Digital nudges for cardiovascular health: A scoping review through the lens of dual-process theory.

BACKGROUND

Digital nudging uses technology-based modifications to subtly influence health-related decisions without restricting choice. However, no review has systematically examined digital nudge strategies for cardiovascular disease health behavior promotion through a dual-process theoretical lens that distinguishes between automatic and deliberative cognitive processes.

OBJECTIVE

To synthesize evidence on digital nudge strategies promoting cardiovascular disease-related health outcomes from a dual-process perspective.

DESIGN

A scoping review.

REVIEW

METHODS

Nine databases were searched from inception to November 2025 using terms related to digital nudges and cardiovascular disease. Study selection and data extraction were conducted independently by two reviewers. Identified interventions were classified as Type I (automatic) or Type II (reflective) nudges, and findings were narratively synthesized.

RESULTS

Seventeen studies were included. Digital nudges targeted patients or caregivers, healthcare professionals, or both, and were delivered through short message service, email, electronic health record systems, instant messaging apps, patient portals, voice calls, chatbots, and specialized digital platforms. Twelve nudge types were identified, including environmental cues, reminders, default options, feedback, framing, social norms, social/peer comparison, highlighted suggested choices, pre-commitment, accountability justification, expert authority, and gamification. Reported outcomes included medication adherence, prescribing, follow-up attendance, vaccination or prophylaxis uptake, physical activity, dietary behavior, cardiovascular risk assessment, and preventive care engagement. Study designs, sample sizes, follow-up duration, outcome measures, and reported effect estimates were heterogeneous.

CONCLUSIONS

Digital nudges are increasingly used to support cardiovascular health management across patient-facing and clinician-facing contexts. Current evidence is heterogeneous, and stronger long-term, implementation-focused, and equity-sensitive studies are needed to identify which nudge components work for which behaviors, recipients, and settings.

REGISTRATION: Open Science Framework (https://osf.io/4pyks).