Nudging the dead: How behavioural psychology inspired Nova Scotia’s organ donation scheme


Joseph Brean at National Post: “Nova Scotia’s decision to presume people’s consent to donating their organs after death is not just a North American first. It is also the latest example of how deeply behavioural psychology has changed policy debates.

That is a rare achievement for science. Governments used to appeal to people’s sense of reason, religion, civic duty, or fear of consequences. Today, when they want to change how their citizens behave, they use psychological tricks to hack their minds.

Nudge politics, as it came to be known, has been an intellectual hit among wonks and technocrats ever since Daniel Kahneman won the Nobel Prize in 2002 for destroying the belief people make decisions based on good information and reasonable expectations. Not so, he showed. Not even close. Human decision-making is an organic process, all but immune to reason, but strangely susceptible to simple environmental cues, just waiting to be exploited by a clever policymaker….

Organ donation is a natural fit. Nova Scotia’s experiment aims to solve a policy problem by getting people to do what they always tend to do about government requests — nothing.

The cleverness is evident in the N.S. government’s own words, which play on the meaning of “opportunity”: “Every Nova Scotian will have the opportunity to be an organ and tissue donor unless they opt out.” The policy applies to kidneys, pancreas, heart, liver, lungs, small bowel, cornea, sclera, skin, bones, tendons and heart valves.

It is so clever it aims to make progress as people ignore it. The default position is a positive for the policy. It assumes poor pickup. You can opt out of organ donation if you want. Nova Scotia is simply taking the informed gamble that you probably won’t. That is the goal, and it will make for a revealing case study.

Organ donation is an important question, and chronically low donation rates can reasonably be called a crisis. But most people make their personal choice “thoughtlessly,” as Kahneman wrote in the 2011 book Thinking, Fast and Slow.

He referred to European statistics which showed vast differences in organ donation rights between neighbouring and culturally similar countries, such as Sweden and Denmark, or Germany and Austria. The key difference, he noted, was what he called “framing effects,” or how the question was asked….(More)”.

So Many Nudges, So Little Time: Can Cost-effectiveness Tell Us When It Is Worthwhile to Try to Change Provider Behavior?


Paper by David Atkins: “Interest in behavioral economics has grown steadily within health care. Policy makers, payers, and providers now recognize that the decisions of patients and of their doctors frequently deviate from the strictly “rational” choices that classical economic theory would predict. For example, patients rarely adhere to the medication regimens or health behaviors that would optimize their health outcomes, and clinicians often make decisions that conflict with evidence-based recommendations or even the practices they profess to endorse. The groundbreaking work of psychologist Daniel Kahneman and his collaborator Amos Tversky raised attention to this field, which was accelerated by Kahneman’s 2002 Nobel Prize in economics and his popular 2011 book “Thinking Fast and Slow” which reached a much broader audience.

Behavioral economics examines cognitive, psychological, and cultural factors that may influence how we make decisions, resulting in behavior that another Nobel laureate, economist Richard Thaler, has termed “predictably irrational.” Principles from behavioral economics have been adopted to health care, including the role of heuristics (rules of thumb), the importance of framing, and the effects of specific cognitive biases (for example, overconfidence and status quo bias).

These principles have been incorporated into interventions that seek to use these insights to change health-related behaviors—these include nudges, where systems are redesigned to make the preferred choice the default choice (for example, making generic versions the default in electronic prescribing); incentive programs that reward patients for taking their medications on schedule or getting preventive interventions like immunizations; and specific interventions aimed at how clinicians respond to information or make decisions….(More)”.

How Effective Is Nudging? A Quantitative Review on the Effect Sizes and Limits of Empirical Nudging Studies


Paper by Dennis Hummel and Alexander Maedche: “Changes in the choice architecture, so-called nudges, have been employed in a variety of contexts to alter people’s behavior. Although nudging has gained a widespread popularity, the effect sizes of its influences vary considerably across studies. In addition, nudges have proven to be ineffective or even backfire in selected studies which raises the question whether, and under which conditions, nudges are effective. Therefore, we conduct a quantitative review on nudging with 100 primary publications including 317 effect sizes from different research areas. We derive four key results. (1) A morphological box on nudging based on eight dimensions, (2) an assessment of the effectiveness of different nudging interventions, (3) a categorization of the relative importance of the application context and the nudge category, and (4) a comparison of nudging and digital nudging. Thereby, we shed light on the (in)effectiveness of nudging and we show how the findings of the past can be used for future research. Practitioners, especially government officials, can use the results to review and adjust their policy making….(More)”.

