When in Doubt, Follow the Crowd? Responsiveness to Social Proof Nudges in the Absence of Clear Preferences

Nudging intensive care unit personnel towards sustainable behaviour

BACKGROUND

The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. Policies are only effective if people comply.

AIM

Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU).

STUDY DESIGN

We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented.

RESULTS

Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage.

CONCLUSIONS

While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment.

RELEVANCE TO CLINICAL PRACTICE

The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.

Creating demand for unmet needs: Agile Storytelling

Introduction

The translational gap from the discovery of evidence-based solutions to their implementation in healthcare delivery organizations derives from an incorrect assumption that the need for change among executive, administrative, or clinical personnel is the same as the demand for change. For sickle cell disease (SCD), implementation of evidence-based guidelines is often delayed or obstructed due to lack of demand. This challenge allows for the persistence of resource limitations and care delivery models that do not meet the community's unique needs. Agile Storytelling is a process built on the scientific foundations of behavioral economics, complexity science, and network science to create local demand for the implementation of evidence-based solutions.

Methods

Agile Storytelling includes a design phase and a testing phase. The design phase converts the evidence-based solution into a minimally viable story of a hero, a villain, struggle, drama, and a resolution. The testing phase evaluates the effectiveness of the story via a series of storytelling sprints in the target local healthcare delivery organization. The efficacy of Agile Storytelling was tested in an iterative n-of-1 case study design.

Results

Agile Storytelling was used in a large, urban, healthcare system within the United States to facilitate implementation of national SCD best-practice guidelines. After repeated failures attempting to use national and local data regarding the high societal need to hire a SCD-specific social worker, an Agile change conductor using Agile Storytelling was able to create demand for the new position within a week. This decision has ultimately improved patient outcomes and led to the adoption of a specialized collaborative care team for SCD within the health network.

Discussion

Agile Storytelling can lead to structured, effective, and informed storytelling to create local demand within healthcare delivery organizations.

The role of attention and health goals in nudging healthy food choice

Introduction

Nudging is a promising intervention technique that supports people in pursuing their healthy eating goals. Recent research suggests that, despite previous assumptions, disclosure of the presence of a nudge does not compromise nudge effectiveness. However, it is unknown whether attention to a nudge affects nudge effects. We assessed the role of attention systematically, by examining explicit and implicit attention to nudges, while also exploring healthy eating goals as a potential moderator.

Methods

Participants were assigned to a nudge (i.e., a shopping basket inlay with pictures of healthy items) or control condition (i.e., a shopping basket inlay with neutral pictures) and chose a snack in an experimental supermarket field study. Explicit and implicit attention (with a mobile eye-tracker) to nudges, healthiness of snack choice, and healthy eating goals were assessed.

Results

Results showed that attention to the nudge did not hamper the nudge's effect. Furthermore, individuals with strong healthy eating goals made healthier food choices in the nudge condition. Individuals with weak to non-existent healthy eating goals were not influenced by the nudge.

Discussion

Findings are in line with the viewpoint that nudging does not by definition work 'in the dark', and suggests that nudges support people in adhering to their healthy eating goal.

Buy solar, get cashback: do consumer subsidies described as promotions influence electricity choices?

Introduction

Most countries want to make the transition to increased or even exclusive use of renewable energy. To achieve this goal, how can individuals be persuaded to use more renewable electricity? For example, does the way energy companies communicate so-called consumer subsidies matter in this regard, and if so, which communication strategy is best? For example, is a monetary promotion (e.g., cashback) better than a non-monetary one (e.g., gift)?

Methods

In a total of four studies (with a total of more than 1700 participants), we investigated what type of promotion most influenced the choice of a renewable energy product, varying, for example, the environmental friendliness of the renewable energy product.

Results

The monetary promotion (e.g., get $35 back through subsidies) appeared to be the most successful; it significantly increased the choice of the renewable electricity product (i.e., between 12-22%). However, this result was only evident when the subsidized renewable product was not the product already preferred by most individuals. Other measures, such as the willingness to pay (WTP), showed no differential effects.

Discussion

Overall, the observed pattern suggests that promoting renewable energy choices, is similar to promoting donations to a charity. Accordingly, the description of the consumer subsidy as a monetary promotion (i.e., cashback or negative labeling) is most effective in terms of promotion. However, the effect of monetary promotions seems to diminish if the subsidized product is already the product preferred by most consumers. Nevertheless, the use of monetary promotions can encourage the transition to renewable energy.

Assessing Hand Sanitizer Usage in Japanese Elderly Day Care Centers: An Observational and Interventional Study

Purpose Hand hygiene is a vital preventive measure against the novel coronavirus disease 2019 (COVID-19) infection. Though older people are at high risk of infection of COVID-19, there is still a lack of verification of hand sanitization and effective interventions to promote its implementation for older people. This study aimed to validate what kind of intervention can effectively promote hand hygiene among elderly individuals in Japanese day care centers, based on the hypothesis that a particular nudge will significantly promote hand hygiene. Methods We designed two types of interventions that have aspects of the nudge concept based on WHO Guidelines on Hand Hygiene in Health Care. The study was conducted with one-week observation and intervention periods excluding weekends, starting on February 11, 2023. Three groups were defined as follows: control (installation of hand sanitizer dispenser with a basic sign), reminder (additional visual cues using yellow curing tape), and institutional safety (sign appealing to protecting institutional safety by using hand sanitizer). Daily hand sanitizer usage was measured, and statistical analysis was performed using a one-way ANOVA for the number of uses before and after intervention. Results During the observation period, the average number of hand sanitizer pushes per person remained at 0.39 across all facilities. During the intervention period, control, reminder, and institutional safety groups showed increases of 1.13-fold, 1.31-fold, and 1.16-fold, respectively, revealing no significant difference. Conclusions Though these nudges were implemented according to WHO guidelines and the previous study, the older users of day care centers seemed not to react to these nudges significantly. The results underscore the need for tailored interventions to improve hand hygiene among the elderly in day care settings, contributing to the overall goal of preventing infectious diseases.

