Article Text

The challenges and opportunities of ‘nudging’
1. Cristiano Codagnone1,2,
2. Giuseppe Alessandro Veltri3,2,
3. Francisco Lupiáñez-Villanueva4,2,
4. Francesco Bogliacino5,2
1. 1Dipartimento di Scienze Sociali e Politiche, Universitá degli Studi di Milano, Milano, Italy
2. 2Applied Social Science and Behavioural Economics research group Universitat Oberta de Catalunya, Barcelona, Spain
3. 3Department of Media and Communication, University of Leicester, Leicester, UK
4. 4Estudís de Ciències de la Informació i la Comunicació, Universitat Oberta de Catalunya, Barcelona, Spain
5. 5Fundación Universitaria ‘Konrad Lorenz’, Bogota, Colombia
1. Correspondence to Dr Francisco Lupiáñez-Villanueva, Estudís de Ciencies de la Informació i la Comunicació, Universitat Oberta de Catalunya, Rambla de Poblenou 156 08018 Barcelona Spain USA; flupianez{at}uoc.edu

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## Introduction

Consider the following selective evidence of human behaviour in the domain of healthcare. The numeric-cognition feeds typically provided during public vaccination campaigns are less effective than affect-based perception of risk.1 It is common to avoid seeing doctors and/or doing health checks because of anxiety and fear of receiving bad results. The latter means that a perceived ‘loss today’ in the health status has a stronger impact than a ‘gain tomorrow’, namely preventing or curing a potential disease.2 Clinicians fail to act on available knowledge and guidelines despite the intention to do so.3

Instead, consider now the following couple of examples of choice architectures capable of offsetting erroneous conducts. Recent trial studies show that it is enough to change the default settings of electronic order sets to dramatically ‘improve’ clinicians prescribing behaviours.4 A lottery-based financial incentive increased warfarin adherence and anticoagulation control.5

What do these examples have in common? They exemplify the heuristics and biases and the counteracting ‘nudges’ that in the past decade have been presented as part of a behavioural sciences-dictated policy agenda. Altering prescription activities by changing defaults in electronic order sets, for instance, is just a very simple example of a ‘nudge’ leveraging the ‘status quo bias’ to steer clinicians toward a ‘normatively’ defined ‘better’ behaviour. This is achieved by framing the choice set without restricting available options, in other words, acting over presentation of the decision problem, and not on the constraints for the decision maker. This philosophy of policy intervention has been labelled ‘libertarian paternalism’ because by not affecting the options available in the choice set it can be deemed to be libertarian from a consequentialist point of view, while being paternalistic in the sense of trying to induce ‘better’ choices.6

The approach is grounded in behavioural economics (BE), …

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## Footnotes

• Contributors All the authors have made substantial contributions to the manuscript revising it critically for important intellectual content. All the authors have approved the manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

• Competing interests None.

• Provenance and peer review Commissioned; externally peer reviewed.