A multi-nudge-based behavioural insight into ward nurses' respiratory rate measurement: An observational study.

AIM: This study observed changes in respiratory rate measurement (RRM) and identified barriers and challenges in clinical practice that influence healthcare worker behaviour, aiming to improve RRM in a hospital setting. DESIGN: An observational study was conducted. METHODS: We observed and analysed changes in the behaviour of healthcare workers at a hospital where multi-nudges were introduced to improve RRM. RESULTS: We checked respiration rate using electronic data and discovered that the original measurement rates were low. Measurement rates rapidly increased after posters were added. Barriers such as time constraints and measurement equipment were also noted. CONCLUSION: RRM was found to be effective in promoting behavioural economics in medical settings. The results show that incorporating behavioural science principles into medical interventions has the potential to positively change behaviour. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: By increasing nurses' awareness of respiratory rate measurement and addressing barriers to it, the measurement rate of respiratory rate can also increase, leading to more accurate patient evaluations and triage. IMPACT: WHAT PROBLEM DID THE STUDY ADDRESS?: The proportion of respiratory rate measurements leading to rapid response system (RRS) calls was low. WHAT WERE THE MAIN FINDINGS?: The study observed that a multi-nudge approach effectively changes the behaviour of ward nurses, resulting in enhanced quality of medical care. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This research can serve as a valuable reference for leaders promoting healthcare quality projects, by offering a method to encourage behavioural change. REPORTING METHOD: This study complied with the EQUATOR guidelines and its reporting adheres to the STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nudging to assist opioid tapering among chronic non-malignant pain patients: A systematic scoping review.

Objectives: Use of opioids can lead to frequent and severe side effects, prompting the exploration of non-pharmacological alternatives, including nudging, to reduce opioid consumption. This review identifies and evaluates patient-targeted nudges to support opioid tapering among adults with chronic non-cancer pain. Methods: We searched EMBASE, MEDLINE, CINAHL, PsycInfo, and Social Science citation index for articles published from 2010 to January 2023. Eligibility criteria were based on the PICOS framework and included original peer-reviewed English language studies on adults with chronic non-cancer pain and interventions aligning with the nudge definition by Thaler and Sunstein. Studies with relevant comparators, measurable outcomes, real-world data, and pre/post-intervention measures were included. Data were manually extracted and reported in a descriptive manner. The process adhered to PRISMA-ScR reporting guidelines. Results: Four of 222 articles fulfilled the inclusion criteria. All included nudges aimed at providing information to support decision-making and behavior change. Three nudge categories were identified: increasing salience, understanding mappings, and feedback. Outcome measures were program-related, focusing on perceptions, knowledge acquisition, engagement metrics, and psychological well-being. Conclusions: There were no statistically significant effects or only small evidence of effects in the program-related outcomes. None of the studies included a control group with standard care or no intervention comparison and none included objective measures of opioid reduction. More studies are needed to draw conclusions on the effectiveness of nudges to support opioid tapering among chronic non-cancer pain patients.

Does personality matter: examining the value of personality insights for personalized nudges that encourage the selection of learning resources.

Nudging is a mechanism aimed at influencing people's behavior while maintaining the individual's freedom of choice. Nudges have been adopted in learning contexts where individuals are responsible for shaping their learning and, at the same time, receive guidance from the system. Not everyone responds to nudges in the same way. While social science research indicates that individual differences play a crucial role in peoples' nudgeability, there has been little research examining computational approaches that explore how individual differences affect user responses to nudges (especially in a learning context). Two studies were conducted to explore how individual differences, specifically focusing on personality, can affect nudge response in the context of healthcare education, where individuals use resources as a part of their informal learning and professional development. Different nudges, designed based on personality characteristics, were provided to draw individual users' attention to educational resources to encourage user engagement. The findings indicate that personality insights can be a predictor for nudge selection, suggesting that different nudges may be more effective when recommending learning resources to people with different personality characteristics.

A quick access to information on influenza burden and prevention in Lyon university hospital: A prospective QR code-based information campaign in 2022-2023.

