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Forte T, Santinha G, Patrão M. Exploring the Viability and Acceptance of Nudge in Public Policies for Health Promotion. Healthcare (Basel) 2024; 12:476. [PMID: 38391851 PMCID: PMC10887501 DOI: 10.3390/healthcare12040476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Behaviorally informed interventions, such as nudging, encourage actions intended to promote longer and healthier lives. Holding significant potential for influencing health policies and healthcare practices, these interventions are partaking of a shift in governance and public health policymaking. However, a substantial knowledge gap remains regarding the feasibility and appropriateness of implementing policies that draw on nudge. METHODS Ae survey on nudge's acceptability) was adapted to the Portuguese context to access attitudes towards 16 nudge measures. The research focused on evaluating attitudes among political science and public administration BSc and MSc students from nine Portuguese universities, and analyzing the relationship between these attitudes, sociodemographic characteristics, and sociopolitical attitudes. The data analysis involved the application of descriptive and inferential statistics. RESULTS The participants exhibited a moderate-to-high level of approval for various nudge measures, particularly those related to nutrition and public education/awareness raising. The study identified a nuanced relationship between the level of intrusiveness of nudges and their public approval, indicating that interventions preserving the architecture of choice gathered higher acceptance compared to more intrusive approaches. Notably, approval was associated with a high level of trust in social groups and a low propensity for risk-taking and alcohol consumption. CONCLUSIONS This study not only sheds light on the types of nudge measures that are likely to be more acceptable for promoting healthy behaviors, but also establishes a crucial link between behavioral interventions and healthcare policies. Understanding the nuanced factors influencing the public acceptance of nudges contributes to the discourse on the implementation of behaviorally informed health policies and emphasizes the importance of tailoring interventions to align with public values and preferences.
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Affiliation(s)
- Teresa Forte
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention (CINEICC), University of Coimbra, 3000-115 Coimbra, Portugal
| | - Gonçalo Santinha
- Research Unit on Governance, Competitiveness and Public Policies (GOVCOPP), Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Marta Patrão
- Research Unit on Governance, Competitiveness and Public Policies (GOVCOPP), Department of Social, Political and Territorial Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
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2
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Komatsu H, Kubota H, Asano K, Nagai Y. Effect of information provision by familial nudging on attitudes toward offshore wind power. PLoS One 2024; 19:e0297199. [PMID: 38232110 DOI: 10.1371/journal.pone.0297199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024] Open
Abstract
Offshore wind power (OWP) is a promising way to achieve decarbonization and tackle global climate change, but acceptance by residents is an important issue for site location. Information provision could be a more cost-effective intervention than debates or subsidies, assuming that scientifically correct information alone is insufficient and information design to boost the message effects considering realistic human responses is necessary. Thus, we designed nudging messages to increase acceptance of OWP, using a message framework to moderate risk-averse attitudes by reminding readers of familial support based on insights from kin selection theory from evolutionary psychology. A randomized controlled trial based on an internet survey of more than 4000 responses from the general public was performed to investigate the message effects. The messages significantly moderated the risk-averse attitudes toward OWP by 0.228 on average on a five-point Likert scale, which meant that about 5 people out of 100 changed their attitudes to be safer by 1 point. This suggests that disseminating flyers using nudging messages might be an effective way to increase acceptance. We also extracted responses from those who mentioned fisheries in an open-ended question as an alternative to actual fishers. Responses from this segment were more complex and the message effects were limited compared with those who did not mention fisheries; although the attitudes toward OWP before receiving the messages were safer, reading descriptions for potential risks on fisheries may have unexpectedly led them to focus on the risks of which they were unaware at first. Because information provision based on nudging is effective but just one of a wide variety of political interventions available, practitioners should consider a combination of multiple options instead of using only nudging messages.
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Affiliation(s)
- Hidenori Komatsu
- Grid Innovation Research Laboratory, Central Research Institute of Electric Power Industry, Yokosuka-shi, Kanagawa, Japan
| | - Hiromi Kubota
- Sustainable System Research Laboratory, Central Research Institute of Electric Power Industry, Abiko-shi, Chiba, Japan
| | - Kenji Asano
- Socio-Economic Research Center, Central Research Institute of Electric Power Industry, Chiyoda-ku, Tokyo, Japan
| | - Yu Nagai
- Socio-Economic Research Center, Central Research Institute of Electric Power Industry, Chiyoda-ku, Tokyo, Japan
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3
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Carreno-Davidson JT, Faller TN, Richardson MD, Roy TC. Behavioral Health-related Reasons for Permanent Duty Limitation Profiles in the U.S. Army: Population-Based Data from 2017 to 2019. Mil Med 2023; 188:444-449. [PMID: 37948224 DOI: 10.1093/milmed/usad183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/20/2023] [Accepted: 05/10/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION When warfighters are unable to fight, they are formally removed from battle through temporary or permanent duty limitation profiles. This study uses a population-based data repository to characterize permanent behavioral health (BH)-related profiles across the army for an identified 2-year period. The absolute risk of a permanent duty limitation for specific BH categories was also examined. MATERIALS AND METHODS This study utilized a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. Service members identified as having a new BH diagnosis were tracked for 12 months following the diagnosis to determine the recommendation of a permanent duty limitation profile. RESULTS From 2017 to 2018, 16% (n = 102,440) of service members received a "new" BH diagnosis. Less than 10% (9.5%; n = 9,752) of soldiers diagnosed with a BH disorder were issued a permanent BH-related duty profile within 12 months of the initial diagnosis. The absolute risk of a permanent profile was highest for soldiers diagnosed with a psychotic or delusional disorder (42%; n = 324) followed by dissociative or somatoform disorders (26%; n = 178) and eating disorders (23%; n = 108). CONCLUSIONS Military regulations dictating medical readiness and retention standards reflect both the standards required for mission readiness and a layer of medical protection for the service member. This study provides important information on the relationship between a new BH diagnosis and the likelihood that a service member will be referred for a retirement evaluation.
