This study is conducted from the perspective of behavioral economics, where individuals often display bounded rationality in decision-making, opting for habitual choices rather than those most advantageous to themselves. Nudge strategies can utilize individuals\' cognitive and motivational shortcomings to influence behavior. Therefore, the study first examines the decision-making biases present in patients with hypertension (HP) and type 2 diabetes mellitus (T2DM) regarding the maintenance of healthy behaviors based on individuals' bounded rationality; subsequently, it develops an intervention program to encourage healthy behaviors in HP and T2DM patients alongside nudge strategies; finally, it assesses the intervention effects of the program on blood pressure, blood glucose, and health behaviors in HP and T2DM patients.
The study was conducted in Lanzhou City, Gansu Province, China. The research selected two communities of similar scale and level, recruiting 133 patients with HP and T2DM. A six-month quasi-experimental study was performed, where the intervention group implemented nudging strategies while the control group received standard community nursing. By measuring the patients\' blood pressure and blood glucose levels, and utilizing the Diabetes Self-Care Scale, Hypertension Self-Management Behavior rang Scale，Patient Activation Measure，Short-Form Health Survey, Activity of Daily Living Scale to assess the behavioral changes in both groups, validated the intervention effect of the nudging strategy on the health behaviors of patients with HP and T2DM.
Study Type
INTERVENTIONAL
Allocation
NON_RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
133
Nudge interventions are developed based on the scoping review and qualitative research by the research team, which involves commitment (behavioral contracts), norms (case and experience sharing), significance and framing effects (posters, health behavior identification posts), reminders, and incentives (arteriosclerosis detection). The content encompasses diet, physical activity, medication management, self-monitoring, and control of smoking and alcohol. From the viewpoint of bounded rationality in behavioral economics, and drawing on prior research that has pinpointed decision-making biases in patients' self-management behaviors, nudging strategies have been developed to assist individuals in overcoming these biases or to utilize the patterns of these biases to steer them toward making choices that are in line with their health.
School of nursing, Lanzhou University
Lanzhou, Gansu, China
Self-management behavior
The self-management behaviors of T2DM patients were evaluated using the Diabetes Self-Care Scale (DSCS), encompasses six dimensions: dietary control, regular exercise, medication adherence, blood glucose monitoring, foot care, and management of high/low blood sugar, consisting of a total of 26 items rated on a 5-point Likert scale, with higher total scores reflecting greater levels of the behaviors. The self-management behaviors of hypertensive patients were assessed using the Chinese Self-Management Behavior Assessment Scale for Hypertensive Patients, which includes six dimensions and 33 items: exercise management, health monitoring, work and rest management, emotional management, medication management, and dietary management, all rated on a 5-point Likert scale, with a minimum score of 33 and a maximum of 165. The higher scores mean a better outcome. These scales are answered by patients according to their actual situation.
Time frame: Baseline, 3rd month, 6th month
Activity of Daily Living
The Barthel Index (BI) is a widely used assessment tool for evaluating Activity of Daily Living (ADL), distinguishing individual self-care abilities based on the score. This score encompasses bowel movements, urination, grooming, eating, toileting, transferring, mobility, dressing, climbing stairs, and bathing, with a maximum score of 100. A score of 100 signifies excellent daily living ability without reliance on others; scores above 60 are classified as good, indicating mild functional impairment but sufficient self-care in daily living; scores between 60 and 41 reflect moderate functional impairment with some assistance required; scores between 40 and 21 denote severe functional impairment with considerable dependence on others; scores below 20 indicate complete disability with total reliance on others for daily living. This measurement is assessed during the interaction between the researcher and the participant.
Time frame: Baseline, 3rd month, 6th month
Life quality
The research measured patients quality of life during the study using 12-item short form health survey (SF-12), which is a simplified version of the SF-36, comprising 12 items across 8 domains: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE), and Mental Health (MH). Among these, PF, RP, BP, and GH are classified as physical component summary, while VT, SF, RE, and MH are classified as mental component summary. The standard scoring method was used to calculate the scores of each dimension and the total score was from 0 to 100 points, with a higher score indicating a better quality of life for the individual. The scale is answered by the patient based on their current situation.
Time frame: Baseline, 3rd month, 6th month
Blood pressure(BP)
Blood pressure(BP) is recorded in a calm environment by designated community nurses with a standardized electronic blood pressure monitor, precise to 1mmHg. Patients are grouped into the community. The measuring instruments must adhere to China metrology certification standards. The measurement methods align with the industry standards of the People's Republic of China - Human Health Monitoring and Human Measurement Methods (WS/T424-2013) requirements.
Time frame: Baseline, 3rd month, 6th month
Blood sugar
Blood glucose is a random blood glucose measured by community nurses who gather participants in the community. The instruments must adhere to China metrology certification standards. The measurement methods align with the industry standards of the People's Republic of China - Human Health Monitoring and Human Measurement Methods (WS/T424-2013) requirements.
Time frame: Baseline, 3rd month, 6th month
Body Mass Index(BMI)
Patients are grouped in the community and measured by community nurses. The readings for patients' height and weight are documented with height accurate to 0.1cm and weight accurate to 0.1kg. BMI is calculated as weight (kg) / height (m²). The normal value range is 18.5 to 23.9 kg/m², \<18.5 kg/m² indicates underweight, BMI ≥ 24 kg/m² indicates overweight, and BMI ≥ 28 kg/m² indicates obesity. All measuring instruments must adhere to China metrology certification standards. The measurement methods align with the industry standards of the People's Republic of China - Human Health Monitoring and Human Measurement Methods (WS/T424-2013) requirements.
Time frame: Baseline, 3rd month, 6th month
Patient Activation Measure
The research measured patients enthusiasm for self-management during the study using the Patient Activation Measure (PAM). The scale was developed to assess patients' awareness, knowledge, skills, and confidence in self-managing their diseases. This scale is unidimensional and consists of 13 items, with a Cronbach's α of 0.882. It employs a 5-point Likert scale, where scores range from 0 to 4, representing "not at all suitable for me" to "strongly agree," with higher scores indicating greater positivity. The original total score of the scale ranges from 13 to 52 points. Based on the conversion table provided by the original author, the total score is transformed from 0 to 100 points. A score of ≤47 is classified as low, 47-55.1 as low to moderate, 55.2-67 as moderate, and ≥67.1 as high.The scale is answered by the patient.
Time frame: Baseline, 3rd month, 6th month
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