Models of Cognition and Their Applications in Behavioral Economics: A Conceptual Framework for Nudging Derived From Behavior Analysis and Relational Frame Theory

Online retail nudges to help parents with lower-income choose healthy beverages for their children: A randomized clinical trial

BACKGROUND

Nudges offer a promising tool to reduce sugary drink intake among children who are most at risk for diet-related disease.

OBJECTIVE

To examine the impact of online store nudges on purchases of sugary drinks for children in lower-income households.

METHODS

Caregivers with lower-income were recruited to an online shopping experiment and instructed to spend $10-$30 on three beverages for their child aged 1-5 years. Participants were randomized to navigate an online supermarket in its standard version (n = 1106) or a version with nudges (n = 1135), including a product placement nudge (i.e. placing healthy beverages in prominent positions) and a swap nudge (i.e. offering a swap of water, plain milk and/or 100% fruit juice upon selection of sugary drinks).

RESULTS

On average, participants purchased 1887 (SD = 2113) and 620 (SD = 1528) calories from sugary drinks per basket in the control and experimental conditions, respectively. Model-based results indicate that those in the experimental condition purchased 1267 (95% CI: 1419, 1114) fewer calories from sugary drinks, and fewer grams of total sugar (β = -253.5 g (95% CI: -286.3, -220.6)) and added sugar (β = -287.8 g (95% CI: -323.1, -252.5)) purchased from sugary drinks.

CONCLUSION

Nudges may be an effective, acceptable, scalable strategy for leading caregivers in lower-income households to purchase fewer sugary drinks for their children.

Do NOT Read this Article: the Effects of Autoclitics and Nudge on Choosing

The use of autoclitics can influence the behavior of individuals making choices when responding to a survey (e.g., checking or unchecking a box). In two studies, we investigated the effects of autoclitics as "nudges" on choice by manipulating different frames (opt-in and opt-out) and default options (i.e., unchecked and checked boxes). Undergraduate students recruited from behavioral science courses engaged with materials in the study. In study 1, we used an online survey at the beginning of the semester offering the choice of whether to enroll in extra-academic activities (i.e., practice tests) available via the online course platform, Blackboard. We randomly assigned students into one of four groups: 1) option to enroll with an unchecked box, 2) option to not enroll with an unchecked box, 3) option to enroll with a checked box, or 4) option to not enroll with a checked box. Results showed that the option to not enroll with an unchecked box produced higher enrollment to receive extra academic activities. In the middle of the semester, we conducted a within-subject arrangement wherein students who initially opted out of receiving activities had the option to accept them following exposure to the negative autoclitic frame. Most of these students opted into receiving activities. In study 2, we replicated the methods of study 1 in Canvas, a different course platform, and obtained similar results. We briefly discuss the implications of a nudge for ethical consent.

Non-pharmaceutical interventions to optimize cancer immunotherapy

The traditional picture of cancer patients as weak individuals requiring maximum rest and protection is beginning to dissolve. Too much focus on the medical side and one's own vulnerability and mortality might be counterproductive and not doing justice to the complexity of human nature. Unlike cytotoxic and lympho-depleting treatments, immune-engaging therapies strengthen the immune system and are typically less harmful for patients. Thus, cancer patients receiving checkpoint inhibitors are not viewed as being vulnerable per se, at least not in immunological and physical terms. This perspective article advocates a holistic approach to cancer immunotherapy, with an empowered patient in the center, focusing on personal resources and receiving domain-specific support from healthcare professionals. It summarizes recent evidence on non-pharmaceutical interventions to enhance the efficacy of immune checkpoint blockade and improve quality of life. These interventions target behavioral factors such as diet, physical activity, stress management, circadian timing of checkpoint inhibitor infusion, and waiving unnecessary co-medication curtailing immunotherapy efficacy. Non-pharmaceutical interventions are universally accessible, broadly applicable, instantly actionable, scalable, and economically sustainable, creating value for all stakeholders involved. Most importantly, this holistic framework re-emphasizes the patient as a whole and harnesses the full potential of anticancer immunity and checkpoint blockade, potentially leading to survival benefits. Digital therapeutics are proposed to accompany the patients on their mission toward change in lifestyle-related behaviors for creating optimal conditions for treatment efficacy and personal growth.

Tutorial. A Behavioral Analysis of Rationality, Nudging, and Boosting: Implications for Policymaking

As recent trends in policymaking call for increased contributions from behavioral science, nudging and boosting represent two effective and relatively economic approaches for influencing choice behavior. They utilize concepts from behavioral economics to affect agents’ concurrent suboptimal choices: in principle, without applying coercion. However, most choice situations involve some coercive elements. This study features a functional analysis of rationality, nudging, and boosting applied to public policy. The relationship between behavior and environmental variables is termed a “behavioral contingency,” and the analysis can include social and cultural phenomena by applying a selectionist perspective. Principles of behavioral control, whether tight or loose, may be exerted by policymakers or regulators who subscribe to paternalistic principles and may be met with demands of libertarianism among their recipients. This warrants discussion of the legitimacy and likelihood of behavioral control and influence on choices. Cases and examples are provided for extending the unit of analysis of choice behavior to achieve outcomes regulated by policies at the individual and group levels, including health, climate, and education. Further research and intervention comprise the study of macrocontingencies and metacontingencies. Advancing the understanding and application of behavioral science to policymaking may, therefore, benefit from moving from the relatively independent contributions of behavioral economics and behavior analysis to an inclusive selectionist approach for addressing choice behavior and cultural practices.

