The Healthy Nudge
May 2021
Welcome to The Healthy Nudge. Each month, we'll get you up to speed on the latest developments in policy-relevant health behavioral economics research at CHIBE. Want more frequent updates? Follow us on Twitter @PennCHIBE and visit our website.
Exploring barriers to statin adherence and lipid control
This study highlights that participants with socioeconomic disadvantages and clinical burdens may need a more customized approach
A new qualitative study looked at potential barriers to statin therapy adherence and control of cholesterol levels among participants in a randomized trial of financial incentives for adherence. This JAMA Network Open paper led by Iwan Barankay, PhD, and many other CHIBE-affiliated faculty members, found that "participants whose LDLC levels did not improve found it more difficult to create medication routines and respond to financial incentives in the context of complex living conditions and a high burden of chronic illness. These findings suggest that future studies should be more attentive to socioeconomic circumstances of trial participants."
Can financial incentives and deposit contracts promote HIV retesting in Uganda?
retesting HIV graph
A new paper in PLOS Medicine led by Gabriel Chamie, MD, MPH, and colleagues — including CHIBE Associate Director Harsha Thirumurthy, PhD — found that offering financial incentives to high-risk adults in Uganda resulted in significantly higher HIV retesting, while deposit contracts did not increase retesting overall.
Nudges and choice architecture in organizations
organizational behavior and human decision processes
Two CHIBE-affiliated faculty members Gretchen Chapman, PhD, and Katherine L. Milkman, PhD along with colleagues Todd Rogers, PhD, and David G. Rand, PhD, recently edited a special issue of Organizational Behavior and Human Decision Processes called "Nudges and Choice Architecture in Organizations."

Explore the whole issue here; the papers cover topics such as active choice and implicit defaults, nudges in the workplace, choice architecture in US health insurance marketplaces, and much more. Also, CHIBE-affiliated faculty members Marissa A. Sharif, PhD, led this piece on "Nudging persistence after failure through emergency reserves," and Silvia Saccardo, PhD, led "Nudging generosity in consumer elective pricing."
CHIBE Q&A with Dr. Katy Milkman
katy milkman
Katherine L. Milkman, PhD, James G. Dinan Professor at the Wharton School of The University of Pennsylvania, is Co-Director of The Behavior Change for Good Initiative and a CHIBE-affiliated faculty member. Read our Q&A to learn more about Dr. Milkman's new book called How to Change, which was released this month.

How might this book be helpful for those in the health care field who are trying to encourage patients to have healthier habits?
I’m optimistic that anyone who’s interested in encouraging healthy habits will find my book packed with strategic advice. How to Change covers everything from how to promote exercise, medication adherence, and healthy eating, to how to nudge people toward getting flu vaccinations and colonoscopies.

The key lesson about behavior change that I hope every reader will take away is that to make the most progress, it’s important to tailor your tactics to whatever obstacles you face. If your patient never gets to the gym because she finds exercise to be a drag, helping her calls for a very different approach than nudging a patient who forgets to make time for the gym. In one case, you’re tackling temptation and in the other, you’re combating flake out. But too often, we apply a one-size fits all approach when solving for very different obstacles to change. In How to Change, I interweave stories with research to lay out the most common barriers to change and describe the most promising, science-based solutions that can help us overcome them.

One of the topics your book explores is why timing is important when you’re trying to make a change. Can you tell us a bit more about that?
Yes, absolutely! About a decade ago, I gave a talk at Google about nudging people to get vaccinated and exercise more regularly. After the presentation, I got a great question from the audience: Did I know *when* it was best to nudge people to make a positive change? Was there some ideal time? This led me to study what my collaborators and I have since dubbed “the fresh start effect.” We’ve found that there are moments in life when people are particularly motivated to make positive changes, and those moments come about whenever we feel like we’re experiencing a new beginning. That new beginning can be as small as the start of a new week or month or more momentous like the start of a new year or the celebration of a birthday. We saw spikes in gym attendance and goal-setting on a popular goal-setting website on these fresh start dates as well as extra searches on Google for the term “diet.” And we’ve found that simply labeling March 20 “the first day of spring” so it’s more obviously a fresh start has a big impact on people’s interest in enrolling in a savings program or starting some other goal on that date. This suggests that if you’re trying to make a change or help someone else do the same, a fresh start can be just the right moment to begin.

Dr. Ravi Parikh's Proposal Wins Funding from NCCN Foundation
Congratulations to CHIBE-affiliated faculty member Ravi Parikh, MD, MPP, FACP, whose proposal on machine learning and behavioral nudges to improve palliative care utilization in advanced cancer has won funding from the National Comprehensive Cancer Network® (NCCN®) Foundation Young Investigator Awards Committee. “This award is critical to taking the next step in using algorithms to improve patient-centric care and symptom management for patients with cancer,” Dr. Parikh said. “We are thankful to the NCCN Foundation for this honor.”
May 13, from 12-1 PM EST
“Political partisanship and physician prescribing of proposed COVID-19 treatments in 2020 (work in progress).”
Virtual Seminar with Michael L. Barnett, MD, MS, Assistant Professor of Health Policy and Management, Harvard T. H. Chan School of Public Health. Find more details here.

May 27, from 12-1 PM EST
Virtual Seminar with John Hoddinott, PhD, H.E. Babcock Professor of Food and Nutrition Economics and Policy, Cornell University. Find more details here.

June 3 from 12-1 PM EST
Virtual Book Discussion with Shantanu Nundy, MD, MBA, Author of "Care After COVID," and Chief Medical Officer, Accolade. Find more details here.
Selected Media Coverage
Selected New Publications
The Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania conducts behavioral economics research aimed at reducing the disease burden from major U.S. public health problems. Originally founded within the Leonard Davis Institute of Health Economics, our mission is to inform health policy, improve health care delivery, and increase healthy behavior.