Nudging Health Behavior Change Among Home-Based Cardiac Rehabilitation Patients: A Scoping Review

Zhen Yang,1,* Dan Jin,2,* Hao Huang,3 Xutong Zheng,1 Shu Liu,1 Aiping Wang1 1Department of Public Service, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, People’s Republic of China; 2Department of Nursing, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 3School of Nursing, the Hong Kong Polytechnic University, Hong Kong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Aiping Wang, Department of Public Service, the First Affiliated Hospital of China, Medical University, No.155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, People’s Republic of China, Email [email protected]: In home-based cardiac rehabilitation practices, nudging has emerged and was actively explored to promote health behavior change among patients with heart disease. The literature on nudging strategy is fragmented and lacks comprehensive reviews.Objective: This study aimed to identify nudging interventions to promote health behavior change among patients undergoing home-based cardiac rehabilitation, focusing on the scope, characteristics and delivery.Methods: A scoping review was conducted from July to September 2023, during which databases including PubMed, Web of Science, and OVID (Embase, Cochrane Library, JBI) were searched. Search terms were constructed based on population-concept-context mnemonics approach. Reviewers screened articles independently and reviewed the included articles to extract key information about each nudge intervention.Results: In included 25 studies, the majority (n=21) with the nudging strategy had positive results. 14 nudge strategies were identified and coded with the primary objective of changing health behaviors. The most common nudging strategy was goal setting, followed by feedback, and reminders and alerts. To capture the heterogeneity of nudging strategies, two independent dimensions were introduced to further classify them into four quadrants (active vs passive and synchronous vs passive). For example, some nudging strategies usually occur when the target behavior must be performed (synchronization) and requires the immediate participation of the home-based cardiac rehabilitation patients (active). In addition, digital nudging technology with gamification elements may become the mainstream in future research.Conclusion: These studies reflected different objectives and implement nudging strategies in different ways. Despite the multiple nudging strategies are widely adopted, identifying the contributing components remains challenging.Keywords: nudge, cardiac rehabilitation, decision architecture, health behavior, intervention