BACKGROUND: Influenza vaccines are effective in decreasing hospitalizations and mortality related to influenza and its complications. However, the Vaccine Coverage Rate of influenza remains low and multifaceted efforts are required to improve it. The aim of this study was to assess the impact on influenza vaccine perception using a digital tool among outpatients and health care workers (HCWs). METHODS: A study was performed among outpatients and the HCWs of 23 hospital departments from 4 hospitals affiliated to Lyon university Hospitals (France), between October 2022 and February 2023. By scanning QR (Quick Response) codes, displayed on posters for patients, their companions, as well as in the letters sent to HCWs, users accessed anonymously to a web-application (ELEFIGHT®), which provided information on influenza and invited them to initiate a discussion on influenza prevention with their physicians during the consultation. Patients were also invited to complete a questionnaire regarding their perception of influenza vaccination before and after reading the information on ELEFIGHT®. The retention rate (RR = proportion of people who remain on the page for >2 s), the conversion rate (CR = proportion of people who click on the "Call-To-Action" button) and the absolute variation (difference in the perception before/after) and relative variation (absolute change as a percentage of the initial perception) in perception regarding influenza vaccination before and after consulting the application were calculated. RESULTS: 3791 scans were performed by 3298 patients and/or their companions with a RR of 52% and a CR of 55.1% and 253 scans by 221 HCWs with a RR of 71.2% and a CR of 115.3%. Participants spent an average of 47 s on the application. The questionnaire on influenza vaccination perception was completed by 1533 participants (46.5%); 1390 (90.7%) maintained the same position (neutral, favorable or unfavorable) on this vaccination before and after consulting the application. The relative variations in favor of vaccination were + 7.2% (unfavorable then favorable) and + 19.8% (neutral then favorable). CONCLUSION: This study suggests that a facilitated direct access to medical information through QR codes disseminated in health settings can help nudge people to foster their awareness of influenza and its prevention. Future deployments in a similar context or to other populations could be envisaged. Other vaccine-preventable and/or chronic diseases could also be the target of similar projects as part of public health programs.

Using artificial agents to nudge outgroup altruism and reduce ingroup favoritism in human-agent interaction.

Ingroup favoritism and intergroup discrimination can be mutually reinforcing during social interaction, threatening intergroup cooperation and the sustainability of societies. In two studies (N = 880), we investigated whether promoting prosocial outgroup altruism would weaken the ingroup favoritism cycle of influence. Using novel methods of human-agent interaction via a computer-mediated experimental platform, we introduced outgroup altruism by (i) nonadaptive artificial agents with preprogrammed outgroup altruistic behavior (Study 1; N = 400) and (ii) adaptive artificial agents whose altruistic behavior was informed by the prediction of a machine learning algorithm (Study 2; N = 480). A rating task ensured that the observed behavior did not result from the participant's awareness of the artificial agents. In Study 1, nonadaptive agents prompted ingroup members to withhold cooperation from ingroup agents and reinforced ingroup favoritism among humans. In Study 2, adaptive agents were able to weaken ingroup favoritism over time by maintaining a good reputation with both the ingroup and outgroup members, who perceived agents as being fairer than humans and rated agents as more human than humans. We conclude that a good reputation of the individual exhibiting outgroup altruism is necessary to weaken ingroup favoritism and improve intergroup cooperation. Thus, reputation is important for designing nudge agents.

They approve but they don't act: promoting sustainable minority behavior with (conflicting) social norm appeals.

Background: Social norm appeals are effective in promoting sustainable majority behavior but could backfire when the target behavior is only performed by a minority of people. However, emphasizing that an increasing number of people have started engaging in the behavior or that the majority approve the behavior might prevent such negative effects. However, only a few studies have investigated the combination of descriptive minority and injunctive majority social norm appeals, with inconsistent results. Some studies of minority behavior suggest that the characteristics of recipients might determine the inconsistent results regarding the impact of minority social norm appeals and that social norm appeals could have a greater impact on individuals with weaker environment related dispositions. Method: Two two-wave studies investigated how descriptive minority appeals, injunctive majority appeals, and their combination can be used to motivate sustainable minority behavior and what role environment related dispositions play in this context. In the first part, perceived social norms, environment related dispositions, behavioral intentions, and pre-attitudes were measured. Two weeks later, respondents participated in a 3 (descriptive social norm appeal: static vs. dynamic vs. absent) × 2 (injunctive majority social norm appeal: present vs. absent) between-subjects experiment and watched an explainer video on voluntary carbon offsets that included various social norm appeals. Results: In both studies, we found that social norm appeals influenced perceived social norms. However, persuasive effects were only observed in the first study, and an injunctive majority appeal increased persuasive outcomes, but there were no differences between the descriptive conditions and no differences in their impact depending on individuals' environment related dispositions in either study. Discussion: A single exposure may be insufficient to exert persuasive effects and the change in perceived social norms may first need to be internalized. In online explainer videos, the effects of social norm appeals could be amplified by algorithm-based suggestions and when social norm appeals draw attention to norm-conforming content. However, further research is required on the long-term effects and their possible amplification via social media.

