The acceptability of nudging for health: what does the public say?

Background: Promoting sustainable health behavior can be arrived at in several ways. While the most often-used strategy of health education has been criticized for being too focused on intentional behavior change, structural approaches such as legislative measures are considered as too controlling. To address these shortcomings, nudging has been suggested as an alternative. Nudging refers to behavior-change interventions that organize the choice architecture to alter people’s behavior in a predictable way,while preserving their freedom of choice and refraining from using economic incentives. While the strategy is welcomed by health policy makers as a novel and effective way to influence healthy lifestyles, it has also met with ethical criticism. This ethical opposition mainly comes from public health professionals, who consider the technique too paternalistic and disempowering. This qualitative study aimed to investigate the acceptability of nudging from the perspective of both decision makers and the public. Methods:. Interviews were conducted among participants in a study investigating the effects of nudging on healthy vegetable choice on a university restaurant (nudges) and among decision-makers (nudgers) who were involved in the study. The interviews were held immediately after the intervention, lasted a few minutes and used open-ended questions asking the participants whether had realized they had been nudged, whether they agreed, and under what conditions they thought nudging was acceptable. Results: Content analysis of the interviews showed that both nudgees and nudgers accept the use of nudges. Common identified conditions of approval were the use of other health promotion techniques such as education and evidence-based practice. Nudgees emphasized the importance of transparency about the methods and objectives, and respect for free choice and legislation to ensure the boundaries of the technique. Nudgers emphasized the importance of a sense of responsibility of beneficiaries, proof of feasibility, and cost-effectiveness of the technique. Conclusion: The elements favoring the adoption of nudging are confirmed. It encourages the implementation of nudging to promote health. The approach must be transparent, complementary, participatory and encourage thoughtful choices.