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Can nudge-interventions address health service overuse and underuse? Protocol for a systematic review
  1. Mary O’Keeffe1,
  2. Adrian C Traeger1,
  3. Tammy Hoffmann2,
  4. Giovanni Esteves Ferreira1,
  5. Jason Soon3,
  6. Christopher Maher1
  1. 1Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Bond University, Gold Coast, Queensland, Australia
  3. 3Royal Australasian College of Physicians, Sydney, New South Wales, Australia
  1. Correspondence to Dr Mary O’Keeffe; mary.okeeffe{at}


Introduction Nudge-interventions aimed at health professionals are proposed to reduce the overuse and underuse of health services. However, little is known about their effectiveness at changing health professionals’ behaviours in relation to overuse or underuse of tests or treatments.

Objective The aim of this study is to systematically identify and synthesise the studies that have assessed the effect of nudge-interventions aimed at health professionals on the overuse or underuse of health services.

Methods and analysis We will perform a systematic review. All study designs that include a control comparison will be included. Any qualified health professional, across any specialty or setting, will be included. Only nudge-interventions aimed at altering the behaviour of health professionals will be included. We will examine the effect of choice architecture nudges (default options, active choice, framing effects, order effects) and social nudges (accountable justification and pre-commitment or publicly declared pledge/contract). Studies with outcomes relevant to overuse or underuse of health services will be included. Relevant studies will be identified by a computer-aided search of the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, CINAHL, Embase and PsycINFO databases. Two independent reviewers will screen studies for eligibility, extract data and perform the risk of bias assessment using the criteria recommended by the Cochrane Effective Practice and Organisation of Care (EPOC) group. We will report our results in a structured synthesis format, as recommended by the Cochrane EPOC group.

Ethics and dissemination No ethical approval is required for this study. Results will be presented at relevant scientific conferences and in peer-reviewed literature.

  • nudge
  • overuse
  • underuse
  • health services
  • health professionals

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  • Contributors MOK is the guarantor. All authors contributed to the conception and design of the study. MOK drafted the manuscript and CM provided overall guidance. MOK, JS and ACT developed the nudge-intervention categories. MOK and GEF designed the search strategy and picked the risk of bias assessment tool. TH gave specific feedback on data extraction and the analysis plan. All authors commented on drafts of the protocol and added subject-specific expertise where necessary. All authors read the final draft of the manuscript and provided feedback. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.