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Abstract：
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.
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.
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.
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).
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.
This review was not prospectively registered.
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.
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.
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).
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.
This review was not prospectively registered.
摘要：
推动干预是那些试图改变社会和物理环境，以增强与个人内在价值观相一致的潜意识行为能力的干预措施。没有积极限制选择。本研究旨在描述微推策略对临床医生实施健康相关指南的应用和影响。相关Cochrane系统评价中包含的研究中的政策和实践。
由于描述轻推的术语多种多样，本研究审查了相关系统综述中的研究.进行了两个阶段的筛选过程，首先,我们对2016年至2018年在Cochrane图书馆发表的所有系统综述进行了筛选,以确定纳入量化研究的综述,以改善医疗保健提供者指南的实施.其次,如果相关系统综述中的个别研究是(i)随机对照试验(RCT)，(Ii)在至少一个干预部门中包括推动策略，和（iii）明确旨在改善临床医生的执行行为。我们将推动策略归类为启动策略，显著性和影响，默认值,激励机制，承诺和自我，以及基于Mindspace框架的规范和信使。
计算使用每种微动策略的试验次数和百分比。由于巨大的异质性，我们没有进行荟萃分析.相反，我们计算了研究内点估计和95%置信区间，并使用计票方法来探索效果。
纳入7项综述，包括42项试验报告57项结果。最常见的推动策略是启动(69%)，然后规范和信使（40％）。在57项成果中，86%的人在假设的方向上对临床医生的行为有影响，其中53%具有统计学意义。对于连续的结果，中位效应大小为0.39(0.22，0.45)，而二分法结局的中位赔率为1.62(1.13,2.76).
这项对Cochrane系统评价中包含的42项随机对照试验的综述发现，轻推策略对临床医生行为的影响至少与其他旨在实施循证指南的干预措施相当。虽然不确定性仍然存在，该审查为正在进行的关于评估和应用微推干预措施以支持提供者行为改变的调查提供了理由.
此评论未进行前瞻性注册。
由于描述轻推的术语多种多样，本研究审查了相关系统综述中的研究.进行了两个阶段的筛选过程，首先,我们对2016年至2018年在Cochrane图书馆发表的所有系统综述进行了筛选,以确定纳入量化研究的综述,以改善医疗保健提供者指南的实施.其次,如果相关系统综述中的个别研究是(i)随机对照试验(RCT)，(Ii)在至少一个干预部门中包括推动策略，和（iii）明确旨在改善临床医生的执行行为。我们将推动策略归类为启动策略，显著性和影响，默认值,激励机制，承诺和自我，以及基于Mindspace框架的规范和信使。
计算使用每种微动策略的试验次数和百分比。由于巨大的异质性，我们没有进行荟萃分析.相反，我们计算了研究内点估计和95%置信区间，并使用计票方法来探索效果。
纳入7项综述，包括42项试验报告57项结果。最常见的推动策略是启动(69%)，然后规范和信使（40％）。在57项成果中，86%的人在假设的方向上对临床医生的行为有影响，其中53%具有统计学意义。对于连续的结果，中位效应大小为0.39(0.22，0.45)，而二分法结局的中位赔率为1.62(1.13,2.76).
这项对Cochrane系统评价中包含的42项随机对照试验的综述发现，轻推策略对临床医生行为的影响至少与其他旨在实施循证指南的干预措施相当。虽然不确定性仍然存在，该审查为正在进行的关于评估和应用微推干预措施以支持提供者行为改变的调查提供了理由.
此评论未进行前瞻性注册。