Why we should not "help bad choosers:" screening, nudging, and epistemic risk.

One prominent line of support for nudging in screening programs is the claim that nudging can help 'bad choosers' - that is, it can help some patients make choices more in line with their own values and preferences. In this article, I argue that due to the presence of epistemic risk in many screening programs, the argument that nudging can help 'bad choosers' should be revised or rejected. Expanding on the work of Biddle, J. B. 2020. Epistemic risks in cancer screening: Implications for ethics and policy. Studies in History and Philosophy of Science Part C: Studies in History and Philosophy of Biological and Biomedical Sciences 79: 101200.), I argue that epistemic risk undermines the argument that nudging can help to promote patient autonomy in the context of screening. Specifically, I argue that epistemic risk results in the inclusion of non-patient values and preferences in the screening process, which challenges the claim that nudging can help patients make choices more in line with their own values and preferences. I present four reasons to think epistemic risk undermines the argument in this way: (1) conflicting values; (2) lack of transparency; (3) limited autonomy in opting out; (4) unjustified manipulation. The presence of epistemic risk in screening programs means that nudging may not always be an effective means of promoting patient autonomy and informed consent. As such, epistemic risk poses significant challenges to at least one ethical justification of nudging in screening programs, and raises further questions about the role of nudging in promoting patient decision-making.

Shop-to-Stop Hypertension: A multicenter cluster-randomized controlled trial protocol to improve screening and text message follow-up of adults with high blood pressure at health kiosks in hardware retail stores.

High blood pressure (BP) is the leading preventable risk factor for death, but only one in three patients achieve target BP control. A key contributor to this problem is poor population awareness of high BP, as the majority of patients are asymptomatic. The Shop-To-Stop Hypertension study is a multicenter, cluster-randomized controlled trial to identify, refer and follow adults in need of hypertension care, whilst raising population-wide awareness. In participants with high BP measured by SiSU Health Stations located in major hardware chain stores across New South Wales, Australia, we will determine whether text message-based nudges will encourage repeat BP checks and visits to their doctor. Based on pilot data, we anticipate 65,340 participants will be screened over 12 months, of which 18% will have high BP. Thirty hardware stores will be randomized (1:1) to: (i) Intervention: participants detected with high BP (≥140/≥90 mmHg) will receive text message-based nudges to return for a repeat SiSU Health Station BP check and to visit their general practitioner (GP) to check and manage their BP; (ii) Control: participants with high BP will not receive text messages. The primary outcome is the difference in the proportion of participants with high BP having a repeat BP check at hardware Health Stations in the intervention vs. control group at 12 months. This novel setting for screening utilises a novel 'citizen science' approach inviting the general public to perform their own BP screening at health kiosks and foster behavioral change. This will allow screening in a low-stress environment.

An Integrative Scoping Review of Behavioral Economics Applications in Higher Education: Opportunities for Academic Pharmacy.

OBJECTIVES: This integrative scoping review explores the applications of behavioral economics within higher education, particularly, through the lens of nudging (a concept that leverages insights from economics and psychology to guide individuals' decisions subtly). The primary objective is to provide a broad overview of interventions that use behavioral economics principles and, secondarily, discuss their potential to improve pharmacy education and create a foundation for future research in this area. FINDINGS: The review analyzed 89 studies that applied behavioral economics principles in higher education settings. Reminders and prompts were the most frequently used principles, with generally positive outcomes, especially in enrollment management. Framing, incentives, and salience also demonstrated effectiveness, depending on the context. Social norms and simplification showed mixed results, whereas priming, loss aversion, feedback, comparison, and commitment had varying degrees of success in influencing behavior. SUMMARY: Behavioral economics principles offer valuable insights and tools for enhancing various aspects of education. The review highlights the potential for using these principles to improve student engagement, enrollment processes, and health and well-being initiatives. However, it emphasizes the importance of context-specific design and careful implementation when applying these interventions. Future research opportunities exist to further explore the applications of behavioral economics in pharmacy education and beyond.

Nudging Interventions on Stair Use: A Scoping Review.

