【OBJECTIVES】

The purpose of this study is to clarify the decision-making process of a first time visit and continuous visits to clinics of patients who are suffering from chronic diseases.

【METHODS】

We conducted a semi structured interview and used a grounded theory approach analysis. The number of patients were 9. We also used the way of Intuitive Thinking and Reflective Thinking to understand the results.

【RESULTS】

First, the factors of choosing the clinic at first time are “physical requirement”, “referral or reputation by family and acquaintances”. Second, the reasons of continuous visits to clinics are “problems solving” and “trust towards doctor” such as doctor's understandings about patients, reputation or evaluation by other patients and doctor’s communication ability. These factors, as a result，make a patient's trust to the doctor.

【CONCLUSIONS】

The conclusion is that when patients choose a clinic at first time, they make a decision by Reflective thinking and, then, the decision making of continuous visits to clinics is made by Intuitive thinking.

Cancer prevention and cancer screening are important ways to reduce the number of people suffering from cancer. However, although there is sufficient scientific evidence, they are not always fully practiced（evidence-practice gap）. Cancer prevention such as smoking cessation and taking cancer screening are all promoting behavior change of individuals. In recent years, the conventional “educational approach” is not enough to promote behavior change, and it is necessary to introduce an“environmental approach”. In particular, the effects of new behavioral science approaches are expected. In this article, we will focus on social marketing and nudge as new approaches.

Social marketing approach uses the concepts and techniques used in commercial marketing to promote public health behavior changes such as cancer prevention and cancer screening. Nudge is an approach that guides people to choose the desired behavior by understanding the habits（inertia, bias, etc.）when they choose an action, ensuring freedom of choice without forcing them. In terms of desirable behavior, nudge is appropriate for public health policies. We will explain the social marketing process such as analysis, strategy development, communication design, execution, evaluation and feedback, using the example of our non-smoking / smoke prevention campaign for university students. In addition to social marketing, we will also exemplify an approach to behavior change that utilizes behavioral economic methods such as nudge, using our project aiming improvement of cancer screening rate.