How behavioral economics can inform the next mass vaccination campaign: A narrative review.

Designing the next mass vaccination campaign will require ideas and techniques from behavioral economics. History and current events have shown how failing to consider features of human behavior, from individual biases in information processing to the relationships between people and policymakers, frustrated public health efforts. Behavioral economics can inform how a vaccination campaign needs to deliver processes and information necessary to help people decide to vaccinate, especially when mandates to vaccinate are not possible. Such campaigns need to employ both "nudges" (i.e., promote action) and remove "sludge" (i.e., break down blockers) to influence decisions directly. Strategies must be both acute and systemic to the current approach to public health.

End-of-Life Preferences: A Randomized Trial of Framing Comfort Care as Refusal of Treatment in the Context of COVID-19.

BACKGROUND: Rates of advance directive (AD) completion in the United Kingdom are lower than in the United States and other western European countries, which is especially concerning in light of the COVID-19 pandemic. UK residents typically complete an advance decision to refuse care (ADRT), whereas US versions of ADs present a more neutral choice between comfort-oriented or life-prolonging care. The purpose of this study is to test whether this framing affects decision making for end-of-life care and if this is affected by exposure to information about the COVID-19 pandemic. METHODS: In an online experiment, 801 UK-based respondents were randomly allocated to document their preferences for end-of-life care in a 2 (US AD or UK ADRT) by 2 (presence or absence of COVID-19 prime) between-subjects factorial design. RESULTS: Most (74.8%) of participants across all conditions chose comfort-oriented care. However, framing comfort care as a refusal of treatment made respondents significantly less likely to choose it (65.4% v. 84.1%, P < 0.001). This effect was exacerbated by priming participants to think about COVID-19: those completing an ADRT were significantly more likely to choose life-prolonging care when exposed to the COVID-19 prime (39.8% v. 29.6%, P = 0.032). Subgroup analyses revealed these effects differed by age, with older participants' choices influenced more by COVID-19 while younger participants were more affected by the AD framing. CONCLUSIONS: The UK ADRT significantly reduced the proportion of participants choosing comfort-oriented care, an effect that was heightened in the presence of information about COVID-19. This suggests the current way end-of-life care wishes are documented in the United Kingdom could affect people's choices in a way that does not align with their preferences, especially in the context of the COVID-19 pandemic. HIGHLIGHTS: Participants completing an AD framed as an advance decision to refuse treatment were significantly less likely to choose comfort-oriented care than participants completing an AD with a neutral choice between comfort-oriented and life-prolonging care.Exposure to a COVID-19 prime had an interactive effect on documented preferences in the refusal of treatment condition, with these participants even less likely to choose comfort-oriented care.Policy makers and organizations that design templates for advance care planning, particularly in the time of the COVID-19 pandemic, should be aware how the framing of these forms can influence decisions.

Dupchanchia Model of Students' drop-out control through engagement and appreciation after Covid-19: A Behavioral Policy intervention in the field administration of Bangladesh

Bangladesh is a country which has successfully accomplished the millennium development goals. Upon such accomplishment and with new growing consensus with the global community, the country at present is in pursuit of achieving the sustainable development goals with mostly concentrating on the education sector. However, what impacted the growth and pace of the initiatives was the overwhelming impact of Covid-19 and the lockdown afterwards. Academic institutions remained closed at least for two years which resulted in a compromising number of students after the resumption. This study starts from the identification of a genuine problem with original field level data of the gradually declining number of students. It requires policy intervention centrally and locally. Government of Bangladesh has been deploying some traditional method like vocational and stipend system which is involved with large amount of monetary disbursement. This study found that government like Bangladesh should introduce new or customized education policy which can reduce budgetary involvement and change the choice structure of students. This approach and method has the transferability whereby other similar states can adapt. As a crucial part of local government, I have been working as the chief executive officer of a sub-district called Dupchanchia, and coordinating government departments to implement government policy. After rigorous discussion and brainstorming among the local stakeholders and teachers we uncovered that the students have become demotivated, traumatized and panicked of social engagement and any form of shared activities like classes, games and others. It required us to find out a local policy solution followed by a detailed literature review and primary data collection maneuver. Taking twenty schools into consideration for the study, the project initiated a behavioral policy intervention in ten particular schools and did not interfere with the other ten schools. I engaged local teachers, students and other related stakeholders and continued to use six behavioral tools to change the choice structure of the students of ten selected schools. We observed other ten schools without intervening in their environment and academic atmosphere at all. At the end of the study we collected data through key informant interviews and focus group discussion engaging teachers, peoples' representatives and government officials. Behavioral public policy intervention like nudge and engagement approaches are found to have a positive relation with the change in students number and their performance in the academic and co-curricular activities. This approach may contribute to controlling students' drop out in the lower and lower middle income countries after Covid shock. This policy intervention may have some challenges and limitations which need intensive and rigorous pre-study and prolonged design. Nevertheless, it has unlimited opportunities to be addressed. [ FROM AUTHOR] Copyright of Technium Social Sciences Journal is the property of Technium Press Constanta and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The ethics of health nudges: a discussion about their acceptability in public health

