助推手卫生的行为干预策略

保持手卫生是感染防控的重要策略,但是如何提高其依从性成为预防传染性疾病和减少医疗机构获得性感染的一大挑战。以行为科学为基础的手卫生助推干预以更“隐性”的方式将洗手转变为一种可自动触发的行为习惯,弥补了以知识分享和健康宣教为主的传统手卫生干预策略的诸多局限性。基于影响机制的不同,手卫生助推干预策略可分为提供决策信息、优化决策选项、影响决策结构、提醒决策方向4个大类的框架体系。多模式助推策略的有效性也已在实践中得到印证,但目前还非常缺乏在中国社会文化情境下开展的助推洗手行为的干预研究,今后可尝试基于行为科学理论有针对性地在医院、学校和社区等公共场所开展此类干预研究和实践,为感染防控、疾病预防和改善公共健康做出相应的贡献。     

The Fruitless Pursuit of Nudging Healthy Behavior: Comment on Lin,Osman, and Ashcroft

The premise of Lin, Osman, and Ashcroft (this issue) is that nudge theory can be applied in all aspects of public life to improve people’s health and well-being. Unfortunately, the literature they present shows only a dismal empirical record of the effectiveness of nudging healthy behavior. In spite of the overwhelmingly positive tone of the authors, the successes attributed to nudge-based interventions in other domains cannot yet be made in the area of health and wellness. In fact, Lin et al.’s review suggests quite the opposite: nudging healthy behavior bears no fruit.     

Why Nudges Coerce: Experimental Evidence on the Architecture of Regulation

Critics frequently argue that nudges are more covert, less transparent, and more difficult to monitor than traditional regulatory tools. Edward Glaeser, for example, argues that “[p]ublic monitoring of soft paternalism is much more difficult than public monitoring of hard paternalism”. As one of the leading proponents of soft paternalism, Cass Sunstein, acknowledges, while “[m]andates and commands are highly visible”, soft paternalism, “and some nudges in particular[,] may be invisible”. In response to this challenge, proponents of nudging argue that invisibility for any given individual in a particular choice environment is compatible with “careful public scrutiny” of the nudge. This paper offers the first of its kind experimental evidence that tests whether nudges are, in fact, compatible with “careful public scrutiny”. Using three sets of experiments, the paper argues that, even when entirely visible, nudges attract less scrutiny than their “hard law” counterparts.     

The need for public policies to promote healthier food consumption: A comment on Wansink and Chandon (2014)

Current approaches to addressing obesity have fallen short. This is largely due to the many environmental forces that undermine people's self-regulatory capacity to be personally responsible for their food choices. Novel insights from the social sciences are needed to inform voluntary, health-promoting actions by companies, institutions, and citizens as well as the design of public health policies. Voluntary interventions that rely on nudges should complement traditional public health strategies such as taxation and restriction of child-targeted marketing in schools. In this commentary, we discuss four food policy issues that would benefit from consumer psychology research: (a) the restriction of food marketing to children, (b) provision of nutrition information through food labels, (c) improving school food environments, and (d) placing limits on portion sizes. Identifying effective solutions for obesity will require approaches that integrate psychological, public health, and legal perspectives and methods.     

Situating interventions to bridge the intention–behaviour gap: A framework for recruiting nonconscious processes for behaviour change

This paper presents a situated cognition framework for creating social psychological interventions to bridge the intention–behaviour gap and illustrates this framework by reviewing examples from the domains of health behaviour, environmental behaviour, stereotyping, and aggression. A recurrent problem in behaviour change is the fact that often, intentions are not translated into behaviour, causing the so‐called intention–behaviour gap. Here, it is argued that this happens when situational cues trigger situated conceptualizations, such as habits, impulses, hedonic goals, or stereotypical associations, which can then guide behaviour automatically. To be effective in changing such automatic effects, behaviour change interventions can attempt to change situational cues through cueing interventions such as priming, nudging, upstream policy interventions, or reminders of social norms. Alternatively, behaviour change interventions can attempt to change the underlying situated conceptualizations through training interventions, such as behavioural inhibition training, mindfulness training, or implementation intentions. Examples of situated behaviour change interventions of both types will be discussed across domains, along with recommendations to situate interventions more strongly and thus enhance their effectiveness to change automatic behaviour. Finally, the discussion addresses the difference between tailoring and situating interventions, issues of generalization and long‐term effectiveness, and avenues for further research.     

