69, 17003, Girona, Spain
| | - María Molinos-Senante
- Pontificia Universidad Católica de Chile, Hydraulic and Environmental Engineering Department, Avda. Vicuña Mackenna, 4860, Santiago, Chile; Research Center for the Integrated Management of Natural Disasters (CIGIDEN), ANID/FONDAP/15110017, Vicuña Mackenna, Santiago, 4860, Chile
| |
Collapse
|
9
|
Diaz-Beltran M, Almanza B, Byrd K, Behnke C, Nelson D. Fast-Food Optimal Defaults Reduce Calories Ordered, as Well as Dietary Autonomy: A Scenario-Based Experiment. J Acad Nutr Diet 2023; 123:65-76.e2. [PMID: 35710043 DOI: 10.1016/j.jand.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/01/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low-calorie menu items as optimal defaults may encourage healthier choices when people eat out. Limited research has studied default effects from the restauranteurs' perspective, as well as the public health perspective. OBJECTIVE To examine the effects of optimal defaults on calories ordered, dietary autonomy, and visit intention in the context of a fast-food drive-through. DESIGN Between-subjects randomized scenario-based experiment. PARTICIPANTS/SETTING In all, 377 adults who lived in the United States were recruited through a crowdsourcing platform in July 2020. INTERVENTION Participants were asked to visualize ordering a combo meal in a fast-food drive-through. They were randomly assigned to order from 1 of 3 menu boards: (1) menu items available for combos by customer choice, (2) combos that included traditional high-calorie default items, or (3) combos that included low-calorie optimal defaults. MAIN OUTCOME MEASURES Differences in calories ordered among groups, dietary autonomy, and restaurant visit intention. ANALYSIS Statistical tests included multiple regression, Kruskal-Wallis, χ2, and 1-way analysis of variance. Covariates such as education and sex were tested in regression models as potential confounders. RESULTS Compared with the choice combo meals, optimal combo meals reduced calories ordered by consumers (-337 kcal, standard error = 19, P < .001), while traditional combos increased them (+132 kcal, standard error = 20, P < .001). No significant difference was found in visit intention. Dietary autonomy was affected by the optimal defaults (P = .025), even in participants with high health concern. Conversely, the traditional combo's effect on dietary autonomy was moderated by health concern (B = -0.26, P = .023), with only individuals with very high levels of health concern perceiving less autonomy. CONCLUSIONS Optimal defaults provided a robust reduction in calories ordered but had implications for dietary autonomy.
Collapse
Affiliation(s)
- Monica Diaz-Beltran
- Nutrition and Biochemistry Department, Pontificia Universidad Javeriana, Bogota, Colombia.
| | - Barbara Almanza
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Karen Byrd
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Carl Behnke
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Douglas Nelson
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| |
Collapse
|
10
|
Diaz-Beltran M, Almanza B, Byrd K, Behnke C, Nelson D. Visual Cues and Optimal Defaults in Fast-Food Combo Meals Benefit Health-Concerned Consumers-A Randomized Scenario-Based Experiment. J Acad Nutr Diet 2023; 123:52-64.e1. [PMID: 35710044 DOI: 10.1016/j.jand.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of low-calorie menu items as optimal defaults and visual cues may nudge consumers to healthier choices at restaurants. However, little is known regarding their effects on emotions and behavioral intentions, particularly among people with different levels of health concern. OBJECTIVE Evaluate optimal defaults and visual cues' effect on anticipated pleasure and order intention depending upon consumers' health concern level. DESIGN Between-subjects randomized scenario-based experiment. PARTICIPANTS/SETTING In all, 636 US adults recruited through an online crowdsourcing platform in July 2020. INTERVENTION Participants saw 1 of 6 menu boards in a fast-food drive-through simulation. Half the menu boards included meal photos with (1) menu items to be arranged as a combo by choice (ie, create-your-own combo); (2) traditional combos that included high-calorie default items; or (3) optimal combos that included low-calorie default items. The remaining 3 boards were identical without photos. MAIN OUTCOME MEASURES Anticipated pleasure, order intention, and health concern were evaluated with 7-point Likert scales. ANALYSIS Statistical tests included multiple regression, Kruskal-Wallis, χ2, and analysis of variance. Education and sex were tested as potential confounders. RESULTS Optimal combos negatively affected anticipated pleasure (P = .003) and order intention (P < .001) compared with choice combos. Order intention reduction was the same for traditional and optimal combos (P = .128). The presence of photos changed order intention for optimal combos but varied by consumer's health concern level. When health concern was lower, photos decreased the likelihood of ordering the optimal combos (B = -3.06, P = .001), but when health concern was higher, photos enhanced ordering intention compared with the choice group (B = 0.60, P = .001). The photos did not affect anticipated pleasure for any level of health concern. CONCLUSIONS The adverse effect of optimal defaults and how visual cues may reduce their negative effect should be considered in menu design.