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Affiliation(s)
- Jamie T Carreno-Davidson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Theresa N Faller
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Department of Mental Health, John Hopkins University, Baltimore, MD 21205, USA
| | - Melissa D Richardson
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Tanja C Roy
- Military Performance Division, US Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
- Operational Health Services, Army Public Health Center, Aberdeen Proving Ground, MD 21010, USA
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Araujo-Chaveron L, Sicsic J, Moffroid H, Díaz Luévano C, Blondel S, Langot F, Mueller JE. Impact of a COVID-19 certificate requirement on vaccine uptake pattern and intention for future vaccination. A cross-sectional study among French adults. Vaccine 2023; 41:5412-5423. [PMID: 37481404 DOI: 10.1016/j.vaccine.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/22/2023] [Accepted: 07/02/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND In August 2021, France enacted a COVID-19 certificate requirement (vaccination/recovery/test) to access specific services, with mandates for professional groups. We evaluated the impact of this incentive-coercive policy in terms of vaccine uptake equality, future vaccine intention and confidence in authorities' crisis management. METHODS In late August 2021, a representative sample of adults (18-75 years) completed an internet-based questionnaire. We classified vaccinated participants by stated reasons for vaccination and estimated adjusted prevalence ratios (aPR) using multivariable Poisson regression. Counterfactual vaccine status assumed non-vaccination of those vaccinated for the certificate. We analysed the association of free-text testimonial themes with level of confidence in authorities. RESULTS Among 972 participants, 85.7% were vaccinated or intended vaccination: 3.6% only for certificate/mandate, 17.7% mainly for certificate/mandate plus other reasons, and 64.4% mainly for other reasons. In the counterfactual situation, vaccine uptake would have been significantly more likely among older vs. younger participants (aPR = 1.35) and among those with moderate-high vs. low levels of confidence in authorities for COVID-19 crisis management (aPR = 2.04). In the observed situation, confidence was the only significant determinant of vaccine status (moderate-high vs. low, aPR = 1.39). Among those without genuine motivation for vaccination, professionally active persons were more likely to have ceded to the certificate requirement (aPR = 3.76). Those vaccinated only for the certificate were more likely to express future COVID-19 vaccine intention than unvaccinated persons (aPR = 6.41). Themes significantly associated with lower confidence were criticism of morality (aPR = 1.76) and poor communication by the authorities (aPR = 1.66). CONCLUSION The incentive-coercive policy has reduced the negative association of vaccine status with younger age and low confidence in authorities, but may have reinforced isolation of professionally inactive persons. The requirement did not negatively impact future COVID-19 vaccine intention. Future vaccine-incentive policies should pay special attention to populations with low levels of confidence in authorities.
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Affiliation(s)
- Lucia Araujo-Chaveron
- EHESP French School of Public Health, Rennes, France; Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France
| | | | - Hadrien Moffroid
- Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France; University of Melbourne, Australia
| | | | - Serge Blondel
- Université Paris Cité, LIRAES, F-75006 Paris, France; GRANEM - Groupe de Recherche Angevin en Economie et Management, Paris, France
| | - François Langot
- Le Mans Université (Gains-TEPP, IRA), Le Mans, France; IUF - Institut Universitaire de France, Paris, France; PSE - Paris School of Economics, Paris, France; CEPREMAP - Centre pour la recherche économique et ses applications, Paris, France; IZA - Forschungsinstitut zur Zukunft der Arbeit - Institute of Labor Economics, Bonn, Germany
| | - Judith E Mueller
- EHESP French School of Public Health, Rennes, France; Institut Pasteur, Université Paris Cité, Emerging Disease Epidemiology Unit, F-75015 Paris, France; Univ. Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, F-35000 Rennes, France.
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Welch EW, Johnson TP, Chen T, Ma J, Islam S, Michalegko LF, Caldarulo M, Frandell A. How Scientists View Vaccine Hesitancy. Vaccines (Basel) 2023; 11:1208. [PMID: 37515024 PMCID: PMC10385302 DOI: 10.3390/vaccines11071208] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023] Open
Abstract
This paper examines possible causes, consequences, and potential solutions for addressing vaccine hesitancy in the United States, focusing on the perspectives of academic scientists. By examining the experiences of scientists, who are arguably a critical community in US society, we gain deeper insights into how they understand the complexities of vaccine hesitancy and whether their insights and opinions converge with or diverge from the current literature. We present findings from a national survey of a representative sample of academic scientists from the fields of biology and public health regarding vaccine hesitancy and related topics. Empirical analysis using descriptive, bivariate, and multivariate analyses covers multiple topics, including vaccine controversy, trust in science, causes of vaccine hesitancy, preferred policy and regulatory approaches, risk perceptions, and scientists' ethics and perceived communication roles. The results highlight a diversity of opinions within the scientific community regarding how to improve science-society communication in regard to vaccines, including the need to be transparent and candid to the public about the risk of vaccines and their research.
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Affiliation(s)
- Eric W Welch
- Center for Science, Technology and Environmental Policy Studies, School of Public Affairs, Arizona State University, Phoenix, AZ 85004, USA
- Montpellier Advanced Knowledge Institute on Transitions, University of Montpellier, 34000 Montpellier, France
| | - Timothy P Johnson
- Department of Public Policy, Management, and Analytics, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Tipeng Chen
- Center for Science, Technology and Environmental Policy Studies, School of Public Affairs, Arizona State University, Phoenix, AZ 85004, USA
| | - Jinghuan Ma
- Center for Science, Technology and Environmental Policy Studies, School of Public Affairs, Arizona State University, Phoenix, AZ 85004, USA
| | - Shaika Islam
- Center for Science, Technology and Environmental Policy Studies, School of Public Affairs, Arizona State University, Phoenix, AZ 85004, USA
| | - Lesley Forst Michalegko
- Center for Science, Technology and Environmental Policy Studies, School of Public Affairs, Arizona State University, Phoenix, AZ 85004, USA
| | - Mattia Caldarulo
- Center for Science, Technology and Environmental Policy Studies, School of Public Affairs, Arizona State University, Phoenix, AZ 85004, USA
| | - Ashlee Frandell
- Center for Science, Technology and Environmental Policy Studies, School of Public Affairs, Arizona State University, Phoenix, AZ 85004, USA
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Michiura N, Matsuda Y, Suwa H, Yasumoto K. A self-management system for preventing hyperglycemia through blood glucose level prediction and nudge-based food amount reduction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-7. [PMID: 38082991 DOI: 10.1109/embc40787.2023.10340402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
In recent years, the number of diabetic patients has been increasing rapidly all over the world. Diabetes cannot be completely cured once it develops, so it is important to prevent diabetes before it develops. To prevent the onset of diabetes, it is necessary to avoid prolonged hyperglycemia after meals. In this paper, we propose a self-management system to help users prevent diabetes. The system monitors blood glucose levels in real time, calculates foods to be reduced taking into account the user's preferences, and presents them to the user as soon as the system predicts that the planned diet will cause high blood glucose. We designed and conducted two experiments to show the effectiveness of the proposed system. Experiment 1 was to construct and evaluate a model for predicting blood glucose levels two hours later. Experiment 2 was to evaluate the degree of satisfaction with the food and recommendations, and the acceptability of the recommendations by participants who actually used the proposed system. The results of Experiment 1 showed that the constructed model was able to predict blood glucose levels with an RMSE of 7.66 and MAE of 4.66. As a result of Experiment 2, we found the recommended intake was more acceptable if it reflected the user's preferences.