Stair use is a physical activity that can be incorporated into the daily lifestyle of a majority of the population, resulting in several health benefits. Nudges are increasingly used in public health interventions to encourage healthy behaviours such as physical activity in a cost-effective manner. This scoping review aimed to investigate the effect and the characteristics of nudges used on interventions to promote stair use. We reviewed the relevant literature published in PubMed, Cochrane Library, Mendeley and Google Scholar, from January 2009 to May 2022. Eligibility criteria included original studies of any type of design, written in English, targeting healthy adults, reporting nudging interventions, using elevator or escalator as comparators and defining a baseline for comparisons. Initially, 118 publications were identified, and after applying exclusion criteria, 27 articles were included in the analysis. Results showed that most of the nudging interventions had significant positive effect on stair use in several settings. The evidence from this review suggests that incorporating nudges into public health interventions can effectively promote physical activity through increased stair usage. Emphasizing prevention measures in public health interventions may contribute to better health outcomes.

Nudging intensive care unit personnel towards sustainable behaviour.

BACKGROUND: The health care sector is among the most carbon-intensive sectors, contributing to societal problems like climate change. Previous research demonstrated that especially the use of personal protective equipment (e.g., aprons) in critical care contributes to this problem. To reduce personal protective equipment waste, new sustainable policies are needed. AIMS: Policies are only effective if people comply. Our aim is to examine whether compliance with sustainable policies in critical care can be increased through behavioural influencing. Specifically, we examined the effectiveness of two sets of nudges (i.e., a Prime + Visual prompt nudge and a Social norm nudge) on decreasing apron usage in an intensive care unit (ICU). STUDY DESIGN: We conducted a field experiment with a pre- and post-intervention measurement. Upon the introduction of the new sustainable policy, apron usage data were collected for 9 days before (132 observations) and 9 days after (114 observations) the nudge interventions were implemented. RESULTS: Neither the Prime + Visual prompt nudge, nor the Social norm nudge decreased apron usage. CONCLUSIONS: While previous studies have found that primes, visual nudges and social norm nudges can increase sustainable behaviour, we did not find evidence for this in our ICU field experiment. Future research is needed to determine whether this null finding reflects reality, or whether it was due to methodological decisions and limitations of the presented experiment. RELEVANCE TO CLINICAL PRACTICE: The presented study highlights the importance of studying behavioural interventions that were previously proven successful in the lab and in other field contexts, in the complex setting of critical care. Results previously found in other contexts may not generalize directly to a critical care context. The unique characteristics of the critical care context also pose methodological challenges that may have affected the outcomes of this experiment.

Ethics of Nudging in the COVID-19 Crisis and the Necessary Return to the Principles of Shared Decision Making: A Critical Review.

Nudging, a controversial technique for modifying people's behavior in a predictable way, is claimed to preserve freedom of choice while simultaneously influencing it. Nudging had been largely confined to situations such as promoting healthy eating choices but has been employed in the coronavirus disease 2019 (COVID-19) crisis in a shift towards measures that involve significantly less choice, such as shoves and behavioral prods. Shared decision making (SDM), a method for direct involvement and autonomy, is an alternative approach to communicate risk. Predominantly peer-reviewed scientific publications from standard literature databases like PubMed, PsycInfo, and Psyndex were evaluated in a narrative review. The so-called fear nudges, as well as the dissemination of strongly emotionalizing or moralizing messages can lead to intense psycho-physical stress. The use of these nudges by specialized units during the COVID-19 pandemic generated a societal atmosphere of fear that precipitated a deterioration of the mental and physical health of the population. Major recommendations of the German COVID-19 Snapshot Monitoring (COSMO) study, which are based on elements of nudging and coercive measures, do not comply with ethical principles, basic psychological principles, or evidence-based data. SDM was misused in the COVID-19 crisis, which helped to achieve one-sided goals of governments. The emphasis on utilitarian thinking is criticized and the unethical behavior of decision makers is explained by both using the concept of moral disengagement and the maturity level of coping strategies. There should be a return to an open-ended, democratic, and pluralistic scientific debate without using nudges. It is therefore necessary to return to the origins of SDM.

Spillover effects of reminder nudges in complex environments.

