Exploring the use of nudging in public health lifestyle interventions: A literature review

Abstract Background The concept of nudging has been imported from behavioral economics into the public health context to correct 'unhealthy behaviours' and produce health-promoting behavior changes in individuals. However, there is lack of clarity as to what constitutes a nudge and whether nudging techniques in public health lifestyle interventions are effective. The aim of this literature review is to identify nudging techniques used in public health lifestyle interventions and to investigate whether nudging techniques induce expected healthy lifestyle changes in interventions that relate to diet, exercise, sleep, alcohol and smoking. Methods A systematic literature review on the concept “nudging” in public health lifestyle interventions was conducted, applying a free text search strategy on a set of search terms in three databases: PubMed, CINAHL and PsycINFO. Articles meeting the inclusion criteria were included in our data set, and we performed a meta-synthesis to construct interpretative explanations. Results 66 original studies published in international peer-reviewed journals were identified. The findings showed that most nudging interventions involved diet/nutrition (n = 55), were carried out as single experiments, lasted for a short period of time and that the majority had the intended effects. Specific nudging techniques were identified and sorted into eight broader categories. The most commonly used nudging technique involved making healthier food items more apparent and accessible than less healthy foods. Conclusions The synthesis showed that these studies were limited with regard to their design, target groups, duration of the intervention, measures of effectiveness and critical reflection on ethical issues. Key messages Nudging may be effective in producing immediate behavioral changes; however, there is little evidence that nudging interventions result in lasting behavioral changes outside the setting of the studies. Further critical discussions about the implications of nudging in public health lifestyles intervention are required.

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Nudging in Public Health Lifestyle Interventions: A Systematic Literature Review and Metasynthesis

Health Education & Behavior ◽

10.1177/1090198120931788 ◽

2020 ◽

Vol 47 (5) ◽

pp. 749-764 ◽

Cited By ~ 2

Author(s):

Loni Ledderer ◽

Marianne Kjær ◽

Emilie Kirstine Madsen ◽

Jacob Busch ◽

Antoinette Fage-Butler

Keyword(s):

Public Health ◽

Financial Incentives ◽

Healthy Lifestyle ◽

Lifestyle Changes ◽

Health Interventions ◽

Lifestyle Interventions ◽

Public Health Interventions ◽

The Public ◽

Health Lifestyle ◽

Health Promoting

Nudging is increasingly used in public health interventions in Western societies to produced health-promoting behavior changes; however, there is lack of clarity as to what constitutes a nudge, scant knowledge of the effectiveness of nudging techniques in public health lifestyle interventions and a number of ethical and value-based concerns. The aim of this review is to address these research lacunae and identify the characteristics of nudges in empirical research on public health interventions intended to induce healthy lifestyle changes, including whether they are effective. We conducted systematic searches for relevant articles published between January 2008 and April 2019 in three databases, PubMed, CINAHL and PsycINFO, and combined this with a metasynthesis to construct interpretative explanations. A total of 66 original studies met the inclusion criteria. The findings of the systematic review showed that most nudging interventions involved diet/nutrition, most were carried out as single experiments, and the majority had the intended effects. Specific nudging techniques were identified with respect to the broader nudging categories of accessibility, presentation, using messages and pictures, technology-supported information, financial incentives, affecting the senses, and cognitive loading; several studies included more than one nudging technique. Although many nudging techniques had the intended effects, it is unclear whether they would work outside the study setting. The synthesis revealed that the studies lacked critical reflection on the assumptions about health that were implicit in nudging interventions, the cultural acceptability of nudges, the context-free assumptions of nudging theory, and the implications of these aspects for the public health context.

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Recent Advances in Treatment of Childhood Obesity

Current Drug Metabolism ◽

10.2174/1389200221666200817112311 ◽

2020 ◽

Vol 21 (14) ◽

pp. 1072-1078

Author(s):

Walter Milano ◽

Paola Ambrosio ◽

Francesca Carizzone ◽

Walter Di Munzio ◽

Valeria De Biasio ◽

...

Keyword(s):

Public Health ◽

Physical Activity ◽

Bariatric Surgery ◽

Childhood Obesity ◽

Treatment Strategies ◽

Lifestyle Changes ◽

Family Context ◽

Review Of The Literature ◽

Biological Factors ◽

The Family

: Childhood obesity has assumed epidemic proportions and is currently one of the most widespread public health problems. Many are the factors involved in the pathogenesis of excess weight with interactions between genetic, environmental and biological factors and therefore, also the therapeutic approach must be multidisciplinary and multidimensional. In this review of the literature, we report the contiguity of childhood obesity with eating disorders and the importance of involving the family context in order to induce stable lifestyle changes, both in relation to dietary and nutritional habits, but also in increasing physical activity. Finally, among the therapeutic options, although for selected cases, pharmacotherapy and bariatric surgery can be used as treatment strategies.