In behavioral science, the term nudge refers to any aspect of decision architecture that predictably alters people's behavior to impro-ve the chooser's own welfare without forbidding or significantly restricting their choices. Its promoters invoke libertarian paternalism, which means, on the one hand, that the behavior of the individual is guided without counting on his autonomy, but, on the other hand, that this form of influence does not reach the point of restricting freedom of choice when it is manifest. This paper analyzes the role of nudges in the field of health policies. A cognitive analysis of these nudges is carried out and are distinguished the clinical nudges (those that take place within the healthcare professional and patient relationship) from the public health nudges (specific to public health policies). The ethical aspects of both categories of nudge will be analyzed to point out some of their virtues and the ethical challenges they face. This study focuses in particular on public health nudges, to consider whether it is reasonable, and with what limits, their implementation in health crises (for example, pandemics). Analyzing that public policies face the dilemma between preserving freedom at the expense of health or, on the contrary, prioritize health to the point of limiting freedom. It is raised whe-ther in this context greater restrictions on individual freedoms should be allowed (for example, through mandatory lockdowns and quarantines, imposed vaccinations, forced tests) or whether to use nudges as an intermediate solution and less harmful to individual rights to promote health measures.

COVID-Pass under Scrutiny. Nudging and Fundamental Rights

The requirement of the COVID-19 certificate by the regional Ministries of Health generalised in December 2021 to access leisure, catering and socio-healthcare establishments as an instrument to contain the pandemic and encourage vaccination limits, among others, the following fundamental rights: equality, physical integrity, privacy, freedom of movement and free enterprise. Given its novelty the literature on the topic is still in its infancy. This work analyses the legal basis of this instrument to establish such limitations, its proportionality and the constitutionality of the measure as a nudge to promote vaccination taking into account its real effectiveness and safety. The study concludes evaluating the general COVID-19 vaccination campaign's constitutionality.

Informational value of visual nudges during crises: Improving public health outcomes through social media engagement amid COVID-19

In this study, we conceptualize and empirically evaluate how large-scale organizations can utilize the informational value of visual nudges on social media to promote safety among users and thus improve public health outcomes in the context of the coronovirus desease caused by the SARS-CoV-2 virus (COVID-19) pandemic. We construct a unique panel dataset combining data collected from multiple public and proprietary sources. To operationalize visual nudges from user-generated content, we engage in extensive manual classification of images collected from Instagram (IG), Twitter (TW), and Facebook (FB). To examine the relationship between visual nudging and COVID-19 positivity, we rely on a combination of econometric and epidemiological models. We find that when institutional actors share more images containing mask-related information on IG, their COVID-19 positivity rates decrease by up to 25%, on average. Also, given the fragmentary evidence behind FB and TW effects, our results provide suggestive evidence of the "boundary condition” of the visual nudge effect. Finally, empirical evidence indicates the dynamic and curvilinear effect of visual nudges on positivity over time, such that the informational value of visual nudging is most prominent if communicated 3 to 5 weeks ahead of time, on average. Our results demonstrate the informational value of visual nudges communicated through pertinent social media channels, as well as their capacity to improve public health outcomes. This suggests the feasibility of institutional actors using social media engagement to promote safe behaviors. We conclude by discussing how our findings may be used to develop more effective communication strategies regarding public perceptions of mask use and other relevant safety measures. © 2023 The Authors. Production and Operations Management published by Wiley Periodicals LLC on behalf of Production and Operations Management Society.

A Real-Time Portable IoT System for Telework Tracking.

