Nudge Intervention Research Articles

We meat again: a field study on the moderating role of location-specific consumer preferences in nudging vegetarian options

This field study set out to test whether consumers’ history of making decisions in a particular choice context moderated the effectiveness of a nudge intervention to reduce meat consumption. In a Danish hospital canteen that served both staff members and visitors, a combination of nudges (Chef’s recommendation sticker + prominent positioning) was implemented to promote vegetarian sandwiches. The sales of these sandwiches increased from 16.45% during the baseline period to 25.16% during the nudge intervention period. Most notably, this increase was caused by the visitors, who had weak location-bound preferences. Hospital staff members (who had strong location-bound preferences) were unaffected by the nudge in their choice. This is an important finding because the two consumer groups did not differ on their person-bound preferences for meat. It seems that behaviour change is best predicted by location-bound preferences, whereas the behaviour itself is best predicted by person-bound preferences. These findings can help organizations in estimating whether a nudge intervention has enough potential for behaviour change, or whether more directive policies are required.

Short Message Service Reminder Nudge for Parents and Influenza Vaccination Uptake in Children and Adolescents With Special Risk Medical Conditions

Children with chronic medical conditions are at increased risk of severe influenza. Uptake of influenza vaccination in children and adolescents with these identified special risk medical conditions (SRMCs) is suboptimal. To assess the effectiveness of Flutext-4U, a parent short message service (SMS) reminder nudge intervention, in increasing influenza immunization in children and adolescents with SRMCs. This randomized clinical trial was conducted at a tertiary pediatric hospital in Adelaide, South Australia, from April 15 to September 30, 2021. Children and adolescents aged 6 months to younger than 18 years with SRMCs and a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021) were eligible to participate. Follow-up was until September 30, 2021. Participants were randomly assigned (1:1 ratio) to control: clinician nudges (hospital vaccine availability, ease of access, and recommendation from hospital subspecialists) or SMS intervention (control conditions plus an additional SMS reminder nudge to parents), with randomization stratified by age group (<5 years, 5-14 years, or >14 to <18 years). The primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register. A total of 600 participants (intervention group: 298 [49.7%]; mean [SD] age, 11.5 [4.6] years; 162 female participants [54.4%]; control group: 302 [50.3%]; mean [SD] age, 11.4 [4.7] years; 155 female participants [51.3%]) were included. Influenza vaccination was 38.6% (113 of 293) in the SMS intervention group compared with 26.2% (79 of 302) in the control group (adjusted odds ratio [aOR], 1.79; 95% CI, 1.27-2.55; P = .001). Time to vaccine receipt was significantly lower among SMS participants (adjusted hazard ratio, 1.67; 95% CI, 1.25-2.22; P < .001). For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period April to June 30 (SMS group: 40.0% [76 of 190] vs 25.4% [50 of 197]; aOR, 1.97; 95% CI, 1.28-3.06; P = .002). Results of this randomized clinical trial suggest that an additional SMS reminder nudge for parents delivered in the tertiary care hospital setting to children and adolescents with SMRCs resulted in higher influenza vaccine uptake compared with clinician nudges alone. ANZCTR Identifier: ACTRN12621000463875.

Empirical Evidence to Support a Nudge Intervention for Increasing Online Engagement in Higher Education

Student engagement is recognised as being a critical factor linked to student success and learning outcomes. The same holds true for online learning and engagement in higher education, where the appetite for this mode of learning has escalated worldwide over several decades, and as a result of COVID-19. At the same time teachers in higher education are increasingly able to access and utilise tools to identify and analyse student online behaviours, such as tracking evidence of engagement and non-engagement. However, even with significant headway being made in fields such as learning analytics, ways in which to make sense of this data, and to utilise data to inform interventions and refine teaching approaches, continue to be areas that would benefit from further insights and exploration. This paper reports on a project that sought to investigate whether low levels of student online engagement could be enhanced through a course specific intervention strategy designed to address student engagement with online materials in a regional university. The intervention used course learning analytics data (CLAD) in combination with the behavioral science concept of nudging as a strategy for increasing student engagement with online content. The study gathered qualitative and quantitative data to explore the impact of nudging on student engagement with 187 students across two disciplines, Education and Regional/Town Planning. The results not only revealed that the use of the nudge intervention was successful in increasing the levels of engagement in online courses but also revealed that the prerequisites for nudging were needed in order to increase success rates. The paper points to the value for the broader awareness, update, and use of learning analytics as well as nudging at a course, program, and institutional level to support student online engagement.