We present an experiment on the immediate and lasting effects of reminder nudges in a complex environment. In the study, 1,542 subjects face a setting where, within a brief time frame, they have to pay attention to and perform multiple actions in a computer game. The experiment investigates i) the effect of reminders on the reminded actions and their spillovers on nonreminded actions; ii) spillovers between multiple nudges when the number of reminded actions is increased; and iii) intertemporal spillovers from having been exposed to reminders on actions after reminders are withdrawn. Our findings reveal, first, that reminders have a positive effect on the overall number of actions performed. It results from the positive direct effect on the reminded actions dominating the negative spillovers on nonreminded actions. These negative effects are notable in our setting, where reminders could potentially have positive spillovers by freezing attention or by indirectly prompting actions similar to the reminded ones. Second, we observe that reminder nudges are scalable. Increasing the number of reminded actions leads subjects to take more actions overall, albeit with diminishing returns and more pronounced negative spillover effects. Third, after reminders are withdrawn, the positive effect on reminded actions diminishes, while negative spillovers on nonreminded actions persist, thus rendering reminders ineffective in increasing the overall number of actions performed.

Effectiveness of visual nudges for encouraging healthier beverage choices from vending machines.

ISSUES ADDRESSED: Research suggests visual nudging techniques can subtly encourage healthier consumption. Two experiments explored the effect of four visual primes for nudging drink choices from a vending machine display. METHODS: Participants (17-25 years) were randomly assigned to view vending machine advertising posters containing pictorial nudges of water, soft drink, general health (runner), or a text-only control, for nudging vending machine choices. Participants then selected an item from a vending machine display containing drinks only (Experiment 1; n = 164), or both drinks and snack foods (Experiment 2, n = 684). RESULTS: In both experiments, nudging condition predicted beverage choice. Specifically, the water image nudged healthier beverage choices in both experiments. However, there was no effect on food choice in Experiment 2. Furthermore, in both experiments, liking and habitual consumption of chosen items were also significant predictors of choice, but condition predicted beverage choice over and above these. CONCLUSION: A water prime may be an effective means of encouraging healthier beverage choices in a vending machine environment. SO WHAT?: Findings have the potential to inform strategies for encouraging healthier beverage choices from vending machine environments.

Effects of traffic light labelling and increased healthy range on beverage choices from vending machines.

OBJECTIVE: To test whether traffic light labels and an increased range of healthy beverages, individually and in combination, can increase healthy beverage choices from vending machines. DESIGN: Two studies (n 558, 420) tested whether the provision of traffic light labels (green, amber and red) and an increased range of healthy beverages (from 20 % to 50 % green options), individually and in combination, could increase healthy beverage choices from a digital vending machine display. The studies used a between-subjects experimental design, and a hypothetical beverage choice, a limitation when considering real-world applicability. SETTING: Both studies utilised an online Qualtrics survey that featured a digital vending machine display. PARTICIPANTS: Both studies (n 558, 420) consisted of university students from Flinders University and individuals from a survey recruitment service. RESULTS: Featuring traffic lights did not significantly influence beverage choices (P = 0·074), while increasing the healthy range (P = 0·003, OR = 3·27), and the combination of both, did significantly increase healthier beverage choices (P < 0·001, OR = 4·83). CONCLUSIONS: The results suggest that the traffic light system and increased healthy range are not maximally effective when used on their own, and benefit greatly when combined, to increase healthy beverage choices. It was suggested that the provision of traffic light labels supplied the necessary nutritional information, and the increased healthy range offered greater opportunity to act in accordance with that information. In so doing, the present findings offer a promising pathway for reducing unhealthy beverage consumption.

Every step you take: Nudging animal welfare product purchases in a virtual supermarket.

Animal welfare (AW) is a growing concern for consumers in Germany; however, not all consumers regularly purchase products that have been produced according to high AW standards. The goal of the present study is to test the effect of a multilayered nudge to increase the availability and improve the visibility of AW products in a 3D online virtual supermarket (VS). The nudge included a shelf with AW products (referred to as AW shelf) which was made visible through banners and footsteps on the floor of the VS. The sample of this pre-registered experiment consisted of n = 374 German consumers who regularly purchase meat, milk, and eggs. The results demonstrated that the multilayered nudge was highly effective: the percentage of AW products purchased in the nudging condition was almost twice as high as in the control group. Furthermore, we investigated variables that mediate (ease of finding AW products in the VS) and moderate (price sensitivity) the effectiveness of the multilayered nudge, but no evidence for an effect was obtained. We conclude that multilayered nudges may be a promising tool to increase consumers' AW product purchases. More research is needed to replicate this finding with a field study in a real supermarket.

Impact of dishware size on energy intake in adult females: A randomized control trial examining effects on within-meal and post-meal energy intake.

