Elsevier

Health Policy

Volume 123, Issue 12, December 2019, Pages 1199-1209
Health Policy

The effectiveness of nudges in improving the self-management of patients with chronic diseases: A systematic literature review

https://doi.org/10.1016/j.healthpol.2019.09.008Get rights and content
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open access

Highlights

  • Nudges can enhance the self-management of patients with chronic diseases.

  • All nudges tested were grouped as type 2 nudges that influence (reflective) choices.

  • Positive effects are most evident for reminders, feedback, and planning prompts.

  • Studies are very heterogeneous in design, nudge types tested and outcome measures.

  • Evidence on nudges to improve chronic disease self-management is still sparse.

Abstract

In this systematic literature review, we identify evidence on the effectiveness of nudges in improving the self-management of adults with chronic diseases and derive policy recommendations. We included empirical studies of any design published up to April 12th, 2018. We synthesized the results of the studies narratively by comparing statistical significance and direction of different nudge types’ effects on primary study outcomes. Lastly, we categorized the nudges according to their degree of manipulation and transparency.

We identified 26 studies, where 13 were of high or moderate quality. The most commonly tested nudges were reminders, planning prompts, small financial incentives, and feedback. Overall, 8 of 9 studies with a high or moderate quality ranking, focused on self-management outcomes, i.e., physical activity, attendance, self-monitoring, and medication adherence, found that nudges had significant positive effects. However, only 1 of 4 studies of high or moderate quality, analyzing disease control outcomes (e.g., glycemic control), found that nudges had a significant positive effect for one intervention arm.

In summary, this review demonstrates that nudges can improve chronic disease self-management, but there is hardly any evidence to date that these interventions lead to improved disease control. Reminders, feedback, and planning prompts appear to improve chronic disease self-management most consistently and are among the least controversial types of nudges. Accordingly, they can generally be recommended to policymakers.

Keywords

Nudging
Behavioral economics
Chronic disease
Self-management
Systematic review
Effectiveness

Cited by (0)

This paper was published on behalf of the SUSTAIN consortium: Borja Arrue, Eliva Atieno Ambugo, Caroline Baan, Jenny Billings, Simone de Bruin, Michele Calabro, Nuri Cayuelas Mateu, Sandra Degelsegger, Mireia Espallargues Carreras, Erica Gadsby, Nick Goodwin, Terje Hagen, Christina Häusler, Viktoria Hoel, Henrik Hoffmann, Usman Khan, Julie MacInnes, Federica Margheri, Jenna McArthur, Maggie Langins, Manon Lette, Lina Masana, Mirella Minkman, Giel Nijpels, Konrad Obermann, Gerli Paat-Ahi, Jillian Reynolds, Mari Rull, Georg Ruppe, Monique Spierenburg, Annerieke Stoop, Lian Stouthard, Nhu Tram, Gerald Wistow and Nick Zonneveld.