Abstract
BACKGROUND: The rate of tobacco use among people with HIV (PWH) is > 2 fold higher vs. the general population and accounts for more life years lost than the virus. Yet, evidence-based tobacco treatments are uncommonly offered by clinicians or used by PWH. Biases informed by behavioral economics concerning tobacco treatments may drive this practice gap. METHODS: This formative study tested nudges in the form of messages that target four behavioral economic biases - status quo, availability, omission, and focusing effect - to determine which message would be most strongly associated with PWH willingness to use or clinician referral for tobacco treatment; 19 clinicians and 75 PWH assessed pair-wise comparisons of the four messages with instructions to select the message that, if sent via text or a patient portal, or via the electronic medical record (EMR) at a clinic visit, would increase willingness to use or provide a referral for tobacco treatment. RESULTS: There were significant differences in reported preference across the messages among PWH (χ(2)[3]=24.79, p < 0.001) and clinicians (χ(2)[3]=33.85, p < 0.001). The message that addressed focusing effect bias was most preferred for increasing use and referral for tobacco treatment among PWH (29 %) and clinicians (38 %). CONCLUSIONS: A message that addressed focusing effect bias was associated with greater interest in the use of or referral for tobacco treatment within HIV care. These results can help design a clinical trial to test the effectiveness of these messages within the clinical workflow for their effects on actual use of and referral for tobacco treatment for PWH.