行為主義導向公共政策的設計與應用：以提升大腸癌篩檢率的推力工具為例之探究

The Design and Application of Behavioral Public Policy: Nudge-Based Intervention to Increase Colorectal Cancer Screening in Taiwan

行為主義導向公共政策（behavioral public policy）近十年來被大量應用於公共政策領域，其中推力（nudge）因具有低成本、高成效的特徵，更廣泛為各國政府與國際組織所用，惟國內相關研究與應用甚少。本研究試圖建構行為主義導向公共政策設計（policy design）的具體作法，並實際以提升臺灣大腸癌篩檢率的政策進行實作，挑選兩家醫院為個案，設計腸篩衛教單為推力工具，透過實驗搭配觀察與焦點座談的混合研究方法（mixed methods），驗證其成效與可行性。研究結果主要有三點結論與建議：1.推力工具確實能顯著提升大腸癌篩檢的領管率，但作用機制並非簡化的「刺激一反應」，可再考量影響因素，針對實施脈絡與對象客製化設計；2.推力工具效果的測量，不宜只靠實驗法，混合搭配其他研究方法才能較全面且有效；3.推力工具的實施，宜先了解既有運作模式的問題與限制，進行必要的因應調整與再設計。本研究所研提的作法與經驗，應可作為後續研究與實務上設計與實施推力工具的參考，進而發揮拋磚引玉的功能，促發未來更多本土的實務與研究投入行為主義導向公共政策的應用。

Nudges have been widely adopted worldwide due to the low cost and high effectiveness and in the field of behavioral public policy they have been widely applied by public policy practice in the last few decades. However, the applications in Taiwan have been limited. This study developed strategies to design behavioral public policy. We chose two hospitals in Taiwan as the context, and employed a nudge-based flier to encourage people to participate in colorectal cancer screening. We conducted a three-part mixed-methods experiment embedded with observation and focus group interviews within to assess its effectiveness. Results show that this nudge-based intervention had a positive impact on the screening rate, while appearing to have a positive spill-over effect. Some obstacles in the context were also found. Evidence suggests that nudges can be customized to contexts and targets based on related factors, while the contextual obstacles should be recognized and solved before implementation. Moreover, evaluating a nudge through a mix of quantitative and qualitative data is the best way to assess its impact on targeted behavior. It is expected that the methodology and findings of the study can inform future research and practice, and initiate more local-scale applications of behavioral public policy.