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Will it nudge: A feasibility study of PCC nudging to increase uptake of PCC practice

Research project
Active research
Project period
2020 - ongoing
Project owner
The Institute of Health and Care Sciences

Short description

The purpose of this study is to understand if and how nudging can be used to help healthcare professionals adopt PCC practices.

What Is Nudging?
Nudging is defined as “any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives”.

Nudging in Healthcare?
Nudging has been successfully applied by governmental agencies to improve their services and interactions with citizens. Many studies have tested nudging interventions to encourage health behaviours such as exercise and diet.

Can PCC uptake be nudged?
We have not found any studies where nudging was used to increase PCC uptake. Nonetheless, there is substantial evidence that nudging can affect individual behavior for both the provider and the client.

Study purpose

The purpose of this study is to understand if and how nudging can be used to help healthcare professionals adopt PCC practices.

What Is Nudging?

Nudging is defined as “any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives” [1].

How Does Nudging Work?

The UK government’s Behavioral Insight Team has summarized the nine most robust and powerful mechanisms to affect behaviour under the acronym MINDSPACE [2]. Messenger: we are heavily influenced by who communicates information. Incentives: our responses to incentives are shaped by predictable mental shortcuts such as strongly avoiding losses. Norms: we are strongly influenced by what others do. Defaults: we “go with the flow‟ of pre-set options. Salience: our attention is drawn to what is novel and seems relevant to us. Priming: our acts are often influenced by subconscious cues. Affect: our emotional associations can powerfully shape our actions. Commitments: we seek to be consistent with our public promises, and reciprocate acts. Ego: we act in ways that make us feel better about ourselves.

Other commonly used mechanisms include: Framing, Anchoring, Hyperbolic discounting, Decoupling, and Availability Heuristics [3].

Nudging in Healthcare

Nudging has been successfully applied by governmental agencies to improve their services and interactions with citizens [4,5]. Many studies have tested nudging interventions to encourage health behaviours such as exercise and diet [6]. A few studies have looked at nudging health professionals, for example, towards better hand hygiene [7], or appropriate prescription of antibiotics [8].

Can PCC uptake be nudged?

We have not found any studies where nudging was used to increase PCC uptake. Nonetheless, there is substantial evidence that nudging can affect individual behavior for both the provider and the client. We believe that we can nudge PCC uptake by identifying the choices and contexts relevant PCC.

References

1] Thaler RH & Sunstein C (2008). Nudge: improving decisions about health, wealth, and happiness. Yale University Press.

[2] Dolan P et al. (2010). MINDSPACE: Influencing behavior through public policy. London: Cabinet Office.

[3]Schneider C et al. (2018). Digital Nudging–Guiding Choices by Using Interface Design, Communications of the ACM, 61(7), 67-73.

[4] Halpern D & Sanders M. (2016). Nudging by government: Progress, impact, & lessons learned. Behavioral Science & Policy, 2(2), pp. 53–65

[5] Richburg-Hayes et al. (2017). Nudging Change in Human Services.OPRE Report 2017-23. Washington, DC.

[6] Marteau TM et al.. (2011). Judging nudging: can nudging improve population health?. Bmj, 342, d228.

[7] M.G. Caris, H.A. Labuschagne, M. Dekker, M.H.H. Kramer, M.A. van Agtmael, C.M.J.E. Vandenbroucke-Grauls, Nudging to improve hand hygiene, Journal of Hospital Infection, Volume 98, Issue 4, 2018,Pages 352-358,

[8] Meeker D et al. (2014). Nudging Guideline-Concordant Antibiotic Prescribing: A Randomized Clinical Trial. JAMA Intern Med;174(3):425–431.

Primary investigator

RN/Assoc. Professor Axel Wolf (xwolax)

Researchers

Post-Doc Anita SantAnna

Post-Doc Andreas Vilhelmsson