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Giroux M, Park J, Kim JE, Choi YK, Lee JC, Kim S(S, Jang S, Gonzalez-Jimenez H, Kim J. The Impact of Communication Information on the Perceived Threat of COVID-19 and Stockpiling Intention. AUSTRALASIAN MARKETING JOURNAL 2023. [PMCID: PMC10076984 DOI: 10.1177/18393349211028670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
This article investigates the role of diverse nudging communication strategies on perceived threat and stockpiling intention. Across three studies, the authors examined the various effects of “nudging” on consumer behavior. Study 1 demonstrates that a commonly used picture has a stronger impact on perceived threat than a less frequently exposed picture regardless of its accuracy. Study 2 shows that the perceived threat of COVID-19, in terms of severe health consequences, is lower when using an indirect (vs. direct) explanation of the virus, as well as when reducing the amount of information about the virus. Study 3 investigates the impact of salient negative information and childhood socioeconomic status (SES). Findings reveal that negative information about deaths associated with the virus increases the level of perceived threat and stockpiling intention, especially among people of low childhood SES.
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Affiliation(s)
| | | | - Jae-Eun Kim
- Auckland University of Technology, New Zealand
| | | | | | | | | | | | - Jungkeun Kim
- Auckland University of Technology, New Zealand
- Jungkeun Kim, Department of Marketing, Auckland University of Technology, 120 Mayoral Drive, Auckland 1010, New Zealand.
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A Scoping Review and Field Guide of Theoretical Approaches and Recommendations to Studying the Decision to Adopt Hearing Aids. Ear Hear 2022; 44:460-476. [PMID: 36536499 DOI: 10.1097/aud.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Given the low rates of hearing aid adoption among individuals with hearing loss, it is imperative to better understand the decision-making processes leading to greater hearing aid uptake. A careful analysis of the existing literature on theoretical approaches to studying these processes is needed to help researchers frame hypotheses and methodology in studies on audiology. Therefore, we conducted a scoping review with two aims. First, we examine theories that have been used to study research on hearing aid adoption. Second, we propose additional theories from the behavioral sciences that have not yet been used to examine hearing aid uptake but that can inform future research. DESIGN We identified peer-reviewed publications whose research was driven by one or more theoretical approaches by searching through PubMed, ProQuest PsycINFO, CINHAL Plus, Web of Science, Scopus, and OVID Medline/Embase/PsycINFO. The publications were examined by two researchers for eligibility. RESULTS Twenty-three papers were included in the analysis. The most common theoretical approaches studied include the Health Belief Model, the Transtheoretical Model of Behavior Change, Self-Determination Theory, and the COM-B Model. Seven other theoretical frameworks based on cognitive psychology and behavioral economics have also appeared in the literature. In addition, we propose considering nudge theory, framing effect, prospect theory, social learning theory, social identity theory, dual process theories, and affective-based theories of decision making when studying hearing aid adoption. CONCLUSIONS We conclude that, although a number of theories have been considered in research on hearing aid uptake, there are considerable methodological limitations to their use. Furthermore, the field can benefit greatly from the inclusion of novel theoretical approaches drawn from outside of audiology.
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9
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Vandenplas Y, Simoens S, Turk F, Vulto AG, Huys I. Applications of Behavioral Economics to Pharmaceutical Policymaking: A Scoping Review with Implications for Best-Value Biological Medicines. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2022; 20:803-817. [PMID: 35972683 PMCID: PMC9379236 DOI: 10.1007/s40258-022-00751-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Pharmaceutical policies are generally based on the assumption that involved stakeholders make rational decisions. However, behavioral economics has taught us that this is not always the case as people deviate from rational behavior in rather predictable patterns. This scoping review examined to what extent behavioral concepts have already been applied in the pharmaceutical domain and what evidence exists about their effectiveness, with the aim of formulating future applications and research hypotheses on policymaking for best-value biologicals. METHODS A scoping literature review was conducted on the evidence of behavioral applications to pharmaceuticals. Scientific databases (Embase, MEDLINE, APA PsycArticles, and Scopus) were searched up to 20 October, 2021. RESULTS Forty-four full-text scientific articles were identified and narratively described in this article. Pharmaceutical domains where behavioral concepts have been investigated relate to influencing prescribing behavior, improving medication adherence, and increasing vaccination uptake. Multiple behavioral concepts were examined in the identified studies, such as social norms, defaults, framing, loss aversion, availability, and present bias. The effectiveness of the applied interventions was generally positive, but depended on the context. Some of the examined interventions can easily be translated into effective policy interventions for best-value biological medicines. However, some applications require further investigation in a research context. CONCLUSIONS Applications of behavioral economics to pharmaceutical policymaking are promising. However, further research is required to investigate the effect of behavioral applications on policy interventions for a more sustainable market environment for best-value biological medicines.
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Affiliation(s)
- Yannick Vandenplas
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Steven Simoens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Arnold G Vulto
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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10
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Bukoye OT, Ejohwomu O, Roehrich J, Too J. Using nudges to realize project performance management. INTERNATIONAL JOURNAL OF PROJECT MANAGEMENT 2022. [DOI: 10.1016/j.ijproman.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Taufik D, Bouwman EP, Reinders MJ, Dagevos H. A reversal of defaults: Implementing a menu-based default nudge to promote out-of-home consumer adoption of plant-based meat alternatives. Appetite 2022; 175:106049. [PMID: 35460809 DOI: 10.1016/j.appet.2022.106049] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 01/12/2023]
Abstract
Restaurants are characterized by high levels of meat being consumed in this out-of-home setting, while plant-based meat alternatives remain a niche product, thus preserving a high environmental impact of food consumption. We tested whether subtly re-designing the restaurant menu, so that plant-based meat alternatives were perceived as the default to a greater extent, increased consumer selection of plant-based meat alternatives. Consumers' freedom of choice was preserved by leaving all choice options on the menu. An online experiment in The Netherlands showed that consumers choose plant-based meat alternatives more often relative to meat when the plant-based option is framed as the default. In a field experiment in a Dutch restaurant, we found that the amount of ordered plant-based meat alternative dishes substantially increased relative to an equivalent meat dish when implementing a default nudge (bean alternative: from 8.6% to 80.0%; seaweed alternative: from 16.1% to 58.3%). Thus, re-designing the menu in a way that suggests that plant-based meat alternatives are the default, while preserving autonomous decision-making, is a promising route to promote out-of-home adoption of plant-based meat alternatives in restaurants.
