Effectiveness, ethics, and sustainability of nudge-based interventions for self-monitoring in patients with hypertension and type 2 diabetes: A systematic review.

OBJECTIVE

This study aims to assess the effectiveness, ethics, and sustainability of nudge-based interventions in improving self-monitoring behaviors among patients with hypertension (HTN) and type 2 diabetes mellitus (T2DM).

METHOD: A systematic search of seven databases (January 2008-October 2024) identified studies on nudge-based interventions for HTN and T2DM self-monitoring. Nudge strategies were categorized using Münscher et al.'s taxonomy of choice architecture, which includes "decision information," "decision architecture," and "decision assistance." The included nudge-based interventions were evaluated across three domains: effectiveness, ethical quality, and sustainability.

RESULTS

Seventeen studies (19 trials) were included in this review; 58% of the nudge-based interventions significantly improved self-monitoring adherence, and 47% yielded measurable improvements in clinical outcomes, such as reductions in blood pressure and glycated haemoglobin levels compared to usual care. Ethical evaluations revealed that the majority of nudge-based interventions exhibited above-average ethical quality. Regarding sustainability, while multicomponent interventions were common, they proved more difficult to implement due to higher resource demands.

CONCLUSIONS

This review highlights the potential of nudge-based interventions to improve self-monitoring adherence among patients with HTN and T2DM. However, balancing effectiveness, ethical considerations, and sustainability will be crucial for optimizing these interventions in real-world settings. (PsycInfo Database Record (c) 2026 APA, all rights reserved).