Objective: eHealth is an essential technology for individuals living in a modern society to appreciate safe and high-quality healthcare. The set of skills associated with the utilization of eHealth technology is called eHealth literacy. Norman and Skinner first introduced the concept in 2006. This paper is a narrative review on the current status of eHealth literacy, with a focus on definitions and frameworks.

Methods: The methodology employed in this study involved a literature review using a combination of a literature search engine, manual searches, and online literature search application.

Results: Six definitions and nine frameworks were identified. The frameworks are the “Lilly model” proposed by Norman and Skinner, two related frameworks, and six frameworks unrelated to the “Lilly model.” The elements included in the nine frameworks were classified into four categories: “skills/knowledge/experience,” “environment/conditions,” “outcomes,” and “others.”

Conclusion: Since 2006, the scope of eHealth literacy has grown significantly, reflecting both advancements in individual literacy through experience, learning, and changes in technology. This trend is observed in the definitions and frameworks of eHealth literacy, indicating a dynamic and evolving field.

Objective: To clarify the effect of a cooking program that provides cooking videos and feedback for children to improve self-esteem.

Methods: In this quasi-experimental design, a total of five programs were conducted utilizing 4th–6th grade students at Kumamoto city in June, 2021. The 24 intervention group participants were provided with the ingredients and a cooking operation video. Participants were asked to submit a reflection sheet after cooking, and they received feedback messages. The 29 control group participants were provided with the ingredients and paper recipes. A process evaluation was conducted after each session, asking about the cooking difficulty degree. The effectiveness of the program was evaluated based on changes in self-esteem before and after participation in the program, using a scale with confirmed reliability and validity (scores range: 8–32). The analysis included 23 participants in the intervention group and 28 in the control group, after excluding those who withdrew from the program due to scheduling.

Results: There were no group differences regarding sex, grade, or pre-participation self-esteem. The process evaluation results for both groups were generally favorable. The median (25th, 75th percentile) self-esteem of the intervention group was significantly higher (P=0.022) at 25.0 (20.0, 28.0), after program participation than at 23.0 (21.0, 25.0), before program participation. No changes in self-esteem were identified in the control group.

Conclusion: These results suggested that a cooking program that provides cooking videos and feedback may increase self-esteem among 4th–6th graders.

This paper aims to provide an overview of behavioral economics and nudges for health promotion professionals.

Economics analyzes how limited resources can be allocated to increase satisfaction. Traditional economics models a “homo economicus” who always does his/her best to achieve the goals. Behavioral economics targets “human/homo sapiens” who knows the importance of health but cannot take healthy attitudes due to cognitive biases.

Nudges, derived from behavioral economics, are designed to encourage human beings to take desirable actions in accordance with the characteristics of cognitive biases. Nudge can promote healthy behaviors because the response of cognitive biases to information can be predicted with a certain probability. Nudges are more cost-effective than other interventions, and high effectiveness of default nudge has been reported. On the other hand, nudges have some limitations; they are not strong enough to maintain behaviors, and there are few studies in Japan.

Nudges are interventions which work on the automatic system, which means ethical considerations must be taken into account. When designing an intervention, it is necessary to carefully consider the possibility of sludge, that is elements of choice architecture consisting of frictions or obstacles that makes it harder for people making the choice to benefit.

Changing dietary behavior is not easy, and various factors affect the achievement of desirable dietary habits. Therefore, nudges have attracted attention, which are strategies to understand how people make decisions and encourage them to make choices voluntarily for desirable behaviors, including individuals who are not interested in health and nutrition. This review describes the various nudges that are used to change dietary behavior and outlines their effectiveness and challenges.

In a meta-analysis of studies using nudges to change dietary behavior, behaviorally oriented nudges such as “enhanced convenience” and “change size” were more effective than the cognitively oriented nudges such as “nutrition labels.” Additionally, in providing information such as menu names, the results showed that representing “taste” was more effective than promoting “health” in encouraging food choices and providing greater satisfaction after eating the food. However, further research is needed regarding the continuity of individual behavior change.

Nudges are highly convenient as they are relatively inexpensive and can be performed simply by changing the way in which the information and choices are presented, based on an understanding of the biases that arise in decision-making situations. Furthermore, they could be effective in changing the behavior of people who are not interested in their health. Although defaults are effective among other tactics, they are not sufficient. Nudges not only help in making healthier choices easier but also in improving health literacy. Instead of choosing between nudges or education, it is important to implement both in order to proceed with the “leave no one behind” initiative.

The use of behavioral science approaches, such as nudge and social marketing, is recommended to address the “population indifferent to health”. The authors used nudge and social marketing approaches to develop cancer screening recommendation materials. From 2015 to 2018, 4.3 million residents from 787 municipalities were sent these invitation materials for cancer screening. Of 167 municipalities which data were available that were compared with the last year, 141 (83%) showed an increase in screening rate. Overall, the screening rate improved by 2.6% or 1.44 fold.

As a further promotion using nudges, the author strategically utilized PR mass media to conduct a campaign in which postcards for breast cancer screening were sent to individuals from municipalities in conjunction with a TV program on breast cancer screening. In the three months following the program's broadcast, the screening rate increased 1.5–7.6 times compared to the same month of the previous year. After the broadcast, the call for screening spread to other TV programs, newspapers, magazines, events, and social networking services. The following year, the same method encouraged people to take a detailed colorectal cancer screening.

The authors showed that the use of nudges and social marketing approaches is effective for behavioral change, such as taking a cancer screening. Although a nationwide campaign requires time and effort due to the need to establish regular and steady relationships with the media and municipalities, it is expected to be more feasible and effective if implemented in each prefecture.

Background: In recent years, “nudge” has been attracting attention as a means of behavior change. In this paper, aiming to contribute to the utilization of nudges in the research and practice of health education and health promotion, the related studies in Japan, mostly published in the Japanese Journal of Health Education and Promotion, were reviewed, and future challenges were identified.

Contents: The main findings were as follows: (1) while many studies published in the Japanese Journal of Health Education and Promotion reported on the use of nudges in food-related studies, the studies in other journals reported on eating behavior, recommendation to undergo examinations, and referrals to specialists; (2) on design of nudges, there were many reports using EAST (Easy, Attractive, Social, and Timely), a framework proposed by the Behavioral Insight Team in the UK; (3) regarding the design of nudges based on EAST, both the design including all elements of EAST and the design considering combinations of a few elements were reported; (4) a few studies had suggested that the use of nudges entails additional time and cost burdens; and (5) the need for discussions on ethics and development of human resources capable of utilizing nudges was recognized.

Conclusion: Although the researches reviewed in this paper were limited, efficacy of nudges in behavior change has been suggested. For utilization of nudges in health education and promotion, it is necessary to accumulate research and practice on various research themes and develop human resources capable of utilizing nudges.