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Affiliation(s)
- Danny Taufik
- Wageningen University & Research, Wageningen Economic Research, P.O. Box 35, 6700 AA, Wageningen, the Netherlands.
| | - Emily P Bouwman
- Wageningen University & Research, Wageningen Economic Research, P.O. Box 35, 6700 AA, Wageningen, the Netherlands
| | - Machiel J Reinders
- Wageningen University & Research, Wageningen Economic Research, P.O. Box 29703, 2502 LS, The Hague, the Netherlands
| | - Hans Dagevos
- Wageningen University & Research, Wageningen Economic Research, P.O. Box 29703, 2502 LS, The Hague, the Netherlands
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12
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Joachim S, Forkan ARM, Jayaraman PP, Morshed A, Wickramasinghe N. A Nudge-Inspired AI-Driven Health Platform for Self-Management of Diabetes. SENSORS 2022; 22:s22124620. [PMID: 35746402 PMCID: PMC9227220 DOI: 10.3390/s22124620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Diabetes mellitus is a serious chronic disease that affects the blood sugar levels in individuals, with current predictions estimating that nearly 578 million people will be affected by diabetes by 2030. Patients with type II diabetes usually follow a self-management regime as directed by a clinician to help regulate their blood glucose levels. Today, various technology solutions exist to support self-management; however, these solutions tend to be independently built, with little to no research or clinical grounding, which has resulted in poor uptake. In this paper, we propose, develop, and implement a nudge-inspired artificial intelligence (AI)-driven health platform for self-management of diabetes. The proposed platform has been co-designed with patients and clinicians, using the adapted 4-cycle design science research methodology (A4C-DSRM) model. The platform includes (a) a cross-platform mobile application for patients that incorporates a macronutrient detection algorithm for meal recognition and nudge-inspired meal logger, and (b) a web-based application for the clinician to support the self-management regime of patients. Further, the platform incorporates behavioral intervention techniques stemming from nudge theory that aim to support and encourage a sustained change in patient lifestyle. Application of the platform has been demonstrated through an illustrative case study via two exemplars. Further, a technical evaluation is conducted to understand the performance of the MDA to meet the personalization requirements of patients with type II diabetes.
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Affiliation(s)
- Shane Joachim
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
- Correspondence: ; Tel.: +61-392-148-150
| | - Abdur Rahim Mohammad Forkan
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
| | - Prem Prakash Jayaraman
- Department of Computing Technologies, School of Science, Computing and Engineering, Swinburne University of Technology, Melbourne 3122, Australia; (A.R.M.F.); (P.P.J.)
| | - Ahsan Morshed
- College of Information and Communications Technology, School of Engineering and Technology, Central Queensland University, Melbourne 3000, Australia;
| | - Nilmini Wickramasinghe
- Department of Health Sciences and Biostatistics, School of Health Sciences, Swinburne University of Technology, Melbourne 3122, Australia;
- Epworth Healthcare, Richmond 3121, Australia
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Misuraca R, Teuscher U, Scaffidi Abbate C, Ceresia F, Roccella M, Parisi L, Vetri L, Miceli S. Can We Do Better Next Time? Italians' Response to the COVID-19 Emergency through a Heuristics and Biases Lens. Behav Sci (Basel) 2022; 12:39. [PMID: 35200290 PMCID: PMC8869375 DOI: 10.3390/bs12020039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023] Open
Abstract
During the outbreak of COVID-19 in Italy, people often failed to adopt behaviors that could have stopped, or at least slowed down, the spread of this deadly disease. We offer cognitive explanations for these decisions, based on some of the most common heuristics and biases that are known to influence human judgment and decision-making, especially under conditions of high uncertainty. Our analysis concludes with the following recommendations: policymakers can and should take advantage of this established science, in order to communicate more effectively and increase the likelihood that people choose responsible actions in a public health crisis.
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Affiliation(s)
- Raffaella Misuraca
- Department of Political Science and International Relations (DEMS), University of Palermo, 90134 Palermo, Italy;
| | - Ursina Teuscher
- Department of Psychology, Portland State University, Portland, OR 97207, USA;
| | - Costanza Scaffidi Abbate
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
| | - Francesco Ceresia
- Department of Political Science and International Relations (DEMS), University of Palermo, 90134 Palermo, Italy;
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
| | - Lucia Parisi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
| | - Luigi Vetri
- OASI, Research Institute-IRCCS, 94018 Troina, Italy;
| | - Silvana Miceli
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
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Kierkegaard P, Hicks T, Allen AJ, Yang Y, Hayward G, Glogowska M, Nicholson BD, Buckle P. Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel. Implement Sci Commun 2021; 2:139. [PMID: 34922624 PMCID: PMC8684208 DOI: 10.1186/s43058-021-00242-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/17/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians' attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. METHODS We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. RESULTS Several factors underpinned primary care physicians' attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians' willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians' confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians' perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. CONCLUSIONS Improving primary care physicians' knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.
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Affiliation(s)
- Patrick Kierkegaard
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
- CRUK Convergence Science Center, Institute for Cancer Research & Imperial College London, Roderic Hill Building, South Kensington Campus, Exhibition Road, London, SW7 2AZ, UK.
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - A Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-Operative, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
- Translational and Clinical Research Institute, The Medical School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Yaling Yang
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Margaret Glogowska
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Brian D Nicholson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- NIHR Community Healthcare MedTech and In-Vitro Diagnostics Co-operative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Peter Buckle
- NIHR London In Vitro Diagnostics Co-operative, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed Street, London, W2 1NY, UK
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15
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Li M, Colby H. Physicians' flawed heuristics in the delivery room. Science 2021; 374:260-261. [PMID: 34648312 DOI: 10.1126/science.abl5647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Meng Li
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
| | - Helen Colby
- Kelley School of Business, Indiana University, Indianapolis, IN, USA
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16
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Dudás L, Szántó R. Nudging in the time of coronavirus? Comparing public support for soft and hard preventive measures, highlighting the role of risk perception and experience. PLoS One 2021; 16:e0256241. [PMID: 34388215 PMCID: PMC8362989 DOI: 10.1371/journal.pone.0256241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022] Open
Abstract
The importance of researching public support for preventive policies have been amplified by the COVID-19 pandemic. Using a representative sample of the Hungarian population, we investigated the support for commonly used preventive measures (social distancing, hand hygiene and wearing masks) comparing two different policy tools (nudges and regulations). Because of the high risk and unfamiliarity of the pandemic, the respondents' risk perception and experience with the disease was also assessed. All preventive measures were generally supported and, contrary to the findings of previous nudge research, there was no clear pattern whether regulations or nudges are preferred. People with higher level of risk perception supported both types of policies more but slightly favoured the regulations. Those who had contact with the disease (either themselves or a close friend or family member contracting COVID-19) reported a higher level of risk perception. When the person themselves was afflicted, this higher levels of risk perception did not translate to a higher level of support, moreover, it even decreased support for the regulations according to regression analysis. In case of a loved one contracting the disease, there was an increased support for both types of measures, but that is explained by the higher risk perception.