Collapse
Affiliation(s)
- Monica Diaz-Beltran
- Nutrition and Biochemistry Department, Pontificia Universidad Javeriana, Bogota, Colombia.
| | - Barbara Almanza
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Karen Byrd
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Carl Behnke
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| | - Douglas Nelson
- White Lodging-J.W. Marriott, Jr. School of Hospitality and Tourism Management, Purdue University, West Lafayette, Indiana
| |
Collapse
|
11
|
Vos M, Deforche B, Van Kerckhove A, Michels N, Geuens M, Van Lippevelde W. Intervention strategies to promote healthy and sustainable food choices among parents with lower and higher socioeconomic status. BMC Public Health 2022; 22:2378. [PMID: 36536355 PMCID: PMC9761028 DOI: 10.1186/s12889-022-14817-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A global shift towards more healthy and sustainable diets is necessary for the prevention of obesity and chronic diseases, as well as for the growing pressure on our ecosystems. Given that parents are important actors in affecting dietary behaviors of their children, developing intervention strategies targeting families and their practices is promising to reach positive behavior change among children. Also, it is important to tailor these interventions to the needs of parents with different socioeconomic statuses (SES), given that health inequalities continue to grow. This study aims to investigate perspectives of lower and higher SES parents on the usability and acceptability of various innovative intervention strategies. METHODS Fourteen focus groups and four individual interviews (n = 78, nlowerSES = 17; nhigherSES = 61) were conducted in Belgium. A semi-structured interview guide was used to facilitate the discussions. The interviews were recorded, transcribed, and analyzed via thematic content analysis using NVivo. RESULTS To encourage healthy and sustainable food choices, interventions via online food shopping platforms and nudging strategies in grocery stores were mostly cited by higher SES parents, but these were less applicable for lower SES parents as they buy less online and mainly consider the price of products. Mobile applications that provide inspiration for healthy and sustainable recipes and easily accessible shopping lists received moderate support among lower and higher SES parents. Furthermore, both lower and higher SES parents showed interest in meal boxes delivered at home, but lower SES parents have not yet tried such meal boxes because of their higher prices. Still, both groups of SES parents mentioned many advantages of these meal boxes, such as the convenience and time-saving component, as well as the cooking inspiration aspect. CONCLUSION Our study reveals the preferences of lower and higher SES parents for practical intervention strategies, providing insight in what features these strategies should have to be acceptable and useful. Hence, the findings can inform the development of a tailored family-based intervention strategy to improve parental food choices in favor of increased health and sustainability.
Collapse
Affiliation(s)
- Marjolijn Vos
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Benedicte Deforche
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Movement and Nutrition for Health and Performance Research Group, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Ixelles, Belgium
| | - Anneleen Van Kerckhove
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Nathalie Michels
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maggie Geuens
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Wendy Van Lippevelde
- grid.5342.00000 0001 2069 7798Department of Marketing, Innovation and Organization, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
12
|
Sterie AC, Jox RJ, Rubli Truchard E. Decision-making ethics in regards to life-sustaining interventions: when physicians refer to what other patients decide. BMC Med Ethics 2022; 23:91. [PMID: 36056340 PMCID: PMC9440599 DOI: 10.1186/s12910-022-00828-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health decisions occur in a context with omnipresent social influences. Information concerning what other patients decide may present certain interventions as more desirable than others. OBJECTIVES To explore how physicians refer to what other people decide in conversations about the relevancy of cardio-pulmonary resuscitation (CPR) or do-not-attempt-resuscitation orders (DNAR). METHODS We recorded forty-three physician-patient admission interviews taking place in a hospital in French-speaking Switzerland, during which CPR is discussed. Data was analysed with conversation analysis. RESULTS Reference to what other people decide in regards to CPR is used five times, through reported speech. The reference is generic, and employed as a resource to deal with trouble encountered with the patient's preference, either because it is absent or potentially incompatible with the medical recommendation. In our data, it is a way for physicians to present decisional paths and to steer towards the relevancy of DNAR orders ("Patients tell us 'no futile care'"). By calling out to a sense of membership, it builds towards the patient embracing norms that are associated with a desirable or relevant social group. CONCLUSIONS Introducing DNAR decisions in terms of what other people opt for is a way for physicians to bring up the eventuality of allowing natural death in a less overt way. Formulating treatment choices in terms of what other people do has implications in terms of supporting autonomous and informed decision making, since it nudges patients towards conformity with what is presented as the most preferable choice on the basis of social norms.