A Systematic Review of Nudge Interventions to Optimize Medication Prescribing

Background: The benefits of medication optimization are largely uncontroversial but difficult to achieve. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward. These interventions are often referred to as nudges.

Objective: The current systematic literature review characterizes published studies describing nudge interventions to optimize medication prescribing by the behavioral determinants they intend to influence and the techniques they apply.

Methods: Four databases were searched (MEDLINE, Embase, PsychINFO, and CINAHL) to identify studies with nudge-type interventions aiming to optimize prescribing decisions. To describe the behavioral determinants that interventionists aimed to influence, data were extracted according to the Theoretical Domains Framework (TDF). To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE. Next, the recommended TDF-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants.

Results: The current review located 15 studies comprised of 20 interventions. Of the 20 interventions, 16 interventions (80%) were effective. The behavior change techniques most often applied involved prompts (n = 13). The MINDSPACE contextual influencer most often applied involved defaults (n = 10). According to the recommended TDF-BCT mappings, only two interventions applied a sufficient array of behavior change techniques to address the behavioral determinants the interventionists aimed to influence.

Conclusion: The fact that so many interventions successfully changed prescriber behavior encourages the development of future behavior change interventions to optimize prescribing without mandates or financial incentives. The current review encourages interventionists to understand the behavioral determinants they are trying to affect, before the selection and application of techniques to change prescribing behaviors.

Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020168006].

Ensuring Effective Public Health Communication: Insights and Modeling Efforts From Theories of Behavioral Economics, Heuristics, and Behavioral Analysis for Decision Making Under Risk

Public health (PH) messaging can have an enormous impact on shaping how individuals within society behave, and can ensure it is in a safe and responsible way, consistent with up-to-date evidence-based PH guidelines. If done effectively, messaging can save lives and improve the health of those within society. However, unfortunately, those within Government PH bodies typically have little training about how to effectively represent PH messages in a way that is consistent with psychological theories of cognitive bias, in order to avoid cognitively biasing the public through their messages. As a result of this, inadequate representation of PH messages can result, which can often lead to cognitive bias in those from the public who read or listen to the message information. This can lead to poor decision making of the pubic as a whole, which can then further lead to harm and even death of public members as a result of these poor decisions. One way to minimize the problem of bias in decision making is to explore psychology theories that model how bias can occur from PH messaging, and identify ways in which PH agencies can utilize such approaches to improve the effectiveness of their messages. Previous focus has been largely on behavioral economic theories, however, here, other accounts are offered in addition to these. These include theories of heuristics and theories from the behavior analysis domain, which may increase the predictive power of modeling bias, and have applications for how best to represent PH message information which minimize bias.

Ethical, legal, and communication challenges in managing goals-of-care discussions in chronically critically ill patients

Clinicians should expect controversial goals of care discussions in the surgical intensive care from time to time. Differing opinions about the likelihood of meaningful recovery in patients with chronic critical illness often exist between intensive care unit providers of different disciplines. Outcome predictions presented by health-care providers are often reflections of their own point of view that is influenced by provider experience, profession, and personal values, rather than the consequence of reliable scientific evaluation. In addition, family members of intensive care unit patients often develop acute cognitive, psychologic, and physical challenges. Providers in the surgical intensive care unit should approach goals-of-care discussions in a structured and interprofessional manner. This best practice paper highlights medical, legal and ethical implications of changing goals of care from prioritizing cure to prioritizing comfort and provides tools that help physicians become effective leaders in the multi-disciplinary management of patients with challenging prognostication.

Organizational Silos: A Scoping Review Informed by a Behavioral Perspective on Systems and Networks

In recent years, several organizations have implemented interventions aimed at integrating work processes and bridging network clusters. These are often permeated by different assumptions regarding clusters in organizational settings. There are concerns about the formation of silos and structural barriers to communication across the formal and informal network structures. Conversely, network clusters are regarded as spaces of local social reinforcement from which innovation ideas may emerge. Although terminologically and functionally different, they share some common features insofar as organizational behavior is concerned and the production of artifacts that fulfill organizational goals. The present scoping review presents an analysis of the literature on organizational silos while investigating attempts to bridge network clusters. Based on the search results, 40 studies were included in the analysis of the findings; of these, 20 were empirical studies and were included in a further quantitative analysis of methods and findings. We identified patterns of definitions of silos and variation in terms of aims, variables, and methods used to evaluate interventions among the heterogeneous studies. Special attention was dedicated to the role of consequences of siloed organizational behavior. We conclude that silos comprise barriers to achieving organizational goals insofar as they pose a threat to internal cooperation.