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Are public health measures and individualised care compatible in the face of a pandemic? A national observational study of bereaved relatives’ experiences during the COVID-19 pandemic

Palliative Medicine ◽

10.1177/02692163211019885 ◽

2021 ◽

pp. 026921632110198

Author(s):

Catriona R Mayland ◽

Rosemary Hughes ◽

Steven Lane ◽

Tamsin McGlinchey ◽

Warren Donnellan ◽

...

Keyword(s):

Public Health ◽

Family Support ◽

Online Survey ◽

Free Text ◽

Professional Networks ◽

Dying Patients ◽

The Face ◽

Individualised Care ◽

The Impact ◽

Informative Communication

Background: COVID-19 public health restrictions have affected end-of-life care experiences for dying patients and their families. Aim: To explore bereaved relatives’ experiences of quality of care and family support provided during the last days of life; to identify the impact of factors associated with perceived support. Design: A national, observational, open online survey was developed and disseminated via social media, public fora and professional networks (June–September 2020). Validated instruments and purposively designed questions assessed experiences. Analysis used descriptive statistics, logistic regression and thematic analysis of free-text responses. Participants: Individuals (⩾18 years) who had experienced the death of a relative/friend (all care settings) within the United Kingdome during the COVID-19 pandemic. Results: Respondents ( n = 278, mean 53.4 years) tended to be female ( n = 216, 78%); over half were ‘son/daughter’ (174, 62.6%) to the deceased. Deceased individuals (mean 81.6 years) most frequently died in their ‘usual place of care’ ( n = 192, 69.3%). Analysis established five conceptual themes affecting individualised care: (1) public health restrictions compounding the distress of ‘not knowing’; (2) disparate views about support from doctors and nurses; (3) challenges in communication and level of preparedness for the death; (4) delivery of compassionate care; (5) emotional needs and potential impact on grief. Male respondents (OR 2.9, p = 0.03) and those able to visit (OR 2.2, p = 0.04) were independently associated with good perceptions of family support. Conclusion: Despite public health restrictions, individualised care can be enabled by proactive, informative communication; recognising dying in a timely manner and facilitating the ability to be present before death.

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SuperWASP variable stars: classifying light curves using citizen science

Monthly Notices of the Royal Astronomical Society ◽

10.1093/mnras/stab140 ◽

2021 ◽

Vol 502 (1) ◽

pp. 1299-1311

Author(s):

Heidi B Thiemann ◽

Andrew J Norton ◽

Hugh J Dickinson ◽

Adam McMaster ◽

Ulrich C Kolb

Keyword(s):

Variable Stars ◽

Eclipsing Binaries ◽

Light Curves ◽

Data Set ◽

Resultant Data ◽

Sky Survey ◽

Short Period ◽

Contact Binaries ◽

Analysis Of Results

ABSTRACT We present the first analysis of results from the SuperWASP variable stars Zooniverse project, which is aiming to classify 1.6 million phase-folded light curves of candidate stellar variables observed by the SuperWASP all sky survey with periods detected in the SuperWASP periodicity catalogue. The resultant data set currently contains >1 million classifications corresponding to >500 000 object–period combinations, provided by citizen–scientist volunteers. Volunteer-classified light curves have ∼89 per cent accuracy for detached and semidetached eclipsing binaries, but only ∼9 per cent accuracy for rotationally modulated variables, based on known objects. We demonstrate that this Zooniverse project will be valuable for both population studies of individual variable types and the identification of stellar variables for follow-up. We present preliminary findings on various unique and extreme variables in this analysis, including long-period contact binaries and binaries near the short-period cut-off, and we identify 301 previously unknown binaries and pulsators. We are now in the process of developing a web portal to enable other researchers to access the outputs of the SuperWASP variable stars project.

