Increasing The Utilization Of Well-Baby Screening In Primary Health Care Centers Using Two Nudging Techniques: Randomized Controlled Trials
DOI:
https://doi.org/10.29284/rr0d2f86Keywords:
well-baby - Primary health care centers – Saudi Arabia.Abstract
Background: Well-baby visits provide opportunities for early disease detection and prevention. However, the adherence to such visits is suboptimal. This issue could be improved by nudging techniques, which could save the healthcare system enormous direct and indirect costs. The objective of the current two randomized controlled trials was to assess the effects of defaults and text message framing on parents to increase the uptake of well-baby visits in Saudi Arabia.
Method: Two single-blinded, randomized controlled trials examined the efficacy of the default option and framed messages in child’s attendance to the well-baby clinic.
Study 1: For the default, participants (N = 250) were randomly and equally assigned to either control or intervention group which received auto-scheduling. The control group did not receive appointment. The main outcome was percentage of attendance to the clinic.
Study 2: For the framing study (N = 378), three types of messages were randomly assigned to participants to test the farming effect against the control group. The main outcome of this study was percentage of booked appointments. Chi-square tests assessed the statistical differences in both studies.
Results: Study 1: The result indicates a significant difference in the well-baby clinic attendance between the default and the control group (X2 = 19.5, p <.001). The intervention group had 20% attended appointments versus 2.4% in the control group
Study 2: The chi-square test shows that only the authority-framed message had a statistical difference compared to the control (X2 = 5.7, p = .017). No difference was detected between the three types of messages.
Conclusion: Nudges such as default and framing are a promising approach to improve public’s engagement with health services. Policymakers should consider behavioral insights when designing and implementing public health programs.
References
1. Abhyankar, P., O'connor, D. B., & Lawton, R. (2008). The role of message framing in promoting MMR vaccination: Evidence of a loss-frame advantage. Psychology, Health and Medicine, 13(1), 1-16.
2. Abu-Bader, S. H. (2011). Using statistical methods in social science research: A complete SPSS guide (2nd edition). Lyceum Books, Inc.
3. Aldayel, A. S., Aldayel, A. A., Almutairi, A. M., Alhussain, H. A., Alwehaibi, S. A., & Almutairi, T. A. (2020). Parental Knowledge of Children’s Developmental Milestones in Riyadh, Saudi Arabia. International Journal of Pediatrics, 2020.
4. Almutairi, A. F., BaniMustafa, A. a., Alessa, Y. M., Almutairi, S. B., & Almaleh, Y. (2020). Public trust and compliance with the precautionary measures against COVID-19 employed by authorities in Saudi Arabia. Risk Management and Healthcare Policy, 13, 753.
5. Alnasser, A. H. A., Al-Tawfiq, J. A., Al Kalif, M. S. H., Alobaysi, A. M. A., Al Mubarak, M. H. M., Alturki, H. N. H., Alharbi, A. A. A., Albahrani, R. S. S., Sultan, S. A., & AlHamad, A. R. N. (2020). The positive impact of social media on the level of COVID-19 awareness in Saudi Arabia: a web-based cross-sectional survey. Infez Med, 28(4), 545-550.
6. Binder, A., Naderer, B., & Matthes, J. (2020). The effects of gain-and loss-framed nutritional messages on children’s healthy eating behaviour. Public health nutrition, 23(10), 1726-1734.
7. Blumenthal‐Barby, J., & Opel, D. J. (2018). Nudge or Grudge? Choice Architecture and Parental Decision‐Making. Hastings Center Report, 48(2), 33-39.
8. Carroll, G. D., Choi, J. J., Laibson, D., Madrian, B. C., & Metrick, A. (2009). Optimal defaults and active decisions. The quarterly journal of economics, 124(4), 1639-1674.
9. Chapman, G. B., Li, M., Colby, H., & Yoon, H. (2010). Opting in vs opting out of influenza vaccination. Jama, 304(1), 43-44.
10. Cookson, D., Jolley, D., Dempsey, R. C., & Povey, R. (2021). A social norms approach intervention to address misperceptions of anti-vaccine conspiracy beliefs amongst UK parents. PloS one, 16(11), e0258985.
11. Delehanty, A., Lee, J., Hooker, J. L., Cortese, J., & Woods, J. (2020). Exploring message framing to engage parents in early screening for autism spectrum disorder. Patient Education and Counseling, 103(12), 2525-2531.
12. Deslatte, A. (2020). To shop or shelter? Issue framing effects and social-distancing preferences in the COVID-19 pandemic. Journal of Behavioral Public Administration, 3(1).
13. Dolan, P., Hallsworth, M., Halpern, D., King, D., & Vlaev, I. (2010). MINDSPACE: influencing behaviour for public policy.
14. Gennetian, L. A., Coskun, L. Z., Kennedy, J. L., Kuchirko, Y., & Aber, J. L. (2020). The impact of default options for parent participation in an early language intervention. Journal of child and family studies, 29(12), 3565-3574.
