Using Behavioral Nudges to Engage Pregnant Women in a Smoking Cessation Trial: An Online Field Quasi-Experiment

Frățilă, Teodora D; Meghea, Cristian

doi:10.3390/healthcare8040531

Cited by 3 publications

(5 citation statements)

References 23 publications

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“…Although the data we collect on failed and replaced neuraxial blocks are for the purpose of review and analysis for our own division, a simple intervention like this has potential to be implemented on a much larger scale and to make significant impact on patient care and cost-savings strategies for hospitals and healthcare systems. Nudge theory and choice architecture have been successfully used in the promotion of smoking cessation in pregnancy17 and pre-eclampsia prevention in obstetric patients 18. Particular to anaesthesiology, similar principles have been used to encourage adherence with guidelines for lung protective ventilation strategies during surgery,19 safer opioid prescribing practices,20 sedation minimisation and liberation from mechanical ventilation in the ICU21 and antibiotic stewardship 22.…”

Section: Discussionmentioning

confidence: 99%

Effect of an electronic medical record nudge to improve quality improvement program tracking of neuraxial catheter replacements in obstetric patients

Fedoruk,

Xie,

Wang

et al. 2023

BMJ Open Qual

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BackgroundMonitoring complications associated with medical procedures requires reliable and accurate record keeping. Nudge reminders executed by way of electronic medical record (EMR) alerts influence clinician behaviour. We hypothesised that the introduction of an EMR nudge would improve documentation of replaced neuraxial blocks by obstetric anaesthesiologists at our institution.MethodsWe developed an EMR nudge that would alert the physician to a replaced neuraxial block if two or more neuraxial procedure notes in a single patient encounter were detected. The nudge encouraged physicians to document neuraxial block replacements in our institution’s quality improvement database. We assessed the rate of physician adherence to replaced neuraxial block charting prior to the introduction of the nudge (January 2019–September 2019) and after the implementation (October 2019–December 2020).Results494 encounters during the chart review period, January 2019–December 2020, required a neuraxial block replacement, representing an actual neuraxial replacement rate of 6.3% prior to the introduction of the nudge in October 2019. This rate was largely unchanged (6.2%) after the introduction of the nudge (0.1% difference, 95% CI: −0.0119 to 0.0099). Prior to the introduction of the nudge, the proportion of correctly charted failed/replaced blocks in our quality improvement database was 80.0%, and after nudge introduction, the rate was 96.2% (p value <0.00001, OR=6.32, 95% CI: 3.15 to 12.66). A p-chart of the monthly adherence rate demonstrated sustained improvement over time.ConclusionsEMR nudge technology significantly improved adherence with quality metric monitoring of neuraxial catheter replacement in obstetric patients. The results imply that data collection for quality metric databases of neuraxial block failures and replacements that rely on clinician memory without a nudge are likely under-reporting neuraxial block failures and replacements. This study supports widespread implementation of nudges in EMRs to improve quality metric reporting.

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Section: Discussionmentioning

confidence: 99%

Effect of an electronic medical record nudge to improve quality improvement program tracking of neuraxial catheter replacements in obstetric patients

Fedoruk,

Xie,

Wang

et al. 2023

BMJ Open Qual

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“…However, more recent work in the psychology of decision-making has revealed that most decisions, including informed consent, are influenced by an array of deliberative and non-deliberative mechanisms, including a variety of factors that relate to the way in which the information is presented and framed [12,[42][43][44][45]. A recent study by Blaga, Frăţilă, and Meghea reported the effectiveness of leveraging non-deliberative behavioral influences to increase recruitment to a randomized controlled trial evaluating interventions to help pregnant women quit smoking [46]. One strategy was deployed in a Facebook ad for the trial that reads as follows: "Over 2000 future moms have already visited our website to learn more about the Quit Together program.…”

Section: Is It Ethical To Leverage Cognitive Biases?mentioning

confidence: 99%

“…Why not find out more about our free smoking cessation program?" [46]. This statement is intended to influence behavior by appealing to social norms.…”