Collapse
Affiliation(s)
- Anca-Cristina Sterie
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. .,Service of Palliative and Supportive Care, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Ralf J Jox
- Institute of Humanities in Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Eve Rubli Truchard
- Chair of Geriatric Palliative Care, Palliative and Supportive Care Service and Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
13
|
Tan YWB, Tan ER, Sin KY, AshaRani PV, Abdin E, Roystonn K, Wang P, Devi F, Vaingankar J, van Dam RM, Sum CF, Lee ES, Chow WL, Chong SA, Subramaniam M. Acceptance of healthy lifestyle nudges in the general population of Singapore. BMC Public Health 2022; 22:1297. [PMID: 35790920 PMCID: PMC9258182 DOI: 10.1186/s12889-022-13668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background In recent years, behaviourally driven policies such as nudges have been increasingly implemented to steer desired outcomes in public health. This study examines the different nudges and the socio-demographic characteristics and lifestyle behaviours that are associated with public acceptance of lifestyle nudges. Methods The study used data from the nationwide Knowledge, Attitudes and Practices study (KAP) on diabetes in Singapore. Three types of nudges arranged in increasing order of intrusiveness were examined: (1) information government campaigns, (2) government mandated information and (3) default rules and choice architecture. Acceptance was assessed based upon how much respondents ‘agreed’ with related statements describing heathy lifestyle nudges. Multivariable linear regressions were performed with socio-demographics and lifestyle behaviours using scores calculated for each nudge. Results The percentage of respondents who agreed to all statements related to each nudge were: 75.9% (information government campaigns), 73.0% (government mandated information), and 33.4% (default rules and choice architecture). Respondents of Malay/Others ethnicity (vs. Chinese) were more likely to accept information government campaigns. Respondents who were 18 – 34 years old (vs 65 years and above), female, of Malay/Indian ethnicity (vs Chinese), were sufficiently physically active, and with a healthier diet based on the DASH (Dietary Approach to Stop Hypertension) score were more likely to accept nudges related to government mandated information. Respondents of Malay/Indian ethnicity (vs Chinese), and who had a healthier diet were more likely to accept default rules and choice architecture. Conclusion Individuals prefer less intrusive approaches for promoting healthy lifestyle. Ethnicity and lifestyle behaviours are associated with acceptance of nudges and should be taken into consideration during the formulation and implementation of behaviourally informed health policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13668-x.
Collapse
Affiliation(s)
- Yeow Wee Brian Tan
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore.
| | - Edward Ryan Tan
- Yong Loo Lin School of Medicine, 10 Medical Drive, Singapore, 117597, Singapore
| | - Koh Yen Sin
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - P V AshaRani
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Janhavi Vaingankar
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, 12 Science Drive, Singapore, 117549, Singapore
| | - Chee Fang Sum
- Admiralty Medical Centre, Khoo Teck Puat Hospital, 676 Woodlands Drive 71, Singapore, 730676, Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, 3 Fusionopolis Link. Nexus@One-North, Singapore, 138542, Singapore
| | - Wai Leng Chow
- Epidemiology and Communicable Diseases Division, Ministry of Health, Singapore, 169854, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Buangkok Green Medical Park, Singapore, 539747, Singapore.,Saw Swee Hock School of Public Health, 12 Science Drive, Singapore, 117549, Singapore
| |
Collapse
|
14
|
Olson JA, Sandra DA, Chmoulevitch D, Raz A, Veissière SPL. A Nudge-Based Intervention to Reduce Problematic Smartphone Use: Randomised Controlled Trial. Int J Ment Health Addict 2022; 21:1-23. [PMID: 35600564 PMCID: PMC9112639 DOI: 10.1007/s11469-022-00826-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 10/29/2022] Open
Abstract
Problematic smartphone use is rising across the world. We tested an intervention with ten strategies that nudge users to reduce their smartphone use, for example by disabling non-essential notifications and changing their display to greyscale. Participants first completed baseline measures of smartphone use, well-being, and cognition before choosing which intervention strategies to follow for 2 to 6 weeks. Study 1 ( N = 51 ) used a pre-post design while study 2 ( N = 70 ) compared the intervention to a control group who monitored their screen time. Study 1 found reductions in problematic smartphone use, screen time, and depressive symptoms after 2 weeks. Study 2 found that the intervention reduced problematic smartphone use, lowered screen time, and improved sleep quality compared to the control group. Our brief intervention returned problematic smartphone use scores to normal levels for at least 6 weeks. These results demonstrate that various strategies can be combined while maintaining feasibility and efficacy.
Collapse
Affiliation(s)
- Jay A. Olson
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada
| | - Dasha A. Sandra
- Integrated Program in Neuroscience, McGill University, Montreal, QC Canada
| | | | - Amir Raz
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada
- Institute for Interdisciplinary Behavioral and Brain Sciences, Chapman University, Irvine, CA USA
| | - Samuel P. L. Veissière
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC H3A 1A1 Canada
| |
Collapse
|
15
|
Solano-Hermosilla G, Barreiro-Hurle J, Adewopo JB, Gorrín-González C. Increasing engagement in price crowdsourcing initiatives: Using nudges in Nigeria. World Dev 2022; 152:105818. [PMID: 35370345 PMCID: PMC8886569 DOI: 10.1016/j.worlddev.2022.105818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
African agriculture is yet to reach its full food production potential. One way of addressing this is a better distribution of market signals to farmers and other market participants, which can help them make better-informed decisions, leading to increased income and capacity for investment. Hence, increasing the availability of market information in Africa is a priority and alternative data sources, and new Information Communication Technologies (ICTs) offer huge potential to complement classic official statistics. This has given rise to a number of ICTs and citizen science projects to monitor data in real time, of which food price crowdsourcing in Africa is one. However, one of the main challenges faced by crowdsourcing initiatives is to ensure that individuals feed useful information into the system. In this paper, we test the potential of behavioural interventions to help sustain crowd contributions by leveraging intrinsic and/or extrinsic motivations. We used two randomised control trials (RCTs) to evaluate whether the inclusion of two nudges (one based on social norms and one based on information disclosure) in the design of a food price crowdsourcing initiative can improve crowd engagement. Our results show that social norms increase crowd participation while disclosing price information does not. The latter highlights the need for further research to identify which type of information and format to make it accessible would best help to sustain crowd effort levels. These findings have the potential to be useful in designing future crowdsourcing (or other types of) initiatives that require sustained citizen engagement over time.
