Purpose: To articulate and defend normative guidelines for the responsible deployment of behavioral economics and behavioral psychology principles to change health decisions and behaviors.
Method: Systematic review of the literature to identify studies recently done and policies recently developed that use principles from behavioral economics and behavioral psychology to change health decisions and behaviors, followed by conceptual analysis to develop and defend normative guidelines.
Result: Motivated in part by the NIH’s designation of The Science of Behavior Change as a Roadmap Initiative, policy makers, researchers, and clinicians are turning increasingly to behavioral economics and behavioral psychology for tools to change individual and group health-related behaviors and decisions. Examples include exploiting the principle of loss aversion through incentives to get people to lose weight and engage in regular cancer screenings, exploiting the principle of the status quo to set defaults to increase HIV screening (CDC policy) and Sickle Cell Trait screening (NCAA policy), exploiting the principle of availability bias to paint vivid images in people’s minds to discourage smoking (FDA policy) and full code status for certain patients, and exploiting the power of subconscious cues to prime people to pick healthy foods in restaurants and grocery stores. No corresponding guidelines have been developed to guide the use of these methods to ensure that they are used in an ethically responsible way.
Conclusion: The use of behavioral economics and behavioral psychology principles to change health decisions and behaviors fall into the following main categories: incentives, defaults, salience and affect, norms, and subconscious priming. Incentives must be guided by considerations of amount, kind, and whether they will damage the physician-patient relationship. Default settings and subconscious priming must be guided by considerations of whether it is fairly easy for people to opt-out or avoid and go their own way, and whether the default represents what is in most people’s interests from an evidence-based point of view. The use of salience and affect, and also norms, must be guided by considerations of whether what is being presented is true and accurate, and whether there is a justification for appealing to emotion instead of rational argument.