A formative study to develop nudges informed by behavioral economics to increase engagement with tobacco treatment among people who smoke receiving care for HIV.

BACKGROUND

The rate of tobacco use among people with HIV (PWH) is > 2 fold higher vs. the general population and accounts for more life years lost than the virus. Yet, evidence-based tobacco treatments are uncommonly offered by clinicians or used by PWH. Biases informed by behavioral economics concerning tobacco treatments may drive this practice gap.

METHODS

This formative study tested nudges in the form of messages that target four behavioral economic biases - status quo, availability, omission, and focusing effect - to determine which message would be most strongly associated with PWH willingness to use or clinician referral for tobacco treatment; 19 clinicians and 75 PWH assessed pair-wise comparisons of the four messages with instructions to select the message that, if sent via text or a patient portal, or via the electronic medical record (EMR) at a clinic visit, would increase willingness to use or provide a referral for tobacco treatment.

RESULTS

There were significant differences in reported preference across the messages among PWH (χ2[3]=24.79, p < 0.001) and clinicians (χ2[3]=33.85, p < 0.001). The message that addressed focusing effect bias was most preferred for increasing use and referral for tobacco treatment among PWH (29 %) and clinicians (38 %).

CONCLUSIONS

A message that addressed focusing effect bias was associated with greater interest in the use of or referral for tobacco treatment within HIV care. These results can help design a clinical trial to test the effectiveness of these messages within the clinical workflow for their effects on actual use of and referral for tobacco treatment for PWH.