Section: Is It Ethical To Leverage Cognitive Biases?mentioning

confidence: 99%

“…A second strategy was deployed on the trial's website. Here, pregnant women were cautioned, "By not enrolling, you may miss out on 8 free counseling sessions with a counselor specialized in [motivational techniques]" [46,48]. This behavioral influence works by exploiting "loss aversion, " which refers to the cognitive bias that people find losing something they already have more unpleasant than not gaining something of similar value [49].…”

Section: Is It Ethical To Leverage Cognitive Biases?mentioning

confidence: 99%

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Changing patient preferences toward better trial recruitment: an ethical analysis

Hey

Weijer

et al. 2023

Trials

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While randomized controlled trials are essential to health research, many of these trials fail to recruit enough participants. Approaching recruitment through the lens of behavioral science can help trialists to understand influences on the decision to participate and use them to increase recruitment. Although this approach is promising, the use of behavioral influences during recruitment is in tension with the ethical principle of respect for persons, as at least some of these influences could be used to manipulate potential participants. In this paper, we examine this tension by discussing two types of behavioral influences: one example involves physician recommendations, and the other involves framing of information to exploit cognitive biases. We argue that despite the apparent tension with ethical principles, influencing trial participants through behavior change strategies can be ethically acceptable. However, we argue that trialists have a positive obligation to analyze their recruitment strategies for behavioral influences and disclose these upfront to the research ethics committee. But we also acknowledge that since neither trialists nor ethics committees are presently well equipped to perform these analyses, additional resources and guidance are needed. We close by outlining a path toward the development of such guidance.

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“…For example, campaigns could potentially showcase how many people have quit smoking or reduced their alcohol intake. Highlighting social norms of healthier behaviors, such as emphasizing that most people do not smoke or only drink in moderation, can nudge individuals toward aligning their behavior with the norm (38).…”

Section: Tobacco and Alcohol Consumptionmentioning

confidence: 99%

Nudging oral habits; application of behavioral economics in oral health promotion: a critical review

Kazemian,

Hoseinzadeh,

Banihashem Rad

et al. 2023

Front. Public Health

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BackgroundOral health disorders significantly contribute to the global incidence of chronic diseases. Nudge interventions have demonstrated effectiveness in enhancing people’s decision-making and self-management capacities in a cost-efficient manner. As a result, these interventions could be valuable tools for fostering improved oral care habits. This critical review explores potential behavioral nudges applicable to promoting oral health.MethodsA thorough electronic literature search was conducted on Scopus, Embase, and PubMed databases for papers published post-2008. The search focused on empirical evidence concerning the direct and indirect application of Nudge theory in oral health enhancement. In addition, the investigation included the nudge intervention’s role in managing common non-communicable disease risk factors (tobacco, alcohol, and sugar) and their use in other health sectors.Results and conclusionThere is a dearth of studies on behavioral economics, particularly those involving reward and reminder techniques. However, various successful nudge interventions have been identified in other sectors that aim to improve health decisions. These include strategies encouraging healthier nutritional choices, tobacco and alcohol cessation, medication compliance, routine physical activity, and regular health check-ups. Such interventions can also have direct or indirect positive impacts on oral health. Implementing these interventions within an oral care framework could promote oral health due to similar underlying cognitive mechanisms. However, different types of nudge interventions have varying degrees of effectiveness. Furthermore, factors such as the method of delivery and the characteristics of the targeted population significantly influence the outcome of the intervention. Hence, it is imperative to conduct extensive studies in diverse socioeconomic settings to fully understand the potentials, limitations, and impacts of nudge interventions in promoting oral health.

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Using Behavioral Nudges to Engage Pregnant Women in a Smoking Cessation Trial: An Online Field Quasi-Experiment

Cited by 3 publications

References 23 publications

Effect of an electronic medical record nudge to improve quality improvement program tracking of neuraxial catheter replacements in obstetric patients

Effect of an electronic medical record nudge to improve quality improvement program tracking of neuraxial catheter replacements in obstetric patients

Changing patient preferences toward better trial recruitment: an ethical analysis

Nudging oral habits; application of behavioral economics in oral health promotion: a critical review

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