What is a Nudge?
Nudges guide or motivate good decision-making by changing how information is presented or choices are framed. A well-designed nudge will make the right choice the easy choice to help people act in their own best interest. Whereas laws, rules, or mandates seek to force behavior, nudges always preserve freedom of choice.
Nudges and Cognitive Bias
Cognitive biases are systematic tendencies in the human brain that subconsciously influence behavior and decision-making. When applied correctly, nudges can exploit common cognitive biases without restricting choice to steer people toward better decision-making.
For example, loss aversion bias refers to a phenomenon where an actual or potential loss is felt more strongly than its equivalent gain – which leads people to avoid decisions that might result in loss. A study designed by our team demonstrated that a loss-framed incentive that withdrew money from a virtual account if goals were not achieved proved most effective at increasing physical activity among overweight and obese adults – increasing physical activity goal achievement by 50 percent relative to the control.
Examples of other cognitive biases that can be leveraged to improve health and health care include:
A preference for keeping things as they are
A preference for a smaller reward now rather than a larger reward later
The human tendency to rely on information that comes readily to mind when making decisions
Why Nudge in Health Care?
Human behavior is critical to realizing medical advances. No matter how effective a medication, protective a vaccine, or beneficial a lifestyle modification is, these interventions can improve health only if they are recommended by clinicians and utilized by patients. Nudges help close the gap between research and practice by providing a proven framework to modify behavior and encourage adherence to evidence-based practices.
Nudges can take many forms in health care. For example, our team has been able to increase generic prescribing rates and reduce opioid durations using defaults, improve statin prescribing rates by introducing active choice and peer comparisons, and improve flu vaccination rates with information framing.
Whom to Nudge
There are three target audiences for nudges in health care.
The design of practice environments heavily influences medical decision-making. Nudges can be implemented to improve workflow and steer decision-making toward evidence-based care.
Patient behaviors impact long-term health outcomes. Nudges can be implemented to enact significant and sustained change in daily health behaviors or motivate patients to complete one-time actions to enhance health.
Nudges can be implemented to reduce the burden of epidemics, such as opioid addiction, gun violence, and distracted or impaired driving, thereby improving public health.
We plan to add to and iterate on this content regularly. As such, we invite you to share feedback on your experience and suggestions for updates.