Although CKD screening programs have been implemented in a variety of contexts, little is known about how to successfully translate those programs into better health. Between April 2018 and March 2019, researchers, for a study, conducted a randomized clinical study on national health screening for CKD. A total of 4,011 CKD screening program participants aged 40–63 years were randomly assigned to one of two interventions or the control, with a 2:2:1 ratio, respectively – the nudge-based letter containing a message based on behavioral economics, the clinical letter containing general information about CKD risks, and the control (informed only of the screening results). Adherence to a suggested physician appointment within 6 months of the intervention was the primary outcome. About 1 year after the intervention, the secondary outcomes were eGFR, proteinuria, and blood pressure.
Participants who received the nudge-based letter (19.7% for the intervention group versus 15.8% for the control; difference, +3.9% points [pp]; 95% CI, +0.8 to +7.0; P=0.02) and the clinical letter (19.7% versus 15.8%; difference, +3.9 pp; 95% CI, +0.8 to +7.0; P=0.02) were more likely to undergo a recommended physician visit than those who received the control group. The study team discovered no evidence that treatments were linked to better early health outcomes.
In the big RCT, the behavioral economics intervention had no effect in changing behavior or improving health outcomes. Although the method had potential, the study highlighted the difficulty in establishing behavioral treatments to increase the efficiency of CKD screening programs.