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Affiliation(s)
- Levente Dudás
- Department of Decision Sciences, Corvinus University of Budapest, Budapest, Hungary
| | - Richárd Szántó
- Department of Decision Sciences, Corvinus University of Budapest, Budapest, Hungary
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17
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The moderating role of childhood socioeconomic status on the impact of nudging on the perceived threat of coronavirus and stockpiling intention. JOURNAL OF RETAILING AND CONSUMER SERVICES 2021. [PMCID: PMC7590644 DOI: 10.1016/j.jretconser.2020.102362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Communications that include nudges and framing strategies are ubiquitous in our daily lives. In this paper, we investigate how different nudging strategies during a public health campaign, particularly supplementary information and statistics, influence perceptions of threat and stockpiling intentions, while also considering the role of childhood socioeconomic status. Specifically, building upon prior work in behavioral economics, we hypothesize that the presence of additional statistics elicits lower perceived threat and intention to stockpile. In addition, we predict find that the childhood socioeconomic status of individuals influences these effects. Three studies offer evidence for those predictions and demonstrate the importance of message framing in uncertain circumstances. Overall, this work contributes to the literature on nudging and life history theory by investigating how communication strategies can be used to increase or decrease perceived threat in order to achieve desired outcomes (e.g., limiting stockpiling or respecting social distancing). The information presented and the design of health campaigns significantly influence perceived threats and irrational behaviors such as stockpiling intentions. Childhood socioeconomic status of individuals has an impact on the effectiveness of these advertising strategies. Health campaign design about COVID-19 and childhood SES influence perceived threat and stockpiling intentions.
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18
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Nudging persistence after failure through emergency reserves. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2021. [DOI: 10.1016/j.obhdp.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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19
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Exercise Shifts Hypothetical Food Choices toward Greater Amounts and More Immediate Consumption. Nutrients 2021; 13:nu13020347. [PMID: 33498953 PMCID: PMC7911174 DOI: 10.3390/nu13020347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022] Open
Abstract
Although exercise modulates appetite regulation and food intake, it remains poorly understood how exercise impacts decision-making about food. The purpose of the present study was to assess the impact of an acute exercise bout on hypothetical choices related to the amount and timing of food intake. Forty-one healthy participants (22.0 ± 2.6 years; 23.7 ± 2.5 kg/m2, 56% female) completed 45 min of aerobic exercise and a resting control condition in randomized order. Food amount preferences and intertemporal food preferences (preference for immediate vs. delayed consumption) were assessed using electronic questionnaires with visual food cues. Compared to rest, exercise resulted in a greater increase in the food amount selected, both immediately post-exercise (+25.8 ± 11.0 vs. +7.8 ± 11.0 kcal/item, p = 0.02) and 30 min post-exercise (+47.3 ± 12.4 vs. +21.3 ± 12.4 kcal/item, p = 0.005). Exercise further resulted in a greater increase in the preference for immediate consumption immediately post-exercise (+0.23 ± 0.10 vs. +0.06 ± 0.10; p = 0.03) and 30 min post-exercise (+0.30 ± 0.12 vs. +0.08 ± 0.12; p = 0.01). Our findings demonstrate that a single bout of aerobic exercise shifts hypothetical food choices toward greater amounts and more immediate consumption, highlighting the importance of the timing of food choices made in the exercise context.
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20
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Connelly LB, Birch S. Sustainability of Publicly Funded Health Care Systems: What Does Behavioural Economics Offer? PHARMACOECONOMICS 2020; 38:1289-1295. [PMID: 32895899 DOI: 10.1007/s40273-020-00955-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There has been a rapid increase in the use of behavioural economics (BE) as a tool for policy makers to deploy, including in health-related applications. While this development has occurred over the past decade, health care systems have continued to struggle with escalating costs. We consider the potential role of BE for making improvements to health care system performance and the sustainability of publicly funded health care systems, in particular. We argue that the vast majority of applications in this field have been largely focussed on BE and public health, or the prevailing level of risks to health in populations, and with policy proposals to 'nudge' individual behaviour (e.g. in respect of dietary choices). Yet, improvements in population health may have little, if any, impact on the size, cost or efficiency of health care systems. Few applications of BE have focussed on the management, production, delivery or utilisation of health care services per se. The latter is our focus in this paper. We review the contributions on BE and health care and consider the potential for complementing the considerable work on BE and public health with a clear agenda for behavioural health care economics. This agenda should complement the work of conventional microeconomics in the health care sector.
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Affiliation(s)
- Luke B Connelly
- Centre for the Business and Economics of Health, The University of Queensland, Sir Llew Edwards Building, Level 5, St Lucia, Brisbane, QLD, 4072, Australia
- Department of Sociology and Business Law, The University of Bologna, Strada Maggiore 45, 40126, Bologna, Italy
| | - Stephen Birch
- Centre for the Business and Economics of Health, The University of Queensland, Sir Llew Edwards Building, Level 5, St Lucia, Brisbane, QLD, 4072, Australia.
- Manchester Centre for Health Economics, The University of Manchester, Oxford Road, Manchester, M13 9PL, England, UK.
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21
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Promoting Influenza Vaccination among Staff of Nursing Homes According to Behavioral Insights: Analyzing the Choice Architecture during a Nudge-Based Intervention. Vaccines (Basel) 2020; 8:vaccines8040600. [PMID: 33053868 PMCID: PMC7712811 DOI: 10.3390/vaccines8040600] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Influenza vaccination uptake in nursing home (NH) workers is uncommon. The aim of this study was to understand the choice architecture of influenza vaccination acceptance or refusal among them and to promote vaccination acceptance using the nudge approach. (2) Methods: In autumn 2019, a nudge intervention with a contextual qualitative analysis of choice architecture of vaccination was performed among the staff of eight Tuscan NHs. In summer 2020, a cross-sectional study including the staff of 111 NHs (8 in the nudge, 103 in the comparison group) was conducted to assess the impact of the nudge intervention in promoting vaccination uptake. (3) Results: Macro-categories of motivations for vaccination uptake that emerged from the qualitative analysis were risk perception, value dimension, and trust, while those regarding refusal were risk perception, distrust, value dimension, and reasons related to one’s health. Considering the cross-sectional study, influenza vaccination uptake in the 2018–2019 season was similar in the two groups (23.6% vs. 22.2% respectively, in the nudge and comparison group), but significantly different in the 2019–2020 season: 28% in the nudge vs. 20% in the comparison group. Also, the intention to get the vaccine in the 2020–2021 season was significantly different in the two groups: 37.9% in the nudge and 30.8% in the comparison group. (4) Conclusions: Nudge interventions-simple, fast, low cost-could be effective in promoting vaccination acceptance among NH workers and the analysis of choice architecture could be useful in improving tailored, new nudge interventions aimed at modifying irrational biased and cognitive errors.