Telework has become a universal working style under the background of COVID-19. With the increased time of working at home, problems, such as lack of physical activities and prolonged sedentary behavior become more prominent. In this situation, a self-managing working pattern regulation may be the most practical way to maintain worker's well-being. To this end, this paper validated the idea of using an Internet of Things (IoT) system (a smartphone and the accompanying smartwatch) to monitor the working status in real-time so as to record the working pattern and nudge the user to have a behavior change. By using the accelerometer and gyroscope enclosed in the smartwatch worn on the right wrist, nine-channel data streams of the two sensors were sent to the paired smartphone for data preprocessing, and action recognition in real time. By considering the cooperativity and orthogonality of the data streams, a shallow convolutional neural network (CNN) model was constructed to recognize the working status from a common working routine. As preliminary research, the results of the CNN model show accurate performance [5-fold cross-validation: 0.97 recall and 0.98 precision; leave-one-out validation: 0.95 recall and 0.94 precision; (support vector machine (SVM): 0.89 recall and 0.90 precision; random forest: 0.95 recall and 0.93 precision)] for the recognition of working status, suggesting the feasibility of this fully online method. Although further validation in a more realistic working scenario should be conducted for this method, this proof-of-concept study clarifies the prospect of a user-friendly online working tracking system. With a tailored working pattern guidance, this method is expected to contribute to the workers' wellness not only during the COVID-19 pandemic but also take effect in the post-COVID-19 era.

Blue, rather than red light can nudge employees to choose delayed but larger wage payment

Most businesses have been severely affected during the ongoing Coronavirus Disease 2019 (COVID-19) pandemic, as they lack sufficient cash reserves for turnaround in this devastated business environment. This study presents a nudge-based approach for encouraging employees to choose delayed but larger wage payment. Through two laboratory experiments and one field experiment, we found that blue light more likely promotes individuals choosing the farsighted intertemporal option (i.e., delayed but larger payment) than red light. We further investigated why blue light can promote such a farsighted decision and found that the intradimensional difference comparison-that is, comparing the difference between the two options in the time dimension (time A,B) and the difference in the payoff dimension (payoff A,B)-mediates the effect of blue (vs. red) light on intertemporal choice. The current study demonstrates the effectiveness of light color and provides a solution to nudge people to make farsighted choices. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

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. © 2023 by the authors.

Does the Power of Social Example Fade? Nudge Effect of Social Information on Individual's Donation Behaviors During the COVID-19 Pandemic: A Moderated Mediation Model with Three-Wave Cross-Sectional Data.

Purpose: This study assesses how various social information influence individuals' money donation behaviors towards charitable funds against the COVID-19 pandemic at different stages of the pandemic. It also explores the mediating role of social anxiety and the moderating role of self-control. Materials and Methods: This three-wave study was conducted with online survey experiments using convenience sampling at the pandemic's outbreak stage (April-June 2020), trough stage (February-March 2021), and resurgence stage (May 2022) in China. The nudge power of social information was measured by whether participants changed their initial money donation decisions after informed positive or negative social information. Self-report scales were used to measure levels of social anxiety (Social Interaction Anxiety Scale) and self-control (Self-Control Scale). The final data set included 1371 participants from 26 provinces of mainland China. Stata medeff package and SPSS PROCESS were used to analyze the data. Results: Individuals' initial donation behaviors did not fluctuate along with the pandemic status, but the nudge effect of social information did. From outbreak stage to trough stage, the nudge power of positive social information significantly declined, but did not significantly change again at the resurgence stage. By contrast, the nudge power of negative social information did not significantly differ between outbreak and trough stage but did significantly increase at the resurgence stage. Social anxiety played a significant mediating role in the relationship between COVID-19 status and power of social information. Moreover, self-control moderated the direct effect of COVID-19 status on power of social information and the indirect effect via social anxiety. Conclusion: Our findings enrich research on the nudge power variation of social information on individuals' donation behaviors along with the pandemic status and its potential psychological influence factors. This study also helps guide organizations to better design and carry out social information nudge mechanism.

A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit.

PURPOSE: To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. DESIGN: Randomized, controlled trial. SETTING: Two health systems in the Northeastern US between September 2020 and March 2021. SUBJECTS: 74,811 adults. INTERVENTIONS: Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. MEASURES: Influenza vaccination. ANALYSIS: Intention-to-treat. RESULTS: Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control. CONCLUSIONS: Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

The effects of default nudges on promoting approval of welfare cuts: An exploration during COVID-19.

The global COVID-19 pandemic has created significant financial and operational challenges for some businesses. As a result, temporary welfare benefit reduction may be a tough but future-oriented choice for both employers and employees. The present study examined whether default nudges can be used to promote employees' approval of welfare-cutting policy while avoiding negative attitudes. Two online surveys were conducted during the first pandemic wave in China (February 2020). In the first study (N = 310), the participants were presented with a hypothetical welfare-cutting policy that used either an opt-in approach or an opt-out approach. We aimed to investigate how their approval and attitudes were different between two conditions. The results showed that the employees in the opt-out condition were more likely to accept the welfare-cutting policy than those in the opt-in condition, while participants' attitudes toward the policy employing opt-out approach were as negative as that employing opt-in approach. Study 2 (N = 1,519) involved a replication of Study 1 with two additional improved opt-out approaches (opt-out education and opt-out transparency). Compared with the opt-in approach and standard opt-out approach, the opt-out education approach both increased policy support and improved attitudes toward the welfare-cutting policy. The theoretical and practical implications of these findings are discussed.

