A 680,000-person megastudy of nudges to encourage vaccination in pharmacies.

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was "waiting for you." Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.

Clinicians' Use of Choice Framing in ICU Family Meetings.

OBJECTIVES: To quantify the frequency and patterns of clinicians' use of choice frames when discussing preference-sensitive care with surrogate decision-makers in the ICU. DESIGN: Secondary sequential content analysis. SETTING: One hundred one audio-recorded and transcribed conferences between surrogates and clinicians of incapacitated, critically ill adults from a prospective, multicenter cohort study. SUBJECTS: Surrogate decision-makers and clinicians. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Four coders identified preference-sensitive decision episodes addressed in the meetings, including topics such as mechanical ventilation, renal replacement, and overall goals of care. Prior critical care literature provided specific topics identified as preference-sensitive specific to the critical care context. Coders then examined each decision episode for the types of choice frames used by clinicians. The choice frames were selected a priori based on decision science literature. In total, there were 202 decision episodes across the 101 transcripts, with 20.3% of the decision episodes discussing mechanical ventilation, 19.3% overall goals of care, 14.4% renal replacement therapy, 14.4% post-discharge care (i.e., discharge location such as a skilled nursing facility), and the remaining 32.1% other topics. Clinicians used default framing, in which an option is presented that will be carried out if another option is not actively chosen, more frequently than any other choice frame (127 or 62.9% of decision episodes). Clinicians presented a polar interrogative, or a "yes or no question" to accept or reject a specific care choice, in 43 (21.3%) decision episodes. Clinicians more frequently presented options emphasizing both potential losses and gains rather than either in isolation. CONCLUSIONS: Clinicians frequently use default framing and polar questions when discussing preference-sensitive choices with surrogate decision-makers, which are known to be powerful nudges. Future work should focus on designing interventions promoting the informed use of these and the other most common choice frames used by practicing clinicians.

Willpower is a form of, but not synonymous with, self-control.

We build on Ainslie's discussion of willpower by highlighting another common misconception in the literature: the conflation of self-control and willpower. In our commentary, we identify this issue and discuss the importance of recognizing willpower not as synonymous with self-control, but rather as a subset of self-control. We describe a set of upstream strategies as more effective alternatives to willpower.

Default neglect in attempts at social influence.

Current theories suggest that people understand how to exploit common biases to influence others. However, these predictions have received little empirical attention. We consider a widely studied bias with special policy relevance: the default effect, which is the tendency to choose whichever option is the status quo. We asked participants (including managers, law/business/medical students, and US adults) to nudge others toward selecting a target option by choosing whether to present that target option as the default. In contrast to theoretical predictions, we find that people often fail to understand and/or use defaults to influence others, i.e., they show "default neglect." First, in one-shot default-setting games, we find that only 50.8% of participants set the target option as the default across 11 samples (n = 2,844), consistent with people not systematically using defaults at all. Second, when participants have multiple opportunities for experience and feedback, they still do not systematically use defaults. Third, we investigate beliefs related to the default effect. People seem to anticipate some mechanisms that drive default effects, yet most people do not believe in the default effect on average, even in cases where they do use defaults. We discuss implications of default neglect for decision making, social influence, and evidence-based policy.

I May Not Agree With You, but I Trust You: Caring About Social Issues Signals Integrity.

What characteristics of an individual signal trustworthiness to other people? I propose that individuals who care about contentious social issues signal to observers that they have integrity and thus can be trusted. Critically, this signal conveys trustworthiness whether or not the target and the observer hold the same view on the issue. Five studies (N = 3,817) demonstrated the predicted effect of caring on integrity-based trust (Studies 1, 2, 3a, 3b, and 4)-even in cases of strong disagreement-across a variety of issues (Study 1) and when behavioral outcomes with real stakes were used (Studies 3a and 3b). This effect largely results from a perception of low-caring targets as particularly untrustworthy (Study 2). Additionally, participants trusted targets with staunchly opposing views about an issue even though they simultaneously disliked them (Study 4). These findings have important implications for how people form impressions of others and speak to potential interventions to help mitigate the growing ideological divide.

Roles and ranks: The importance of hierarchy for group functioning.

Baumeister et al. propose that role differentiation is critical for group functioning. We propose that effective groups require rank differentiation in addition to role differentiation. We suggest that rank differentiation supports division of labor by incentivizing group members, satisfying fundamental human needs, and organizing and integrating the contributions of differentiated group members.

Going beyond the "self" in self-control: Interpersonal consequences of commitment strategies.

Commitment strategies are effective mechanisms individuals can use to overcome self-control problems. Across seven studies (and two supplemental studies), we explore the negative interpersonal consequences of commitment strategy choice and use. In Study 1, using an incentivized trust game, we demonstrate that individuals trust people who choose to use a commitment strategy less than those who choose to use willpower to achieve their goals. Study 2 shows this relationship holds across four domains and for integrity-based trust in particular. Study 3 provides evidence that it is the choice to use the strategy rather than strategy use itself that incurs this integrity penalty. In Studies 4-5b, we demonstrate that this effect is driven, at least in part, by the fact that people infer past performance from strategy choice. Finally, Study 6 provides evidence that people select commitment strategies more in private than in public, which is consistent with the notion that people anticipate the negative consequences of commitment strategy choice. Thus, we establish the role of willpower as a positive signal in impression formation as well as the negative interpersonal consequences of choosing to rely on external aides when faced with temptation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Are You Listening to Me? The Negative Link Between Extraversion and Perceived Listening.

