Nudging, and Other Applications

Take a look at further research being done in the realm of cognitive bias. This tile provides insight into how research on cognition has led the way for potential applications in healthcare and policymaking.

Richard Thaler’s Nudge Theory

Richard Thaler and Cass Sunstein’s 2008 book Nudge: Improving Decisions about Health, Wealth, and Happiness introduced the concept of nudges. Drawing from the idea that irrationality pushes humans to act in predictable ways, the book claimed that nudges could leverage our biases and steer action in a particular direction. 

The idea swiftly gained popularity and drew interest from policymakers, business executives, and marketing folk. Many liked that these interventions do not take away people’s ability to choose – there is no coercion or restriction involved. A nudge simply influences behavior by modifying the context in which people make decisions. It could be as simple as rearranging the way menu options are laid out to encourage customers to opt for something healthier.

The cost-effectivity and simplicity of nudges, and the fact that they are not quite as contentious as taxes or bans, endeared them to policymakers who saw them as an easy way to effect changes in policy. Since then, nudges have been used to promote smoking cessation, improve hand hygiene, and increase employee productivity.

Nudges in personalized medicine

The healthcare industry has also explored the potential benefit of nudges in improving patient care through personalized medicine. Innovations in consumer health technology like mobile health apps and wearables have allowed patients to track their health data in real time. Furthermore, patient data such as physical activity, vital signs, and medication adherence can be transmitted to update patient health records. 

Going a step further, consumer health technologies can now deliver personalized medicine in the form of nudges. By using health data, artificial intelligence can glean patient insight and formulate effective nudges specifically designed for the patient.

The use of these technologies is still in its early days. Further study needs to be done to assess the effectiveness of these tools in improving the delivery of care. At this time, user adoption is still low, as concerns about data security have been raised. Companies will have to adopt regulatory frameworks to address patients’ data concerns.

Adoption of and skepticism toward nudges

Among the early adopters of nudging was the UK government, which set up the Behavioral Insights Team (BIT) in 2010. One of the BIT’s first projects was to use nudges to encourage payment of past-due taxes. Through a carefully worded letter sent to delinquent taxpayers, the project contributed an extra £200 million in revenue for HM Revenue and Customs in its first year – equivalent to 6% of letter recipients [32]. Since then, other countries have followed suit and set up their own nudge units.

Aside from government, businesses enthusiastically welcomed the idea of nudging. Companies have used nudges to improve customer satisfaction, encourage employee retention, and avoid workplace incidents.

Nudging has its fair share of critics, who have raised questions about its ethicality. Though nudges are primarily used to help people make better decisions, a line must be drawn between encouragement and manipulation. Nudging may also be used for malicious purposes just as easily as for good intent. Lastly, further studies need to be done to determine how effective nudging really is.

Cognitive bias modification

Cognitive bias modification (CBM) is a relatively new technique that aims to address mental conditions by targeting underlying cognitive biases. CBM rests on the idea that people with conditions like depression and anxiety are vulnerable to attention bias and interpretation bias. For example, someone with anxiety is more alert to threats than average. CBM uses computerized activities like the ‘dot-probe task’ to train individuals to be less sensitive to negative stimuli. 

Since tasks are delivered through computers or mobile phones, CBM is easily accessible to patients. In terms of effectiveness, an early study showed that eight 15-minute sessions of CBM helped 72% of subjects with social anxiety disorder. Results were still evident in patients four months later [33]. That said, proponents of CBM suggest using it to complement (not replace) traditional treatment methods.

While early research shows promise, overall reception thus far has been mixed. However, the lukewarm reception has not discouraged researchers from exploring CBM’s potential use in post-traumatic stress disorder and addiction issues. Watch this space as further studies are being conducted.

The MINDSPACE framework

Similar to Thaler’s nudging, the MINDSPACE framework applies behavioral science concepts in promoting behavioral change. The framework encourages policymakers to design programs with the understanding that human behavior is driven by system 1 thinking, the intuitive mind. This is a clear shift from the traditional focus on facts and information, dominated by system 2 thinking. 

A product of the UK Cabinet Office’s attempts to improve policymaking, ‘MINDSPACE’ identifies nine elements behind human behavior – Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments, and Ego. Instead of explaining how a policy benefits constituents, changing the context in which decisions are made – any of the nine elements identified by the framework – is more effective in promoting behavior change.

Applying this thinking, policies should make the desired behavior frictionless, effortless, and natural, or otherwise regarded as a norm or societal expectation. How policies are framed – and who provides recommendations – matters. Humans tend to follow through on behavior changes recommended by experts they respect, or if it makes them feel better about themselves.

Applying MINDSPACE in policy

The UK’s Behavioral Insight Team has supplemented the MINDSPACE framework with the 4Es policy framework, which has been used in prior behavior change programs. The 4Es refer to the four actions that government needs to undertakle when trying to sway human behavior – Enable, Encourage, Engage, and Exemplify. To this, the BIT suggests two more Es – Explore and Evaluate.

One of the programs born out of the MINDSPACE framework was the ‘Get Braids Not AIDS’ campaign in Zimbabwe. This program relied on hairdressers to serve as effective messengers of information on female contraceptives. Women were more receptive to advice from their hairdressers because they were perceived as friendly and supportive, offering a safe space to discuss personal issues. Study results report that, among participants, female condom use increased from 15% to 28% [34]. However, the issue of continued use persists since half of the women reported using the contraceptive only once. As with other behavior change policies, ensuring that behavior change is sustainable is an area for improvement.

Sources

[32] Doshi, M. (2017, June 10). How the British government got more citizens to pay their taxes on time. BloombergQuint. https://www.bloombergquint.com/politics/uk-the-nudge-unit-uses-behavioural-science-to-influence-policy-outcomes-such-as-improved-tax-collections-and-pension-enrolment

[33] https://www.apa.org/monitor/2011/11/behavior-change

[34] https://www.bi.team/wp-content/uploads/2015/07/MINDSPACE.pdf

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