Reducing Younger and Older Adults’ Engagement with COVID-19 Misinformation: The Effects of Accuracy Nudge and Exogenous Cues

COVID-19 misinformation got a lot of engagement on social media, which has been a big threat to public health and international relations. Therefore, this study designed an accuracy nudge intervention to induce people to discern misinformation and adopted exogenous cues to reinforce their discernment ability. The two interventions were expected to reduce people’s engagement in COVID-19 misinformation. To test the hypothesis, 80 younger adults and 80 older adults completed this experiment. As expected, the accuracy nudge motivated people to judge misinformation to a large extent. Most of the participants (91.3%) voluntarily used the accuracy nudge, which also decreased the sharing of misinformation by 62.7%. While the intervention combining the accuracy nudge and exogenous cues did not work better than any single intervention in reducing misinformation engagement. Besides, older adults tend to like or share articles that just rely on their glance at headlines, which may account for their vulnerability to misinformation.

Improving comprehensive genotyping in patients with newly diagnosed non-squamous NSCLC: Results from a prospective trial of a behavioral nudge intervention.

362 Background: Despite current guidelines, less than 50% of patients with metastatic (m) non-squamous (NSq) NSCLC undergo comprehensive molecular genotyping. At our institution, based on improved comprehensiveness of genotyping with use of concurrent tissue (T) and plasma (P) next generation sequencing (NGS), we designed an electronic medical record (EMR)-based “nudge intervention” to auto-generate an order for P NGS at the time of initial consultation, while T NGS was carried out reflexively based on institutional pathways. Methods: A prospective study was conducted at the Abramson Cancer Center and 2 community sites within the University of Pennsylvania Health System after IRB approval. A provider team-focused EMR-based “nudge intervention” was designed to order P NGS at the time of new patient consultation. Eligible patients for the nudge were identified using an EMR based checklist, that included 3 criteria i. newly diagnosed, ii. treatment naïve, iii. mNSq NSCLC. Results from the intervention period (4/2021-12/2021) were compared to baseline data from similar patients treated at our institution between 01/2019 and 03/2021. Categories of NCCN guideline recommended molecular genotyping were defined as: i) comprehensive: EGFR, ALK, BRAF, ROS1, MET, RET, NTRK testing, and ii) incomplete or no testing performed. The proportion of patients with comprehensive molecular genotyping prior to 1st-line therapy were compared in the pre- and post-intervention groups using the chi-square test. Results: 526 patients with mNSq NSCLC were included in this analysis: 381 in the pre-intervention cohort, 145 in the post-intervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent concurrent T+P testing resulting in improved comprehensive molecular genotyping. In addition, a greater proportion of patients had comprehensive genotyping available prior to 1st-line therapy in the post-intervention vs pre-intervention cohort (Table). Conclusions: Across 3 practice sites, a provider team-focused EMR-based nudge intervention was associated with a significantly higher proportion of patients with mNSq NSCLC undergoing comprehensive molecular genotyping, both overall and prior to 1st-line therapy. These findings demonstrate that behavioral, EMR-based nudges can promote guideline concordant diagnostic testing at both community and academic sites and should be studied further as a tool to improve rates of molecular testing in NSCLC.[Table: see text]

Nudging Learning Behaviour: A Systematic Review

ABSTRACTThis review examines nudge intervention in influencing learning behaviours from the context of the information use environment. It was conducted based on PRISMA guidelines. Six major databases were searched, and ten studies were included in this review after screening. Overall, the included studies reported beneficial outcomes in the academic settings, but results were mixed as nudge interventions were context‐dependent. To convey course‐related information during the nudge intervention, all the included studies used at least one technique from category A‐Decision Information and most used a secondary technique to enhance or manipulate the intervention. Among the techniques, A1‐Translate Information, A2‐Make Information Visible, and C1‐Provide Reminders were widely used. However, there was no ideal nudge technique or a combination of nudge techniques that were effective across all situations. Nonetheless, this review underscored the importance of incorporating nudge techniques in an informational learning environment that could shape and motivate learners.

A nudge intervention to improve hand hygiene compliance in the hospital.

