Digital Nudging Research Articles

Electronic nudges to increase influenza vaccination in patients with chronic kidney disease: a prespecified analysis of NUDGE-FLU-CHRONIC

Abstract Background Annual influenza vaccination is recommended for individuals with chronic kidney disease (CKD); however, guideline adherence is suboptimal potentially related to lack of awareness of vaccine availability and effectiveness. Purpose This prespecified analysis of the NUDGE-FLU-CHRONIC trial investigated the effectiveness of digital behavioral nudges on influenza vaccine uptake based on the presence or absence of CKD. Methods NUDGE-FLU-CHRONIC was a randomized, nationwide trial, conducted during the 2023/2024 influenza season including younger and middle-aged (18-64 years) Danish citizens with chronic illnesses (making them eligible for the free Danish vaccine program). Participants were randomized in a ratio of 2.45:1:1:1:1:1:1 to receive either usual care (no letter) or one of six different letter-based nudges, delivered via the governmental electronic letter system on September 26, 2023. Baseline and outcome data were obtained with the Danish nationwide registers. Primary endpoint was receipt of an influenza vaccine no later than January 1, 2024. Results A total of 299,881 individuals were randomized in NUDGE-FLU-CHRONIC trial, among them, 15,208 (5.1%) had a history of CKD. Participants with CKD had a median age was 53.1 years (IQR, 42.2-59.6) and 46.0% were female. During follow-up, 43.7% of participants with CKD were vaccinated compared with 35.8% of participants without CKD (p<0.001). Any letter was highly effective in increasing influenza vaccination in the overall population but was slightly less effective in those with a history of CKD (p for interaction = 0.005). In participants with CKD, any letter increased vaccination by 25% versus no letter (46.3% vs. 37.1%; difference, 9.3 percentage points; 99.29%CI, 6.9-11.6; RR, 1.25; 99.29%CI, 1.18-1.33). In participants without CKD, any letter increased vaccination by 43% (39.2% vs. 27.4%; difference, 11.8 percentage points; 99.29%CI, 11.3-12.3; RR, 1.43; 99.29%CI, 1.41-1.45). Similar patterns were observed when assessing each intervention letter individually (Figure 1). Effectiveness of any letter vs. usual care was consistent across CKD subgroups, except for concomitant diabetes vs no diabetes (Figure 2). There was no observed effect modification by CKD duration (p for interaction = 0.78) or by estimated glomerular filtration rate (p for interaction = 0.78) modelled continuously for any letter vs. usual care. Conclusion In this prespecified analysis from the nationwide NUDGE-FLU-CHRONIC trial, only approximately 1 in 3 younger and middle-aged adults with CKD received influenza vaccination. Digital nudge letters emphasizing the importance of annual influenza vaccination significantly boosted rates of vaccination across a broad range of individuals with CKD.Figure 1Figure 2

Keeping viewers hooked: Netflix’s innovative strategies for reducing churn

Netflix’s digital disruption in the entertainment industry has been significantly enhanced by digital nudging, which refers to using behavioural science techniques to subtly influence user decisions (Thaler and Sunstein, 2008). By leveraging data analytics, Netflix personalises the viewing experience, guiding users toward content they are likely to enjoy, which increases engagement and encourages binge-watching. The platform employs sophisticated algorithms to recommend titles, effectively nudging viewers to explore new genres or original content based on their viewing history (Lobato, 2019). This strategy has been pivotal in fostering a binge-watching culture, contrasting sharply with traditional broadcasting schedules offering weekly instalments. Netflix’s ability to analyse user data allows it to create content that aligns with viewer preferences, further enhancing its appeal. By understanding what resonates with audiences, Netflix can produce targeted original content that captures attention and retains subscribers. Digital nudging plays a crucial role in Netflix’s strategy, reinforcing its position as a leader in the streaming market while reshaping consumption habits across the industry. However, digital nudging presents both opportunities and challenges for customer churn management, raising critical ethical questions about autonomy and manipulation. Finding the right balance between effective customer retention strategies and ethical considerations will be vital for fostering trust and enhancing the overall user experience on the platform.

