Can nudging increase the uptake of recommended health services?

Type 2 diabetes (T2DM) represents a significant threat to global public health. When supported by their general practitioner (GP), patients who self-manage effectively can prevent or delay serious complications. This study examines whether an innovative information initiative can nudge members of the Norwegian Diabetes Association (NDA) with T2DM to schedule a comprehensive annual checkup with their GP.

We randomized 12,484 NDA members with T2DM into an intervention group with two subgroups and a control group with two subgroups. The intervention group received a message describing the health benefits of a comprehensive checkup, a link to an explanatory video, and a prompt to contact their GP to book an appointment. One intervention subgroup received an email followed by an SMS reminder 1 week later (Group 1); the other intervention subgroup received both messages by SMS (Group 2). The control group received no information. All groups were sent a questionnaire 4 weeks after the initial message.

The overall effect of the intervention was 3.5 percentage points (p = 0.020). Participants in intervention Group 1 initiated a comprehensive annual checkup 4.2 percentage points (p = 0.024) more often than the control group. For Group 2, we did not find a statistically significant effect of the intervention.

This intervention nudging patients with T2DM to initiate a comprehensive annual checkup had a significant effect, particularly for the group that received initial information by email and a reminder by SMS.

This study adds to the emerging literature on low-cost digital interventions by demonstrating that brief, scalable digital information can increase uptake of guideline-recommended preventive care among patients with T2DM. The findings suggest that such interventions may offer a cost-effective approach to increasing preventive-care uptake, which could in turn help reduce diabetes-related complications at the population level.