Nudge-Based Interventions on Health Promotion Activity Among Very Old People: A Pragmatic, 2-Arm, Participant-Blinded Randomized Controlled Trial.

OBJECTIVES: Social distancing due to the coronavirus disease 2019 crisis can exacerbate inactivity in older adults. Novel approaches for older adults must be designed to improve their activity and maintain their health. This study examined the effect of nudge-based behavioral interventions on health-promoting activities in older adults in Japan. DESIGN: Two-arm, participant-blinded randomized controlled trial. SETTING AND PARTICIPANTS: Japanese continuing care retirement community residents (n = 99, median age 82 years, 73% women) INTERVENTION: Two-step nudge-based behavioral intervention promoting tablet usage. METHODS: We enrolled participants from an ongoing Internet of Things project in a retirement community in Japan. For the health promotion program, tablet computers were installed in a common area for participants to receive information about their health. The intervention group received a 1-time loss-emphasized nudge (first step), followed by asking questions about when they planned to use it again (second step). The control group used the tablet computers without being asked those questions. The main outcome was the participants' mean daily tablet activity every 4 weeks for the next 16 weeks. RESULTS: Ninety-nine individuals were randomly assigned to the intervention or control group. The rate ratios for tablet use were significantly higher in the intervention group in the second and third periods. The subgroup analysis showed that these effects were largely attributable to men. CONCLUSIONS AND IMPLICATIONS: Nudge-based interventions can be effective in promoting activities for older adults, especially older men. The finding of this study indicates a possible intervention to engage people who are socially isolated.

A Good Practice Project Related To Sustainable Solutions to Address the Global Pandemic and Achieve Agenda 2030

The COVID-19 pandemic has stressed the relevance of performing a deep review regarding the robustness of current food production and consumption systems. The health crisis derived from the outbreak has directly influenced lifestyle habits throughout the planet, including food consumption and its related food loss and waste (FLW) generation, mainly by the compulsory "staying home”. The reduction of FLW is a key to achieving sustainability, and more recently a main objective of the EU Farm to Fork (F2F) strategy for sustainable food, which aims at making food systems fair, healthy and environmentally-friendly. In this context, EC will strengthen educational messages on the importance of reducing food waste within school. Italian Project: "Food waste, consumer attitudes and behaviour: a project exploring the reasons linked to consumer-related food waste, involving Italian schools” (named SPAIC), was carried out by Ministry of Health, INAIL and three Italian high schools (from 2016 to 2020). SPAIC project was chosen by Food and Agriculture Organization of the United Nations (FAO) as good practice and lesson on food security and nutrition policy implementation in Europe and Central Asia region. Reducing the amount of wasted food is a key element in developing programs of global environmental, ethical and sustainable food system production. Food waste occurs at all stages of the food production, starting from harvesting, through manufacturing and distributing and finally consumption, but the largest contribution to food waste occurs surprisingly at home in the developed countries. To reduce consumer-related food waste, it is necessary to have a clear understanding of the factors influencing food waste-related consumer perceptions and behaviours. The Project focused on the food consumption to explore the reasons of food waste production at family level in order to overcome food-wasting behaviour. Then, the aim was to point out options to design prevention measures by the responsible involvement of the students. © 2021, Avestia Publishing. All rights reserved.

Structured reflection increases intentions to reduce other people's health risks during COVID-19.

People believe they should consider how their behavior might negatively impact other people, Yet their behavior often increases others' health risks. This creates challenges for managing public health crises like the COVID-19 pandemic. We examined a procedure wherein people reflect on their personal criteria regarding how their behavior impacts others' health risks. We expected structured reflection to increase people's intentions and decisions to reduce others' health risks. Structured reflection increases attention to others' health risks and the correspondence between people's personal criteria and behavioral intentions. In four experiments during COVID-19, people (N  = 12,995) reported their personal criteria about how much specific attributes, including the impact on others' health risks, should influence their behavior. Compared with control conditions, people who engaged in structured reflection reported greater intentions to reduce business capacity (experiment 1) and avoid large social gatherings (experiments 2 and 3). They also donated more to provide vaccines to refugees (experiment 4). These effects emerged across seven countries that varied in collectivism and COVID-19 case rates (experiments 1 and 2). Structured reflection was distinct from instructions to carefully deliberate (experiment 3). Structured reflection increased the correlation between personal criteria and behavioral intentions (experiments 1 and 3). And structured reflection increased donations more among people who scored lower in cognitive reflection compared with those who scored higher in cognitive reflection (experiment 4). These findings suggest that structured reflection can effectively increase behaviors to reduce public health risks.