Hand hygiene among professionals plays a crucial role in preventing healthcare‐associated infections, yet poor compliance in hospital settings remains a lasting reason for concern. Nudge theory is an innovative approach to behavioral change first developed in economics and cognitive psychology, and recently spread and discussed in clinical medicine. To assess a combined nudge intervention (localized dispensers, visual reminders, and gain-framed posters) to promote hand hygiene compliance among hospital personnel. A quasi-experimental study including a pre-intervention phase and a post-intervention phase (9 + 9 consecutive months) with 117 professionals overall from three wards in a 350-bed general city hospital. Hand hygiene compliance was measured using direct observations by trained personnel and measurement of alcohol-based hand-rub consumption. Levels of hand hygiene compliance were low in the pre-intervention phase: 11.44% of hand hygiene opportunities prescribed were fulfilled overall. We observed a statistically significant effect of the nudge intervention with an increase to 18.71% (p < 0.001) in the post-intervention phase. Improvement was observed in all experimental settings (the three hospital wards). A statistical comparison across three subsequent periods of the post-intervention phase revealed no significant decay of the effect. An assessment of the collected data on alcohol-based hand-rub consumption indirectly confirms the main result in all experimental settings. Behavioral outcomes concerning hand hygiene in the hospital are indeed affected by contextual, nudging factors to a significant extent. If properly devised, nudging measures can provide a sustainable contribution to increase hand hygiene compliance in a hospital setting.

HETEROGENEOUS TREATMENT EFFECTS OF NUDGE AND REBATE: CAUSAL MACHINE LEARNING IN A FIELD EXPERIMENT ON ELECTRICITY CONSERVATION

AbstractThis study investigates the different impacts of monetary and nonmonetary incentives on energy‐saving behaviors using a field experiment conducted in Japan. We find that the average reduction in electricity consumption from the rebate is 4%, whereas that from the nudge is not significantly different from zero. Applying a novel machine learning method for causal inference (causal forest) to estimate heterogeneous treatment effects at the household level, we demonstrate that the nudge intervention's treatment effects generate greater heterogeneity among households. These findings suggest that selective targeting for treatment increases the policy efficiency of monetary and nonmonetary interventions.

EnTraP: A factorial randomised controlled trial embedded within world hip trauma evaluation eight COPAL investigating the effect of an enhanced trainee principal investigator package and digital nudge on recruitment rates

Background Randomised controlled trials (RCTs) often struggle with various aspects of participant recruitment, including engaging clinicians to recruit effectively, and subsequently fail to reach their target sample size. Studies evaluating interventions to improve recruitment aimed specifically at recruiters to the trial are limited in number. The RCTs embedded into the World Hip Trauma Evaluation (WHiTE) cohort study use Trainee Principal Investigators (TPIs) to help manage and drive recruitment at trial sites. No formalised training or support is provided by central trials units to the TPIs. Additionally, trial recruiters receive a generic automated email confirming randomisation to the trial with no other communication to influence or incentivise their behaviour to further recruit. The primary aim of this factorial trial was to evaluate the effectiveness of an educational intervention to TPIs and a positive reinforcement intervention via an email (digital) nudge on increasing recruitment. Secondary aims included feasibility of implementing the interventions and surveying TPIs on the educational package quality of content, delivery and ongoing support. Design This was a multicentre, open, cluster, 2x2 factorial RCT embedded in the WHiTE 8 COPAL RCT, in which research sites were randomised 1:1:1:1 to receive the enhanced TPI package, the digital nudge intervention, both, or neither. Results 1215 patients were recruited to the WHiTE 8 COPAL trial across 20 sites during the SWAT between August 2018 and March 2019. There was a statistically significant interaction between the interventions (IRR 2.09, 95% CI 1.64 to 2.68, p &lt; 0.001). There was a statistically significant benefit on recruitment (IRR 1.23 95% 1.09 to 1.40, p=0.001) from utilizing an enhanced TPI education intervention. The digital nudge intervention had no significant impact on recruitment (IRR 0.89 95% CI 0.79 to 1.01, p=0.07). Within enhanced TPI package sites, the digital nudge had a beneficial effect, while in the standard practice TPI sites it had a detrimental effect. Feasibility analysis showed the median time to site digital nudge and enhanced TPI set up were one day and 17 days, respectively. 353 digital nudges were created taking an average of 12 min to construct, log the activity and then disseminate to recruiters. Median induction time for enhanced TPI was 32 min and 100% of the groups were extremely satisfied with the induction content, delivery and ongoing support. Discussion An education and support programme targeted at surgical TPIs involving a digital education package, 1:1 telephone induction and subsequent support package was effective in increasing recruitment in the first 6 months of trial commencement. There was no evidence for the effectiveness of the digital nudge intervention in isolation, although our results show that when combined with an education programme, it leads to enhanced effectiveness of that programme.