A theoretical framework explaining the mechanisms of nudging


Paper by Löfgren, Åsa & Nordblom, Katarina: “…we develop a theoretical model to clarify the underlying mechanisms that drive individual decision making and responses to behavioral interventions, such as nudges. The contribution of the paper is three-fold: First, the model provides a theoretical framework that comprehensively structures the individual decision-making process applicable to a wide range of choice situations. Second, we reduce the confusion regarding what should be called a nudge by offering a clear classification of behavioral interventions. We distinguish among what we label as pure nudges, preference nudges, and other behavioral interventions. Third, we identify the mechanisms behind the effectiveness of behavioral interventions based on the structured decision-making process. Hence, the model can be used to predict under which circumstances, and in which choice situations, a nudge is likely to be effective….(More)”

Applying behavioral insights to improve postsecondary education outcomes


Brookings: “Policymakers under President Obama implemented behaviorally-informed policies to improve college access, completion, and affordability. Given the complexity of the college application process, many of these policies aimed to simplify college and financial aid application processes and reduce informational barriers that students face when evaluating college options. Katharine Meyer and Kelly Ochs Rosinger summarize empirical evidence on these policies and conclude that behaviorally-informed policies play an important role, especially as supplements to (rather than replacements for) broader structural changes. For example, recent changes in the FAFSA filing timeline provided students with more time to complete the form. But this large shift may be more effective in changing behavior when accompanied by informational campaigns and nudges that improve students’ understanding of the new system. Governments and colleges can leverage behavioral science to increase awareness of student support services if more structural policy changes occur to provide the services in the first place….(More)”.

Nudging Citizens through Technology in Smart Cities


Sofia Ranchordas in the International Review of Law, Computers & Technology: “In the last decade, several smart cities throughout the world have started employing Internet of Things, big data, and algorithms to nudge citizens to save more water and energy, live healthily, use public transportation, and participate more actively in local affairs. Thus far, the potential and implications of data-driven nudges and behavioral insights in smart cities have remained an overlooked subject in the legal literature. Nevertheless, combining technology with behavioral insights may allow smart cities to nudge citizens more systematically and help these urban centers achieve their sustainability goals and promote civic engagement. For example, in Boston, real-time feedback on driving has increased road safety and in Eindhoven, light sensors have been used to successfully reduce nightlife crime and disturbance. While nudging tends to be well-intended, data-driven nudges raise a number of legal and ethical issues. This article offers a novel and interdisciplinary perspective on nudging which delves into the legal, ethical, and trust implications of collecting and processing large amounts of personal and impersonal data to influence citizens’ behavior in smart cities….(More)”.

Impact of a nudging intervention and factors associated with vegetable dish choice among European adolescents


Paper by Q. Dos Santos et al: “To test the impact of a nudge strategy (dish of the day strategy) and the factors associated with vegetable dish choice, upon food selection by European adolescents in a real foodservice setting.

A cross-sectional quasi-experimental study was implemented in restaurants in four European countries: Denmark, France, Italy and United Kingdom. In total, 360 individuals aged 12-19 years were allocated into control or intervention groups, and asked to select from meat-based, fish-based, or vegetable-based meals. All three dishes were identically presented in appearance (balls with similar size and weight) and with the same sauce (tomato sauce) and side dishes (pasta and salad). In the intervention condition, the vegetable-based option was presented as the “dish of the day” and numbers of dishes chosen by each group were compared using the Pearson chi-square test. Multivariate logistic regression analysis was run to assess associations between choice of vegetable-based dish and its potential associated factors (adherence to Mediterranean diet, food neophobia, attitudes towards nudging for vegetables, food choice questionnaire, human values scale, social norms and self-estimated health, country, gender and belonging to control or intervention groups). All analyses were run in SPSS 22.0.

The nudging strategy (dish of the day) did not show a difference on the choice of the vegetable-based option among adolescents tested (p = 0.80 for Denmark and France and p = 0.69 and p = 0.53 for Italy and UK, respectively). However, natural dimension of food choice questionnaire, social norms and attitudes towards vegetable nudging were all positively associated with the choice of the vegetable-based dish. Being male was negatively associated with choosing the vegetable-based dish.

