Back to Search
Start Over
Nudge strategies to improve healthcare providers' implementation of evidence-based guidelines, policies and practices: a systematic review of trials included within Cochrane systematic reviews
- Source :
- Implementation Science : IS, Implementation Science, Vol 15, Iss 1, Pp 1-30 (2020)
- Publication Year :
- 2020
-
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.
- Subjects :
- Evidence-based practice
Attitude of Health Personnel
Health Personnel
Reminder Systems
Implementation intervention
Psychological intervention
Health Informatics
Review
030501 epidemiology
Cochrane Library
Environment
Guidelines
Social Environment
Health informatics
Health administration
03 medical and health sciences
0302 clinical medicine
Nursing
Medicine
Humans
030212 general & internal medicine
Health policy
Randomized Controlled Trials as Topic
lcsh:R5-920
Nudge
business.industry
Health Policy
Public Health, Environmental and Occupational Health
Health services research
General Medicine
Systematic review
Evidence-Based Practice
Practice Guidelines as Topic
Guideline Adherence
Systematic Review
lcsh:Medicine (General)
0305 other medical science
business
Healthcare provider
Subjects
Details
- ISSN :
- 17485908
- Volume :
- 15
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Implementation science : IS
- Accession number :
- edsair.doi.dedup.....579b16ea7350cc0c7dc62f2ba160cc60