Dilip Soman’s research while affiliated with University of Toronto and other places

Considerable research suggests making information simpler is better. Simplification improves the efficiency of information extraction and lowers psychological frictions, leading to its popularity with policymakers and practitioners worldwide. However, it remains unclear when and how simplification can be utilized most effectively, or if there are contexts where simplification may produce unintended maleficent effects. Using two large-scale field experiments (N = 126,673), we test whether simplifying account statements helps encourage retirement savings in Mexico. We partner with two retirement firms, one ranked high in rate of returns and the other ranked lower. We find that simplifying retirement account statements improves contribution rates for consumers in the high-ranking firm but reduces contribution rates for consumers in the low-ranking firm. Five follow-up experiments provide evidence consistent with a fluency amplification account. Simplifying information improves processing fluency making it easier to accurately recall firm rank relative to the control, which amplifies behavior bidirectionally: High-ranking (low-ranking) firm consumers more accurately recall their firm’s rank, subsequently increasing (decreasing) contributions. However, if simplification is harnessed in ways that improve processing fluency and lower perceived switching costs, then simplification can improve retirement savings for everyone either by boosting contributions or encouraging people to switch to higher performing alternatives.

Importance Pediatric patients with cancer experience severely bothersome symptoms during treatment. It was hypothesized that symptom screening and provision of symptom reports to the health care team would reduce symptom burden in pediatric patients with cancer. Objective To determine if daily symptom screening and provision of symptom reports to the health care team was associated with lower total symptom burden as measured by the Symptom Screening in Pediatrics Tool (SSPedi) compared to usual care among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days. Design, Setting, and Participants This randomized clinical trial enrolled participants from July 2018 to September 2023 from 8 Canadian tertiary care centers that diagnose and treat pediatric patients with cancer. Patients aged 8 to 18 years with cancer expected to be in a hospital or clinic daily for at least 5 consecutive days were eligible for inclusion. Participants were randomized to intervention (n = 176) vs control (n = 169) groups. Data were analyzed from November 2023 to December 2023. Intervention Intervention participants completed the SSPedi once daily for 5 days. Printed symptom reports were provided daily to the health care team, and email alerts were distributed for severely bothersome symptoms. Control participants received usual care. Main Outcomes and Measures The primary outcome was self-reported total SSPedi score on day 5. Secondary outcomes were individual SSPedi symptoms, pain, quality of life, symptom documentation, and intervention provision. The primary analysis compared the day 5 total SSPedi scores between randomized groups using a multiple linear regression model. For the secondary analysis comparing individual SSPedi symptom scores, the odds ratio for the intervention was estimated using a proportional odds model. Pain and quality of life were analyzed using the same approach as the primary outcome. Fisher exact test was used to compare symptom documentation, any intervention, and symptom-specific intervention between groups. Results A total of 345 participants were enrolled; median (range) participant age was 13.8 (8.0-18.8) years, and 150 participants (43.5%) were female. Day 5 SSPedi score was significantly better with symptom screening compared to usual care (adjusted mean difference, −2.5; 95% CI, −3.8 to −1.2). Symptom screening reduced the odds of higher individual symptom scores; 8 of 15 symptom reductions were statistically significant. There were no significant differences in pain or quality of life scores between groups. Five symptoms were documented or treated significantly more often with symptom screening than usual care. Conclusions and Relevance In this randomized clinical trial, among pediatric patients with cancer admitted to a hospital or seen in a clinic daily for at least 5 days, symptom screening with SSPedi improved total symptom scores compared to usual care. Trial Registration ClinicalTrials.gov Identifier: NCT03593525

Public and private institutions have gained traction in developing interventions to alter people's behaviours in predictable ways without limiting the freedom of choice or significantly changing the incentive structure. A nudge is designed to facilitate actions by minimizing friction, while a sludge is an intervention that inhibits actions by increasing friction, but the underlying cognitive mechanisms behind these interventions remain largely unknown. Here, we develop a novel cognitive framework by organizing these interventions along six cognitive processes: attention, perception, memory, effort, intrinsic motivation and extrinsic motivation. In addition, we conduct a meta-analysis of field experiments (i.e. randomized controlled trials) that contained real behavioural measures (n = 184 papers, k = 184 observations, N = 2 245 373 participants) from 2008 to 2021 to examine the effect size of these interventions targeting each cognitive process. Our findings demonstrate that interventions changing effort are more effective than interventions changing intrinsic motivation, and nudge and sludge interventions had similar effect sizes. However, these results need to be interpreted with caution due to a potential publication bias. This new meta-analytic framework provides cognitive principles for organizing nudge and sludge with corresponding behavioural impacts. The insights gained from this framework help inform the design and development of future interventions based on cognitive insights.

Despite their increasing use, choice architecture interventions have faced criticism for being possibly manipulative and unethical. We empirically explore how an intervention’s acceptability differs by the type of intervention used, by the domain, and by the way in which its implementation and benefits are explained. We employ a 5 × 5 × 5 factorial design with three fully crossed predictor variables: domain, type of intervention, and explanation. We measure participants’ acceptance of the proposed intervention, perceived threat to autonomy and freedom of choice, and belief that the intervention will be successful. We hypothesized that acceptability of the intervention and perceived threat to autonomy will change as a function of the type of intervention used, the domain in which it is implemented, and the rationale for which its use is presented. We find that acceptability of the intervention, perceived threat to autonomy, and belief that the intervention will be successful differ by the type of intervention used and by the domain in which it is implemented. The rationale for the use of the intervention appears to change acceptability of the intervention depending on the type of intervention that is being used, and the domain in which it is implemented. Exploratory analyses were conducted to investigate differences between specific levels within factors, and interactions between factors. Given the variation in acceptability across the three factors, we believe that the discourse about the ethics of choice architecture should avoid generalizations and should instead be at the level of individual interventions in a specific situation. We conclude with a discussion about areas for future research. Protocol registration The stage 1 protocol for this Registered Report was accepted in principle on 14 October 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.6084/m9.figshare.21758666 .

Excessive credit card use has been a serious concern across the world since the introduction of the payment method. In South Korea, credit card companies and the government collaborated on a behavioral intervention, the transaction reminder service, to help consumers better manage their credit. Credit card transactions trigger text message confirmations sent to users’ mobile phones, increasing the salience and memory of expenses and resulting in more controlled spending. Experimenting in an institutional setting in which one group receives reminders and the other does not, the authors combined difference-in-differences methodology with inverse probability treatment weighting to assimilate random assignment. The empirical findings show that this intervention counterintuitively brings an overall increase in spending. This increase is substantial among those who had been light to medium spenders before the implementation, whereas historically high spenders experience little to no change after receiving the transaction reminders. The results are consistent with a theory that users reallocate the mental effort of remembering their past spending (mental recordkeeping) to digital devices, leading to higher spending due to poor recall. These findings attest to the value of evaluating a policy before scaling it broadly.

Purpose To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates. Design Randomized, controlled trial. Setting Two health systems in the Northeastern US between September 2020 and March 2021. Subjects 74,811 adults. Interventions Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content. Measures Influenza vaccination. Analysis Intention-to-treat. Results Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as “reserved for you” and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as “reserved for you.” None of the interventions performed worse than control. Conclusions Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.