Nudge intervention to transition care after hypertensive disorders of pregnancy: a randomized clinical trial

Scalable interventions are needed to improve preventative care for those with increased cardiovascular disease (CVD) risk identified during pregnancy. We hypothesized that a nudge (reminder message) would increase counseling by the postpartum visit (PPV) provider on transitions of care and CVD risk after pregnancy.

P24 Effect of a Nudge Intervention for Increasing Vegetable Intake Among University Students in a University Cafeteria

<h3>Background</h3> An intake of ≥350 g of vegetables per day is recommended in Japan. However, the average intake of vegetables among adults ≥20 years is about 280 g in 2019, and the intake of young adults in their 20s, including university students, is low (about 223 g). Recently, the use of nudge strategies for behavioral change has been gaining attention. However, relatively few nudge trials for increasing vegetable intake have been conducted in Japan. <h3>Objective</h3> To evaluate the effectiveness of a nudge intervention for increasing vegetable intake among university students. <h3>Study Design, Setting, Participants</h3> The participants were university students who ate at a university cafeteria in Japan from October to November 2020. The study consisted of baseline (1 week), intervention (2 weeks), and follow-up (2 weeks) periods. As a nudge intervention, a tack board was set at the entrance of the cafeteria and it displayed the number of small bowls of vegetable dishes that were sold by putting magnets on the tack board on a real-time basis. <h3>Measurable Outcome/Analysis</h3> The change in the number of small bowls of vegetable dishes selected by students during the study periods were evaluated by collecting receipts. Friedman's test was used for the analysis. Awareness of the tack board and a conscious change in vegetable intake were also evaluated using self-administered questionnaires. Cochran's Q-test was used for a conscious change in vegetable intake. <h3>Results</h3> A total of 53 students completed the study. Among them, 67.9% students saw the tack board. However, the number of small bowls of vegetable dishes selected (<i>P</i> = 0.811) and consciousness of vegetable intake (<i>P</i> = 0.794) did not change significantly during the study period. <h3>Conclusion</h3> Nudge intervention in this study did not change students' behavior significantly. Developing more attractive nudge tools for behavioral change might be needed.

Systematic review of clinician-directed nudges in healthcare contexts

ObjectiveNudges are interventions that alter the way options are presented, enabling individuals to more easily select the best option. Health systems and researchers have tested nudges to shape clinician decision-making...

Nudging openly – An experimental analysis of nudge transparency in a public goods setting

Abstract Around the world, policy makers and public authorities are increasingly turning to behaviorally informed interventions (“nudges”) in order to help tackle important contexts of public policy. Despite their impressive merit record, these policy tools have been heavily criticized as being obscure and manipulative, thus facing challenges for their legitimate assertion in the regulatory toolkit. In this study, we seek to assess whether transparency over the use of such interventions may constitute a viable way of addressing these ethical concerns, and focus particularly on the potentially moderating role of something we call “status quo experience”, i. e. subjects’ understanding of the behavioral consequences of different choice architectures. We conduct a laboratory experiment, whereby subjects play three rounds of a public good game, the first of which defaults them towards a fully non-cooperative contribution, while the rest default them towards a fully cooperative one. Subjects in our treatment groups further receive an “informational shock” at varying points in time, disclosing how and why a fully cooperative default contribution is being used. We find that providing subjects with informational disclosure about the nudge intervention did not result in significantly different aggregate behavioral measurements between control and treatment groups. This seems to be independent of status quo experience and of the timing of transparency provision. We nonetheless find some indication that the latter could help sustain cooperation over time.

A Qualitative Analysis of Factors Influencing Critical Care Trial Enrollment Among Surrogates.

We sought to identify factors that influence surrogate decision makers' decisions to enroll patients into a critical care randomized controlled trial. We conducted a qualitative study embedded within a randomized controlled trial testing the effect of a behavioral nudge intervention for surrogate decision makers on enrollment rate in a sham ventilatory weaning trial among patients with acute respiratory failure. Participants were adult surrogate decision makers of patients receiving mechanical ventilation for acute respiratory failure. The study was conducted in 10 ICUs across 2 urban hospitals within an academic medical center in Philadelphia, Pennsylvanaia, United States. Immediately following their trial enrollment decision, surrogate decision makers were asked to enter free-text responses about the factors that influenced their decision. Responses were analyzed using content analysis. Of the 90 (49%) participants who provided free-text responses, the mean age was 54.9 years (SD 14.3), 69 (79%) were Caucasian, and 48 (53%) were the spouse of the eligible patient. We identified 5 themes influencing enrollment decisions: (i) trial characteristics, (ii) patient clinical condition, (iii) decision making processes, (iv) altruism, and (v) enrollment attempt. Among surrogates who enrolled the patient in the trial (n = 40), the most commonly cited factors were helping future patients (n = 24, 60%) and following the patient's wishes (n = 11, 28%). In contrast, those who declined enrollment (n = 50) most commonly reported that the patient was too sick (n = 27, 54%) and that they feared complicating the patient's condition (n = 11, 22%). Surrogates who enroll patients into trials most often cite altruistic motivations, while those who decline enrollment are most often concerned with the severity of the patients' condition.

