Abstract
Background“Nudging”—modifying environments to change people’s behavior, often without their conscious awareness—can improve health, but public acceptability of nudging is largely unknown.MethodsWe compared acceptability, in the United Kingdom (UK) and the United States of America (USA), of government interventions to reduce consumption of sugar-sweetened beverages. Three nudge interventions were assessed: i. reducing portion Size, ii. changing the Shape of the drink containers, iii. changing their shelf Location; alongside two traditional interventions: iv. Taxation and v. Education. We also tested the hypothesis that describing interventions as working through non-conscious processes decreases their acceptability. Predictors of acceptability, including perceived intervention effectiveness, were also assessed. Participants (n = 1093 UK and n = 1082 USA) received a description of each of the five interventions which varied, by randomisation, in how the interventions were said to affect behaviour: (a) via conscious processes; (b) via non-conscious processes; or (c) no process stated. Acceptability was derived from responses to three items.ResultsLevels of acceptability for four of the five interventions did not differ significantly between the UK and US samples; reducing portion size was less accepted by the US sample. Within each country, Education was rated as most acceptable and Taxation the least, with the three nudge-type interventions rated between these. There was no evidence to support the study hypothesis: i.e. stating that interventions worked via non-conscious processes did not decrease their acceptability in either the UK or US samples. Perceived effectiveness was the strongest predictor of acceptability for all interventions across the two samples.ConclusionIn conclusion, nudge interventions to reduce consumption of sugar-sweetened beverages seem similarly acceptable in the UK and USA, being more acceptable than taxation, but less acceptable than education. Contrary to prediction, we found no evidence that highlighting the non-conscious processes by which nudge interventions may work decreases their acceptability. However, highlighting the effectiveness of all interventions has the potential to increase their acceptability.
Highlights
Much of the global health burden of chronic diseases is associated with modifiable behaviors, principally smoking, alcohol consumption, physical inactivity, and unhealthy food consumption [1]
Levels of acceptability for four of the five interventions did not differ significantly between the United Kingdom (UK) and US samples; reducing portion size was less accepted by the US sample
There was no evidence to support the study hypothesis: i.e. stating that interventions worked via non-conscious processes did not decrease their acceptability in either the UK or US samples
Summary
Much of the global health burden of chronic diseases is associated with modifiable behaviors, principally smoking, alcohol consumption, physical inactivity, and unhealthy food consumption [1]. Altering the environments in which behavior occurs—the “choice architecture”, known as “nudging”—has the potential to change behavior in populations [2,3,4,5,6]. Whether such interventions are implemented depends on their effectiveness, and on their acceptability to policymakers, a judgement likely influenced by perceived public acceptability. Public acceptability of nudge interventions to improve population health is largely unknown. Responses to a recent attempt to nudge populations to improve health entailed altering the sizes of sugar-sweetened beverages to reduce the amount of consumption. Some ethicists have argued that this circumvention renders such interventions coercive [11]
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