Wang Fangfang, Li Yonglin, Zhang Chenxing, Arbing Rachel, Chen Wei-Ti, Huang Feifei
School of Nursing, Fujian Medical University, No 1, Xueyu Road, Minhou County, Fuzhou, Fujian, 350108, China.
School of Nursing, University of California los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA.
BMC Med. 2025 Apr 14;23(1):214. doi: 10.1186/s12916-025-04028-8.
Public adherence to cancer screening remains low and is influenced by both rational and non-rational factors, including decision biases that underestimate screening benefits. Digital nudge interventions have shown promise in promoting screening behaviors among at-risk populations, but systematic evidence is still lacking. This study aims to synthesize the effects of digital nudge interventions on promoting cancer screening behaviors in high-risk individuals.
A systematic search of 10 electronic databases was conducted, and studies published before April 1, 2024, were included. Eligible studies were randomized controlled trials (RCTs) that compared the effects of digital nudge interventions on cancer screening behavior with those of a control group and reported at least one outcome. The risk of bias was evaluated using the Cochrane Risk of Bias tool. Data on cancer screening uptake rates were pooled using a random-effects model. Subgroup analyses were performed for cancer types, intervention media, delivery conditions, and sensitivity. The study identified digital nudge strategies via the MINDSPACE framework and explored their influence on screening behavior through the HSM.
Of the 14 randomized controlled trials included, 10 reported statistically significant results. The types of interventions in these studies were heterogeneous and available across multiple delivery channels based on the web, computer programmes, DVDs, telephones, patient navigation, or apps that tailored or served interactive information to participants to better understand screening risks and options. A random-effects model showed that digital nudge intervention strategies significantly improved adherence to cancer screening behavior (OR = 1.81, 95% CI = 1.35-2.44, p < 0.001). Differences between cancer types, intervention media, and delivery conditions were noted. Based on the MINDSPACE framework and HSM, eight nudge strategies were designed to promote screening behaviors, with the most common being the default strategy (n = 9). Most nudge tools were designed to leverage unconscious System 1 thinking, aiming to influence behavior in a more spontaneous and subtle way.
While digital nudge interventions have demonstrated significant positive effects in promoting early cancer screening participation among high-risk individuals, their impact varies. More robust research is needed to address methodological limitations and facilitate broader adoption and application of these interventions.
公众对癌症筛查的依从性仍然很低，受到理性和非理性因素的影响，包括低估筛查益处的决策偏差。数字助推干预措施在促进高危人群的筛查行为方面显示出了前景，但仍缺乏系统的证据。本研究旨在综合数字助推干预措施对促进高危个体癌症筛查行为的效果。
对10个电子数据库进行了系统检索，纳入了2024年4月1日前发表的研究。符合条件的研究为随机对照试验（RCT），比较了数字助推干预措施与对照组对癌症筛查行为的影响，并报告了至少一项结果。使用Cochrane偏倚风险工具评估偏倚风险。使用随机效应模型汇总癌症筛查接受率的数据。对癌症类型、干预媒介、实施条件和敏感性进行了亚组分析。该研究通过MINDSPACE框架确定了数字助推策略，并通过健康信念模型（HSM）探讨了它们对筛查行为的影响。
在纳入的14项随机对照试验中，10项报告了具有统计学意义的结果。这些研究中的干预类型具有异质性，可通过基于网络、计算机程序、DVD、电话、患者导航或应用程序等多种实施渠道获得，这些应用程序为参与者量身定制或提供交互式信息，以更好地了解筛查风险和选择。随机效应模型显示，数字助推干预策略显著提高了对癌症筛查行为的依从性（OR = 1.81，95% CI = 1.35 - 2.44，p < 0.001）。注意到癌症类型、干预媒介和实施条件之间的差异。基于MINDSPACE框架和健康信念模型，设计了8种助推策略来促进筛查行为，最常见的是默认策略（n = 9）。大多数助推工具旨在利用无意识的系统1思维，旨在以更自发和微妙的方式影响行为。
虽然数字助推干预措施在促进高危个体早期癌症筛查参与方面已显示出显著的积极效果，但其影响各不相同。需要更有力的研究来解决方法学上的局限性，并促进这些干预措施的更广泛采用和应用。
