Y H Kwan1, T Y Cheng2, S Yoon3, L Y C Ho4, C W Huang5, E H Chew2, J Thumboo6, T Østbye7, L L Low8. 1. Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, 20 College Road, Singapore 169856, Singapore; Department of Pharmacy, National University of Singapore, Singapore, Singapore. Electronic address: yuheng@u.duke.nus.edu. 2. Department of Pharmacy, National University of Singapore, Singapore, Singapore. 3. Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, 20 College Road, Singapore 169856, Singapore; PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore. 4. PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore. 5. Duke-NUS Medical School Singapore, Singapore, Singapore. 6. Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, 20 College Road, Singapore 169856, Singapore; Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore; NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 7. Program in Health Services and Systems Research, Duke-NUS Medical School Singapore, 20 College Road, Singapore 169856, Singapore. 8. PULSES Centre Grant, SingHealth Regional Health System, Singapore, Singapore; Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore, Singapore; Post Acute and Continuing Care, Outram Community Hospital, Singapore, Singapore; SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore.
Abstract
BACKGROUND: Diabetes is a chronic disease associated with a variety of complications, and nudging may be a potential solution to improve diabetes control. Since nudging is a new concept, no review of literature on nudging diabetic patients into improving their health behaviour has been done. Therefore, we aim to collate a list of nudge intervention and determine the context in which nudging is successful. METHODS: We adopted a two-arm search strategy comprising the search of literature databases and snowballing using relevant search terms. We summarized patient characteristics, the nudge intervention, according to nudging strategies, delivery mode and their outcomes. The conditions present in effective nudge interventions were assessed and reported. RESULTS: We retrieved 11,494 studies from our searches and included 33. An additional five studies were added through snowballing. Studies included utilized framing (n=5), reminders (n=10), gamification (n=2), social modelling (n=5) and social influence (n=16). Studies on reminders and gamification were more likely to have a statistically significant outcome. The targeted health behaviours identified were medication adherence, physical activity, diet, blood glucose monitoring, foot care, self-efficacy, HbA1c and quality of life. Of these, studies with adherence to medication, foot care practice and quality of life as targeted health behaviours were more likely to show a statistically significant outcome. CONCLUSION: Nudging has shown potential in changing health behaviour of patients with diabetes in specific context. We identified two possible factors (delivery mode and patient characteristics) that may affect the effectiveness of nudge intervention.
BACKGROUND:Diabetes is a chronic disease associated with a variety of complications, and nudging may be a potential solution to improve diabetes control. Since nudging is a new concept, no review of literature on nudging diabeticpatients into improving their health behaviour has been done. Therefore, we aim to collate a list of nudge intervention and determine the context in which nudging is successful. METHODS: We adopted a two-arm search strategy comprising the search of literature databases and snowballing using relevant search terms. We summarized patient characteristics, the nudge intervention, according to nudging strategies, delivery mode and their outcomes. The conditions present in effective nudge interventions were assessed and reported. RESULTS: We retrieved 11,494 studies from our searches and included 33. An additional five studies were added through snowballing. Studies included utilized framing (n=5), reminders (n=10), gamification (n=2), social modelling (n=5) and social influence (n=16). Studies on reminders and gamification were more likely to have a statistically significant outcome. The targeted health behaviours identified were medication adherence, physical activity, diet, blood glucose monitoring, foot care, self-efficacy, HbA1c and quality of life. Of these, studies with adherence to medication, foot care practice and quality of life as targeted health behaviours were more likely to show a statistically significant outcome. CONCLUSION: Nudging has shown potential in changing health behaviour of patients with diabetes in specific context. We identified two possible factors (delivery mode and patient characteristics) that may affect the effectiveness of nudge intervention.