The “dish of the day” strategy did not work under the study conditions. Choice of the vegetable-based dish was predicted by natural dimension, social norms, gender and attitudes towards vegetable nudging. An understanding of factors related to choosing vegetable based dishes is necessary for the development and implementation of public policy interventions aiming to increase the consumption of vegetables among adolescents….(More)”

Nudging does not necessarily improve decisions


University of Zurich: “Nudging is a well-known and popular concept in behavioral economics. It refers to non-coercive interventions that influence the choices people make by changing the way a situation is presented. A well-known example of this is placing the salad bar near the cafeteria entrance to promote a healthy diet. It has been shown that simple change has an effect on the food people choose to eat for lunch. However, is a light salad really the best option from the employee’s perspective, or is it their employer who will benefit from staff who perform better in the afternoon? And, is improving the decisions we make really that simple?

Measuring the quality of a decision

Whether a nudge ultimately results in a person making decisions that are better suited to their needs is an important factor in assessing the effectiveness of nudges. This is the starting point of the research work of Nick Netzer and Jean-Michel Benkert from the Department of Economics at the University of Zurich. How do you measure whether a nudge improves a decision in the eyes of the person being nudged? “We can’t determine whether a nudge improves the choices a person makes until we understand how they reach their decisions,” says Nick Netzer, putting the hype surrounding nudging into perspective. “Depending on which behavioral model we take as a starting point, it is possible to measure the effectiveness of nudges — or not.”

Traditional economics assumes that a person’s preferences can be inferred from their decisions and behavior. According to the rational behavior model, a person’s decision to have a salad or a steak for lunch is based on which meal meets their needs. When it comes to assessing nudges, however, this model is problematic, since nudging manipulates precisely the behavior that is supposed to shed light on a person’s preferences. The researchers therefore looked to alternative behavioral models to determine the assumptions under which a nudge can be assessed in a meaningful way…(More)”.

Nudge, Boost or Design? Limitations of behavioral policy under social interaction.


Paper by Samuli Reijula, Jaakko Kuorikoski et al: “Nudge and boost are two competing approaches to applying the psychology of reasoning and decision making to improve policy. Whereas nudges rely on manipulation of choice architecture to steer people towards better choices, the objective of boosts is to develop good decision-making competences. Proponents of both approaches claim capacity to enhance social welfare through better individual decisions.

We suggest that such efforts should involve a more careful analysis of how individual and social welfare are related in the policy context. First, individual rationality is not always sufficient or necessary for improving collective outcomes. Second, collective outcomes of complex social interactions among individuals are largely ignored by the focus of both nudge and boost on individual decisions. We suggest that the design of mechanisms and social norms can sometimes lead to better collective outcomes than nudge and boost, and present conditions under which the three approaches (nudge, boost, and design) can be expected to enhance social welfare….(More)”.

Trusting Nudges: Toward A Bill of Rights for Nudging


Book by Cass R. Sunstein and Lucia A. Reisch: “Many “nudges” aim to make life simpler, safer, or easier for people to navigate, but what do members of the public really think about these policies? Drawing on surveys from numerous nations around the world, Sunstein and Reisch explore whether citizens approve of nudge policies. Their most important finding is simple and striking. In diverse countries, both democratic and nondemocratic, strong majorities approve of nudges designed to promote health, safety, and environmental protection—and their approval cuts across political divisions.

In recent years, many governments have implemented behaviorally informed policies, focusing on nudges—understood as interventions that preserve freedom of choice, but that also steer people in certain directions. In some circles, nudges have become controversial, with questions raised about whether they amount to forms of manipulation. This fascinating book carefully considers these criticisms and answers important questions. What do citizens actually think about behaviorally informed policies? Do citizens have identifiable principles in mind when they approve or disapprove of the policies? Do citizens of different nations agree with each other?

From the answers to these questions, the authors identify six principles of legitimacy—a “bill of rights” for nudging that build on strong public support for nudging policies around the world, while also recognizing what citizens disapprove of. Their bill of rights is designed to capture citizens’ central concerns, reflecting widespread commitments to freedom and welfare that transcend national boundaries….(More)”.