Nudge applications in healthcare: An experimental study on Type 2 diabetes

The nudge theory developed by Thaler and Sunstein is a theory that influences the decisions of individuals through minor adjustments in a predictable way without restricting their freedom of choice. The theory has been applied in many areas such as health, education and finance. This research was designed as a controlled intervention study to determine whether "nudging," implemented via an interactive mobile phone follow-up method, contributes to the monitoring and treatment of individuals diagnosed with type 2 diabetes. Although many studies have investigated nudge interventions in diabetic patients, no study has yet been found that looks at these interventions in an interactive way via mobile phones. The study thus fills a significant gap in the literature and offers a new perspective. A total of 59 patients were selected — 29 for the experimental group and 30 for the control group. The patients were given a questionnaire with demographic characteristics and the Health Belief Scale. The "herd effect" was used to administer the questionnaire. In addition, patients in the experimental group were given a separate questionnaire on the "halo effect". The HbA1c, HDL and LDL blood levels of the two groups were monitored after 0, 3 and 6 months. Reminder messages were sent to the experimental group over a period of six months, and data was collected on the number of steps taken by the patients, daily water intake and regular intake of medication. The data from these reports were used to test the effect of social nudging. The data were analysed using the SPSS 30 software package. Each of the independent variables — HbA1c, HDL and LDL — was analysed separately. "Time and groups" were selected for the variables with a fixed effect and "patients" for the variables with a random effect. In the experimental group, the number of steps, water intake and regular medication intake were selected as covariates. The differences between the independent variables over time and between the groups were analysed using the linear mixed model (LMM). According to the results of the study, the herding effect was found to be valid in the experimental group that received the nudge intervention. After the researcher read the questions aloud, the average score of the patients in this group decreased from 19.33 to 19.13. In addition, all patients in this group agreed to participate in the study due to the halo effect. The patients in the experimental group were also influenced by the "social nudge effect" by increasing their step count and water intake. In addition, patients in the nudge group experienced an average reduction in HbA1c levels of 1.988 units, a statistically significant increase in HDL levels of 7.157 units and a decrease in LDL levels of 37.751 units between the first and third measurement. One patient was excluded from the study due to complications of retinopathy. In addition, the insulin expenditure of patients in the nudge group decreased from ₺8,711.89-₺12,224.74 to ₺5,543.93-₺7,779.38.