Extraverts are often characterized as highly social individuals who are highly invested in their interpersonal interactions. We propose that extraverts' interaction partners hold a different view-that extraverts are highly social, but not highly invested. Across six studies (five preregistered; N = 2,456), we find that interaction partners consistently judge more extraverted individuals to be worse listeners than less extraverted individuals. Furthermore, interaction partners assume that extraversion is positively associated with a greater ability to modify one's self-presentation. This behavioral malleability (i.e., the "acting" component of self-monitoring) may account for the unfavorable lay belief that extraverts are not listening.

The dynamics of gender and alternatives in negotiation.

A substantial body of prior research documents a gender gap in negotiation performance. Competing accounts suggest that the gap is due either to women's stereotype-congruent behavior in negotiations or to backlash enacted toward women for stereotype-incongruent behavior. In this article, we use a novel data set of over 2,500 individual negotiators to examine how negotiation performance varies as a function of gender and the strength of one's alternative to a negotiated agreement. We find that the gender gap in negotiation outcomes exists only when female negotiators have a strong outside option. Furthermore, our large data set allows us to examine an understudied performance outcome, rate of impasse. We find that negotiations in which at least one negotiator is a woman with a strong alternative disproportionately end in impasse, a performance outcome that leaves considerable potential value unallocated. In addition, we find that these gender differences in negotiation performance are not due to gender differences in aspirations, reservation values, or first offers. Overall, these findings are consistent with a backlash account, whereby counterparts are less likely to come to an agreement and therefore reach a potentially worse outcome when one party is a female negotiator empowered by a strong alternative. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Choice architecture in physician-patient communication: a mixed-methods assessments of physicians' competency.

BACKGROUND: Clinicians' use of choice architecture, or how they present options, systematically influences the choices made by patients and their surrogate decision makers. However, clinicians may incompletely understand this influence. OBJECTIVE: To assess physicians' abilities to predict how common choice frames influence people's choices. METHODS: We conducted a prospective mixed-methods study using a scenario-based competency questionnaire and semistructured interviews. Participants were senior resident physicians from a large health system. Of 160 eligible participants, 93 (58.1%) completed the scenario-based questionnaire and 15 completed the semistructured interview. The primary outcome was choice architecture competency, defined as the number of correct answers on the eight-item scenario-based choice architecture competency questionnaire. We generated the scenarios based on existing decision science literature and validated them using an online sample of lay participants. We then assessed senior resident physicians' choice architecture competency using the questionnaire. We interviewed a subset of participating physicians to explore how they approached the scenario-based questions and their views on choice architecture in clinical medicine and medical education. RESULTS: Physicians' mean correct score was 4.85 (95% CI 4.59 to 5.11) out of 8 scenario-based questions. Regression models identified no associations between choice architecture competency and measured physician characteristics. Physicians found choice architecture highly relevant to clinical practice. They viewed the intentional use of choice architecture as acceptable and ethical, but felt they lacked sufficient training in the principles to do so. CONCLUSION: Clinicians assume the role of choice architect whether they realise it or not. Our results suggest that the majority of physicians have inadequate choice architecture competency. The uninformed use of choice architecture by clinicians may influence patients and family members in ways clinicians may not anticipate nor intend.

Being "good" or "good enough": Prosocial risk and the structure of moral self-regard.

The motivation to feel moral powerfully guides people's prosocial behavior. We propose that people's efforts to preserve their moral self-regard conform to a moral threshold model. This model predicts that people are primarily concerned with whether their prosocial behavior legitimates the claim that they have acted morally, a claim that often diverges from whether their behavior is in the best interests of the recipient. Specifically, it predicts that for people to feel moral following a prosocial decision, that decision need not have promised the greatest benefit for the recipient but only one larger than at least one other available outcome. Moreover, this model predicts that once people produce a benefit that exceeds this threshold, their moral self-regard is relatively insensitive to the magnitude of benefit that they produce. In 6 studies, we test this moral threshold model by examining people's prosocial risk decisions. We find that, compared with risky egoistic decisions, people systematically avoid making risky prosocial decisions that carry the possibility of producing the worst possible outcome in a choice set-even when this means avoiding a decision that is objectively superior. We further find that this aversion to producing the worst possible prosocial outcome leads people's prosocial (vs. egoistic) risk decisions to be less sensitive to those decisions' maximum possible benefit. We highlight theoretical and practical implications of these findings, including the detrimental consequence that people's desire to protect their moral self-regard can have on the amount of good that they produce. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Behavioral Processes in Long-Lag Intervention Studies.

We argue that psychologists who conduct experiments with long lags between the manipulation and the outcome measure should pay more attention to behavioral processes that intervene between the manipulation and the outcome measure. Neglect of such processes, we contend, stems from psychology's long tradition of short-lag lab experiments where there is little scope for intervening behavioral processes. Studying process in the lab invariably involves studying psychological processes, but in long-lag field experiments it is important to study causally relevant behavioral processes as well as psychological ones. To illustrate the roles that behavioral processes can play in long-lag experiments we examine field experiments motivated by three policy-relevant goals: prejudice reduction, health promotion, and educational achievement. In each of the experiments discussed we identify various behavioral pathways through which the manipulated psychological state could have produced the observed outcome. We argue that if psychologists conducting long-lag interventions posited a theory of change that linked manipulated psychological states to outcomes via behavioral pathways, the result would be richer theory and more practically useful research. Movement in this direction would also permit more opportunities for productive collaborations between psychologists and other social scientists interested in similar social problems.