The influence dishware size has on meal energy intake is unclear and no study to date has examined the impact on total daily energy intake. In a pre-registered RCT we investigate the impact of breakfast dishware size on breakfast and post-breakfast energy intake, as well as daily energy intake and hunger/fullness. In a repeated-measures design, 50 females (aged 18-77 years) were randomised to receive smaller or larger breakfast dishware on two separate days. Energy intake was also measured during the rest of the day. The primary outcomes were breakfast and post-breakfast energy intake (kcal). Secondary outcomes were total daily energy intake (kcal), and hunger/fullness (rated from 0 to 100). We examined if results differed by socioeconomic position (SEP). Dishware did not affect energy intake at breakfast (smaller: M = 394.8 kcal; SD = 172.2 larger: M = 394.4 kcal; SD = 164.4; d = 0.003, p = 0.98), and there was no statistically significant evidence that dishware size affected energy intake after breakfast, though post-breakfast energy intake was somewhat higher after using larger breakfast dishware (smaller: M = 1974.6 kcal; SD = 475.2; larger: M = 2077.5 kcal; SD = 525.9; d = -0.27, p = 0.06). Total daily energy intake, hunger and fullness ratings did not significantly differ between dishware conditions. There was no evidence that SEP moderated the effect of dishware size on energy intake. Smaller vs. larger breakfast dishware size had no significant effect on breakfast or post-breakfast energy intake, hunger, fullness, or daily energy intake. Previous studies may have overestimated the promise of dishware size as an intervention for reducing energy intake. Alternative interventions targeting the food environment should now be prioritised.

Hand hygiene compliance in nursing home wards: the effect of increased accessibility of alcohol-based hand rub.

BACKGROUND: Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission. AIM: To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs). METHODS: An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period. FINDINGS: A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and +13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001). CONCLUSION: Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential.

Exploring the Viability and Acceptance of Nudge in Public Policies for Health Promotion.

BACKGROUND: Behaviorally informed interventions, such as nudging, encourage actions intended to promote longer and healthier lives. Holding significant potential for influencing health policies and healthcare practices, these interventions are partaking of a shift in governance and public health policymaking. However, a substantial knowledge gap remains regarding the feasibility and appropriateness of implementing policies that draw on nudge. METHODS: Ae survey on nudge's acceptability) was adapted to the Portuguese context to access attitudes towards 16 nudge measures. The research focused on evaluating attitudes among political science and public administration BSc and MSc students from nine Portuguese universities, and analyzing the relationship between these attitudes, sociodemographic characteristics, and sociopolitical attitudes. The data analysis involved the application of descriptive and inferential statistics. RESULTS: The participants exhibited a moderate-to-high level of approval for various nudge measures, particularly those related to nutrition and public education/awareness raising. The study identified a nuanced relationship between the level of intrusiveness of nudges and their public approval, indicating that interventions preserving the architecture of choice gathered higher acceptance compared to more intrusive approaches. Notably, approval was associated with a high level of trust in social groups and a low propensity for risk-taking and alcohol consumption. CONCLUSIONS: This study not only sheds light on the types of nudge measures that are likely to be more acceptable for promoting healthy behaviors, but also establishes a crucial link between behavioral interventions and healthcare policies. Understanding the nuanced factors influencing the public acceptance of nudges contributes to the discourse on the implementation of behaviorally informed health policies and emphasizes the importance of tailoring interventions to align with public values and preferences.

Exploring open science practices in behavioural public policy research.

In their book 'Nudge: Improving Decisions About Health, Wealth and Happiness', Thaler & Sunstein (2009) argue that choice architectures are promising public policy interventions. This research programme motivated the creation of 'nudge units', government agencies which aim to apply insights from behavioural science to improve public policy. We closely examine a meta-analysis of the evidence gathered by two of the largest and most influential nudge units (DellaVigna & Linos (2022 Econometrica 90, 81-116 (doi:10.3982/ECTA18709))) and use statistical techniques to detect reporting biases. Our analysis shows evidence suggestive of selective reporting. We additionally evaluate the public pre-analysis plans from one of the two nudge units (Office of Evaluation Sciences). We identify several instances of excellent practice; however, we also find that the analysis plans and reporting often lack sufficient detail to evaluate (unintentional) reporting biases. We highlight several improvements that would enhance the effectiveness of the pre-analysis plans and reports as a means to combat reporting biases. Our findings and suggestions can further improve the evidence base for policy decisions.