Informational nudges as an effective approach in raising awareness among young adults about the risk of future disability

As many consumers have neither sufficient time nor the cognitive and motivational resources to deal with complex insurance decisions, the mere provision of information might not be enough to influence consumer perception and choice. The way such information is presented might also affect any decision made. This paper focuses on the risk of becoming unable to continue in a profession as a result of illness or an accident. In collaboration with an insurance company, we examined the effectiveness of ‘informational nudging’ (i.e. providing information which acts as a nudge) in sensitizing young adults to the potential risk of disability. In a pre‐study, an online survey (n = 1003) was conducted to assess the main barriers preventing young Swiss adults from participating in private provision. Based on the results of the pre‐study, we developed four ‘informational nudges’ and tested their effects on risk awareness and insurance choices among young adults using an online experiment (n = 240). We found that by presenting information on a company website in such a way that heuristics such as availability or loss aversion were exploited, enhanced risk awareness and a corresponding increase in insurance preferences were observed to some degree. However, the informational nudges did not motivate the participants to investigate the issues any further. Indeed, the results suggested that informational nudging could be an effective tool in raising participant awareness, but that future research is needed to understand better the interplay between automatic and deliberate processes activated by the informational nudges. Copyright © 2016 John Wiley & Sons, Ltd.     

默认选项设置的助推效果：来自元分析的证据

默认选项设置指通过设置默认选项以增加人们选择该选项可能性的助推方法, 近年来被越来越多地运用于促进公众积极行为上, 然而这种方法在有效性上却受到了来自公众和学者的质疑。据此, 本研究运用元分析法整合了近几年有关默认选项设置的已有实证研究, 分析该助推手段的有效性, 并进一步考察可能影响其有效性的相关变量。研究共纳入符合要求的原始文献56篇, 含92个研究, 结果发现：(1)默认选项设置的确能有效助推人们的行为; (2)默认选项设置的助推有效性在东、西方文化下存在显著差异, 其在西方文化背景下的助推效果要显著好于其在东方文化背景下的使用; (3)默认选项设置的助推有效性在不同情境应用领域中存在显著差异, 相较于健康和环保领域, 默认选项设置在金钱相关的情境领域下助推效果更好。     

Mindfulness: Towards A Critical Relational Perspective

Significant attention has been given to mindfulness and mindfulness meditation in Western culture – often allied with a concern to enhance ‘subjective wellbeing’ through interventions aiming to ameliorate stress, depression and anxiety. While much professional and scientific research has been conducted which studies the nature and effectiveness of mindfulness‐based interventions, few critical accounts exist. I seek to produce a social critique of current understandings of mindfulness in relation to contemporary psychology. I illustrate how mindfulness has become individualised as an object of contemporary psychological investigation. I then propose a relational approach which instead sees mindfulness as socially contingent and as a potential resource for individuals and communities to cultivate a critically distant stance towards society. This involves revisioning our basic understanding of mindfulness as not only an inner state of mind, but also as a public social practice.     

Service Delivery Issues and Program Evaluation in Pediatric Psychology

Presents a framework for categorizing pediatric psychology research into practice and service system outcomes and functioning. The questions of importance are (a) who is being served, (b) what services are provided, (c) how treatments are implemented, (d) how services are organized and staffed, (e) what are the outcomes of the services, (f) how do various consumers perceive services, (g) how services are reimbursed, and (h) what are alternatives and innovations? The framework of program evaluation is detailed for domains most germane to service delivery in pediatric/child health psychology. Such domains include diagnostic information on patients, types of intervention, behavioral/psychological outcome variables, costs of treatments, service system functioning, and perceptions of satisfaction from multiple sources. This framework may be useful in directing future research on the delivery of services in pediatric psychology settings, thereby adding to the value of the field.     

