Quarterly Journal of Social Development
(Previously Human Development)

Quarterly Journal of Social Development (Previously Human Development)

Using Nudge in Public Health Policies and Its Consequences for Social Development: A Paradigmatic Model

Document Type : Research Paper

Authors
1 Department of Business Management and Entrepreneurship, Faculty of Management and Accounting, Farabi Campus, University of Tehran, Qom, Iran
2 Department of Public Administration, Faculty of Management and Accounting, Farabi Campus, University of Tehran, Qom, Iran
3 PhD student in Public Administration, Faculty of Management and Accounting, Farabi Campus, University of Tehran, Qom, Iran
Abstract
The aim of this study is to design a paradigmatic model for the application of nudge in public health policies and its implications for social development. This study was designed with a qualitative approach based on a combination of systematic literature review strategies and evidence-based theory. Through a systematic literature review, primary central categories were extracted in the form of a paradigmatic model (including causal conditions, phenomena, strategies, intervening conditions, contextual conditions, and consequences). A total of 84 articles were identified, filtered, and analyzed after implementing the PRISMA process. The findings showed that in the causal conditions dimension, factors such as the inefficiency of rational decision-making, the complexity of choice environments, and the limitations of traditional policies are the main drivers of the move towards nudge. In the phenomenon dimension, nudge was defined as a combination of choosing architecture design and the use of cognitive biases. Effective strategies included behavioral, communication, motivational, and institutional approaches. Also, intervening conditions (such as institutional capacity and data infrastructure) and contextual conditions (such as service structure) play a decisive role in the success or failure of interventions. In terms of outcomes, the results showed that nudges lead to behavioral changes at the individual level, health system and health service outcomes, economic and cost outcomes, social and demographic outcomes, and governance and public policy outcomes.
Keywords
Subjects