Nudging flow through ‘SMART’ goal setting to decrease stress, increase engagement, and increase performance at work

The construct of flow has been associated with a plethora of positive work outcomes such as performance, engagement, and reduced burnout. However, flow is understudied in the domain of work and there is a lack of empirical examinations of flow interventions. Additionally, until recently, the vast majority of research examining flow at work assumes that individuals are passive agents who only experience flow when their working conditions facilitate the state. Therefore, the study tested a ‘SMART’ goal‐setting nudge intervention for individuals, aimed at increasing flow at work and its positive outcomes. Results of a 5‐day experimental experience sampling study with 65 American MTurk workers (who work full‐time besides MTurk) indicate that those in the goal‐setting condition experienced more flow at work and subsequently experienced less daily stress, as well as higher engagement and subjective performance when compared to the control group. Exploratory analyses revealed that flow decreased later in the week within‐day for participants in the control group, whereas flow remained relatively stable within‐day for those in the goal‐setting condition. Moreover, certain categories of goals, such as mastery goals, resource acquisition goals, and understanding goals, were found to be significant predictors of daily flow.Practitioner points Flow at work predicted daily stress, daily performance, and work engagement. Self‐determination strategies (Occupat Health Sci, 1, 2017, 47), such as goal setting, can increase the amount of flow experienced at work and its subsequent positive outcomes. Nudges (Nudge: Improving decisions about health, wealth, and happiness, Yale University Press, 2008) can provide reminders for individuals to engage in behaviors that help them to experience flow and its positive work outcomes. A proposed model was supported as a framework practitioners can use to better understand flow at work along with its antecedents and outcomes.

Two-Way Risk Communication, Public Value Consensus, and Citizens’ Policy Compliance Willingness About COVID-19: Multilevel Analysis Based on a Nudge View

COVID-19 has spawned a surge in the number of public epidemic prevention policies. More important than active policy-making is how to increase citizens’ policy compliance willingness. Based on public value theory and nudge theory, this study adopts a multilevel mediation and moderation model to analyze the relationships among the government’s authoritarian control, two-way risk communication, public value consensus, nudge, and citizens’ policy compliance willingness. A sample of 2,616 citizens nested in 86 Chinese cities was collected. The study found that (a) local governments can improve citizens’ policy compliance willingness by adopting both “stick” (authoritarian control) and “sermon” (two-way risk communication) policies, whereas two-way risk communication demonstrates a uniquely positive effect on public value consensus; and (b) the effect of two-way risk communication on policy compliance willingness is mediated by public value consensus. By enhancing public value consensus, two-way risk communication helps establish consensus between citizens and the government on “what needs/needs not to be done” and “what should/should not be done” to slow down the pandemic, thus coalescing efforts in a cooperative spirit; (c) nudge intervention positively moderates the effect of two-way risk communication on public value consensus, but has no effect on the authoritarian control–policy compliance willingness relationship. In other words, nudge intervention is a better companion to “sermons,” not “sticks.” Findings of the nuanced relationship manifested the differentiated effect of authoritarian control and two-way risk communication on citizens’ policy compliance willingness during a pandemic. The results provide theoretical implications for scholars to unlock the “black box” of public values and practical implications for strategies from behavioral public administration aspects to curb the ongoing COVID-19 pandemic.

