Desludging Elicits Less Opposition Than Nudging.

Abstract

Many Americans are overdue for their colorectal cancer screening. Behavioral scientists have proposed 2 types of interventions to increase screening uptake. First, well-known nudging interventions aim to steer patients toward screening, by, for example, providing default appointments or emphasizing social norms. Second, desludging interventions remove sludge or frictions that make it unnecessarily difficult for patients to screen. Nudging has attracted controversy, but little is known about public attitudes toward desludging. We therefore examined whether opposition and negative perceptions were more common for nudging or desludging and whether these responses varied by political affiliation. A randomized cross-sectional survey included 8,735 U.S. residents randomized to 1 of 10 descriptions of interventions intended to increase uptake of colorectal screening, including 5 nudging and 5 desludging interventions. Data were collected and analyzed in 2023-2024. Nudging was more likely than desludging to elicit opposition, perceived ineffectiveness, and perceived threats to freedom, with findings holding across political affiliations. Findings suggest widespread support for prioritizing desludging over nudging.