Skip to main content

Nudging to Change, the Role of Digital Health

  • Chapter
  • First Online:
Digital Health

Part of the book series: Health Informatics ((HI))

  • 726 Accesses

Abstract

The use of nudges, i.e., design changes in the way choices are presented to steer users towards predetermined choices, has dramatically increased over the last few years. These interventions have moved online to become digital and are present across many fields from politics to healthcare. As the use of these mechanisms in healthcare has grown exponentially recently, it is crucial to understand the opportunities they offer and the risks they pose. However, at this stage, such an analysis is lacking. This chapter specifically addresses this issue by (1) analyzing how digital nudges can be applied in the continuum of care and (2) mapping the current empirical research landscape on the topic. To do so, this chapter presents a scoping review of the literature by searching relevant research in the electronic database of JMIR (Journal of Medical Internet Research). The search yielded 150 unique articles, of which 19 articles satisfied the criteria for inclusion in this study. The results indicate that feedback and reminders are the most commonly used digital nudges for behavior change in digital health. Moreover, the results show that most digital nudges research focuses on prevention and the post-acute phase of the continuum of care, with none of the studies investigating nudges for the acute phase. Finally, the results indicate that current empirical research on digital nudging in healthcare rarely discusses ethical considerations.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  • Åberg F, Helenius-Hietala J, Puukka P, Jula A. Binge drinking and the risk of liver events: a population-based cohort study. Liver Int. 2017;37(9):1373–81.

    Article  PubMed  Google Scholar 

  • Angellotti E, Wong JB, Pierce A, Hescott B, Pittas AG. Combining wireless technology and behavioral economics to engage patients (WiBEEP) with cardiometabolic disease: a pilot study. Pilot Feasibility Stud. 2019;5(1):1–6.

    Article  Google Scholar 

  • Arigo D, Suls JM. Smartphone apps providing social comparison for health behavior change: a need for better tailoring to person and context. Mhealth. 2018;4:46.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bakker EA, van Bakel BM, Aengevaeren WR, Meindersma EP, Snoek JA, Waskowsky WM, van Kuijk AA, Jacobs MM, Hopman MT, Thijssen DH, et al. Sedentary behaviour in cardiovascular disease patients: risk group identification and the impact of cardiac rehabilitation. Int J Cardiol. 2021;326:194–201.

    Article  PubMed  Google Scholar 

  • Boillat T, Grantcharov P, Rivas H. Increasing completion rate and benefits of checklists: prospective evaluation of surgical safety checklists with smart glasses. JMIR Mhealth Uhealth. 2019;7(4):e13447.

    Article  PubMed  PubMed Central  Google Scholar 

  • Caraban A, Karapanos E, Gonçalves D, Campos P. 23 ways to nudge: a review of technology-mediated nudging in human-computer interaction. In: Proceedings of the 2019 CHI conference on human factors in computing systems; 2019. p. 1–15.

    Google Scholar 

  • Chokshi NP, Adusumalli S, Small DS, Morris A, Feingold J, Ha YP, Lynch MD, Rareshide CA, Hilbert V, Patel MS. Loss-framed financial incentives and personalized goal-setting to increase physical activity among ischemic heart disease patients using wearable devices: the active reward randomized trial. J Am Heart Assoc. 2018;7(12):e009173.

    Article  PubMed  PubMed Central  Google Scholar 

  • Clayton N, Rodriguez LM, Rinker DV, Gonzales RG, Agana M, Tackett JL, Foster DW. Efficacy of personalized normative feedback as a brief intervention for college student gambling: a randomized controlled trial. J Consult Clin Psychol. 2015;83(3):500.

    Article  Google Scholar 

  • Cohen AB, Dorsey E, Mathews SC, Bates DW, Safavi K. A digital health industry cohort across the health continuum. NPJ Digit Med. 2020;3(1):1–10.

    Article  Google Scholar 

  • Cortés-Pérez I, Nieto-Escamez FA, Obrero-Gaitán E. Immersive virtual reality in stroke patients as a new approach for reducing postural disabilities and falls risk: a case series. Brain Sci. 2020;10(5):296.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ensaff H, Homer M, Sahota P, Braybrook D, Coan S, McLeod H. Food choice architecture: an intervention in a secondary school and its impact on students’ plant-based food choices. Nutrients. 2015;7(6):4426–37.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ford AL, Bergh C, Södersten P, Sabin MA, Hollinghurst S, Hunt LP, Shield JP. Treatment of childhood obesity by retraining eating behaviour: randomised controlled trial. BMJ. 2010;340:b5388.

    Article  Google Scholar 

  • Forwood SE, Ahern AL, Marteau TM, Jebb SA. Offering within-category food swaps to reduce energy density of food purchases: a study using an experimental online supermarket. Int J Behav Nutr Phys Act. 2015;12(1):1–10.

