It takes some effort. How minimal physical effort reduces consumption volume

Functional Mechanisms of Health Behavior Change Techniques: A Conceptual Review

Background

Health behavior change is among the top recommendations for improving health of patients with lifestyle-related chronic diseases. An array of behavior change techniques (BCTs) have been developed to support behavior change initiation and maintenance. These BCTs often show limited success when they are not informed by theory, leading to a mismatch between the intention of the BCT and patients' needs or expectations. Previous studies have identified a number of resources (domains) which patients may require to initiate and maintain health behavior change. Indeed, not yet well established is how BCTs address these resources, i.e., the functional mechanisms of BCTs.

Purpose

Provide a theoretical framework of the functional mechanisms of BCTs for developing and implementing successful interventions for health behavior change.

Methods

Conceptual review, including literature analysis and synthesis as well as conceptualization of a new model based on the synthesis.

Results

Through the integration of dual-process models as well as reward and motivation proceeding, i.e., affective, emotional, or intuitive neurobiological cues, into the rational framework of rather linear cognitive or task-related decision progress, we categorize previously identified resources into three distinct sets: external, internal reflective, and internal affective resources. Based on this triad, we classify BCTs according to their functional mechanisms into facilitating (=providing external resources), boosting (=strengthening internal reflective resources), and nudging (=activating internal affective resources). Consequently, we present a simplified Behavior Change Resource Model (BCRM) that is centered on patients' resources.

Conclusion

The model can be applied to develop health behavior change interventions, which promote engagement and empowerment. Future studies should aim at testing the applicability and practicality of the BCRM.

Nudgeability: Mapping Conditions of Susceptibility to Nudge Influence

Nudges are behavioral interventions to subtly steer citizens' choices toward "desirable" options. An important topic of debate concerns the legitimacy of nudging as a policy instrument, and there is a focus on issues relating to nudge transparency, the role of preexisting preferences people may have, and the premise that nudges primarily affect people when they are in "irrational" modes of thinking. Empirical insights into how these factors affect the extent to which people are susceptible to nudge influence (i.e., "nudgeable") are lacking in the debate. This article introduces the new concept of nudgeability and makes a first attempt to synthesize the evidence on when people are responsive to nudges. We find that nudge effects do not hinge on transparency or modes of thinking but that personal preferences moderate effects such that people cannot be nudged into something they do not want. We conclude that, in view of these findings, concerns about nudging legitimacy should be softened and that future research should attend to these and other conditions of nudgeability.

A nudge in the right direction: the role of food choice architecture in changing populations' diets

Populations' diets typically fall short of recommendations. The implication of this on ill health and quality of life is well established, as are the subsequent health care costs. An area of growing interest within public health nutrition is food choice architecture; how a food choice is framed and its influence on subsequent food selection. In particular, there is an appeal to manipulating the choice architecture in order to nudge individuals' food choice. This review outlines the current understanding of food choice architecture, theoretical background to nudging and the evidence on the effectiveness of nudge strategies, as well as their design and implementation. Interventions emphasising the role of nudge strategies have investigated changes to the accessibility, availability and presentation of food and the use of prompts. Empirical studies have been conducted in laboratories, online and in real-world food settings, and with different populations. Evidence on the effectiveness of nudge strategies in shifting food choice is encouraging. Underpinning mechanisms, not yet fully explicated, are proposed to relate to salience, social norms and the principle of least effort. Emerging evidence points to areas for development including the effectiveness of choice architecture interventions with different and diverse populations, and the combined effect of multiple nudges. This, alongside further examination of theoretical mechanisms and guidance to engage and inspire across the breadth of food provision, is critical. In this way, the potential of choice architecture to effect meaningful change in populations' diets will be realised.

Beyond Discrete Choices - Investigating the Effectiveness of a Proximity Nudge With Multiple Alternative Options

Nudges are defined as small adjustments in the choice architecture that stimulate desirable behavior. Nudging techniques can be used as a promising policy tool, but research has hardly systematically taken into account the complexity of the situation in which nudges have been implemented. In the current studies, we investigated the effectiveness of a proximity nudge on food choice in a realistic situation with multiple options in the immediate surroundings of the target option. In two studies, we presented participants from a community sample with an assortment of either three or nine different types of chocolate. For half of the participants, the target chocolate was placed most proximally on a table. Across two studies, we demonstrated that the proximity nudge was effective in stimulating the choice for a specific piece of chocolate in a simple and more complex situation. Results were further qualified by Bayesian analyses, which revealed most support for the hypothesis that the proximity effect existed in both the conditions with three and nine options, regardless of the number of options in the choice set. Results imply that the proximity effect can remain robust in realistic situations that include multiple options in the immediate environment to choose from.

You can't "nudge" nuggets: An investigation of college late-night dining with behavioral economics interventions

A mixed-methods approach was used to evaluate and improve the "late-night dining" options in a university dining hall. Surveys assessed student desires for late-night offerings, and evaluated students' habits and motivations during late-night dining. Two interventions were implemented to see if students could be "nudged" into different choice patterns. In the first, a "veggie-heavy" entrée was added at the beginning of the entrée line, so that students would substitute an entrée containing vegetables for the alternatives. In the second, a snack-food bar was set up to cater to students who didn't want to stand in the long entrée line, and preferred a snack. Data on food choice was collected during the interventions. Survey responses showed significant differences in the reasons females and males utilized late-night dining (p<0.001). We also found that students at late-night dining had a lower emphasis on health than the general student population. Even students at late-night who reported being health-conscious showed no difference in food selections from students who said health was not important (p = 0.883). Veggie-heavy entrées had mild success in increasing vegetable selection. However, veggie-heavy entrées were largely ignored when the other option was chicken nuggets. The snack bar was very popular. Entrée placement and convenience lines may have mild impacts on food selection in a late-night dining environment.