Blog Post
Nudge Theory in Practice: Designing Experiences That Influence Healthcare Consumer Behaviors
Have you ever noticed how much easier it feels to hit the gym after work when your bag is already packed and waiting in the car, compared to those days when you have to go home, gather your things, and talk yourself into leaving again?
Or maybe you’ve realized that it’s easier to stick to healthy eating when your meals are prepped ahead of time and ready to go in the morning, rather than when you have to plan and cook from scratch in the rushed early morning.
You might also remember finally getting your vaccination or cancer screening only after receiving a reminder text from your health plan, even though it had been on your to-do list for a while.
These are all examples of how nudges in our environment can help us take action, especially when we’re trying to change health-related behaviors. For healthcare organizations focused on influencing patient behaviors, nudges can be a powerful and effective communication tool.
Understanding Nudge Theory
The concept of nudge theory was coined and popularized by economists Richard Thaler and Cass Sunstein in their 2008 book “Nudge: Improving Decisions About Health, Wealth, and Happiness.” They defined nudges as subtle adjustments in how choices are presented that influence decisions without limiting freedom of choice. This is also known as choice architecture.
The idea is simple but powerful: small tweaks in our environment can strongly shape our actions. Nudges work by tapping into our natural mental shortcuts and biases, such as choosing the path of least resistance or sticking with the default. Importantly, nudges don’t force anyone to act in a specific way; they simply make some actions easier or more appealing while leaving all options open.
Nudges in Action: Real-World Examples
Researchers have tested different types of nudges—from reminders and incentives to gamified systems—with impressive results.
- In a megastudy involving 689,000 Walmart pharmacy customers, text message reminders increased vaccination rates by an average of 6.8% compared with business as usual. The most effective message used the concept of the endowment effect by telling healthcare consumers, “A flu shot is waiting for you.”
- Another study tested incentives and gamification to increase physical activity among people at high risk of heart disease. Participants could earn points and level up by meeting daily step goals. They received $14 a week in potential rewards but lost $2 each day they missed their step goals. Those who combined the financial incentive with the game element were most successful during the 12-month program as well as at six-month follow-up.
At Engagys, we’ve seen the use of nudges significantly impact member engagement across a range of use cases. In practice, some of the most effective nudges are also the simplest. For example, incorporating a subtle Fear of Missing Out (FOMO) prompt, such as “Are you sure,” has been shown to increase healthcare engagement rates by up to 30%.
For healthcare organizations, these examples underscore how thoughtful design can drive measurable behavior change at scale.
Using Nudges for Healthcare Consumer Engagement
There are many ways to apply nudges to improve healthcare consumer engagement. For instance, in a weight loss program, reminders can support behavior change in nutrition and exercise. Also, allowing healthcare consumers to personalize their own reminders (the timing, frequency, and content) can increase their effectiveness, since autonomy enhances engagement.
Gamification can also motivate people to stay active. Features like badges, leaderboards, meaningful rewards, and immediate feedback help create a sense of progress and challenge. The key is personalization: knowing your members and segmenting them effectively for tailored interventions.
Step-by-Step Guide to Designing Nudges
- Define your goal. What problem are you trying to solve? Use available data to understand your target population and meet them where they are. For example, if your goal is to increase breast cancer screening rates, but your audience doesn’t yet have a primary care provider, the first goal should be helping them choose one and schedule a visit.
- Analyze barriers. Identify what stops your target audience from taking action. Is it access, knowledge gaps, fear, motivation, or simply forgetfulness? The right nudge depends on the barrier. If it’s a knowledge issue, send reminders focused on health benefits. If fear is the barrier, share content that explains what to expect during the procedure.
- Test and refine. There’s no one-size-fits-all approach. A/B testing helps determine which message, format, or communication channel works best for your target group. Use results from these tests to refine your interventions continuously.
A Few Caveats About Nudges
- Nudges are powerful, but they’re not a cure-all. They work best when other barriers such as affordability or access aren’t the main obstacles. Some challenges require broader systemic changes to make healthy behaviors possible.
- Nudges often have the greatest impact in the short term. For lasting behavior change, deeper motivational and structural interventions are needed.
- Additionally, nudges can lose their effectiveness if people feel manipulated or if the approach doesn’t align with their preferences.
In short, nudges are an important tool in the broader behavioral science toolbox. But like all tools, they need to be used strategically. There’s no universal formula, but when engagement is designed around how people actually make decisions, small changes can lead to meaningful shifts in utilization, adherence, and preventive care. Success depends on personalization, timing, and matching the right intervention to the right population at the right moment.
