Nudged to Budge

What if I told you IKEA’s meatballs are so cheap so you’ll think that the soft, suede couch is equally as affordable? What if I told you your supermarket intentionally puts the bakery at the store entrance so you’ll feel happy, relaxed, and shop for longer?

We’ve weaved psychology into a countless number of industries. It’s about time it’s made it into health care design.

Enter behavioral economics. The antithesis to classical economics, it combines neuroscience and psychology to argue that we’re actually not that rational. We’re not very good at making logical decisions. We really don’t know what we want.

The good news?

All this irrationality is predictable. We have a preference for the status quo and for instant gratification. We have an aversion to loss.

Traditionally in disease prevention, public health has encouraged education. It connects people with information. Smoking cessation brochures and black and white nutrition labels. Activity trackers and calorie counter apps. The more facts you have, the healthier decisions you’ll make… right? But, despite the abundance of information, a weight loss app doesn’t make you lose weight. And we continue to give into that cigarette or extra spoonful of nutella. While education is necessary, it’s just the first step.

Informed by behavioral economics, we can restructure the architecture of options to positively influence health decisions.

People can be nudged to budge.

Let’s look at an example in digital health to unpack this a bit.

Consider Walter. He’s a 65-year-old patient who just got out of the hospital for complications related to his type 2 diabetes. He could become one of the many people on blood sugar medications that don’t take their drugs, regardless of being armed with educational materials. He could be readmitted to the hospital due to medication nonadherence, a problem which leads to an estimated $300 billion in losses to the US healthcare system yearly.

OR, Walter could beat the odds by enrolling in the mobile app program, Wellth. This program applies behavioral economics principles to help people adhere to their medications. It’s user-friendly and designed with an often poor, low-educated, and elderly population in mind.

Here’s how it works…

Upon enrollment, Walter receives $150. Each day, he sends a picture of his medication in his hand to verify he successfully takes it. If he skips a day, he loses $2. If he complies with the regimen after a three-month period, he gets to keep the money. This approach appeals to his strong sense of loss aversion and preference for immediate financial incentives.

Does it create lasting behavior change?

Wellth reports that 84% of their users adhere to their daily medications 80% of the time. In the general population, these adherence numbers are usually closer to 50%. Literature even confirms that changes from programs of the same length extend beyond this incentive period. The behaviors are sticking.

This time, we’re not just trying to sell suede couches. We’re tapping into health promotion potential at an individual, societal, and systemic level. We’re protecting autonomy by not limiting choices but reframing them. We’re coupling technology with behavioral insights. We’re activating the triggers that motivate people.

Start nudging, start budging.