The Healthy Nudge

May 2025

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. See our 5 top stories below.

1) Using a social network-based intervention to promote HIV testing and linkage to HIV services

• What the study tested: After mapping social networks of men in Kenyan communities, "central" individuals in intervention clusters were trained to distribute HIV self-tests and support their peers in linking to care. A control group received info and referral vouchers for a free HIV self-test or provider-administered test in nearby clinics that they were encouraged to offer to cluster members.

• What the study authors found: The intervention approach significantly increased HIV testing rates, self-testing, and linkage to HIV treatment or PrEP.

2) Research integrity at CHIBE: A Q&A with Jingsan Zhu

Director of Data Analytics Jingsan Zhu, MS, MBA, offers concrete steps our research groups can take:

• For our PIs and research leads: "I’d like you to start your research meetings by asking about data management processes and identifying any gaps that the team can address immediately."

• For our project management staff: "I’d like you to identify a documentation process to log and track operational and research decisions with strong version control that is accessible to both analysts and non-analyst staff and faculty. Teams normally have some form of decision-logging processes, but they are often managed by different staff roles in a highly fragmented way, including storage choice. Avoid using emails as the main tool for documentation purposes!"

• For our analysts: "I’d like to ask you to establish routines for code checks and other quality checks of your programs. Engage project leaders to allocate time and resources (such as inviting collaborative reviewers) for this important aspect of research."

3) New Medicare program could dramatically improve affordability for cancer drugs–if patients enroll

• The context: Out-of-pocket cancer medications used to cost $10,000 or more, even for patients covered by Medicare—until recently. Thanks to changes in Medicare Part D introduced by the Inflation Reduction Act (IRA), annual out-of-pocket drug costs for all beneficiaries are now capped at $2,000.

• What's overlooked: An overlooked voluntary program that’s part of the IRA could be the key to improving affordability for Medicare patients needing expensive oral cancer drugs, according to a new study. Patients can enroll voluntarily in the Medicare Prescription Payment Plan (MPPP), which allows people to spread out-of-pocket costs throughout the year in monthly payments.

• What's the impact of these changes: Previously, annual out-of-pocket costs for an oral cancer drug could run more than $11,000, much of that due early in the year. Now, the IRA would limit these costs to $2,000 annually. MPPP enrollment in January would allow this total to be spread across 12 monthly payments, each $167.

• Why this matters: “High out-of-pocket costs often put these critical medicines out of reach and can lead to patients abandoning treatment,” said study lead author Dr. Jalpa Doshi.

4) Short-term diet trials are designed to fail

• The question: What diet works best to prevent obesity, diabetes, cardiovascular disease, cancer and Alzheimer’s?

• Why haven’t we answered this question definitively? A new paper suggests the problem may be rooted in poorly designed nutrition research.

• A problematic example: In an associated opinion piece in STAT News, Drs. David S. Ludwig and Mary E. Putt argue that short-term dietary trials – such as those in the $170 million Nutrition for Precision Health initiative of the NIH – not only waste money, but could also distort the evidence base upon which future national nutrition guidelines are based.

5) 5 examples of how behavioral economics can influence patient behavior

• The topics: See how behavioral economics can help increase physical activity, safer driving, medication adherence, vaccinations, and understanding of HIV.

• The techniques: In these studies, researchers used tools such as incentives, gamification, behaviorally informed texts, and mental models.

• The gist: Behavioral economics is a field full of tools that can make the right choice the easy choice to make.