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22
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Cappa F, Rosso F, Giustiniano L, Porfiri M. Nudging and citizen science: The effectiveness of feedback in energy-demand management. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2020; 269:110759. [PMID: 32425166 DOI: 10.1016/j.jenvman.2020.110759] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 06/11/2023]
Abstract
Nudging is a framework for directing individuals toward better behavior, both for personal and societal benefits, through heuristics that drive the decision-making process but without preventing any available choice. Considering the Grand Challenges that our society faces today, nudging represents an effective framework to tackle some of these pressing issues. In this work, we assessed the effectiveness of informational nudges in the form of detailed, customized feedback, within an energy-demand-management project. The project aligns energy production and demand, thereby reducing greenhouse gases and pollutant emissions to mitigate climate change. We also offered evidence that this kind of feedback is efficacious in involving individuals as citizen scientists, who volunteer their efforts toward the success of the environmentally-related aim of the project. The results of this research - based on surveys, electroencephalography measurements and online participation measures - indicate that feedback can be an effective tool to steer participants' behavior under the libertarian paternalistic view of nudging, increase their motivation to contribute to citizen science, and improve their awareness about environmentally-related issues. In so doing, we provide evidence that nudging and citizen science can be jointly adopted toward the mitigation of pressing environmental issues.
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Affiliation(s)
- Francesco Cappa
- LUISS Guido Carli University, Department of Business and Management, Viale Pola 12, 00198, Rome, Italy.
| | - Federica Rosso
- Sapienza University of Rome, Department of Civil, Construction and Environmental Engineering, Via Eudossiana 18, 00184, Rome, Italy
| | - Luca Giustiniano
- LUISS Guido Carli University, Department of Business and Management, Viale Pola 12, 00198, Rome, Italy
| | - Maurizio Porfiri
- New York University Tandon School of Engineering, Department of Mechanical and Aerospace Engineering and Department of Biomedical Engineering, 6 MetroTech Center Brooklyn, New York, 11201, USA
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23
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Sheffler ZJ, Liu D, Curley SP. Ingredients for successful badges: evidence from a field experiment in bike commuting. EUR J INFORM SYST 2020. [DOI: 10.1080/0960085x.2020.1808539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Zachary J. Sheffler
- Operations and Information Management, University of Massachusetts Amherst, Amherst, MA, USA
| | - De Liu
- Information and Decision Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Shawn P. Curley
- Information and Decision Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
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24
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Chong NK, Chu Shan Elaine C, de Korne DF. Creating a Learning Televillage and Automated Digital Child Health Ecosystem. Pediatr Clin North Am 2020; 67:707-724. [PMID: 32650868 DOI: 10.1016/j.pcl.2020.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article explores the impact of digital technologies, including telehealth, teleconsultations, wireless devices, and chatbots, in pediatrics. Automated digital health with the Internet of things will allow better collection of real-world data for generation of real-world evidence to improve child health. Artificial intelligence with predictive analytics in turn will drive evidence-based decision-support systems and deliver personalized care to children. This technology creates building blocks for a learning child health and health care ecosystem.
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Affiliation(s)
- Ng Kee Chong
- Medical Innovation & Care Transformation, Division of Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore.
| | - Chew Chu Shan Elaine
- Adolescent Medicine Service, Department of Paediatrics, KK Women's & Children's Hospital, Singapore
| | - Dirk F de Korne
- Medical Innovation & Care Transformation, KK Women's & Children's Hospital, Singapore; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Netherlands; SVRZ Cares in Zeeland, Middelburg, Netherlands
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25
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Sensory Nudges: The Influences of Environmental Contexts on Consumers' Sensory Perception, Emotional Responses, and Behaviors toward Foods and Beverages. Foods 2020; 9:foods9040509. [PMID: 32316596 PMCID: PMC7230734 DOI: 10.3390/foods9040509] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/14/2020] [Indexed: 11/21/2022] Open
Abstract
Food products with highly acceptable flavors are not always successful in the marketplace. Sales of identical food products sold in two different stores often differ. Patrons’ choices of specific menu items vary depending on menu designs at restaurants. Such examples suggest that consumer behavior related to eating, preparing, or purchasing foods and beverages is typically complex, dynamic, and sensitive. There is a growing body of evidence that environmental cues surrounding foods and beverages can modulate consumer perception and behavior in the context of eating and drinking. In light of increasing interest in environmental cues, this Special Issue was designed to introduce recent research that highlights how sensory cues derived from environmental cues can modulate consumer perceptions, emotional responses, and behavior related to foods and beverages. The eleven articles addressed in this Special Issue provide informative and insightful findings that may be applied to a wide range of food-related sites, including grocery stores, retail markets, restaurants, dining facilities, and public dining areas. The findings from these articles also suggest that product developers, sensory professionals, retailers, marketers, and business owners should consider not only sensory aspects of food products, but also sensory cues derived from surrounding contexts to better understand consumer perception, acceptability, and behavior toward their food products.
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Giubilini A, Caviola L, Maslen H, Douglas T, Nussberger AM, Faber N, Vanderslott S, Loving S, Harrison M, Savulescu J. Nudging Immunity: The Case for Vaccinating Children in School and Day Care by Default. HEC Forum 2019; 31:325-344. [PMID: 31606869 PMCID: PMC6841646 DOI: 10.1007/s10730-019-09383-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is (1) likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, (2) ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and (3) likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public.
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Affiliation(s)
- Alberto Giubilini
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK.
- Oxford Martin School, University of Oxford, Oxford, UK.
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK.
| | - Lucius Caviola
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hannah Maslen
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK
| | - Thomas Douglas
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK
| | | | - Nadira Faber
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Samantha Vanderslott
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Sarah Loving
- Oxford Martin School, University of Oxford, Oxford, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Mark Harrison
- Oxford Martin School, University of Oxford, Oxford, UK
- Wellcome Unit for the History of Medicine, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
- Oxford Martin School, University of Oxford, Oxford, UK
- Uehiro Centre for Practical Ethics, University of Oxford, Littlegate House, 16-17 St Ebbes St, OX1 1PT, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Australia
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27
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Chapman GB. A Decision-Science Approach to Health-Behavior Change. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2019. [DOI: 10.1177/0963721419854102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Behavior change has the potential to radically impact health outcomes. Successfully influencing health behavior requires an understanding of the decision processes underlying health choices and techniques to harness those psychological factors in the service of effective interventions. The way in which information is presented, social consequences of behavior, and methods for guiding behavior without trying to change beliefs and attitudes are examples of using decision science in the service of health.