Collapse
|
16
|
Kelley MA, Persell SD, Linder JA, Friedberg MW, Meeker D, Fox CR, Goldstein NJ, Knight TK, Zein D, Sullivan M, Doctor JN. The protocol of the Application of Economics & Social psychology to improve Opioid Prescribing Safety trial 2 (AESOPS-2): Availability of opioid harm. Contemp Clin Trials 2022; 112:106650. [PMID: 34896295 PMCID: PMC8869359 DOI: 10.1016/j.cct.2021.106650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 11/29/2021] [Accepted: 12/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND High levels of opioid prescribing in the United States has resulted in an alarming trend in opioid-related harms. The objective of Trial 2 of the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS-2) is to dampen the intensity and frequency of opioid prescribing in accordance with the Centers for Disease Control and Prevention recommendation to "go low and slow". We aim to accomplish this by notifying clinicians of harmful patient outcomes, which we expect to increase the mental availability of risks associated with opioid use. METHODS The trial is multi-site. Random assignment determines if prescribers to persons who suffer an opioid overdose (fatal or nonfatal) learn of this event (intervention) or practice usual care (control). Clinicians in the intervention group receive a letter notifying them of their patient's overdose. The primary outcome is the change in clinician weekly milligram morphine equivalent (MME) prescribed in a 6-month period before and after receiving the letter. Additional outcomes are the change in the proportion of patients prescribed at least 50 daily MME and in the proportion of patients referred to medication assisted treatment. Group differences in these outcomes will be compared using an intent-to-treat difference-in-differences framework with a mixed-effects regression model to estimate clinician MME. DISCUSSION The AESOPS-2 trial will provide new knowledge about whether increasing prescribers' awareness of patients' opioid-related overdoses leads to a reduction in opioid prescribing. Additionally, this trial may better inform how to reduce opioid use disorder and opioid overdoses by lowering population exposure to these drugs. TRIAL REGISTRATION ClinicalTrials.gov: NCT04758637.
Collapse
Affiliation(s)
- Marcella A. Kelley
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA.,School of Pharmacy, University of Southern California, Los Angeles, CA
| | - Stephen D. Persell
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey A. Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Daniella Meeker
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA.,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Craig R. Fox
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA
| | - Noah J. Goldstein
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA
| | - Tara K. Knight
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA
| | - Dina Zein
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA
| | - Mark Sullivan
- School of Medicine, University of Washington, School of Medicine, Seattle, WA
| | - Jason N. Doctor
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA.,School of Pharmacy, University of Southern California, Los Angeles, CA.,Sol Price School of Public Policy, University of Southern California, Los Angeles, CA
| |
Collapse
|
17
|
Krawiec JM, Piaskowska OM, Piesiewicz PF, Białaszek W. Tools for public health policy: nudges and boosts as active support of the law in special situations such as the COVID-19 pandemic. Global Health 2021; 17:132. [PMID: 34801054 PMCID: PMC8605446 DOI: 10.1186/s12992-021-00782-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 10/27/2021] [Indexed: 12/23/2022] Open
Abstract
In recent years, "nudging" has become a standard behavioral intervention at the individual level and for the design of social policies. Although nudges are effective, such interventions seem to be limited to a given space and time, and there is only scant evidence to support the contrary view. On the other hand, choice architects may utilize another type of intervention called "boosting," which shows the promise of generalized and lasting behavioral change. A government can use these tools to shape public policy. Behavioral interventions such as policy-making tools have their boundaries, as does the law. We argue that nudging and boosting may serve as active local or global aids in support of the legal system under certain circumstances. Nudging and boosting can also support the legal system, especially in relation to emerging social issues or events that are unprecedented, such as the recent global COVID-19 pandemic, where certain behavioral patterns are expected, but it would be difficult or impossible to enforce them through the law alone.
Collapse
Affiliation(s)
- Jakub M Krawiec
- SWPS University of Social Sciences and Humanities, Institute of Psychology, DecisionLab: Center for Behavioral Research in Decision Making, Warsaw, Poland
| | - Olga M Piaskowska
- SWPS University of Social Sciences and Humanities, Institute of Law, Warsaw, Poland
| | - Piotr F Piesiewicz
- SWPS University of Social Sciences and Humanities, Institute of Law, Warsaw, Poland
| | - Wojciech Białaszek
- SWPS University of Social Sciences and Humanities, Institute of Psychology, DecisionLab: Center for Behavioral Research in Decision Making, Warsaw, Poland.
| |
Collapse
|
18
|
Ceschi A, Sartori R, Dickert S, Scalco A, Tur EM, Tommasi F, Delfini K. Testing a norm-based policy for waste management: An agent-based modeling simulation on nudging recycling behavior. J Environ Manage 2021; 294:112938. [PMID: 34214943 DOI: 10.1016/j.jenvman.2021.112938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 06/13/2023]
Abstract
The present study uses agent-based modeling (ABM) to examine the effectiveness of a nudge policy for improving recycling behavior. In our simulation, agents' recycling behavior is computed by components of the Theory of Planned Behaviour (i.e., attitudes, perceived behavioral control, social norms) and influenced by other agents as well as their surrounding (i.e., amount of waste in the area). The simulation, based on real data from a Taiwan community district, confirms realistic recycling trends and demonstrates the usefulness and reliability of ABM as a method to examine the effectiveness of waste management policies. An additional step in our simulation was to manipulate the amount of waste in the community to test the effect of a nudge policy based on social norms. Results showed that the policy increases recycling activity, but predominantly in low waste scenarios. This suggests that nudges, in the form of norm-based policies, can be an effective solution to enhancing people's recycling behavior under specific circumstances.
