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Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews.
Implement Sci. 2020 07 01; 15(1):50.IS

Abstract

BACKGROUND

Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an individual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews.

METHODS

As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, individual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework.

SYNTHESIS

The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects.

RESULTS

Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds Ratio was 1.62 (1.13, 2.76).

CONCLUSIONS

This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change.

TRIAL REGISTRATION

This review was not prospectively registered.

Authors+Show Affiliations

Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia. serene.yoong@health.nsw.gov.au. School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. serene.yoong@health.nsw.gov.au. Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia. serene.yoong@health.nsw.gov.au. Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. serene.yoong@health.nsw.gov.au.Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia.Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia.Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia. School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia. Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia. School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia. Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia. School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia. Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia.Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia. School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia. Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.Hunter New England Population Health, University of Newcastle, Locked Bag 10, Wallsend, New South Wales, 2287, Australia. School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. Hunter Medical Research Institute, Newcastle, New South Wales, 2300, Australia. Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.

Pub Type(s)

Journal Article
Review
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32611354

Citation

Yoong, Sze Lin, et al. "Nudge Strategies to Improve Healthcare Providers' Implementation of Evidence-based Guidelines, Policies and Practices: a Systematic Review of Trials Included Within Cochrane Systematic Reviews." Implementation Science : IS, vol. 15, no. 1, 2020, p. 50.
Yoong SL, Hall A, Stacey F, et al. Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews. Implement Sci. 2020;15(1):50.
Yoong, S. L., Hall, A., Stacey, F., Grady, A., Sutherland, R., Wyse, R., Anderson, A., Nathan, N., & Wolfenden, L. (2020). Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews. Implementation Science : IS, 15(1), 50. https://doi.org/10.1186/s13012-020-01011-0
Yoong SL, et al. Nudge Strategies to Improve Healthcare Providers' Implementation of Evidence-based Guidelines, Policies and Practices: a Systematic Review of Trials Included Within Cochrane Systematic Reviews. Implement Sci. 2020 07 1;15(1):50. PubMed PMID: 32611354.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews. AU - Yoong,Sze Lin, AU - Hall,Alix, AU - Stacey,Fiona, AU - Grady,Alice, AU - Sutherland,Rachel, AU - Wyse,Rebecca, AU - Anderson,Amy, AU - Nathan,Nicole, AU - Wolfenden,Luke, Y1 - 2020/07/01/ PY - 2020/02/04/received PY - 2020/06/16/accepted PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline KW - Guidelines KW - Healthcare provider KW - Implementation intervention KW - Nudge KW - Review SP - 50 EP - 50 JF - Implementation science : IS JO - Implement Sci VL - 15 IS - 1 N2 - BACKGROUND: Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an individual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews. METHODS: As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, individual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework. SYNTHESIS: The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects. RESULTS: Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds Ratio was 1.62 (1.13, 2.76). CONCLUSIONS: This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change. TRIAL REGISTRATION: This review was not prospectively registered. SN - 1748-5908 UR - https://www.unboundmedicine.com/medline/citation/32611354/Nudge_strategies_to_improve_healthcare_providers'_implementation_of_evidence-based_guidelines,_policies_and_practices:_a_systematic_review_of_trials_included_within_Cochrane_systematic_reviews L2 - https://implementationscience.biomedcentral.com/articles/10.1186/s13012-020-01011-0 DB - PRIME DP - Unbound Medicine ER -
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