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Applying NUDGE to Inform Design of EBP Implementation Strategies in Community Mental Health Settings

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Abstract

We demonstrate the application of NUDGE (Narrow, Understand, Discover, Generate, Evaluate), a behavioral economics approach to systematically identifying behavioral barriers that impede behavior enactment, to the challenge of evidence-based practice (EBP) use in community behavioral health. Drawing on 65 clinician responses to a system-wide crowdsourcing challenge about EBP underutilization, we applied NUDGE to discover, synthesize and validate specific behavioral barriers to EBP utilization that directly inform the design of tailored implementation strategies. To our knowledge, this is the first study to apply behavioral economic insights to clinician-proposed solutions to implementation challenges in order to design implementation strategies. The study demonstrates the successful application of NUDGE to implementation strategy design and provides novel targets for intervention.

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Acknowledgements

We are especially grateful for the support that DBHIDS has provided for this project. We gratefully acknowledge Emily Becker-Haimes, Sriram Sridharan and Molly Candon for their assistance with hypothesis generation and confirmation. We would also like to thank all of the clinicians who participated in the innovation tournament and all who helped recruit those clinicians, making it possible.

Funding

P50MH113840 (Beidas, Mandell, Volpp).

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Authors and Affiliations

  1. Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Rebecca E. Stewart, Rinad S. Beidas & Y. Vivian Byeon

  2. Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA

    Briana S. Last

  3. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Rinad S. Beidas

  4. Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA

    Rinad S. Beidas

  5. Center for Health Incentives and Behavioral Economics, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

    Alison M. Buttenheim

  6. Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA

    Nathaniel J. Williams

  7. Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

    Katelin Hoskins & Alison M. Buttenheim

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  1. Rebecca E. Stewart
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All authors substantially contributed to the conception, design, and analysis of the work and provided final approval of the version to be published.

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Correspondence to Rebecca E. Stewart.

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Stewart, R.E., Beidas, R.S., Last, B.S. et al. Applying NUDGE to Inform Design of EBP Implementation Strategies in Community Mental Health Settings. Adm Policy Ment Health 48, 131–142 (2021). https://doi.org/10.1007/s10488-020-01052-z

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