Collapse
Affiliation(s)
- Andrea Ceschi
- University of Verona, Human Sciences Department, Verona, IT, Italy.
| | - Riccardo Sartori
- University of Verona, Human Sciences Department, Verona, IT, Italy.
| | - Stephan Dickert
- University of Klagenfurt, Department of Psychology, Austria.
| | | | - Elena M Tur
- School of Innovation Sciences, Eindhoven University of Technology, Netherlands; University of Gothenburg, Institute of Innovation and Entrepreneurship, School of Business, Law and Economics, University of Gothenburg, Sweden.
| | | | - Keren Delfini
- University of Verona, Human Sciences Department, Verona, IT, Italy.
| |
Collapse
|
19
|
Mecheva MDV, Rieger M, Sparrow R, Prafiantini E, Agustina R. Snacks, nudges and asymmetric peer influence: Evidence from food choice experiments with children in Indonesia. J Health Econ 2021; 79:102508. [PMID: 34333202 DOI: 10.1016/j.jhealeco.2021.102508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/09/2021] [Accepted: 07/13/2021] [Indexed: 06/13/2023]
Abstract
Many children in low- and middle-income countries are growing up during a rapid nutrition transition. Experimental evidence on food choice in developing countries is scarce, while it is unclear to what extent evidence from high-income countries can be generalized. Children participated in a snack choice experiment. We expose some children to emoji labels encouraging healthy snacks, while others observe healthy or unhealthy snacking by peers. While emoji labels moderately promote healthy snacking, the adverse effect of observing a peer eating the unhealthy snack is very large. The effect associated with observing a healthy peer is insignificant. Additionally, cross-randomized blocks of children watched a nutrition video to study the interaction of information provision and nudging. The video independently improves healthy choices but does not aid the emoji nudge and cannot counter the strong negative peer effect. We compare our findings to studies conducted in developed countries and discuss policy implications.
Collapse
Affiliation(s)
| | - Matthias Rieger
- The International Institute of Social Studies of Erasmus University Rotterdam, the Netherlands.
| | - Robert Sparrow
- The International Institute of Social Studies of Erasmus University Rotterdam, the Netherlands; Development Economics Group, Wageningen University, the Netherlands
| | - Erfi Prafiantini
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia; Human Nutrition Research Center, Indonesian Medical Education and Research Institute (HNRC-IMERI), Faculty of Medicine, Universitas Indonesia, Indonesia
| |
Collapse
|
20
|
Nwafor O, Singh R, Collier C, DeLeon D, Osborne J, DeYoung J. Effectiveness of nudges as a tool to promote adherence to guidelines in healthcare and their organizational implications: A systematic review. Soc Sci Med 2021; 286:114321. [PMID: 34438185 DOI: 10.1016/j.socscimed.2021.114321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 08/13/2021] [Accepted: 08/15/2021] [Indexed: 11/23/2022]
Abstract
The shift in the United States in recent years toward value-based healthcare delivery models has brought renewed pressure on healthcare organizations to improve adherence to clinical and administrative guidelines designed to deliver high quality care at lower costs. However, getting clinicians to adhere to these guidelines remains a persistent problem for many organizations. The use of nudges has emerged as a popular intervention in healthcare settings to promote adherence to both sets of guidelines. This systematic review aims to assess the empirical evidence base on the use of various types of nudges and their effectiveness as a tool to promote this adherence and to identify the boundary conditions under which they are effective. In our assessment of 83 empirical studies, we found compelling evidence that nudges are an effective tool for promoting adherence to guidelines. However, much of this evidence relies heavily on studies focused on three types of nudges (increasing salience, providing feedback, and default). Other types of nudges (anticipated error reduction, structuring of complex problems, and understanding mapping) received far less attention. We also found that this literature is primarily focused on whether nudge interventions work, with little consideration for organizational issues such as cost effectiveness, impact on healthcare workers, and disruptions of established workflows and routines. We offer observations and recommendations on how research at the intersection of organizational studies and health services can improve our understanding of nudge interventions.
Collapse
|
21
|
Cherry TL, James AG, Murphy J. The impact of public health messaging and personal experience on the acceptance of mask wearing during the COVID-19 pandemic. J Econ Behav Organ 2021; 187:415-430. [PMID: 33994606 PMCID: PMC8112387 DOI: 10.1016/j.jebo.2021.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/11/2021] [Accepted: 04/04/2021] [Indexed: 05/09/2023]
Abstract
Face coverings have been shown to slow the spread of COVID-19, yet their use is not universal and remains controversial in the United States. Designing effective nudges for widespread adoption is important when federal mandates are politically or legally infeasible. We report the results from a survey experiment in which subjects were exposed to one of three video messages from President Trump, and then indicated their preference for wearing a mask. In the first video, the President simply recited the Centers for Disease Control and Prevention (CDC) guidelines. In the second, the President additionally emphasized that wearing a mask is optional. In the third video, the President added that he will not personally wear a mask. We find that exposure to presidential messages can increase the stated likelihood of wearing a mask-particularly among the President's supporters. We also explore experiential effects of COVID-19, and find that people (especially supporters of the President) are more likely to support wearing a mask if they know someone who has tested positive for COVID-19. These results offer guidance to policy makers and practitioners interested in understanding the factors that influence viral risk mitigation strategies.
