Exploring the use of nudging in public health lifestyle interventions: A literature review

Abstract

Background The concept of nudging has been imported from behavioral economics into the public health context to correct 'unhealthy behaviours' and produce health-promoting behavior changes in individuals. However, there is lack of clarity as to what constitutes a nudge and whether nudging techniques in public health lifestyle interventions are effective. The aim of this literature review is to identify nudging techniques used in public health lifestyle interventions and to investigate whether nudging techniques induce expected healthy lifestyle changes in interventions that relate to diet, exercise, sleep, alcohol and smoking. Methods A systematic literature review on the concept “nudging” in public health lifestyle interventions was conducted, applying a free text search strategy on a set of search terms in three databases: PubMed, CINAHL and PsycINFO. Articles meeting the inclusion criteria were included in our data set, and we performed a meta-synthesis to construct interpretative explanations. Results 66 original studies published in international peer-reviewed journals were identified. The findings showed that most nudging interventions involved diet/nutrition (n = 55), were carried out as single experiments, lasted for a short period of time and that the majority had the intended effects. Specific nudging techniques were identified and sorted into eight broader categories. The most commonly used nudging technique involved making healthier food items more apparent and accessible than less healthy foods. Conclusions The synthesis showed that these studies were limited with regard to their design, target groups, duration of the intervention, measures of effectiveness and critical reflection on ethical issues. Key messages Nudging may be effective in producing immediate behavioral changes; however, there is little evidence that nudging interventions result in lasting behavioral changes outside the setting of the studies. Further critical discussions about the implications of nudging in public health lifestyles intervention are required.