Young men's perceptions about the risks associated with sports betting: a critical qualitative inquiry

BACKGROUND

Gambling is an inherently risky activity. New technologies have led to the development of new, online forms of gambling such as sports betting, with round the clock availability and accessibility. While young men have been identified as a group that may be particularly vulnerable to the harms associated with these new online products, few studies have qualitatively explored young men's perceptions of the risks associated with these products. Using concepts associated with the sociology of risk, this paper sought to explore the range of factors that may influence how 18-24 year old young Australian men conceptualise the risks associated with sports betting.

METHODS

Using a critical qualitative inquiry approach, in-depth interviews were conducted with sixteen participants in Victoria, Australia, who engaged in sports betting at least monthly. The data interpreted for this study included questions relating to awareness of gambling, the contexts associated with early gambling experiences; the factors that influenced current gambling behaviours, and why they engaged in gambling. A reflexive approach to thematic analysis was used to interpreted themes from the data.

RESULTS

Four key themes were constructed from the data relating to the factors that influenced risk perceptions. These included: 1) 'The role of early experiences', including exposure to gambling advertising in sport, and the gambling behaviours of social networks; 2) 'The influence of peer rivalry and competition', in which sports betting was used to form connections within and across peer groups; 3) 'The normalisation of gambling', including the embedding of gambling in everyday activities; and 4) 'The influence of perceptions of knowledge, skill, and control', including the belief that they could engage in responsible behaviours and stop gambling if they needed to.

CONCLUSION

This study indicated that a range of factors may influence how young men conceptualise the risks and benefits associated with sports betting. Current public health strategies for gambling that focus on individual determinants and responsibility paradigms must be broadened to target the social and commercial factors that influence young men's attitudes towards, and engagement in sports betting.

Nudgeability: Mapping Conditions of Susceptibility to Nudge Influence

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

When Not to Ask: A Defense of Choice-Masking Nudges in Medical Research

In this article, we examine the legality and ethics of a controversial but widespread practice in clinical research: choice-masking nudges. A choice-masking nudge (CMN) exists when a research team explicitly obscures a meaningful choice from participants by presenting a default decision as the standard way forward. Even though an easy-to-use opt-out mechanism is available for participants who independently express concerns with the standard default, the fact that a default has been pre-selected is not made obvious to research participants. To opt out of the nudge, a participant must overtly request non-standard treatment. We argue that use of such nudges in medical research can be justified by their individual, collective, and social benefits, provided that they respect autonomy and satisfy our four further acceptability conditions. The structure of this Article is as follows. In Part II, we describe three controversial cases of CMNs in medical research. In Part III, we provide background on nudging and explain how our proposed CMNs fit into the existing literature on nudging and libertarian paternalism. In Part IV, we explain how the reasonable person standard as employed by United States research regulations can be used to support CMNs. In Part IV, we anticipate some of the strongest objections to CMNs by explaining how CMNs are compatible with a wide range of plausible accounts of autonomy. Finally, in Part VI, we discuss four additional core considerations an acceptable CMN must meet: legitimate policy goals; benefits outweighing harms; burdens distributed fairly; and absence of ethically superior feasible alternatives. We also analyze the three existing controversies explored in Part II and show how each would benefit from the conceptual clarity offered by our analytic framework. Medical research is complicated and can be difficult for participants to understand; thoughtfully designed CMNs can play an important role in gently guiding large numbers of research participants toward decision outcomes that really are best for them and their communities.

Trends in Health Care Worker Intentions to Receive a COVID-19 Vaccine and Reasons for Hesitancy

This survey study queried employees of a health care system before COVID-19 vaccine distribution to assess their intentions to receive a vaccine and to understand their reasons for hesitancy to do so.

Under pressure: Nudging increases healthy food choice in a virtual reality supermarket, irrespective of system 1 reasoning

Previous research has shown that nudging can effectively support people's healthy food choices. Yet, to date knowledge about the psychological premises of nudging is limited, highlighting the need for closer scrutiny to determine how and when nudging is most effective. In the current study, we assessed whether the presumed effect of nudging on healthy food choice is enhanced under time pressure, a condition probing alleged system 1 reasoning. Food choice was studied in a realistic virtual reality supermarket where healthier alternatives were nudged by making them more salient. We additionally explored possible differences in decision-making experiences related to nudging or time pressure. The study took place at a science festival where visitors could decide to participate in a study. Participants (n = 99) had to purchase four products, each from a different product category that was provided on a shopping list. In the nudging condition, one healthier option within each product category was nudged by making it more salient. While a main effect of nudging was found, showing in increased healthy food choices, this effect was not further qualified by time pressure, suggesting that the effectiveness of nudging is not enhanced under system 1 conditions. Relatedly, people who were and who were not aware of the nudges showed similar effects of nudging on healthy food choice. Furthermore, no differences in decision-making experiences showed, suggesting that people have similar experiences regarding impulsive and reflective decision-making irrespective of whether they are being nudged or put under time pressure. All in all, our findings are in line with recent viewpoints on the premises of nudges, suggesting that alleged system 1 conditions are not a prerequisite for nudging to be effective.