gms | German Medical Science

20. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin e. V.

Deutsches Netzwerk Evidenzbasierte Medizin e. V.

21. - 23.03.2019, Berlin

Nudging health? Using digital tools for patient engagement and behavior change in diabetes II

Meeting Abstract

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  • Maren M. Michaelsen - Universität Witten/Herdecke, Institut für Integrative Gesundheitsversorgung/Gesundheitsförderung, Witten, Deutschland
  • Lena Werdecker - Universität Witten/Herdecke, Institut für Integrative Gesundheitsversorgung/Gesundheitsförderung, Witten, Deutschland
  • Tobias Esch - Universität Witten/Herdecke, Institut für Integrative Gesundheitsversorgung/Gesundheitsförderung, Witten, Deutschland; State University of New York, Neuroscience Research Institute, New York, USA

EbM und Digitale Transformation in der Medizin. 20. Jahrestagung des Deutschen Netzwerks Evidenzbasierte Medizin. Berlin, 21.-23.03.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. Doc19ebmP-EG01-05

doi: 10.3205/19ebm040, urn:nbn:de:0183-19ebm0401

Published: March 20, 2019

© 2019 Michaelsen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Background/research question: Changing habits is hard. Considerable research addresses this problem and many interventions aim at inducing and maintaining health behavior change among patients with different types of diseases. Most of the proposed interventions are costly, show little sustainability, or both. In this project, we develop a mobile interface that aims at empowering diabetes type 2 patients to change their lifestyle with respect to better eating and more exercise.

In a first step, we explore the psychological, neurobiological and economic literatures on behavior change in order to develop a multi-stage health behavior model that can explain the likelihood of lifestyle change in diabetes type 2 patients. Our model allows for discontinuity in the process of change and takes into account various psychological and social-cognitive traits and states, such as affects and attitudes, as well as approach motivation and reward systems in the brain. In addition to a person’s conscious cognition, we investigate nonconscious aspects of behavior, such as cognitive and emotional biases in decision-making, which have been highlighted as important variables of health behavior in the recent literature (e.g. [1]).

To test the validity of our model, we will introduce a survey at our Outpatient Center for Integrative Health Care at Witten/Herdecke University using appropriate, validated questionnaires and apply rigorous statistical analyses.

Having identified a valid dual-process multi-stage health behavior change model, we will develop nudging tools tailored to each change process stage, which aim at (i) activating the patient’s nonconscious resources, as well as (ii) increase the patient’s awareness in order to empower the patient to actively engage in her healing process. The tools will draw from positive psychology, i.e. we intent to construct an architecture for lifestyle change that is enjoyable and rewarding for the patient, as this has been shown to be important for sustainable change [2]. The tools will be combined in a mobile interface that, finally, will be implemented and evaluated in a randomized controlled trial.

The project will contribute not only to the set of tools available to improving clinical outcomes, such as weight loss, a reduction in HbA1c-leves etc., but also enhance the overall well-being of patients.

Methods: Mixed-methods research

Competing interests: Financial support provided by Dr. Ausbüttel & Co. GmbH


Sheeran P, Gollwitzer PM, Bargh JA. Nonconscious processes and health. Health Psychol. 2013 May;32(5):460-73. DOI: 10.1037/a0029203 External link
Esch T, Stefano GB. The neurobiology of pleasure, reward processes, addiction and their health implications. Neuro Endocrinol Lett. 2004 Aug;25(4):235-51.