The Choice Architect’s Trilemma

Critics have long dismissed paternalistic choice architecture as conceptually muddled at best and oxymoronic at worst. In this article, I argue that this criticism remains true despite recent replies to the contrary. Further, I suggest that a similar conceptual criticism also applies to non-paternalistic choice architecture. This is due to a three-way tension between the effectiveness, avoidability, and distinctiveness of each nudge. To illustrate this tension, I provide a novel explanation of the mechanics of nudging and a taxonomy of these interventions. I then argue that choice architects who defend the distinctiveness of nudging according to how it guides our behaviour via our unreflective intuitive reasoning encounter a trilemma because the distinctiveness of nudging hinges on interventions being both avoidable and effective. Choice architects cannot achieve this aim without harnessing both our automatic and reflective systems of thought in tandem. However, this diminishes the distinctive character of nudging by bringing it closer to other traditional policy interventions. This establishes the choice architect’s trilemma: a nudge is likely to be either ineffective, effective via some morally unacceptable means, or effective in a manner that is conceptually indistinct from other evidence-based policy interventions.     

The role of work in psychological health and well-being: a conceptual, historical, and public policy perspective

The primary theme of this article, which serves as the introductory contribution of a special section of the American Psychologist, is that work plays a central role in the development, expression, and maintenance of psychological health. The argument underlying this assumption is articulated at the outset of the article in conjunction with a historical review of vocational psychology and industrial/organizational psychology. The article follows with an overview of contemporary vocational psychology and a presentation of the psychology-of-working perspective, which has emerged from critiques of vocational psychology and from multicultural, feminist, and expanded epistemological analyses of psychological explorations of working. Three illustrative lines of inquiry in which research has affected the potential for informing public policy are presented. These three lines of scholarship (role of work in recovery from mental illness; occupational health psychology; and working, racism, and psychological health) are reviewed briefly to furnish exemplars of how the psychological study of working can inform public policy.     

Nudge to Health: Harnessing Decision Research to Promote Health Behavior

We review selected literature that examines how biases in decision making can be utilized to encourage individual health behavior, such as vaccination, and promote policy decisions, such as resource allocation. These studies use simple interventions to nudge people towards more optimal health decisions without restricting decision‐makers’ freedom of choice. Examples include framing effects, defaults, implementation intentions, position effects, social norm, incentives, and emotions. We suggest that nudges are an effective way to promote healthy behavior.     

Social citizenship and social psychology

This paper outlines the concept of social citizenship, which was first theorized in the late 1940s alongside the creation of the UK welfare state and concerns citizens' rights to a basic income and standard of living. It suggests that social citizenship—particularly welfare provision—is a useful and important topic for social psychological research, albeit one that has been largely overlooked. We provide an overview of key developments in social citizenship and consider the impact of 30‐plus years of neoliberal governance in Western democracies, which has resulted in ongoing changes to how welfare rights and responsibilities are configured, such as policies that make social citizenship rights contingent on conduct. We outline social scientific work that examines these shifting ideas of citizenship, personhood, welfare, and conditionality and make the case for a critical discursive psychological approach, which we illustrate with a brief empirical example. We suggest that critical discursive social psychology is particularly well‐placed to examine how psychological assumptions are built into both policy and lay discourse and how these can legitimate interventions designed to work on the conduct of the unemployed, such as therapeutic and behavior change initiatives. Finally, we argue that psychology is faced with a choice; while there are opportunities for the discipline to contribute to the design and implementation of such initiatives, to do so requires accepting the basic values of the underpinning neoliberal agenda. Instead, it is vital to place these assumptions under the critical microscope and explore how they work to obscure structural disadvantage.     

Prevention and public health. Psychology's response to the nation's health care crisis

Psychology as a scientific and applied discipline has a unique responsibility to participate in the pursuit of strategies that reduce the nation's health care needs. As a social and behavioral science, psychology can contribute to unraveling the processes underlying conditions of health and disorder. As an applied discipline, psychology can work to design effective interventions to promote human health and to avoid disease and dysfunction. Insofar as these endeavors are unsuccessful, psychology can help reduce significant contributors to the nation's morbidity and mortality. Achieving such success, however, challenges psychologists to collaborate effectively, to combine science with practice and policy, and to address complex philosophical and ethical issues concerned with individual freedom and public responsibility.     

Health psychology. The science and the field

Reviews scientific and professional trends in the field of health psychology. I discuss recent research on health promotion, psychological factors in the development of illness, cognitive representations of health and illness, stress and coping, social support, interventions to promote coping, and trends that will affect progress in the field, such as the need for cost containment and the aging of the population.     