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28
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Jarmolowicz DP, Reed DD, Francisco AJ, Bruce JM, Lemley SM, Bruce AS. Modeling effects of risk and social distance on vaccination choice. J Exp Anal Behav 2018; 110:39-53. [DOI: 10.1002/jeab.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 04/20/2018] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | | | - Amanda S. Bruce
- University of Kansas Medical Center and Children's Mercy Hospital
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29
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Brewer NT, Chapman GB, Rothman AJ, Leask J, Kempe A. Increasing Vaccination: Putting Psychological Science Into Action. Psychol Sci Public Interest 2018; 18:149-207. [DOI: 10.1177/1529100618760521] [Citation(s) in RCA: 483] [Impact Index Per Article: 80.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Vaccination is one of the great achievements of the 20th century, yet persistent public-health problems include inadequate, delayed, and unstable vaccination uptake. Psychology offers three general propositions for understanding and intervening to increase uptake where vaccines are available and affordable. The first proposition is that thoughts and feelings can motivate getting vaccinated. Hundreds of studies have shown that risk beliefs and anticipated regret about infectious disease correlate reliably with getting vaccinated; low confidence in vaccine effectiveness and concern about safety correlate reliably with not getting vaccinated. We were surprised to find that few randomized trials have successfully changed what people think and feel about vaccines, and those few that succeeded were minimally effective in increasing uptake. The second proposition is that social processes can motivate getting vaccinated. Substantial research has shown that social norms are associated with vaccination, but few interventions examined whether normative messages increase vaccination uptake. Many experimental studies have relied on hypothetical scenarios to demonstrate that altruism and free riding (i.e., taking advantage of the protection provided by others) can affect intended behavior, but few randomized trials have tested strategies to change social processes to increase vaccination uptake. The third proposition is that interventions can facilitate vaccination directly by leveraging, but not trying to change, what people think and feel. These interventions are by far the most plentiful and effective in the literature. To increase vaccine uptake, these interventions build on existing favorable intentions by facilitating action (through reminders, prompts, and primes) and reducing barriers (through logistics and healthy defaults); these interventions also shape behavior (through incentives, sanctions, and requirements). Although identification of principles for changing thoughts and feelings to motivate vaccination is a work in progress, psychological principles can now inform the design of systems and policies to directly facilitate action.
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Affiliation(s)
- Noel T. Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina
| | | | | | - Julie Leask
- Faculty of Nursing and Midwifery, University of Sydney
- Faculty of Medicine, University of Sydney
| | - Allison Kempe
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine
- Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, Colorado
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30
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Szaszi B, Palinkas A, Palfi B, Szollosi A, Aczel B. A Systematic Scoping Review of the Choice Architecture Movement: Toward Understanding When and Why Nudges Work. JOURNAL OF BEHAVIORAL DECISION MAKING 2017. [DOI: 10.1002/bdm.2035] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Barnabas Szaszi
- Doctoral School of Psychology; ELTE Eötvös Loránd University; Budapest Hungary
- Institute of Psychology, ELTE Eötvös Loránd University; Budapest Hungary
| | - Anna Palinkas
- Institute of Psychology, ELTE Eötvös Loránd University; Budapest Hungary
| | - Bence Palfi
- School of Psychology; University of Sussex; Brighton UK
- Sackler Centre for Consciousness Science; University of Sussex; Brighton UK
| | - Aba Szollosi
- School of Psychology; University of New South Wales; Sydney Australia
| | - Balazs Aczel
- Institute of Psychology, ELTE Eötvös Loránd University; Budapest Hungary
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The effect of interactive reminders on medication adherence: A randomized trial. Prev Med 2017; 103:98-102. [PMID: 28751176 DOI: 10.1016/j.ypmed.2017.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 05/23/2017] [Accepted: 07/14/2017] [Indexed: 11/22/2022]
Abstract
Expanding on evidence that interventions to improve health are more effective when informed by behavioral science, we explore whether reminders designed to harness behavioral science principles can improve medication adherence. We conducted a randomized controlled trial with 46,581 U.S. participants with commercial or Medicare Advantage insurance from Humana. Participants were randomly assigned to one of four experimental conditions. Participants in the usual care condition only received standard mailings that the insurer usually sends. In addition to the standard mailings, participants in the other three conditions also received (1) mailings that reminded them to take a target medication (basic reminder condition), (2) reminders that prompted them to predict their medication adherence in the next 30days (prediction condition), or (3) reminders that prompted them to commit to a self-determined level of adherence for the next 30days (commitment condition). We sent these mailings once a month for three months from November, 2014 through January, 2015, and tracked prescription refills. We find that, during the mailing period, reminders increased adherence by 0.95 percentage points (p<0.05), and this effect was driven by the prediction and commitment conditions; during the three-month post-mailing period, reminders increased adherence by 0.98 percentage points (p<0.05), and this effect was driven by the basic reminder and commitment conditions. The reminders increased medication adherence by 0.7 pills per dollar spent over our 181day study period. Trial registry name: Effect of Reminders on Adherence. Registration identification number: NCT02411006 URL for the registry: https://clinicaltrials.gov/ct2/show/NCT02411006.
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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.
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Affiliation(s)
- Mark C Navin
- Department of Philosophy, Oakland University, 746 Mathematics and Science Center, Rochester, MI, 48309-4401, USA.
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Kottwitz MU, Schnyder R, Berset M, Elfering A. Thirst at Work Implies More Than Just Inadequate Facilities for Breaks. Appl Psychophysiol Biofeedback 2017; 42:223-234. [PMID: 28676982 DOI: 10.1007/s10484-017-9369-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Early signs of dehydration, such as headaches, are not unusual in the working population. Even slight deficiencies of water intake may have negative effects on both health and performance. However, little is known about work-related fluid intake. We expect the daily experience of interruptions to distract from perceived thirst, resulting in reduced daily fluid intake. This effect may be more pronounced when the workload is generally less predictable due to the assignment of tasks that are beyond the definition of the worker's professional role (unreasonable tasks). Data were gathered from 29 female service employees across five workdays. Multilevel analyses revealed daily work interruptions to be negatively associated with fluid intake, especially when there were frequent unreasonable task-assignments. Results suggest that interruptions at work might reduce daily fluid intake. However, adequate allocation of tasks by managers can protect employees against insufficient drinking.
