Can digital nudges power Singapore’s preventative healthcare push?

Instead of reminding people to eat their fruits or clock those extra steps, can subtle nudges unlock a healthier future for Singapore? 

For example, a nudge may involve placing fresh fruits at eye level and right next to the checkout counter - instead of telling people to eat more fruits - making it the most convenient and visible healthy option.  

While traditional public health messaging relies heavily on educating and motivating individuals, nudges work by subtly altering the environment to make healthier options easier, more appealing or convenient, explains Dr Soye Shin, an Assistant Professor in Health Services and Systems Research at Duke-NUS Medical School. 

Speaking to GovInsider, she highlights the value of nudges in overcoming barriers for individuals to make healthier choices. These barriers include limited attention, time pressure or decision fatigue. 

The medical school recently published a study and released a new digital toolkit containing simple but strategic features that could be added to online platforms to promote healthier purchasing among consumers. 

The digital features included traffic light colour-coded labels, nutritional sorting, real-time cart feedback and healthier alternative suggestions. 

The study found that when used in an online grocery shopping platform, it led to healthier food choices among shoppers. 

Given Singapore's high smartphone and internet usage across all income brackets, the integration of digital nudges into online platforms and applications is feasible and scalable, she says. 

With Singapore's Healthier SG initiative gaining momentum, Dr Shin elaborates how Duke-NUS plans to integrate digital nudges into public health efforts, as well as key success factors for making these nudges effective across various environments. 

To subscribe to the GovInsider bulletin, click here. 

Where do digital nudges fit into public health? 

Dr Shin shares two promising pathways to embed digital nudges into public health.  

The first promising pathway is integrating them into national digital health platforms, such as Healthy 365, electronic health records, and other patient-facing platforms. 

Healthy 365 is a mobile application developed by the Health Promotion Board (HPB) that uses gamification to encourage healthy lifestyles among Singaporeans.   

Digital nudges offer another opportunity to “institutionalise behaviourally informed design within national preventative health strategies,” she said. 

The high availability of personal real-time data, including the individual’s health status, goals and preferences, is making it possible to personalise digital nudges to encourage healthier behaviours among individuals. 

The second pathway is through commercial grocery platforms, particularly during the point of purchase.  

As of June 2, when the writer checked the major online grocery platforms like FairPrice, Cold Storage, RedMart and Sheng Siong, only FairPrice’s website indicates the nutritional data.

Even so, consumers may not necessarily understand what the breakdown means.  

She adds that when digital nudges are implemented at scale, policymakers can use masked transaction data to assess population-level trends in food purchasing behaviour over time.  

“To evaluate health outcomes, longer-term data is required.

"And this necessitates a robust partnership with a commercial retailer to facilitate seamless integration of shopping, payment and delivery – making sustained engagement feasible,” she explains. 

She highlights an opportunity for the Ministry of Health (MOH) to partner with major grocery retailers to incentivise the adoption of behaviour-focused tools, such as suggesting healthier substitute options and providing feedback on the “healthiness” of a shopping cart. 

“For long-term sustainability, the intervention must be cost-effective for retailers, unobtrusive for consumers, and adaptable to updated dietary guidelines and user feedback,” she notes. 

How can policymakers leverage data from digital nudges? 

The data gathered on consumer behaviour over time can support Singapore’s precision public health and medicine initiatives, says Dr Shin.  

“Data generated from digital nudge usage - such as which nudges are accepted and which are ignored, purchase patterns over time, and demographic responsiveness - can be used to refine and personalise future interventions.  

“For instance, healthier substitute suggestions could be tailored based on an individual’s past purchases, dietary needs, or cultural food preferences,” she explains. 

Additionally, such data also help policymakers identify nutrition gaps at the community level, enabling targeted resource allocation and programme design for vulnerable populations, she notes. 

“We are actively disseminating our [research] findings to key stakeholders, including media, potential grocery retailer partners, and government agencies such as the HPB," she says.  

What makes nudges tick for consumers? 

The key is framing and autonomy, says Dr Shin, adding that positive, autonomy-supportive messaging makes nudges feel like guidance instead of judgement. 

For example, if a shopper's basket is not very healthy, a message like "There's room to make your basket even healthier - try these recommended swaps!" is far more encouraging than simply stating, "Your basket is unhealthy - please replace items." 

Users should also always have the option to disable nudges, ensuring their autonomy is respected and preventing any concerns about manipulation or unwanted pressure, she adds. 

For policymakers looking to integrate nudges into digital platforms, it is also crucial to consider more than just nutritional value.  

Socioeconomic status and cultural relevance must also be factored in to ensure nudges do not unfairly burden or exclude certain groups. For example, nudges that are recommending products that are culturally inappropriate or too expensive. 

“Inclusive design processes, regular feedback loops with users, and periodic auditing of algorithmic decisions are key to ensuring that digital nudges remain equitable, ethical, and effective in supporting public health goals,” she shares. 

Dr Shin adds that her team found that consumers are challenged by decision fatigue and cognitive overload when it comes to making healthier food or behaviour choices. 

Instead of simply providing general dietary advice, healthcare professionals can use nudges and behaviourally-informed strategies to guide patients to use apps or tools that show simple food swaps. 

To effectively reach older adults, a group where digital literacy can be a challenge, digital nudges need simple visuals and intuitive designs.  

Dr Shin also adds that this should be supported by community outreach, like hands-on tutorials and educational sessions run by local organisations.