Catalysts of successful WealthTech continuous usage: the role of fit factors, usage experience and digital nudging

Catalysts of successful WealthTech continuous usage: the role of fit factors, usage experience and digital nudging

Acceptability of Nudge in Digital Learning Environment

ABSTRACTDigital nudging is gaining traction in the educational domain to guide students' decision‐making processes and achieve desirable learning outcomes through subtle changes in the digital learning environment. From the information science perspective, these changes are realized through informational cues and human‐computer interface design to affect the influences. Studies have shown nudge effectiveness in influencing students' behaviors, but the extent to which digital nudging affects them and who is susceptible to nudges remains unclear. Although progress has been made in understanding nudge acceptability, research in the context of learning and students' characteristics, such as procrastination behavior, remains limited. To fill this gap, this study surveyed 305 university students to assess their nudge acceptability on two types of nudges: System 1, which involves automatic and intuitive processes, and System 2, which engages deliberate and reflective thinking. The results show that students, regardless of their procrastination tendencies, were receptive to nudges in supporting their learning. System 1 nudge was preferred due to its simplistic and straightforward intervention approach. The insights gained from this study contributed to the advancement of nudge research by demonstrating that students with various procrastination tendencies were receptive to nudging and guiding researchers in designing tailored nudges to maximize effectiveness.

‘Let me recommend… ’: use of digital nudges or recommender systems for overweight and obesity prevention—a scoping review protocol

IntroductionRecommender systems, digital tools providing recommendations, and digital nudges increasingly affect our lives. The combination of digital nudges and recommender systems is very attractive for its application in preventing overweight...

A Survey of Digital Nudges for Fostering Responsible Consumption Behavior in Indonesia Digital Services

A Survey of Digital Nudges for Fostering Responsible Consumption Behavior in Indonesia Digital Services

디지털 헬스케어에서 디지털 넛지와 의사결정의 규범성

In digital healthcare based on healthcare big data, digital nudges are gaining importance and a key role in bioethics. This situation raises new ethical issues, such as: can individuals using digital nudges provided by digital healthcare enhance their autonomy in decision-making? Can individuals be free from external micro-interference in the form of digital nudges? To what extent can individuals be allowed the freedom to participate in the design of precision medicine? Furthermore, the traditional norms and values of individual autonomy, justice, the common good, etc. that have been addressed in bioethics are not appropriate for the new context, so there is a need to reconceptualize existing concepts, especially the concept of autonomy in relation to decision-making. This reconceptualization should have a systematicity that can give timely practicality to the moral issues that may arise in situational contexts, especially in digital healthcare based on personalized medicine. Therefore, the purpose of this paper is to explore the normativity or approach of decision-making that is appropriate for the ethics of digital nudges to address the above emerging ethical issues.

Evaluating design approaches for encouraging behavior change in editors: exploring a digital nudging strategy in a non-personalized recommender system to promote adoption of augmented analytics

AbstractIn the age of digitalization, navigating through vast amounts of data is a challenge. Augmented analytics, which often goes unnoticed by employees, has the potential to support effective decision-making. This study examines the impact of digital nudging on editors' cognitive load and behavioral change towards augmented analytics, providing insights into behavior change design. Combining theory with expert interviews and workshops, this study results in five nudging strategies. The findings reveal varied triggers influencing behavioral change, emphasizing stakeholder involvement in the process.

Digital Nudging and Cookie Rejection: An Experiment

AbstractWhen browsing the Internet, web users tend to accept all cookies even though this may threaten their online security. We apply a salience nudge and a framing nudge to the design of a cookie banner and test their individual and combined effectiveness in fostering rejection of unnecessary cookies in an online experiment (N = 358). The salience nudge makes the rejection button more visible, and the framing nudge phrases button labels as negations. Compared to the control with no nudges, which elicited a rejection rate of 27%, the salience nudge increased rejection rate by 7 percentage points (but p = 0.305), the framing nudge by 18 pp (p = 0.009), and the combination of the two by 53 pp (p < 0.0001). We also find that, when users are offered a customization option rather than the rejection button, only 3% of them select the option and reject non-necessary cookies. Finally, we explore how cookie rejection is related to the time users spend making the decision and to their personality traits. Our findings suggest that cookie rejection can indeed be fostered by an appropriate design of cookie banners and that legislation for protecting the online security of users should introduce specific design guidelines.

#DryByChristmas: A patient and public involvement study on women's engagement with humorous pelvic floor muscle training digital nudges on social media.

