Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Abstract

SummaryObjectives: To assess the feasibility in routine primary care consultation and investigate the effect on risk recall and self-management of a new type of risk communication intervention based on behavioural economics ("nudge-based") for people with Type 2 diabetes mellitus (T2DM).Methods: Forty adults with poorly controlled T2DM (HbA1c > 7.5%) were randomized to receive a personalized, nudge-based risk communication intervention (n = 20) or standard care (n = 20). Risk recall and self-management were evaluated at baseline and 12 weeks after the intervention.Results: Both in terms of feasibility and acceptability, this new risk communication intervention was very satisfactory. Study retention rate after 12 weeks was very high (90%) and participants were highly satisfied with the intervention (4.4 out of 5 on the COMRADE scale). Although not powered to identify significant between-group effects, the intervention significantly improved risk recall after 12 weeks and intentions to make lifestyle changes (dietary behaviour) compared to standard care. Conclusions:This pilot study provides the first evidence of the feasibility of implementing in primary care a nudge-based risk communication intervention for people with T2DM. Based on the promising results observed, an adequately powered trial to determine the effectiveness of the intervention on long-term self-management is judged feasible. As a result of this feasibility study, some minor adaptations to the intervention and study methods that would help to facilitate a definitive trial are also reported. K E Y W O R D Sbehavioural economics, pilot randomized trial, primary care, risk communication, selfmanagement, Type 2 diabetes

The Role of the Representativeness Heuristic in Probability Judgments of Heart Attack and Coronary Heart Disease

“…Ideally, communication and intervention efforts should be based on and framed in relation to the psychological mechanisms through which information is processed. By studying patients' heuristic thinking, programs and interventions can be designed with the prevalence and configuration of these heuristics in mind (Rouyard et al, 2018).…”

“…This study adds to the growing literature addressing heuristics in adherence and T2D. While previous publications had studied the representativeness heuristic with experiments in non-clinical samples through hypothetical vignettes (Kahneman & Tversky, 1972), with experimental designs focusing on real risks in clinical samples (Rouyard et al, 2018), and through qualitative methods (Elstad et al, 2012), ours is distinguished by using a larger sample size to seek for quantitative evidence of natural applications of the heuristic in natural settings while controlling for alternative models of risk perception. Qualitative studies based on hypothetical vignettes are useful for more general inquiries and for exploring the general perceptions of participants but may not offer the same level of standardization and precision for describing and comparing individuals, groups, and parameter effect sizes.…”

“…The representativeness heuristic could have been used by 5 participants when – rather than following the physician’s pill-taking instructions – they took the recommendation of a family member arguably because it fit the typical pill-taking strategy known to them. Rouyard et al (2018) studied the effect of a new type of risk communication intervention on risk recall and self-management based on behavioral economics (a “nudge-based” intervention) for people with type 2 diabetes mellitus (T2D). To increase the patients’ perception that their heart risk is a salient trait and that they are representative of a high-risk case, the 10-year cardiovascular risk was framed as the effective heart age , that is, the chronological age of a person with well-controlled diabetes with the same amount of risk.…”

An Intuitive Risk Communication Tool to Enhance Patient–Provider Partnership in Diabetes Consultation

“…12 In addition, the use of imagery and interactive features, which stimulate attention and working memory, has been recommended. 13,14 Based on these recommendations and on the results of a feasibility study conducted in routine care with 40 patients with T2DM, in which specific innovative risk metrics were found to be superior over probabilistic information in increasing risk perception accuracy, 15 we chose to limit the content of the tool to just two types of risk information, conveyed through carefully selected formats.…”

The Impact of Biofeedback on Diabetic Patients’ Glycemia

“…[17][18][19][20] and the rates of glycated hemoglobin (glycohemoglobin) are higher in people with anxiety or mood disorders (in diabetes types 1 and 2). [21][22][23] Briefly speaking, behavioral and psychosomatic factors are constantly interacting. Stress can cause unhealthy variations in behavior, mood, and physiological responses, which will subsequently increase blood glucose.…”