Collapse
Affiliation(s)
- Todd L Cherry
- Department of Economics, University of Wyoming, Laramie, WY 82071, USA
- CICERO Center for International Climate Research, Oslo, Norway
| | - Alexander G James
- Department of Economics, University of Alaska Anchorage, Anchorage, AK 99508, USA
| | - James Murphy
- Department of Economics, University of Alaska Anchorage, Anchorage, AK 99508, USA
- The Economic Science Institute, Chapman University, Orange, CA 92866, USA
| |
Collapse
|
22
|
Charleston L, Ovbiagele B. Diversity in neurology leadership: Nuances and nudges. J Neurol Sci 2021; 426:117475. [PMID: 33965794 DOI: 10.1016/j.jns.2021.117475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/08/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
Underrepresented in medicine (UIM) academic physicians are poorly represented among medical school faculty when compared with their proportion in the US population, receive NIH research awards less frequently, are promoted less often, indicate lower career satisfaction, and report higher social isolation, than faculty who are not under-represented. Supporting a successful and sustainable workforce of UIM academic physicians is essential in neurology, because such neurologists are more likely to engage in research to reduce disparities in neurological outcomes that affect underserved and/or low-income communities, and help improve the paucity of diverse race-ethnic participation in clinical trials. Having more diverse academic neurologists serve in such roles could bolster their careers and model possibilities for others who share similar cultures and backgrounds. Beyond leading/joining diversity affairs committees, more UIM are needed in mainstream leadership roles. In this work, we explore self-application vs. appointment/nomination opportunities and how this play a role in leadership opportunities. In addition to considering appropriate weighing of self-applications vs. appointments based opportunities, we highlight approaches and introduce the concept of nudging. Nudging, which refers to purposely increasing the visibility and appeal of particular items with the goal of boosting the odds of selecting those items, has been shown to successfully influence the process of selection, and may help level the leadership playing field for UIM in neurology.
Collapse
Affiliation(s)
- Larry Charleston
- Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, East Lansing, MI, United States of America.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, CA, United States of America
| |
Collapse
|
23
|
Kelley MA, Persell SD, Linder JA, Friedberg MW, Meeker D, Fox CR, Goldstein NJ, Knight TK, Zein D, Rowe TA, Sullivan MD, Doctor JN. The protocol of the Application of Economics & Social psychology to improve Opioid Prescribing Safety Trial 1 (AESOPS-1): Electronic health record nudges. Contemp Clin Trials 2021; 103:106329. [PMID: 33636344 PMCID: PMC8089040 DOI: 10.1016/j.cct.2021.106329] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an abundance of evidence of harm. Despite clinical guidelines and education, prescribing continues at a higher rate than before the opioids crisis. The objective of trial 1 of the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS-1) is to discourage unnecessary opioid prescribing in primary care by applying "behavioral insights"-empirically-tested social and psychological interventions that affect choice. METHODS AESOPS-1 randomizes primary care clinics in Illinois and California to behavioral intervention or control. Both arms receive opioid guideline education. Clinics randomized to the behavioral intervention arm receive nudges within the electronic health record (EHR) including: 1) an "accountable justification" entered in the chart, 2) a precommitment to address high-risk prescriptions, and 3) a "PainTracker" that broadens discussions about pain. The control arm receives no EHR-based intervention. The primary outcome is the change in weekly milligram morphine equivalents (MME) prescribed. The secondary outcome is the change in the proportion of patients prescribed at least 50 daily MME. To evaluate these outcomes, we will use a difference-in-differences mixed-effects regression model on clinician MME weekly or daily dose. The analysis will be "intent-to-treat." The intervention period is 18-months, with a 6-month follow-up period to measure persistence of effects. DISCUSSION The AESOPS-1 trial will evaluate the effect of EHR-based interventions in reducing noncancer opioid prescribing in primary care. AESOPS-1 may demonstrate practical and scalable strategies to lower unnecessary population exposure to opioids.
Collapse
Affiliation(s)
- Marcella A Kelley
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America
| | - Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Jeffrey A Linder
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Mark W Friedberg
- Blue Cross Blue Shield of Massachusetts, Boston, MA, United States of America
| | - Daniella Meeker
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | - Craig R Fox
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Noah J Goldstein
- Anderson School of Management, University of California at Los Angeles, Los Angeles, CA, United States of America
| | - Tara K Knight
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, United States of America
| | - Dina Zein
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America
| | - Theresa A Rowe
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Mark D Sullivan
- School of Medicine, University of Washington, School of Medicine, Seattle, WA, United States of America
| | - Jason N Doctor
- Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA, United States of America; School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America; Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, United States of America.
