In a randomized clinical trial of nearly 5,000 emergency room patients, researchers found that the share of patients who were willing to take a rapid H.I.V. test climbed to 66 percent from 38 percent when the test was presented as a medical service they had to deliberately decline, rather than one they had to proactively ask for.
Similarly, coronavirus screening programs are more likely to see wider participation if they are opt-out rather than opt-in. “The more you ask people to put in their own cognitive efforts and behavioral efforts into this, the less likely they’re going to do it,” said Derek Reed, who directs the applied behavioral economics laboratory at the University of Kansas.
And, of course, the actual testing process should be quick and convenient, experts say, with strategically located testing sites and streamlined procedures that allow people to easily incorporate testing into their routines.
Ask people to plan
Experts also suggested asking people to think through the logistics of when and how they plan to get tested. Studies show that people who clearly formulate a plan for how they intend to accomplish something — whether it’s voting in an upcoming election or getting a flu vaccine — are more likely to follow-through.
One possibility, Dr. Reed said, would be to text people reminders of their testing appointments, and ask them to reply with, say, a 1 if they plan to walk to the appointment, a 2 if they plan to drive or a 3 if they plan to take the bus. “And then depending on the response, you just automatically ping back Google map directions or a link to campus or community bus system maps or timetables,” he said.
These kinds of nudges are likely to be most effective for people who are already motivated to get tested but may have trouble following through. “Often you need to nudge them a little bit by just removing frictions to get rid of these small costs,” said Sebastian Linnemayr, a behavioral economist at the RAND Corporation, a think tank in California.
Provide (the right) incentives
Health officials could also reward people who participate in testing programs. “There probably needs to be some sort of incentive at the patient level,” Dr. May said. “We’ve seen the same thing in cancer screening. We’ve seen health insurers provide incentives to patients to participate in healthy lifestyles, to participate in screening measures.”