Patient and public involvement (PPI) is essential for women's health research. Little is known about how women engage with humorous social media and behavioural health messaging targeting pelvic floor muscle training (PFMT). This PPI aimed to understand how women engage with a humorous social media campaign encouraging PFMT. The study findings will influence the co-design of a digital intervention to support women's adherence to PFMT. The Guidance for Reporting Involvement of Patients and the Public Version 2 short form was used to report the study's findings. The study examined public engagement with a humorous social media campaign encouraging PFMT in women. A healthcare professional and comedian ran the campaign following the national guidelines for engagement in PFMT. Instagram analytics gave insight into the demographics of the public who engaged, how they engaged and the most popular content. The behaviour change techniques (BCTs) used in the digital nudges that generated the highest levels of engagement were analysed using the Capability Opportunity Motivation Behaviour Change Wheel. The majority (96%) of the population showing the highest levels of engagement were women aged 35-44 years and were based in the United Kingdom (77%). The Instagram account saw an increase in engagement by 12% over the 3-month campaign, with 22,032 users seeing digital nudges and 2645 engaging with the digital nudges. The preferred way of engaging was using Likes (9723). The common themes in the digital nudges that generated the highest levels of engagement were BCTs associated with the 'social influences' theoretical domain framework that targeted the core behaviour opportunity. The study findings suggest humour may improve women's engagement with online PFMT programmes; however, more rigorous research is required to better understand diverse women's experiences of humorous online PFMT nudges. Future studies may use PFMT mobile apps instead of social media to capture true user engagement and adherence to PFMT more accurately. The insights gained from the study will be taken forward to co-design a digital behavioural intervention as part of a larger study. Members of the public were involved in the co-design of a digital health intervention that will be trialled as part of a larger research study. The public was involved using the social media platform Instagram. Public engagement with a humorous social media campaign to encourage women to engage with pelvic floor exercises was captured using Instagram analytics, for example, the timing of engagement.

Unveiling Digital Manipulation and Persuasion in e-Commerce: A Systematic Literature Review of Dark Patterns and Digital Nudging

Dark patterns and digital nudging are persuasive techniques that influence customer decision-making in the digital world. This study analyzed 80 articles published in reputed peer-reviewed journals and international conferences using the Theory-Context-Characteristics-Methods (TCCM) framework. The paper offers five significant contributions. First, it adds to the theoretical understanding of the area. Second, the study identifies various contexts in which dark patterns and digital nudging are employed. Third, it elucidates the characteristics (key variables) of dark patterns and digital nudging. Fourth, the study determines the methodologies used in prior studies in the field. Lastly, the paper proposes future research areas in the field. By presenting a comprehensive overview of the research in the field, the study could stimulate scholarly research and serve as a valuable base for future researchers. Furthermore, insights into dark patterns and digital nudging will educate online customers and allow managers to devise strategies to mitigate customer pain points.

Understanding the user perception of digital nudging in platform interface design

AbstractGiven the nascent understanding of user perceptions toward digital nudges in e-commerce, our study examines key factors: perceived usefulness, ease of use, trust, and privacy risks. Via an online experiment of 273 participants, we examined the influence of digital nudging interventions – social norms, defaults, and scarcity warnings – against a control group. Employing descriptive and inferential statistics, notable trust variations were found between default and scarcity warning groups versus controls. To assess these findings, we interviewed 11 information systems and psychology experts. This research enriches our understanding of digital nudges in e-commerce and provides design insights. Theoretical implications span from providing propositions in order to enhance user involvement, conducting narrative accompanying research, analyzing diverse time points of nudging. Practical implications focus on emphasizing to users their choice autonomy and the highlighting that defaults and scarcity warnings are designed to mitigate inherent heuristics and biases for combining nudging with boosting elements.

Using Digital Nudges to Enhance Collective Intelligence in Online Collaboration: Insights from Unexpected Outcomes

The dramatic expansion of internet communication tools has led to the increased use of temporary online groups to solve problems, provide services, or produce new knowledge. However, many of these groups need help to collaborate effectively. The rapid development of new tools and collaboration forms requires ongoing experimentation to develop and test new ways to support this novel form of teamwork. Building on research demonstrating the use of nudges to shape behavior, we report the results of an experiment to nudge teamwork in 168 temporary online groups randomly assigned to one of four different nudge treatments. Each nudge was designed to spur one of three targeted collaborative processes (collaborator skill use, effective task strategy, and the level of collective effort) demonstrated to enhance collective intelligence in extant research. Our results support the basic notion that digitally nudging collaborative processes can improve collective intelligence. However, to our surprise, a couple of nudges had unintended negative effects and ultimately decreased collective intelligence. We discuss our results using structured speculation to systematically consider the conditions under which we would or would not expect the same patterns to materialize in order to clearly articulate directions for future research.