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Affiliation(s)
- Maria U Kottwitz
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.,Faculty of Psychology, Work and Organizational Psychology, Philipps University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Romy Schnyder
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
| | - Martial Berset
- University of Applied Sciences and Arts Northwestern Switzerland FHNW, FHNW School of Applied Psychology Institute of Humans in Complex Systems, Riggenbachstrasse 16, 4600, Olten, Switzerland
| | - Achim Elfering
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland. .,National Centre of Competence in Research, Affective Sciences, University of Geneva, CISA, Geneva, Switzerland.
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Active engagement in a web-based tutorial to prevent obesity grounded in Fuzzy-Trace Theory predicts higher knowledge and gist comprehension. Behav Res Methods 2016; 49:1386-1398. [PMID: 27531360 DOI: 10.3758/s13428-016-0794-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We used Sharable Knowledge Objects (SKOs) to create an Intelligent Tutoring System (ITS) grounded in Fuzzy-Trace Theory to teach women about obesity prevention: GistFit, getting the gist of healthy eating and exercise. The theory predicts that reliance on gist mental representations (as opposed to verbatim) is more effective in reducing health risks and improving decision making. Technical information was translated into decision-relevant gist representations and gist principles (i.e., healthy values). The SKO was hypothesized to facilitate extracting these gist representations and principles by engaging women in dialogue, "understanding" their responses, and replying appropriately to prompt additional engagement. Participants were randomly assigned to either the obesity prevention tutorial (GistFit) or a control tutorial containing different content using the same technology. Participants were administered assessments of knowledge about nutrition and exercise, gist comprehension, gist principles, behavioral intentions and self-reported behavior. An analysis of engagement in tutorial dialogues and responses to multiple-choice questions to check understanding throughout the tutorial revealed significant correlations between these conversations and scores on subsequent knowledge tests and gist comprehension. Knowledge and comprehension measures correlated with healthier behavior and greater intentions to perform healthy behavior. Differences between GistFit and control tutorials were greater for participants who engaged more fully. Thus, results are consistent with the hypothesis that active engagement with a new gist-based ITS, rather than a passive memorization of verbatim details, was associated with an array of known psychosocial mediators of preventive health decisions, such as knowledge acquisition, and gist comprehension.
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Betsch C, Böhm R, Airhihenbuwa CO, Butler R, Chapman GB, Haase N, Herrmann B, Igarashi T, Kitayama S, Korn L, Nurm ÜK, Rohrmann B, Rothman AJ, Shavitt S, Updegraff JA, Uskul AK. Improving Medical Decision Making and Health Promotion through Culture-Sensitive Health Communication. Med Decis Making 2016; 36:811-33. [DOI: 10.1177/0272989x15600434] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 07/17/2015] [Indexed: 11/16/2022]
Abstract
This review introduces the concept of culture-sensitive health communication. The basic premise is that congruency between the recipient’s cultural characteristics and the respective message will increase the communication’s effectiveness. Culture-sensitive health communication is therefore defined as the deliberate and evidence-informed adaptation of health communication to the recipients’ cultural background in order to increase knowledge and improve preparation for medical decision making and to enhance the persuasiveness of messages in health promotion. To achieve effective health communication in varying cultural contexts, an empirically and theoretically based understanding of culture will be indispensable. We therefore define culture, discuss which evolutionary and structural factors contribute to the development of cultural diversity, and examine how differences are conceptualized as scientific constructs in current models of cultural differences. In addition, we will explicate the implications of cultural differences for psychological theorizing, because common constructs of health behavior theories and decision making, such as attitudes or risk perception, are subject to cultural variation. In terms of communication, we will review both communication strategies and channels that are used to disseminate health messages, and we will discuss the implications of cultural differences for their effectiveness. Finally, we propose an agenda both for science and for practice to advance and apply the evidence base for culture-sensitive health communication. This calls for more interdisciplinary research between science and practice but also between scientific disciplines and between basic and applied research.
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Affiliation(s)
- Cornelia Betsch
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Robert Böhm
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Collins O. Airhihenbuwa
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Robb Butler
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Gretchen B. Chapman
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Niels Haase
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Benedikt Herrmann
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Tasuku Igarashi
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Shinobu Kitayama
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Lars Korn
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Ülla-Karin Nurm
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Bernd Rohrmann
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Alexander J. Rothman
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Sharon Shavitt
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - John A. Updegraff
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
| | - Ayse K. Uskul
- Center for Empirical Research in Economics and Behavioral Sciences (CEREB), University of Erfurt, Erfurt, Germany (CB, LK)
- School of Business and Economics, RWTH Aachen University, Aachen, Germany (RB)
- Department of Biobehavioral Health, Penn State University, University Park, PA, USA (COA)
- World Health Organization, Regional Office for Europe, Copenhagen, Denmark (RB)
- Institute for Health, Healthcare Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA (GBC)
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Lehmann BA, Chapman GB, Franssen FME, Kok G, Ruiter RAC. Changing the default to promote influenza vaccination among health care workers. Vaccine 2016; 34:1389-92. [PMID: 26851734 DOI: 10.1016/j.vaccine.2016.01.046] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/15/2016] [Accepted: 01/20/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevention of health care acquired infections is an important objective for patient safety and infection control in all health care settings. Influenza vaccination uptake among health care workers (HCWs) is the most effective method to prevent transmission to patients, but vaccination coverage rates are low among HCWs. Several educational campaigns have been developed to increase the influenza vaccination coverage rates of HCWs, but showed only small effects. The aim of this study was to test an opt-out strategy in promoting uptake among HCWs in a tertiary care center for patients with complex chronic organ failure. METHODS HCWs were randomly assigned to one of two conditions. In the opt-out condition (N=61), participants received an e-mail with a pre-scheduled appointment for influenza vaccination, which could be changed or canceled. In the opt-in condition (N=61), participants received an e-mail explaining that they had to schedule an appointment if they wanted to get vaccinated. RESULTS The findings show no statistically detectable effect of condition on being vaccinated against influenza. However, HCWs in the opt-out condition were more likely to have an appointment for influenza vaccination, which in turn increased the probability of getting vaccinated. CONCLUSION To change the default to promote influenza vaccination among HCWs might be an easy and cost-effective alternative to the complex vaccination campaigns that have been proposed in recent years.
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Affiliation(s)
- Birthe A Lehmann
- Center for Infectious Disease Control, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven, BA 3720, The Netherlands.
| | - Gretchen B Chapman
- Department of Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ 08854-8020, USA.
| | - Frits M E Franssen
- CIRO+, Centre of Expertise for Chronic Organ Failure, Hornerheide 1, Horn, NM 6085, The Netherlands.
| | - Gerjo Kok
- Department of Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands.
| | - Robert A C Ruiter
- Department of Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, Maastricht, MD 6200, The Netherlands.
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