Anbari, M. & Sayadian-Barkhordar, M. (2025). “A historical study of the process of developing the girls' education system in Iran”, Quarterly Journal of Social Development (Previously Human Development), 20(1), 95-120. (Persian).
Betsch, C., Bohm, R., & Korn, L. (2017). “Inviting free-riders or appealing to prosocial behavior?”, Health Psychology, 36(11), 1050–1057.
Browne, J., Coffey, B., Cook, K., Meiklejohn, S. & Palermo, C. (2018). “A guide to policy analysis as a research method”, Health Promotion International, https://doi.org/10.1093/heapro/day052.
Dai, H.; Saccardo, S.; Han MA, Roh, L.; Raja, N.; Vangala, S.; Modi, H.; Pandya, S.; Sloyan, M.; Croymans, D.M. (2021). “Behavioural nudges increase COVID-19 vaccinations”, Nature 597(7876):404-409. doi: 10.1038/s41586-021-03843-2.
Ge, L.; Guan, X.; Tang, L.; Zhu, Q.; Zhong, Y.; Lan, M. (2025). “The effectiveness of digital nudging in improving dietary quality: A systematic review of randomized controlled trials”, BMC Public Health. 16;25(1):2804.
Henrich, J., Heine, S. J., & Norenzayan, A. (2010). “The weirdest people in the world?”, Behavioral and Brain Sciences, 33(2–3), 61–83.
Howlett, M., & Ramesh, M. (2020). Studying public policy: Principles and processes (4th ed.). Oxford University Press.
Ibrahim, S.; Al-Dahir, S.; Al Mulla, T. (2021). “Resilience of health systems in conflict affected governorates of Iraq, 2014–2018. Confl Health 15, 76.  
Kazemian, A.; Hoseinzadeh, M.; Banihashem Rad, S.A.; Jouya, A. Tahani, B. (2023). “Nudging oral habits; application of behavioral economics in oral health promotion: a critical review Front”, Public Health. 11:1243246. (Persian).
Kostick, K.M.; Trejo, M.; Volk.; R. J., Estep, J.D., Blumenthal-Barby, J.S. (2020). “Using Nudges to Enhance Clinicians' Implementation of Shared Decision Making With Patient Decision Aids”, MDM Policy Pract, 26, 5(1):2381468320915906.
Kreuter, M. W. & et. al (2019). “Increasing screening uptake using behavioral insights”, Preventive Medicine, 118, 107–114.
Milkman, K. L. & et. al (2021). A megastudy of text-based nudges encouraging patients to get vaccinated. Proc. Natl. Acad. Sci. U.S.A., 118(52). e2101165118
Mirzaei, B.; Mohammadi, A.; Navabakhsh, M. (2024). “Identifying social factors affecting third-party insurance fraud with a mixed approach (case study: insurance company representatives in Tehran)”, Quarterly Journal of Social Development (Previously Human Development), 18(3), 131-166. (Persian).
Mohammadpour, D.; Abbaszadeh, M., Aghayari-Heer, T.; Alizadeh Aghdam, M. B. (2024). “Identifying factors affecting financial recovery using the meta-synthesis method”, Quarterly Journal of Social Development (Previously Human Development), 18(4), 93-132. (Persian).
Nguyen, O.T.; Kunta, A.R.; Katoju, S.; Gheytasvand, S.; Masoumi, N.; Tavasolian, R.; Alishahi Tabriz, A.; Hong YR, Hanna K, Perkins, R.; Parekh, A.; Turner, K.; (2024). “Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care: A Systematic Review”, JAMA Netw Open. 2024 Sep 3;7(9):e2432760. (Persian).
OECD. (2019). Tools and ethics for applied behavioural insights. OECD Publishing.
Oliver, A. (2017). The Origins of Behavioural Public Policy. Cambridge University Press.
Reñosa, M.D.C.; Landicho, J.; Wachinger, J.; Dalglish, S.L.; Barnighausen, K.; Bärnighausen, T.; McMahon, S.A. (2021). Nudging toward vaccination: a systematic review. BMJ Glob Health. Sep;6(9):e006237.
Schneider, C., Weinmann, M., & Vom Brocke, J. (2022). “Digital nudging: Designing choice environments for digital decision-making”, MIS Quarterly, 46(1), 451–486.
Shang, H.; Xiong, L.; Chen, K.; Tian, R.; Tu, J.; Shang, X. (2025). “Ethical dimensions of healthcare nudges: a PRISMA-ScR–guided scoping review and framework for responsible behavioral governance”, Front. Public Health. 13:1716466.
Sunstein, C. R. (2014). Why nudge? The politics of libertarian paternalism. Yale University Press.
Talat, U.; Schmidtke, K.A.; Khanal, S.; Chan, A.; Turner, A.; Horne, R.; Chadborn, T.; Gold, N.; Sallis, A.; Vlaev, I. (2022). A Systematic Review of Nudge Interventions to Optimize Medication Prescribing. Front Pharmacol. Jan 25;13:798916. 
Thaler, R. H.; Sunstein, C. R. (2008). Nudge: Improving decisions about health, wealth, and happiness. Yale University Press.
Thorndike, A. N. & et. al (2014). “A 2-year restaurant study of behavioral nudges”, American Journal of Public Health, 104(12), 2422–2429.
Van Der Zee, S.; Verhoog, T.; Post, T.; Garcia-Gomez, P.; Van Raaij, E.M.; Diehl, J.C.; Hunfeld, N. (2025). “Nudging intensive care unit personnel towards sustainable behaviour”, Nurs Crit Care, Jan; 30 (1):37-46. 
Venema, T. A. & et. al. (2019). “Nudging healthy food choices: A systematic review”, Appetite, 143, 104412.
Volpp, K. G. & et. al (2017). “Medication adherence and behavioral economics”, JAMA, 317(20), 2099–2100.
Wang, F.; Li, Y., Zhang, C.; Arbing, R. H.; Chen, W.; Huang, F. (2025). Evaluating digital nudge interventions for the promotion of cancer screening behavior: a systematic review and meta-analysis. BMC Medicine, 23.
Wolf, A.; Sant'Anna, A.; Vilhelmsson A. (2022). Using nudges to promote clinical decision making of healthcare professionals: A scoping review. Prev Med.164:107320.
Wolfswinkel, J. F.; Furtmueller, E.; Wilderom, C. P. M. (2013). “Using grounded theory as a method for rigorously reviewing literature”, European Journal of Information Systems, 22(1), 45–55.
Zhang, J.; Jin, H. (2024). “Interventions involving nudge theory for COVID-19 vaccination: A systematic review and meta-analysis”, Health Psychology, 43(11), 779–790.