Will the Construction of Sports Facilities Nudge People to Participate in Physical Exercises in China? The Moderating Role of Mental Health.

This study aims to examine the nudging effect of the sports facility construction on physical exercise (PE) participation with consideration of the moderating role of mental health in China. Multiple linear regression models are used in this study. The subjects are 4634 from the 2014 China Family Panel Studies (CFPS) data, which is a nationally representative longitudinal survey of Chinese individuals. We find that the construction of sports facilities nudges people to participate in PE, and gender, age, and education significantly influence people's participation in PE. Young, female, and better-educated people compose the "neo-vulnerable" population, who participate less in PE in China and need more interventions. Mental health status has no significant effect on people's PE participation, while it negatively moderates the nudging effect of the construction of sports facilities on PE. The results of this study suggest that only building sporting facilities is insufficient to encourage PE participation. Policies and interventions should be given to mentally disturbed individuals to guarantee and magnify the nudging effect of sports facilities on PE.

COVID-Pass under Scrutiny. Nudging and Fundamental Rights

The requirement of the COVID-19 certificate by the regional Ministries of Health generalised in December 2021 to access leisure, catering and socio-healthcare establishments as an instrument to contain the pandemic and encourage vaccination limits, among others, the following fundamental rights: equality, physical integrity, privacy, freedom of movement and free enterprise. Given its novelty the literature on the topic is still in its infancy. This work analyses the legal basis of this instrument to establish such limitations, its proportionality and the constitutionality of the measure as a nudge to promote vaccination taking into account its real effectiveness and safety. The study concludes evaluating the general COVID-19 vaccination campaign's constitutionality. © 2022 Universidad Nacional de Educacion a Distancia. All rights reserved.

Fighting the spread of COVID-19 misinformation in Kyrgyzstan, India, and the United States: How replicable are accuracy nudge interventions?

The spread of misinformation has generated confusion and uncertainty about how to behave with respect to protective actions during the COVID-19 pandemic, such as social distancing and getting vaccinated. Pennycook et al. (2020) garnered significant press attention when they found that asking people to think about the accuracy of a single headline (i.e., accuracy nudge) improved their discernment in sharing true versus false information related to COVID-19. The present Open Science Framework preregistered experiment sought to replicate the work of Pennycook et al. (2020) and test the generalizability of their findings to three different countries: Kyrgyzstan, India, and the United States. The present study also explores whether findings extend to information related to COVID-19 vaccine acceptance, a timely and important topic at the time of data collection. The accuracy nudge's effect did not replicate in the Kyrgyzstan sample (n = 1,049). Results were mixed in India (n = 703) and the United States (n = 829);the nudge decreased willingness to share some misinformation but it did not significantly increase willingness to share true information. We discuss potential explanations for these findings and practical implications for those working to combat the spread of misinformation online. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Vaccination nudges: A study of pre-booked COVID-19 vaccinations in Sweden.

A nudge changes people's actions without removing their options or altering their incentives. During the COVID-19 vaccine rollout, the Swedish Region of Uppsala sent letters with pre-booked appointments to inhabitants aged 16-17 instead of opening up manual appointment booking. Using regional and municipal vaccination data, we document a higher vaccine uptake among 16- to 17-year-olds in Uppsala compared to untreated control regions (constructed using the synthetic control method as well as neighboring municipalities). The results highlight pre-booked appointments as a strategy for increasing vaccination rates in populations with low perceived risk.

Social distance "nudge:" a context aware mHealth intervention in response to COVID pandemics.

The impact of the COVID pandemic to our society is unprecedented in our time. As coronavirus mutates, maintaining social distance remains an essential step in defending personal as well as public health. This study conceptualizes the social distance "nudge" and explores the efficacy of mHealth digital intervention, while developing and validating a choice architecture that aims to influence users' behavior in maintaining social distance for their own self-interest. End-user nudging experiments were conducted via a mobile phone app that was developed as a research artifact. The accuracy of social distance nudging was validated in both United States and Japan. Future work will consider behavioral studies to better understand the effectiveness of this digital nudging intervention.