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A Powerful Antidote to Physician Burnout: Intensive Healthy Lifestyle and Positive Psychology Approaches

American Journal of Lifestyle Medicine ◽

10.1177/15598276211006626 ◽

2021 ◽

pp. 155982762110066

Author(s):

Liana Lianov

Keyword(s):

Healthy Lifestyle ◽

Meaningful Work ◽

Well Being ◽

Evidence Base ◽

Lifestyle Changes ◽

Lifestyle Interventions ◽

Physical And Mental Health ◽

Physician Burnout ◽

Lifestyle Medicine ◽

Persistent Symptoms

Burnout rates among physicians are rapidly rising. Leaders in the movement to address burnout have made the case that health care workplaces need to foster a culture of well-being, including trusting coworker interactions, collaborative and transparent leadership, work-life balance, flexibility, opportunities for meaningful work and for professional development, and effective 2-way communication. The rationale for focusing on organizational change to prevent burnout has pointed to persistent symptoms of burnout even when individual healthy lifestyle interventions are adopted. However, a case can be made that the lifestyle interventions were not implemented at the level of intensity recommended by the lifestyle medicine evidence-base to secure the desired improvement in physical and mental health when facing significant personal and environmental stressors. The lifestyle medicine community has the ethical mandate to advocate for intensive healthy lifestyle approaches to burnout prevention, in conjunction with organizational supports. By combining comprehensive and intensive lifestyle changes with organizational cultures of well-being, we can more effectively turn the tide of physician burnout.

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Cardiovascular disease and meaning in life: A systematic literature review and conceptual model

Palliative & Supportive Care ◽

10.1017/s1478951520001261 ◽

2021 ◽

pp. 1-10

Author(s):

Joel Vos

Keyword(s):

Mental Health ◽

Literature Review ◽

Conceptual Model ◽

Psychological Stress ◽

Systematic Literature Review ◽

Meaning In Life ◽

Mental Health Problems ◽

Lifestyle Changes ◽

Meaningful Life ◽

Psychological Treatments

Abstract Objectives Previous studies have shown that psychological stress and mental health problems increase the risk for cardiovascular disease (CVD) events, such as heart attack or stroke. Furthermore, after CVD events, the majority of patients report large stress. However, psychological treatments have only modest effects in CVD patients. Therefore, it has been argued that new conceptual models are needed to understand the aetiology of stress and mental health problems in CVD patients. Therefore, this study included a systematic literature review and a conceptual model on the role of meaning in life for psychological stress, mental health, and CVD risks. Methods A systematic literature review was conducted on relationships between CVD and meaning in life. PRISMA/MOOSE review guidelines were followed. These findings were used to build a conceptual model. Results The literature review included 113 studies on meaning and CVD. The included studies described meaning as a predictor of cardiovascular risks and health, meaning-centered needs of patients in conversations with medical staff, meaning-centered changes after CVD events, meaning-centered coping with CVD, meaning as motivator of CVD-related lifestyle changes, and meaning as an element in psychological treatments of CVD patients. In sum, the literature showed that a central clinical concern for patients is their question how to live a meaningful life despite CVD. Meaning-centered concerns seem to lead to lower motivation to make lifestyle changes, more psychological stress, lower quality-of-life, worse physical well-being, and increased CVD risk. The ability to live a meaningful life after CVD events is related with lower stress, better mental health, and several biomarkers. Significance of results An evidence-based conceptual framework was developed for the relationship between meaning and CVD. It may be hypothesized CVD patients may benefit from psychological therapies focused on meaning.

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TWISTED POUCH SYNDROME - A DIFFICULT TO DIAGNOSE MECHANICAL COMPLICATION OF ILEAL POUCH-ANAL ANASTOMOSIS: OUTCOMES AFTER REDO POUCH PROCEDURES

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa347.041 ◽

2021 ◽

Vol 27 (Supplement_1) ◽

pp. S16-S17

Author(s):

Stefan Holubar ◽

Amy Lightner ◽

Taha Qazi ◽

Erica Savage ◽

Justin Ream ◽

...

Keyword(s):

