Nudge – What Pushes Your Buttons?

By Noa L., Vaica

Olivia R. Van Wyck, contributor

In 2008, Richard Thaler and Cass Sunstein described the Nobel Prize winning idea “nudge” in their book entitled “Nudge – Improving Decisions about Health, Wealth and Happiness”. “Nudging” is the idea that behavior can be changed by understanding why that behavior occurs and attempting to make it easy to modify. A popular success story of “nudge” was in the UK pension policy. Previously, the employees had had to enroll themselves in the pension. However, the UK changed the policy so that the employee would be automatically enrolled and had to opt out if they wanted to be exempted. This made the decision to put money aside for retirement a much easier choice since they had to do nothing to enroll. This simple act increased pension savings significantly. Another area where “nudging” has been successful is in Spain where everyone is automatically enrolled in organ donation and have to opt out if they do not want to be organ donors. Because of this policy, Spain is the world leader in organ donation.

Is pension savings and organ donation the only area that this theory could be applied?

Recently, researchers at Intermountain Medical Center Heart Institute in Salt Lake City, Utah, had the idea to use “nudging” as a way to increase medication adherence. Intermountain and CareCentra teamed up for the 12-month trial called ENCOURAGE. CareCentra compiled patient data to be able to personalize “nudges” so that they are most effective for each individual patient. The four channels that “nudges” are delivered are through emails, texts, voice calls, or recordings. Researchers recently added social media, interaction with Alexa and interface with the Apple Watch. They know that with several channels available, some are better for certain nudges than others. These “nudges” are meant to help engage patients in their health and encourage them to make better choices concerning their health. “To utilize nudges, we must understand both physical health and the view the patients have of their world,” said Benjamin Horne, PhD in the article written about the ENCOURAGE trial. The study is set to end in February 2019 and so far has had good results.

Personally, I think that it is a good idea to try to apply the nudge theory to medication adherence. As stated above, the theory has shown to be very successful. If we can successfully apply the theory to medication adherence, then I think we could see significant improvement to the rate at which patients take their medication as directed. If it were me, I would like it if there was a way to make remembering to take my medication easier and helped me engage in my own best interests concerning my own healthcare. What “nudge” would help you?