    Article  Google Scholar 

  • Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, Rodgers A, Cairns J, Kenward MG, Roberts I. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011;378(9785):49–55.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gold N, Lin Y, Ashcroft R, Osman M. ‘Better off, as judged by themselves’: do people support nudges as a method to change their own behavior? Behav Public Policy. 2020:1–30.

    Google Scholar 

  • Horne BD, Muhlestein JB, Lappé DL, May HT, Le VT, Bair TL, Babcock D, Bride D, Knowlton KU, Anderson JL. Behavioral nudges as patient decision support for medication adherence: the encourage randomized controlled trial. Am Heart J. 2022;244:125–34.

    Article  PubMed  Google Scholar 

  • Intille SS, Kukla C, Farzanfar R, Bakr W. Just-in-time technology to encourage incremental, dietary behavior change. In: AMIA annual symposium proceedings, 2003. American Medical Informatics Association; 2003. p. 874.

    Google Scholar 

  • Jesse M, Jannach D. Digital nudging with recommender systems: survey and future directions. Comput Hum Behav Rep. 2021;3:100052.

    Article  Google Scholar 

  • Karlsen R, Andersen A. Recommendations with a nudge. Technologies. 2019;7(2):45.

    Article  Google Scholar 

  • Kelly JA. Behavior changes & disease prevention: MCW research shows effectiveness of HIV/AIDS risk reduction interventions. Medical College of Wisconsin. WMJ. 2000;99(1):41–3.

    CAS  PubMed  Google Scholar 

  • Krakauer JW, Cortés JC. A non-task-oriented approach based on high-dose playful movement exploration for rehabilitation of the upper limb early after stroke: a proposal. NeuroRehabilitation. 2018;43(1):31–40.

    Article  PubMed  Google Scholar 

  • Lehmann BA, Chapman GB, Franssen FME, Kok G, Ruiter RAC. Changing the default to promote influenza vaccination among health care workers. Vaccine. 2016;34(11):1389–92.

    Article  PubMed  Google Scholar 

  • Levy N. Nudges in a post-truth world. J Med Ethics. 2017;43(8):495–500.

    Article  PubMed  Google Scholar 

  • Marucci S, De Iaco G, Lisco G, Mariano F, Giagulli VA, Guastamacchia E, De Pergola G, Triggiani V Eating disorders and type 1 diabetes: a perspective. Endocr Metab Immune Disord Drug Targets. 2021. https://doi.org/10.2174/1871530321666211109152353

  • Milkman KL, Patel MS, Gandhi L, Graci HN, Gromet DM, Ho H, Kay JS, Lee TW, Akinola M, Beshears J, et al. A megastudy of text-based nudges encouraging patients to get vaccinated at an upcoming doctor’s appointment. Proc Natl Acad Sci. 2021;118(20):e2101165118.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Neto OL, Haenni S, Phuka J, Ozella L, Paolotti D, Cattuto C, Robles D, Lichand G. Combining wearable devices and mobile surveys to study child and youth development in Malawi: implementation study of a multimodal approach. JMIR Public Health Surveill. 2021;7(3):e23154.

    Article  Google Scholar 

  • Ockene JK, Ma Y, Zapka JG, Pbert LA, Goins KV, Stoddard AM. Spontaneous cessation of smoking and alcohol use among low-income pregnant women. Am J Prev Med. 2002;23(3):150–9.

    Article  PubMed  Google Scholar 

  • Okeke F, Sobolev M, Estrin D. Towards a framework for mobile behavior change research. In: Proceedings of the technology, mind, and society; 2018. p. 1–6.

    Google Scholar 

  • Perez-Marcos D, Chevalley O, Schmidlin T, Garipelli G, Serino A, Vuadens P, Tadi T, Blanke O, Millán JDR. Increasing upper limb training intensity in chronic stroke using embodied virtual reality: a pilot study. J Neuroeng Rehabil. 2017;14(1):1–14.

    Article  Google Scholar 

  • Purohit AK, Holzer A. Functional digital nudges: identifying optimal timing for effective behavior change. In: Extended abstracts of the 2019 CHI conference on human factors in computing systems; 2019. p. 1–6.

    Google Scholar 

  • Purohit AK, Holzer A. Unhooked by design: scrolling mindfully on social media by automating digital nudges; 2021.

    Google Scholar 

  • Reijula S, Hertwig R. Self-nudging and the citizen choice architect. Behav Public Policy. 2022;6(1):119–49.

    Article  Google Scholar 

  • Sasco AJ, Secretan MB, Straif K. Tobacco smoking and cancer: a brief review of recent epidemiological evidence. Lung Cancer. 2004;45:S3–9.