| |
Collapse
|
24
|
Banerjee R, Bhattacharya J, Majumdar P. Exponential-growth prediction bias and compliance with safety measures related to COVID-19. Soc Sci Med 2020; 268:113473. [PMID: 33130402 PMCID: PMC7591871 DOI: 10.1016/j.socscimed.2020.113473] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/16/2020] [Accepted: 10/21/2020] [Indexed: 12/16/2022]
Abstract
Objective We define prediction bias as the systematic error arising from an incorrect prediction of the number of positive COVID cases x-weeks hence when presented with y-weeks of prior, actual data on the same. Our objective is to investigate the importance of an exponential-growth prediction bias (EGPB) in understanding why the COVID-19 outbreak has exploded. To that end, our goal is to document EGPB in the comprehension of disease data, study how it evolves as the epidemic progresses, and connect it with compliance of personal safety guidelines such as the use of face coverings and social distancing. We also investigate whether a behavioral nudge, cost less to implement, can significantly reduce EGPB. Rationale The scientific basis for our inquiry is the received wisdom that infectious disease spread, especially in the initial stages, follows an exponential function meaning few positive cases can explode into a widespread pandemic if the disease is sufficiently transmittable. If people suffer from EGPB, they will likely make incorrect judgments about their infection risk, which in turn, may lead to reduced compliance of safety protocols. Method To collect data on prediction bias, we ran an incentivized, experiment on a global, online platform with participation from people in forty-three countries, each at different stages of progression of COVID-19. We also constructed several indices of compliance by surveying participants about their frequency of hand-washing and use of sanitizers and masks; their willingness to pay for masks; their view about the social appropriateness of others’ behavior; and their like/dislike of government responses. The prediction data was used to construct several measures of EGPB. Our experimental design permits us to identify the root of under-prediction as EGPB arising from the general tendency to underestimate the speed at which exponential processes unfold. Results Respondents make predictions about the path of the disease using a model that is substantially less convex than the actual data generating process. This creates significant EGPB, which, in turn, is significantly and negatively associated with non-compliance with safety measures. The bias is significantly higher for respondents from countries at a later stage relative to those at an early stage of disease progression. A simple behavioral nudge that shows prior data in terms of raw numbers, as opposed to a graph, causally reduces EGPB. Conclusion Behavioral biases concerning the comprehension of disease data are quantitatively important, and act as severe impediments to effective policy action against the spread of COVID-19. Clear communication of future infection risk via raw numbers could increase the accuracy of risk perception, in turn, facilitating compliance with suggested protective behaviors. Examines bias in the prediction of number of future positive COVID cases. Bias is negatively associated with non-compliance with WHO safety measures. Bias is higher for those in countries at a later stage of disease progression. Showing prior data through raw numbers, as opposed to graphs, causally reduces bias.
Collapse
|
25
|
Abstract
Setting defaults is an effective nudge, but few studies have examined situations where individuals can select their own default settings. Past research suggests that even when the final outcome is identical, observers perceive stronger signals from choices that switch from, rather than stay with, the default. In five experiments using hypothetical scenarios and an incentivized economic game, we test whether decision-makers driven by image concerns could strategically exploit that asymmetric signal. We found that in the presence of observers, participants were more likely to self-select into defaults that require them to switch to enhance a positive signal and into defaults that require them to stay to attenuate a negative signal. Our results support the framework of choice architecture as an implicit social interaction, and have potential implications for behavioral interventions in real-world settings.
Collapse
|
26
|
Abstract
Techniques from behavioral economics-nudges-may help physicians increase pediatric vaccine compliance, but critics have objected that nudges can undermine autonomy. Since autonomy is a centrally important value in healthcare decision-making contexts, it counts against pediatric vaccination nudges if they undermine parental autonomy. Advocates for healthcare nudges have resisted the charge that nudges undermine autonomy, and the recent bioethics literature illustrates the current intractability of this debate. This article rejects a principle to which parties on both sides of this debate sometimes seem committed: that nudges are morally permissible only if they are consistent with autonomy. Instead, I argue that, at least in the case of pediatric vaccination, some autonomy-undermining nudges may be morally justified. This is because parental autonomy in pediatric decision-making is not as morally valuable as the autonomy of adult patients, and because the interests of both the vaccinated child and other members of the community can sometimes be weighty enough to justify autonomy-infringing pediatric vaccination nudges. This article concludes with a set of worries about the effect of pediatric vaccination nudges on parent-physician relationships, and it calls on the American Academy of Pediatrics to draw on scientific and bioethics research to develop guidelines for the use of nudges in pediatric practice and, in particular, for the use of pediatric vaccination nudges.
Collapse
Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, 746 Mathematics and Science Center, Rochester, MI, 48309-4401, USA.
| |
Collapse
|
27
|
Abstract
We propose a triple test to evaluate the usefulness of behavioral economics models for public health policy. Test 1 is whether the model provides reasonably new insights. Test 2 is on whether these have been properly applied to policy settings. Test 3 is whether they are corroborated by evidence. We exemplify by considering the cases of social interactions models, self-control models and, in relation to health message framing, prospect theory. Out of these sets of models, only a correctly applied prospect theory fully passes the tests at present. Specifically, in broad agreement with the evidence, a gain frame has positive implications for welfare encourages disease prevention activity, though this does not apply if the perceived probability of the bad health outcome is large enough. We see our tests as being useful to identify how much health policy weight policy makers should assign to specific behavioral economic models; they are also useful to verify what next steps would be most useful in further research.