Ileal Pouch ◽

Ileal Pouch Anal Anastomosis ◽

Free Text ◽

Mechanical Complication ◽

Rectal Pain ◽

Bowel Habits ◽

Additional Surgery ◽

Free Text Search ◽

Anal Anastomosis ◽

Redo Pouch

Abstract Background Ileal pouch-anal anastomosis (IPAA) is a technically demanding procedure. Intraoperatively, great care must be taken to assure a straight superior mesenteric axis. Rarely, twisted pouches are inadvertently constructed, resulting in deviations of expected pouch function, i.e. patients readily able to open their bowels on average 7x/24 hours without pain. Twisted pouches may result in symptoms classified as pouch dysfunction. Herein we describe our quaternary pouch referral center experience with twisted pouch syndrome (TPS). Methods We performed a retrospective review of our prospectively maintained pouch registry from 1995 – 2020. Patients were identified using free-text search of redo IPAA operative reports for variations of the term “twist”. We defined twisted pouch syndrome as intraoperative findings of twisting of the pouch as the primary pathology. Data are presented as frequency (proportion) or median (interquartile range). Results Over 25-years, we identified 29 patients with confirmed TPS who underwent a redo pouch procedure by 10 surgeons. Overall, 65% were female, median BMI 21.2 (19.5 – 26) kg/m2. The duration from the index IPAA to the redo procedure was 4 (2 – 8) years; all (100%) were referral cases constructed elsewhere. Original diagnoses included: ulcerative colitis (90%), FAP (10%), lack of interstitial cells of Cajal in 1 patient (10%). All patients presented with symptoms of pouch dysfunction including erratic bowel habits (96%) with urgency/frequency, abdominal/pelvic/rectal pain (92%), and obstructive symptoms (88%). Most had (75%) been treated for chronic pouchitis with antibiotics or biologics, and 46% had undergone 1 or more additional surgery. Prior to redo IPAA procedure patients underwent a thorough workup: 100% pouchoscopy, 96% GGE, 93% underwent EUA, 88% MRI, 73% manometry, and 42% defecography. TPS was diagnosed in 15% by pouchoscopy, in 10% by imaging, and in 75% was diagnosed intra-operatively at re-diversion (20%) or revision/redo IPAA (55%). In terms of surgical intervention, 85% were initially re-diverted. A total of 18 (62%) underwent pouch revision, and 10 (38%) required redo-IPAA. Short-term outcomes: LOS 7.5 (5 – 9) days, any complication 48%, readmission 11%, reoperation 3.4%, zero mortalities. After a median follow-up 50 (28 – 60) months, 2 never had loop ileostomy closure, 1 had pouch excision, and 1 a Kock pouch, yielding an overall pouch survival rate of 86%. Conclusions Twisted pouch syndrome presents with pouch dysfunction manifest by erratic bowel habits, unexplained pain, and obstructive (defecation) symptoms. This syndrome may also mimic chronic pouchitis. Despite a thorough workup which may suggest a mechanical problem, many patient may not be diagnosed until time of redo pouch surgery. Redo surgery for twisted pouch syndrome results in long-term pouch survival for the majority.

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A Literature Review of Medical Record Keeping by Foreign Medical Teams in Sudden Onset Disasters

Prehospital and Disaster Medicine ◽

10.1017/s1049023x15000102 ◽

2015 ◽

Vol 30 (2) ◽

pp. 216-222 ◽

Cited By ~ 17

Author(s):

Anisa J. N. Jafar ◽

Ian Norton ◽

Fiona Lecky ◽

Anthony D. Redmond

Keyword(s):

Literature Review ◽

Medical Record ◽

Medical Records ◽

Sudden Onset ◽

World Health ◽

Publication Type ◽

Data Set ◽

Record Keeping ◽

Medical Teams

AbstractBackgroundMedical records are a tenet of good medical practice and provide one method of communicating individual follow-up arrangements, informing research data, and documenting medical intervention.MethodsThe objective of this review was to look at one source (the published literature) of medical records used by foreign medical teams (FMTs) in sudden onset disasters (SODs). The published literature was searched systematically for evidence of what medical records have been used by FMTs in SODs.FindingsThe style and content of medical records kept by FMTs in SODs varied widely according to the published literature. Similarly, there was great variability in practice as to what happens to the record and/or the data from the record following its use during a patient encounter. However, there was a paucity of published work comprehensively detailing the exact content of records used.InterpretationWithout standardization of the content of medical records kept by FMTs in SODs, it is difficult to ensure robust follow-up arrangements are documented. This may hinder communication between different FMTs and local medical teams (LMTs)/other FMTs who may then need to provide follow-up care for an individual. Furthermore, without a standard method of reporting data, there is an inaccurate picture of the work carried out. Therefore, there is not a solid evidence base for improving the quality of future response to SODs. Further research targeting FMTs and LMTs directly is essential to inform any development of an internationally agreed minimum data set (MDS), for both recording and reporting, in order that FMTs can reach the World Health Organization (WHO) standards for FMT practice.JafarAJN, NortonI, LeckyF, RedmondAD. A literature review of medical record keeping by foreign medical teams in sudden onset disasters. Prehosp Disaster Med. 2015;30(2):1-7.

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