Applying user-centered design in the development of nudges for a pragmatic trial to reduce no-shows among veterans.
Brian J Zikmund-Fisher, Anaïs Tuepker, Emily E Metcalf and 2 others
PMID 34756639WHAT IT FOUND
Veterans rejected a health-risk nudge in appointment reminder letters but strongly liked 'we're here for you' and framing cancellation as helping other veterans.
Key findings
01Veterans did not sort the candidate nudges by the behavioral concepts; they sorted them by liking, belief, or seeing them as a sales pitch.
02A newly added gain-framed health-risk nudge was dropped after veterans raised concerns, while 'we're here for you' was added after positive feedback.
03Behavioral-intention wording and wording about costs to others were poorly received by veterans.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Small, one-site study; only 27 completed interviews; participants were veterans in VA primary care and mental health, so wording may not transfer to other populations. It tested reactions to draft messages, not whether the final letters changed appointment attendance. Pile sorting was hard to interpret; iterative process may favor positive and neutral responses and drop negative ones early.
Declared interests
The article is marked as supported by U.S. Government non-PHS funding; no author conflicts are stated in the supplied text.
The easy way to misread this
Do not read this as evidence that caring language reduces missed appointments. It only shows how veterans reacted to draft reminder letters before the trial.