Promoting Green Fashion Consumption Through Digital Nudges in Recommender Systems

Promoting Green Fashion Consumption Through Digital Nudges in Recommender Systems

Leveraging the internet of behaviours and digital nudges for enhancing customers financial decision-making

Leveraging the internet of behaviours and digital nudges for enhancing customers financial decision-making

Rethinking Digital Nudging: A Taxonomical Approach to Defining and Identifying Characteristics of Digital Nudging Interventions

Rethinking Digital Nudging: A Taxonomical Approach to Defining and Identifying Characteristics of Digital Nudging Interventions

Electronically Delivered Nudges to Increase Influenza Vaccination Uptake in Older Adults With Diabetes

Influenza vaccination is associated with a reduced risk of mortality in patients with diabetes, but vaccination rates remain suboptimal. To assess the effect of electronic nudges on influenza vaccination uptake according to diabetes status. The NUDGE-FLU (Nationwide Utilization of Danish Government Electronic Letter System for Increasing Influenza Vaccine Uptake) trial was a nationwide clinical trial of Danish citizens 65 years or older that randomized participants at the household level to usual care or 9 different electronic nudge letters during the 2022 to 2023 influenza season. End of follow-up was January 1, 2023. This secondary analysis of the NUDGE-FLU trial was performed from May to July 2023. Nine different electronic nudge letters designed to boost influenza vaccination were sent in September to October 2022. Effect modification by diabetes status was assessed in a pooled analysis of all intervention arms vs usual care and for individual letters. The primary end point was receipt of a seasonal influenza vaccine. The trial included 964 870 participants (51.5% female; mean [SD] age, 73.8 [6.3] years); 123 974 had diabetes. During follow-up, 83.5% with diabetes vs 80.2% without diabetes received a vaccine (P < .001). In the pooled analysis, nudges improved vaccination uptake in participants without diabetes (80.4% vs 80.0%; difference, 0.37 percentage points; 99.55% CI, 0.08 to 0.66), whereas there was no evidence of effect in those with diabetes (83.4% vs 83.6%; difference, -0.19 percentage points; 99.55% CI, -0.89 to 0.51) (P = .02 for interaction). In the main results of NUDGE-FLU, 2 of the 9 behaviorally designed letters (cardiovascular benefits letter and a repeated letter) significantly increased uptake of influenza vaccination vs usual care; these benefits similarly appeared attenuated in participants with diabetes (cardiovascular gain letter: 83.7% vs 83.6%; difference, 0.04 percentage points; 99.55% CI, -1.52 to 1.60; repeated letter: 83.5% vs 83.6%; difference, -0.15 percentage points; 99.55% CI, -1.71 to 1.41) vs those without diabetes (cardiovascular gain letter: 81.1% vs 80.0%; difference, 1.06 percentage points; 99.55% CI, 0.42 to 1.70; repeated letter: 80.9% vs 80.0%; difference, 0.87 percentage points; 99.55% CI, 0.22 to 1.52) (P = .07 for interaction). In this exploratory subgroup analysis, electronic nudges improved influenza vaccination uptake in persons without diabetes, whereas there was no evidence of an effect in persons with diabetes. Trials are needed to investigate the effect of digital nudges specifically tailored to individuals with diabetes. ClinicalTrials.gov Identifier: NCT05542004.

Data-driven digital nudging: a systematic literature review and future agenda

ABSTRACT Nudging, a concept rooted in behavioural economics, aims to influence decision-making for individuals’ benefit through non-coercive methods. While initially investigated in real-world contexts, the rise of digital devices has led to the emergence of digital nudging (DN), an area of research examining nudging techniques within digital environments. Integrating smart technologies, Big data analysis, and artificial intelligence (AI) algorithms with DN has garnered attention from Information Systems (IS) scholars and practitioners. Given the evolving and fragmented nature of research in this area, a Systematic Literature Review (SLR) was conducted to analyze data-driven DN literature. In this regard, 57 peer-reviewed papers were selected and analyzed to answer four research questions. The review begins by defining and outlining the characteristics of data-driven DN. It then identifies critical data sources for nudging interventions: user profiles, social media, and contextual data. Additionally, four closely intertwined categories of studies were explored: (1) Personalised nudging, (2) Big data-driven nudging, (3) AI-driven nudging, and (4) DN with recommender systems. The review also highlights challenges and issues within the field and concludes with a discussion on future research directions. This study provides a comprehensive perspective on the data-driven DN status quo and sheds light on relevant promising research agendas.