    Article  PubMed  Google Scholar 

  • Shah N, Adusumalli S. Nudges and the meaningful adoption of digital health. Pers Med. 2020;17:429.

    Article  CAS  Google Scholar 

  • Spring K, Gouze N, Galvin P, Gramatica F, Weltring KM. A model for a life-long personalised continuum of integrated care revolutionising healthcare delivery: description of technological impact. Berlin: Institute for Innovation and Technology; 2020.

    Google Scholar 

  • Stallones RA. The association between tobacco smoking and coronary heart disease. Int J Epidemiol. 2015;44(3):735–43.

    Article  PubMed  Google Scholar 

  • Stuart Mills. Nudge/sludge symmetry: on the relationship between nudge and sludge and the resulting ontological, normative and transparency implications. Behav Public Policy. 2020:1–24.

    Google Scholar 

  • Sunstein CR, Thaler RH. Nudge: improving decisions about health, wealth, and happiness. New Haven, CT: Yale University Press; 2008.

    Google Scholar 

  • Suzuki Y, Sukegawa A, Ueda Y, Sekine M, Enomoto T, Miyagi E, et al. Effect of a brief web-based educational intervention on willingness to consider human papillomavirus vaccination for children in Japan: randomized controlled trial. J Med Internet Res. 2021;23(9):e28355.

    Article  PubMed  PubMed Central  Google Scholar 

  • Thaler RH. Nudge, not sludge. Science. 2018;361(6401):431.

    Article  CAS  PubMed  Google Scholar 

  • Thaler RH, Sunstein CR, Balz JP. Choice architecture. In: The behavioral foundations of public policy. Princeton, NJ: Princeton University Press; 2014.

    Google Scholar 

  • Tversky A, Kahneman D. The framing of decisions and the psychology of choice. In: Behavioral decision making. Boston, MA: Springer; 1985. p. 25–41.

    Google Scholar 

  • Valle CG, Nezami BT, Tate DF. Designing in-app messages to nudge behavior change: lessons learned from a weight management app for young adults. Organ Behav Hum Decis Process. 2020;161:95–101.

    Article  Google Scholar 

  • Van Dalen HP, Henkens K. Comparing the effects of defaults in organ donation systems. Soc Sci Med. 2014;106:137–42.

    Article  PubMed  Google Scholar 

  • Wang YC, Chou MY, Liang CK, Peng LN, Chen LK, Loh CH. Post-acute care as a key component in a healthcare system for older adults. Ann Geriatr Med Res. 2019;23(2):54.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wang Z, Luo Y, Yang S, Zou K, Pei R, He J, Deng Y, Zhou M, Zhao L, Guo H. Premature deaths caused by smoking in Sichuan, Southwest China, 2015–2030. Sci Rep. 2021;11(1):1–8.

    Google Scholar 

  • Weinmann M, Schneider C, Vom Brocke J. Digital nudging. Bus Inf Syst Eng. 2016;58(6):433–6.

    Article  Google Scholar 

  • Wyse R, Delaney T, Stacey F, Lecathelinais C, Ball K, Zoetemeyer R, Lamont H, Sutherland R, Nathan N, Wiggers JH, et al. Long-term effectiveness of a multistrategy behavioral intervention to increase the nutritional quality of primary school students’ online lunch orders: 18-month follow-up of the click & crunch cluster randomized controlled trial. J Med Internet Res. 2021a;23(11):e31734.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wyse R, Delaney T, Stacey F, Zoetemeyer R, Lecathelinais C, Lamont H, Ball K, Campbell K, Rissel C, Attia J, et al. Effectiveness of a multistrategy behavioral intervention to increase the nutritional quality of primary school students’ web-based canteen lunch orders (click & crunch): cluster randomized controlled trial. J Med Internet Res. 2021b;23(9):e26054.

    Article  PubMed  PubMed Central  Google Scholar 

  • Xu Z, Geng J, Zhang S, Zhang K, Yang L, Li J, Li J, et al. A mobile-based intervention for dietary behavior and physical activity change in individuals at high risk for type 2 diabetes mellitus: randomized controlled trial. JMIR Mhealth Uhealth. 2020;8(11):e19869.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We appreciate the help of Satyam V Purohit for his assistance with screening of the research papers.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Adrian Holzer .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Purohit, A.K., Schöbel, S., Bill, O., Holzer, A. (2023). Nudging to Change, the Role of Digital Health . In: Rivas, H., Boillat, T. (eds) Digital Health. Health Informatics. Springer, Cham. https://doi.org/10.1007/978-3-031-17666-1_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-17666-1_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-17665-4

  • Online ISBN: 978-3-031-17666-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics