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CC BY-NC-ND 4.0 · Gesundheitswesen 2022; 84(11): 1059-1066
DOI: 10.1055/a-1709-0591
Originalarbeit

Wirksamkeit und ethische Bewertung von Nudging-Interventionen zur Förderung des Selbstmanagements bei Diabetes Mellitus Typ 2

Effectiveness and Ethical Evaluation of Nudging to Promote the Self-Management in Diabetes Mellitus Type 2
Oliver Rauprich
1   Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Germany
,
Meilin Möllenkamp
2   Lehrstuhl für Management im Gesundheitswesen, Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
,
Jennifer Reimann
3   Institut für Sozial- und Gesundheitsrecht, Ruhr-Universitat Bochum, Bochum, Germany
,
Stefan Huster
3   Institut für Sozial- und Gesundheitsrecht, Ruhr-Universitat Bochum, Bochum, Germany
,
Jonas Schreyögg
2   Lehrstuhl für Management im Gesundheitswesen, Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
,
Georg Marckmann
1   Institut für Ethik, Geschichte und Theorie der Medizin, Ludwig-Maximilians-Universität München, München, Germany
› Author Affiliations Förderung Das Projekt wurde vom Bundesministerium für Gesundheit (BMG) unter dem Kennzeichnen ZMV I 1-2516 FSB 018 gefördert.
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Zusammenfassung

Hintergrund Nudges bieten vielfältige Möglichkeiten zur Förderung von gesundheitsbezogenem Verhalten im Alltag, die klassische Public Health-Maßnahmen ergänzen können. Vor diesem Hintergrund führten wir vorläufige Untersuchungen zur Wirksamkeit und zu ethischen Aspekten verschiedener Nudges zur Förderung des Selbstmanagements von Patienten mit Diabetes mellitus Typ 2 im Kontext von Disease-Management-Programmen (DMPs) durch.

Methodik Die ethische Bewertung der Nudges erfolgte im systematischen Rahmen von Marckmann et al. (2015) zur Public Health-Ethik. Die bisherige Evidenz zur Wirksamkeit von Nudges wurde mittels einer narrativen Literaturübersicht zusammenfassend dargestellt.

Ergebnisse Zielvereinbarungen mit Umsetzungsplänen, Erinnerungen, Feedback, Sammeltermine bei Ärzten, Peer Mentoring sowie Verhaltensverträge sind Nudging-Interventionen mit mäßiger Eingriffstiefe in die Persönlichkeitsrechte der Patienten und ethisch relativ unproblematischen Voraussetzungen, die sich in verschiedenen Kontexten bewährt haben. Automatische Einschreibungen zu Patientenschulungen, Einbindung der Lebenspartner, Konfrontation mit sozialen Normen und Verwendung von Schockbildern können ebenfalls wirksam sein, greifen jedoch tiefer in die Freiheit und Privatsphäre der Patienten ein und unterliegen stärkeren ethischen Voraussetzungen und Beschränkungen. Die Evidenzlage ist insbesondere bei Maßnahmen zur sozialen Unterstützung durch Angehörige und Peers noch unzureichend.

Schlussfolgerungen Nudging bietet ein breites Spektrum gezielter Interventionen zur Förderung des Selbstmanage-ments von Patienten mit chronischen Erkrankungen, dessen Potenzial bislang noch zu wenig erschlossen wurde. Besonders vielversprechende Maßnahmen sollten in Pilotstudien auf ihre Akzeptanz, Wirksamkeit und Kosteneffektivität im Rahmen von DMPs evaluiert werden.

Abstract

Background Nudges offer a wide range of options for protecting health in everyday life that supplements traditional public health measures. Against this background, we conducted initial investigations on the effectiveness and ethical aspects of different nudges for promoting self-management of patients with diabetes mellitus type 2 in the context of Disease Management Programs (DMPs).

Methods The ethical assessment of the nudges was done within the systematic framework of Marckmann et al. (2015) for public health ethics. The existing evidence on the effectiveness of nudges was summarised by means of a narrative literature review.

Results Target agreements with implementation plans, reminder, feedback reports, shared appointments of patients with physicians, peer mentoring, and behavior contracts are nudging interventions with moderate interference with personal rights and relatively unproblematic ethical requirements, which have demonstrated effectiveness in different contexts. Default enrollment for patient training courses, involvement of partners, confrontation with social norms, and shocking pictures may be effective as well; however, they interfere more deeply with the freedom and privacy of patients and, therefore, are bound to stronger ethical requirements and restrictions. The evidence base is still insufficient, especially for social support measures by relatives and peers.

Conclusions Nudging offers a wide range of targeted interventions for supporting self-management of patients with chronic diseases, the potential of which has not yet been fully realized. Particularly promising interventions should be tested in pilot studies for their acceptance, effectiveness and cost-effectiveness in the context of DMPs.

Schlüsselwörter

Nudging - Diabetes Mellitus Typ 2 - Ethik - Gesundheitsökonomie

Key words

nudging - diabetes mellitus type 2 - ethics - health economics

Zusätzliches Material



Publication History

Article published online:
23 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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