Promoting workers’ appointments at follow-up examinations through a nudge-based notification

Abstract

Objectives: Our previous study found that occupational health staff and workers generally prefer a nudge-based notification for follow-up examinations. However, it did not assess their impact on actual screening behaviors. This practice aimed to demonstrate whether the notification could improve the appointment rates of follow-up examinations with abnormal findings. Methods: The notification specified the department where follow-up examinations should be conducted and instructed recipients to report their appointment status. Appointment data from workers of a Japanese transportation company who received a notification in June 2024 were analyzed. Results: A total of 91 workers received notifications. Among them, 53.3% scheduled appointments by the end of July, exceeding the follow-up examination attendance rate of the previous year (43.8%), even without reminder notifications. The age of workers who scheduled appointments (mean 56.2; standard deviation, 8.8 years) was higher than that of workers who did not report appointments (mean 46.2; standard deviation, 11.8 years: p<0.001). Conclusions: Workers who reported their appointment status are expected to have a high probability of undergoing follow-up examinations. Therefore, the notification may have contributed to improved attendance. This improvement is believed to result from the nudges aligning with the cognitive ease and present biases of the workers. This practice has several strengths, including high cost-effectiveness and transparency under nudging conditions. To further enhance this rate, sending reminder notifications integrating several nudges is necessary.