A Systematic Review of Nudge Interventions to Optimize Medication Prescribing

Usman Talat, Kelly Ann Schmidtke*, Saval Khanal, Amy Chan, Alice Turner, Robert Horne, Tim Chadborn, Natalie Gold, Anna Sallis, Ivo Vlaev*

*Corresponding author for this work

    Research output: Contribution to journalReview articlepeer-review

    6 Citations (Scopus)
    4 Downloads (Pure)


    Background: The benefits of medication optimization are largely uncontroversial but difficult to achieve. Behavior change interventions aiming to optimize prescriber medication-related decisions, which do not forbid any option and that do not significantly change financial incentives, offer a promising way forward. These interventions are often referred to as nudges. 

    Objective: The current systematic literature review characterizes published studies describing nudge interventions to optimize medication prescribing by the behavioral determinants they intend to influence and the techniques they apply. 

    Methods: Four databases were searched (MEDLINE, Embase, PsychINFO, and CINAHL) to identify studies with nudge-type interventions aiming to optimize prescribing decisions. To describe the behavioral determinants that interventionists aimed to influence, data were extracted according to the Theoretical Domains Framework (TDF). To describe intervention techniques applied, data were extracted according to the Behavior Change Techniques (BCT) Taxonomy version 1 and MINDSPACE. Next, the recommended TDF-BCT mappings were used to appraise whether each intervention applied a sufficient array of techniques to influence all identified behavioral determinants. 

    Results: The current review located 15 studies comprised of 20 interventions. Of the 20 interventions, 16 interventions (80%) were effective. The behavior change techniques most often applied involved prompts (n = 13). The MINDSPACE contextual influencer most often applied involved defaults (n = 10). According to the recommended TDF-BCT mappings, only two interventions applied a sufficient array of behavior change techniques to address the behavioral determinants the interventionists aimed to influence. 

    Conclusion: The fact that so many interventions successfully changed prescriber behavior encourages the development of future behavior change interventions to optimize prescribing without mandates or financial incentives. The current review encourages interventionists to understand the behavioral determinants they are trying to affect, before the selection and application of techniques to change prescribing behaviors. 

    Systematic Review Registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42020168006].

    Original languageEnglish
    Article number798916
    Number of pages13
    JournalFrontiers in Pharmacology
    Publication statusPublished - 25 Jan 2022

    Bibliographical note

    Funding Information: This work was supported by the Health Foundation’s Behavioral Insights Research program (Award 807263) and the National Institute for Health Research (NIHR) Applied Research Center (ARC) West Midlands (NIHR200165). The views expressed are those of the author(s) and not necessarily the funders. The funders had no role in the design of the study and collection, analysis, and interpretation of data and no role in writing the manuscript.

    Author NG was employed by Kantar Public.

    The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

    Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    Publisher Copyright: © 2022 Talat, Schmidtke, Khanal, Chan, Turner, Horne, Chadborn, Gold, Sallis and Vlaev.

    Citation: Talat U, Schmidtke KA, Khanal S, Chan A, Turner A, Horne R, Chadborn T, Gold N, Sallis A and Vlaev I (2022) A Systematic Review of Nudge Interventions to Optimize Medication Prescribing . Front. Pharmacol. 13:798916.

    DOI: 10.3389/fphar.2022.798916


    • CARE
    • RATES
    • TRIAL
    • behavioural science
    • costs
    • medical decision-making
    • nudge
    • prescribing
    • systematic reviews
    • use


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