Evaluating Patient-Reported Outcomes and Wearable Data Among Individuals with Relapsed/Refractory Multiple Myeloma

Background: Digital life coaching (DLC) pairs patients with a certified health coach to identify and achieve wellness-related goals through phone calls and text messages. DLC has been shown to improve physical quality of life in a recent randomized trial of patients with multiple myeloma (MM) undergoing upfront transplantation (Banerjee, BMT 2023). However, transplantation is an acute life disruption that may not necessarily reflect long-term wellness; this is particularly true for patients living with relapsed/refractory (R/R )MM, for which symptom burden and uncertainty may be chronically higher. As such, a new study (clinicaltrials.gov ID: NCT05956457) is under way to explore the feasibility and outcomes of DLC with integrated symptom monitoring (via a wearable activity tracker) to inform a more complete understanding of the patient experience with R/R MM. Endpoints from this study will include symptom burden, health self-efficacy, and financial, physiologic, and psychosocial well-being, and if and how DLC may be used to support this population. Study Design and Methods: For this prospective, non-randomized, quasi-experimental study at the University of Washington, up to 100 individuals will be enrolled. Individuals must meet the following Inclusion criteria: English speaking; aged 18 years and older, R/R MM diagnosis; initiated at least the second line of therapy for MM at time of study enrollment and must have been exposed to at least one proteasome inhibitor (PI) and/or one immunomodulatory drug (IMiD). Individuals will be excluded from participation if they meet any of following criteria: anticipated to have 6 months or less to live, have a serious and/or unstable pre-existing medical, psychiatric, or other condition that could interfere with participant safety, provision of informed consent, or compliance with study procedures; and those who do not own or have access to a personal smartphone or device allowing for access to text or email Consented individuals will be enrolled in a 3-month DLC coaching program, consisting of weekly calls and up to 4 digital nudges, delivery of content via text or email, each week. The evidence-based coaching curriculum focuses on supporting patient self-management of symptoms; physical, mental, financial, social and sexual health; and nutrition, exercise, and sleep. Patient-reported outcomes (PROs) will be collected at baseline and monthly for 3 months to track progress during both coaching and treatment, and to provide insights into the experience and well-being of participants. PROs include quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 &amp; Quality of Life Questionnaire Multiple Myeloma-20); health self-efficacy (measured with the Cancer Behavior Inventory- Brief); anxiety and depression (Patient Health Questionnaire-4); financial toxicity (Comprehensive Score for Financial Toxicity); and medication adherence (CASE Medication Adherence Index). Physical activity will be captured via wrist-worn activity tracker provided to participants. Descriptive analysis will be conducted for this study. Feasibility for this study is defined as a retention rate greater than or equal to 70%. Retention is defined as individuals who agree to participate in the DLC program and complete the 3 months of engagement post-enrollment. Engagement is defined as the completion of 1 nudge (call, text, or email) per module out of 5 nudge opportunities. Summary statistics, such as frequencies, percentages, means, standard deviations, and ranges, will be used to describe patient demographic and clinical characteristics of the study population. Summary statistics will also be used to describe PRO by assessment time. We will also assess the additional PRO trends over time using linear mixed models (LMMs). Additional models will be created to assess intervention effect while controlling for possible confounding covariates, and the relationship between self-efficacy and other PROs. Implications: Results of this study are anticipated to elucidate (1) if and how DLC may be used to support individuals with R/R MM and (2) clinical and PRO outcomes, including both survey and wearable data, for individuals with R/R MM in a DLC program.

Digitally nudging users to explore off-profile recommendations: here be dragons

In many application domains of recommender systems, e.g., on media streaming sites, one main goal of the provider of the recommendation service is to increase the engagement of users by helping them discover new types of content they like. Standard collaborative filtering algorithms by design often lead to a certain level of discovery. Nonetheless, in certain domains, it may be helpful to more actively promote content to users beyond their past preference profile (“off-profile”) and thereby help users explore new content. However, when showing such off-profile content to users in combination with more familiar content, the new content items may be overlooked. In this research, we explore to what extent digital nudging, i.e., subtly directing user choices in a specific direction, can help to raise the attention and interest of users for off-profile content. We conducted a user study (N=1064\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$N=1064$$\\end{document}) on a real-world social book recommendation app. We find that users who are nudged towards recommended books of their non-preferred genres significantly more often put these off-profile books on their reading lists, thus confirming the effectiveness of digital nudging in this application. However, we also found that digital nudges may negatively impact the users’ beliefs and attitudes towards the system and a more limited intention to use the system in the future. As a result, we find that digital nudging in recommendations, while effective in the short run, must be done with due care, keeping an eye on the overall quality perceptions by users and potentially harmful long-term effects.