Psychologie communautaire et recherche : l’exemple du projet EMILIA

The development of community psychology has also had significant implications in the area of evaluation and research methodology. The empowerment principle, that is, giving users the means to control their health and to make their own health decisions, has important implications for the choice of evaluation strategies for both individual therapeutic acts as well as for public health programmes. If the user's potential expertise in the health area is to be fully acknowledged, how is this to be done with regard to research? How can users become not only actors of their own health, but also play an active role in research and health evaluation? The article gives an overview of research strategies based on community psychology principles, with a particular emphasis on action research and participative-action research. The example of a multisite European project on empowering mental-health service users to access life-long learning and employment, currently underway in Paris, is presented to illustrate these community research methods.     

The future of health psychology interventions.

Progress in health psychology interventions was reviewed to manage chronic illness, treat psychophysiological disorders, and provide complementary treatment for difficult medical symptoms. A closer synergy between research, clinical applications and public policy, and education and training was advocated to guide future work in these areas. Further, the importance of clinical input informing research directions, the need for interventions to focus on a broader range of individual difference and contextual factors, and for effectiveness studies to influence the adoption of treatments in clinical settings was emphasized. In accordance, greater effort should be devoted to disseminating information on treatment effectiveness to professional and lay groups to maximize the public health benefit of established intervention approaches.     

The Future of Psychology in Family Medicine

Psychology has been integral to the field of family medicine since its inception as a medical specialty in the 1960s. Psychologists and other behavioral scientists contribute to family medicine in teaching clinical skills, in defining research questions, in developing research methodology, and in creating integrated physical/mental health care delivery systems. Future developments in the field of psychology in family medicine are likely to emphasize development and evaluation of screening measures which identify mental health problems in primary care, development of early intervention for those mental health problems, and more precise measurement of process and quality of care and health outcomes. Psychologists have an important role to fulfill in educating physicians on alternatives to pharmacologic and medical interventions for common presenting problems in primary care. However, current economic forces shaping the practice of medicine may work against further enhancing the efficacy of the physician in dealing with psychosocial issues. The future role of psychology in family medicine is not yet delineated, and while the move toward parity of reimbursement for mental and physical health care delivery may enhance this collaboration, there is a need to continue to evaluate how the psychological well-being of patients is influenced in the evolution of new models of care delivery.     

Arbitrary metrics in psychology

Many psychological tests have arbitrary metrics but are appropriate for testing psychological theories. Metric arbitrariness is a concern, however, when researchers wish to draw inferences about the true, absolute standing of a group or individual on the latent psychological dimension being measured. The authors illustrate this in the context of 2 case studies in which psychologists need to develop inventories with nonarbitrary metrics. One example comes from social psychology, where researchers have begun using the Implicit Association Test to provide the lay public with feedback about their "hidden biases" via popular Internet Web pages. The other example comes from clinical psychology, where researchers often wish to evaluate the real-world importance of interventions. As the authors show, both pursuits require researchers to conduct formal research that makes their metrics nonarbitrary by linking test scores to meaningful real-world events.     

Emotion Regulation in Adolescent Well-Being and Positive Education

Emotion regulation (ER) becomes increasingly important across adolescent development, and promotes psychological flexibility, resilience and well-being in youth. Positive education programs (PEPs) combine academic training with positive psychology interventions (PPIs) to increase well-being and reduce mental ill-health. Despite considerable overlap between PPIs and ER models, the role and relevance of ER to PEPs remains unclear. This review aimed to evaluate the relationship of ER to PEPs targeting adolescents. First, to evaluate the relationship of ER to domains of well-being targeted by school-based PPIs. Second, to examine whether school-based PPIs can improve adolescents’ ER capacity. Third, to evaluate the role of ER in well-being outcomes of PEPs. Results support the relevance of ER to domains of well-being outlined by the revised PERMA model, including positive emotions, engagement, relationships, meaning, and health. ER can influence the degree to which students benefit from PEP participation. It remains to be determined whether ER capacity is improved as a result of exposure to positive education programs. Findings are limited by the small and heterogeneous group of interventions examined, and the use of inconsistent ER measures. Further research of the role of ER in positive education may contribute to greater understanding of the mechanisms underlying their effectiveness and further promote the psychological well-being of adolescents.