Application of Nudging in Improving Pediatric Dental-Attendance: A Systematic Review

Objectives: Nudging is a concept in behavioral economics that influences choice behavior by affecting individual’s decision-making utilizing cognitive biases, without actively restricting or mandating. The objective of this study was to systematically explore the application of nudging in patient compliance concerning attendance in pediatric dentistry.
Methods: Four electronic databases were searched up to August 2015. The search for data was structured using the PICO outline and PRISMA guidelines in the SCOPUS, Medline (Ovid SP), Psychinfo (Ovid SP), and World Health (Ovid SP) databases. Quantitative and qualitative studies in English language focusing dental attendance of patients 18 years of age or younger were included.
Results: From 988 screened studies, 10 were selected. Eight studies were Randomized Controlled Trials and the remaining two were qualitative with a clinical assessment. In the chosen studies, two kinds of interventions were observed pertaining to either reminders or anticipatory anxiety. For reminders, most studies concluded that utilizing a reminder system in general was beneficial over no reminder system. Interactive reminders or voice reminders were more effective than passive and impersonal reminders, such as texting (SMS), and mixed-framed messages was the best in achieving patient compliance in attendance. For the anticipatory anxiety, they suggested that the child should be informed and addressed prior and during the visit by the dentist themselves to aid in breaking the cycle of dental fear. Aggregate results were divided between different cognitive biases used to exploit nudging techniques to thus explain their value in incrementing patient compliance in attendance.
Conclusions: Recognition of “nudging” as a cost-efficient mechanism used for improving compliance in dental attendance in pediatric dentistry will allow for a foundation that can be built upon and indexed by further research.