Collapse
Affiliation(s)
- Ryota Nakamura
- Hitotsubashi Institute for Advanced Study, Hitotsubashi University, 2-1 Naka, Kunitachi, Tokyo 186-8601 Japan
| | - Marc Suhrcke
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD UK
| | - Daniel John Zizzo
- Faculty of Humanities and Social Sciences, Newcastle University, 5th Floor, Daysh Building, Newcastle upon Tyne, NE1 7RU UK
- BENC and Newcastle University Business School, Newcastle upon Tyne, UK
| |
Collapse
|
28
|
Borenstein J, Arkin R. Robotic Nudges: The Ethics of Engineering a More Socially Just Human Being. Sci Eng Ethics 2016; 22:31-46. [PMID: 25736832 DOI: 10.1007/s11948-015-9636-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/17/2015] [Indexed: 05/21/2023]
Abstract
Robots are becoming an increasingly pervasive feature of our personal lives. As a result, there is growing importance placed on examining what constitutes appropriate behavior when they interact with human beings. In this paper, we discuss whether companion robots should be permitted to "nudge" their human users in the direction of being "more ethical". More specifically, we use Rawlsian principles of justice to illustrate how robots might nurture "socially just" tendencies in their human counterparts. Designing technological artifacts in such a way to influence human behavior is already well-established but merely because the practice is commonplace does not necessarily resolve the ethical issues associated with its implementation.
Collapse
Affiliation(s)
- Jason Borenstein
- Director of Graduate Research Ethics Programs, School of Public Policy and Office of Graduate Studies, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Ron Arkin
- School of Interactive Computing, College of Computing, Georgia Institute of Technology, Atlanta, GA, USA.
| |
Collapse
|
29
|
Sorrentino C, Boggio A, Confalonieri S, Hemenway D, Scita G, Ballabeni A. Increasing both the public health potential of basic research and the scientist satisfaction. An international survey of bio-scientists. F1000Res 2016; 5:56. [PMID: 27347372 PMCID: PMC4909114 DOI: 10.12688/f1000research.7683.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/20/2022] Open
Abstract
Basic scientific research generates knowledge that has intrinsic value which is independent of future applications. Basic research may also lead to practical benefits, such as a new drug or diagnostic method. Building on our previous study of basic biomedical and biological researchers at Harvard, we present findings from a new survey of similar scientists from three countries. The goal of this study was to design policies to enhance both the public health potential and the work satisfaction and test scientists' attitudes towards these factors. The present survey asked about the scientists' motivations, goals and perspectives along with their attitudes concerning policies designed to increase both the practical (i.e. public health) benefits of basic research as well as their own personal satisfaction. Close to 900 basic investigators responded to the survey; results corroborate the main findings from the previous survey of Harvard scientists. In addition, we find that most bioscientists disfavor present policies that require a discussion of the public health potential of their proposals in grants but generally favor softer policies aimed at increasing the quality of work and the potential practical benefits of basic research. In particular, bioscientists are generally supportive of those policies entailing the organization of more meetings between scientists and the general public, the organization of more academic discussion about the role of scientists in the society, and the implementation of a "basic bibliography" for each new approved drug.
Collapse
Affiliation(s)
| | - Andrea Boggio
- Department of History and Social Science, Bryant University, Smithfield, RI, USA
| | | | - David Hemenway
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Giorgio Scita
- IFOM - The FIRC Institute of Molecular Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology-DIPO, School of Medicine, University of Milan, Milan, Italy
| | - Andrea Ballabeni
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
30
|
Abstract
Given that the concept of coercion remains a central concern for bioethics, Quigley's (Monash Bioethics Rev 32:141-158, 2014) recent article provides a helpful analysis of its frequent misapplication in debates over the use of 'nudges'. In this commentary I present a generally sympathetic response to Quigley's argument while also raising several issues that are important for the larger debates about nudges and coercion. I focus on several closely related topics, including the definition of coercion, the role of empirical research, and the normative concerns at the core of these disputes. I suggest that while a degree of precision is certainly required when deploying the relevant concepts, perhaps informed by empirical data, we need to continue to push these debates towards more pressing normative considerations.
Collapse
Affiliation(s)
- Kelso Cratsley
- Kennedy Institute of Ethics, Georgetown University, Healy Hall, Washington, D.C., 20057, USA.
| |
Collapse
|
31
|
Voigt K. Nudging, shaming and stigmatising to improve population health: Comment on "Nudging by shaming, shaming by nudging". Int J Health Policy Manag 2014; 3:351-3. [PMID: 25396213 DOI: 10.15171/ijhpm.2014.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022] Open
Abstract
Nudges are small, often imperceptible changes to how particular decisions present themselves to individuals that are meant to influence those decisions. In his editorial, 'Nudging by shaming, shaming by nudging', Eyal highlights links between nudges and feelings of shame on the part of the 'chooser'. In this commentary, I suggest two further distinctions between different types of shame-based nudges that should affect our assessment of such nudges.
Collapse
Affiliation(s)
- Kristin Voigt
- Institute for Health and Social Policy & Department of Philosophy, McGill University, Montréal, Québec, Canada
| |
Collapse
|