Should you be 'nudged' into better health without knowing it?
Published on the 04 October 2017 by School of Psychology
ճof “nudging” is based on the idea we can push people gently towards doing what’s best for their health.
But what isbest? And who gets to decide?Is it your mum, your doctor, the health department or you?
When could nudging help?
ճis that a benevolent "choice architect"can rearrange information and the environment to make it easier for us to do the "right thing"while preserving our freedom of choice.
The choice architect could be an organisation like theor theNew South Wales Behavioural Insights Unit. But it could also be an individual person in control of your environment, like a shop owner, a school principal or your boss.
The right thing isas something that improves public well-being with minimal cost to individual well-being.
Examples of how nudging is being used to influence our health choices in Australia include:
campaigns to reduce the unnecessary use of antibiotics, such as getting doctors and patients to. This aims to increase your commitment to doing something you agree with
ԳٰǻܳԲfor cigarettes. This reduces the influence of marketing and reminds people of the consequences of smoking without restricting availability or choice of cigarettes brands
from an "opt in"system to an "opt out"system. This idea hasof organ donation registration in other countries, where it is still easy to opt out if you have objections to joining.
When is nudging controversial?
Nudging can be controversial. Many health situations involve a trade-off between benefits and side-effects, length of life and quality of life, or individual freedom and public cost.
Deciding what's best gets complicated when people value different things, and this can vary by.
For example, guidelines to prevent heart disease and stroke recommendfrom medication to reduce their risk, including healthy people.
Is it OK to nudge healthy people into taking medication if we know it will reduce their risk?
Some might agree thatit's worth the cost, inconvenience and potential side-effects of cholesterol-lowering medication to reduce their risk of a heart attack or stroke in the next five years from.
But others may preferto change their diet and exercise habits to reduce their risk. Older people may decide it's not worth theif they add blood pressure-lowering medication to their existing medications.
Some people may be comfortable with this level of risk and decide to do nothing at all.
If we nudge people in a way they are not aware of, these different values and preferences aren'tincluded when deciding which option to take.
Researchsuggests thatpeoplewhen they are being nudged, and why the choice architect has chosen a particular course of action.
What options are there?
Even when we think about the same sort of health decision (for instance, how we use antibiotics),choice architects could use different approaches. Some are more obviousor offer more choicethan others:
shared decision makingas the "gold standard". This process allows doctors and patients to talk through the options, and the evidence for their benefits and harms. One example is to use ato explain how ais likely to disappear in a few days whether or not you take antibiotics
explicit nudgemoves people towards the "right"choice when they want to help themselves make a change or hadn’t realised they are an outlier compared with their peers. This could encourage GPs who prescribe the most antibiotics to commit to not using them unnecessarily for cold and flu over winter
implicit nudgemoves people towards the "right"choice without stating this directly. Thiswhen everyone agrees on what should be done (or would agree if they were asked) but habit, time limitations or effort prevents them from following through. An example of this might be setting the "right"default in software that hospital doctors use when prescribing medicines to encourage them to use antibiotics appropriately
regulationmay be considered more paternalistic but thisto restrict options that have serious adverse consequences for the public or individuals. This option might be appropriateto make it difficult for doctors to prescribe the strongest antibiotics and so reserve them for serious antibiotic-resistant infections.
What can you do?
If you need to make a decision about your healthand are concerned about the direction in which you might be being nudged, you can ask you doctor or health care professionalthe following:
- do I really need this test, treatment or procedure?
- what are the risks?
- are there simpler, safer options?
- what happens if I don’t do anything?
- what are the costs?
You could also look for; these can help you to better understand the benefits and potential consequencesof all options for a range of common health conditions.
is aResearch Fellow,.Professor of Cognitive Psychology,.
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