15. Giubilini, A., Caviola, L., Maslen, H., Douglas, T., Nussberger, A.-M., Faber, N., Vanderslott, S., Loving, S., Harrison, M., & Savulescu, J. (2019). Nudging immunity: The case for vaccinating children in school and day care by default. (Ed.),^(Eds.). Hec Forum.
16. Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2007). Bright futures: Guidelines for health supervision of infants, children, and adolescents. Am Acad Pediatrics.
17. Hallsworth, M., Halpern, D., Algate, F., Gallagher, R., Nguyen, S., Ruda, S., &, & Kirkman, E. (2014). EAST Four simple ways to apply behavioural insights. The BIT: London, UK. https://www.bi.team/wp-content/uploads/2015/07/BIT-Publication-EAST_FA_WEB.pdf
18. Hallsworth, M., Snijders, V., Burd, H., Prestt, J., Judah, G., Huf, S., & Halpern, D. (2016). Applying behavioral insights: simple ways to improve health outcomes. World Innovation Summit for Health, Doha, Qatar, 29–30 November.
19. Hansen, P. G., Schilling, M., & Malthesen, M. S. (2021). Nudging healthy and sustainable food choices: three randomized controlled field experiments using a vegetarian lunch-default as a normative signal. Journal of Public Health, 43(2), 392-397.
20. Huang, Y.-N., Song, X.-Y., Shao, Y., Li, S., & LIANG, Z.-Y. N. (2018). Default option effect and response mode promote organ donor registry participation in China [J]. Acta Psychologica Sinica, 8, 868-879.
21. Jenssen, B. P., Buttenheim, A. M., & Fiks, A. G. (2019). Using behavioral economics to encourage parent behavior change: opportunities to improve clinical effectiveness. Academic pediatrics, 19(1), 4-10.
22. Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives? (Vol. 302, pp. 1338-1339). American Association for the Advancement of Science.
23. Johnson, E. J., & Goldstein, D. G. (2013). Decisions by default (The behavioral foundations of public policy (pp. 417-427). Princeton University Press.
24. Jonas, D. E., Amick, H. R., Wallace, I. F., Feltner, C., Vander Schaaf, E. B., Brown, C. L., & Baker, C. (2018). Vision Screening in Children Ages 6 Months to 5 Years: A Systematic Review for the US Preventive Services Task Force.
25. Leonard, T. C. (2008). Richard H. Thaler, Cass R. Sunstein, Nudge: Improving decisions about health, wealth, and happiness. Springer.
26. Li, J., Chai, L., Nordstrom, O., Tangpong, C., & Hung, K.-T. (2021). Development of a Loss Aversion Scale. Journal of Managerial Issues, 33(1).
27. Mac Iver, M. A., Wills, K., Cruz, A., & Mac Iver, D. J. (2021). The Impact of Nudge Letters on Improving Attendance in an Urban District. Education and Urban Society, 00131245211004561.
28. Ministry of Health. (2021). Child Health Passport https://www.moh.gov.sa/en/HealthAwareness/EducationalContent/BabyHealth/Pages/BabyHealthPassport.aspx
29. Novak, I., & Morgan, C. (2019). High-risk follow-up: early intervention and rehabilitation. Handbook of clinical neurology, 162, 483-510.
30. Nyhan, B., Reifler, J., Richey, S., & Freed, G. L. (2014). Effective messages in vaccine promotion: a randomized trial. Pediatrics, 133(4), e835-e842.
31. Patel, M. S. (2018). Nudges for influenza vaccination. Nature human behaviour, 2(10), 720-721.
32. Reiter, P. L., McRee, A.-L., Pepper, J. K., & Brewer, N. T. (2012). Default policies and parents’ consent for school-located HPV vaccination. Journal of behavioral medicine, 35(6), 651-657.
33. Reñosa, M. D. C., Landicho, J., Wachinger, J., Dalglish, S. L., Bärnighausen, K., Bärnighausen, T., & McMahon, S. A. (2021). Nudging toward vaccination: a systematic review. BMJ global health, 6(9), e006237.
34. Sampson, J., & Thompson, H. (2017). Youth hearing impairment: Early detection is key. Nursing2020, 47(4), 52-56.
35. Sonuga-Barke, E. J., Koerting, J., Smith, E., McCann, D. C., & Thompson, M. (2011). Early detection and intervention for attention-deficit/hyperactivity disorder. Expert Review of Neurotherapeutics, 11(4), 557-563.
36. Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Psychological bulletin, 132(2), 249.
37. world population review. (2021). Saudi Arabia Population https://worldpopulationreview.com/countries/saudi-arabia-population
38. Zey, E., & Windmann, S. (2021). Effects of message framing, sender authority, and recipients’ self-reported trait autonomy on endorsement of health and safety measures during the early COVID-19 pandemic. International journal of environmental research and public health, 18(15), 7740.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