Nudging Consumers toward Healthier Food Choices: A Field Study on the Effect of Social Norms

Food choices influence the health of individuals, and supermarkets are the place where part of the world population makes their food choices on a daily basis. Different methods to influence food purchasing habits are used, from promotions to food location. However, very few supermarket chains use social norms, the human need to conform to the perceived behavior of the group, to increase healthy food purchase habits. This research seeks to understand how a social norm nudge, a message conveying fruit and vegetable purchasing norms positioned in strategic places, can effectively change food choices. Using data from an intervention in a Portuguese supermarket, the fruit and vegetable purchase quantities of 1636 customers were measured over three months and compared with the corresponding period of the previous year. The results show that the nudge intervention positively affected those whose purchasing habits are categorized as less healthy, while those with healthy habits were slightly negatively affected. Moreover, a follow-up inferential statistical analysis allows us to conclude that applying this intervention at a larger scale would deliver significant financial results for the supermarket chain in which the study took place, by decreasing the costs related to produce perishability while simultaneously improving the health of the consumer and the sustainability of the planet.

1. The Impact of Behavioral Nudges, Communication Training and Assessment and Feedback on Adolescent Vaccination Rates and Parent Satisfaction

BackgroundEffective prevention of HPV is possible, but < 50% of adolescents in the Midwest complete the recommended vaccine series. Strategies to increase HPV vaccination rates have demonstrated efficacy, however widespread implementation of these interventions has not been realized. Behavioral nudges have demonstrated efficacy in increasing uptake of desired heath behaviors among providers (e.g. hand hygiene, judicious antibiotic prescribing). This trial assessed the impact of an assessment and feedback, communication training, and behavioral nudge (i.e. poster-sized vaccine commitment statements) intervention (T3) on adolescent vaccination rates and parental satisfaction at four Midwestern pediatric practices.MethodsPractices were randomly assigned to receive either 1) assessment and feedback or 2) T3 intervention. Providers (n=16) completed surveys regarding vaccine polices and parents of vaccine eligible adolescents (n=230) reported their child’s vaccine history and satisfaction with the consultation. Practice- level vaccination rates for Tdap, Meningococcal, and HPV were calculated through billing data queries from an integrated pediatric health network. Vaccination rates and provider/ parental responses were compared by intervention arm.ResultsAll practices evidenced increased adolescent vaccine rates, ranging from 0.8% to 3.4% for Meningococcal and 1.3% to 12.1% for Tdap. Three of the four practices had increased HPV vaccination rates (1% to 10%), however there was no statistically significant difference by study arm. Most parents (M age 41.34; SD 8.05; 85% female, 68% White) indicated their child had previously initiated the HPV vaccine series (61%) and 72% indicated receipt of an HPV vaccine during the study visit. Concerns among HPV vaccine hesitant parents (n=60) included concerns about vaccine safety and necessity. Most (97%) of parents were satisfied with their consultation.ConclusionPractices in both intervention groups evidenced an increase in adolescent vaccination rates. While some parents had concerns about HPV vaccine safety and necessity, parents welcomed discussions about HPV vaccine and were satisfied with their provider’s communication regardless of their vaccine decisions.Disclosures Brian R. Lee, MPH, PhD, Merck (Grant/Research Support)

A nudge intervention providing simple feedback to clinicians of the consequence of radiation exposure on demand for CT scans

Category: Other

Promoting Influenza Vaccination among Staff of Nursing Homes According to Behavioral Insights: Analyzing the Choice Architecture during a Nudge-Based Intervention

(1) Background: Influenza vaccination uptake in nursing home (NH) workers is uncommon. The aim of this study was to understand the choice architecture of influenza vaccination acceptance or refusal among them and to promote vaccination acceptance using the nudge approach. (2) Methods: In autumn 2019, a nudge intervention with a contextual qualitative analysis of choice architecture of vaccination was performed among the staff of eight Tuscan NHs. In summer 2020, a cross-sectional study including the staff of 111 NHs (8 in the nudge, 103 in the comparison group) was conducted to assess the impact of the nudge intervention in promoting vaccination uptake. (3) Results: Macro-categories of motivations for vaccination uptake that emerged from the qualitative analysis were risk perception, value dimension, and trust, while those regarding refusal were risk perception, distrust, value dimension, and reasons related to one’s health. Considering the cross-sectional study, influenza vaccination uptake in the 2018–2019 season was similar in the two groups (23.6% vs. 22.2% respectively, in the nudge and comparison group), but significantly different in the 2019–2020 season: 28% in the nudge vs. 20% in the comparison group. Also, the intention to get the vaccine in the 2020–2021 season was significantly different in the two groups: 37.9% in the nudge and 30.8% in the comparison group. (4) Conclusions: Nudge interventions-simple, fast, low cost-could be effective in promoting vaccination acceptance among NH workers and the analysis of choice architecture could be useful in improving tailored, new nudge interventions aimed at modifying irrational biased and cognitive errors.