**1. Introduction**

Decision making under risk has been a subject of social research for several centuries. This extensive scientific interest has allowed the development of a large theoretical and experimental body on decision making under risky conditions [1], leading to new models that have attempted to solve problems such as the excessive emphasis on normativity. This paper highlights the contribution of Prospect Theory (PT).

PT was created by Kahneman and Tversky [2,3]. It developed as an alternative explanation of risky decision-making processes to Expected Utility Theory [4]. PT contemplates the presence of heuristics and limitations in human cognition, which result in biases and deviations from what is considered normative. However, these deviations are considered systematic and could be studied to improve decision making [5].

PT is based on two fundamentals. The first points out that, in deciding between the different choice options, we depend on a frame of reference and not so much on the absolute value of the options, which violates the economic conception of rationality. The second foundation of the theory is loss aversion bias. Loss aversion refers to a greater sensitivity to potential losses than to potential gains of equal magnitude [5].

To justify these assumptions, controlled experiments were developed in which participants had to choose between different alternatives (usually two) with different probabilities of achieving certain outcomes [2,6]. The obtained results showed that the decision process comprised two phases, the editing phase and the evaluation phase. First, a reference point was set and the possible outcomes were framed as benefits or losses. The process ends with a personal assessment of the usefulness of the options [2,7]. Among the basic findings and principles of Kahneman and Tversky's theory [2,3], the S-shaped value function, the

**Citation:** Gisbert-Pérez, J.; Martí-Vilar, M.; González-Sala, F. Prospect Theory: A Bibliometric and Systematic Review in the Categories of Psychology in Web of Science. *Healthcare* **2022**, *10*, 2098. https:// doi.org/10.3390/healthcare10102098

Academic Editors: Athanassios Tselebis, Argyro Pachi and Daniele Giansanti

Received: 10 August 2022 Accepted: 18 October 2022 Published: 20 October 2022

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**Copyright:** © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

four-fold pattern of risk preferences, the "probability weighting function", the uncertainty effect, and "the reflection effect" are worth mentioning.

PT is a descriptive theory of human behavior which does not explain how people should theoretically make their decisions, but how they actually do [8]. It has been applied, not without difficulties, to different contexts, such as economics [5,9] and politics [10–12]. Likewise, its assumptions have been analyzed in more specific conditions, such as energy efficiency investment [13], terrorism [14], political participation [15], or climate policies [16].

One of Kahneman and Tversky's key insights was that the way risky decisions are framed influences what is selected, and it does so in a way captured by the assumption of an S-shaped value function defined on changes from the status quo [2,17]. Health decisions inherently involve risky choices [18]. Thus, consistent with what PT predicts, subsequent work demonstrated that the way in which health information is framed (to focus on potential gains (e.g., benefits of healthy behavior) versus losses (e.g., harms of unhealthy behavior)) systematically influences decisions and choices [17,19]. In addition, the COVID pandemic also involved risky decision making at the societal level. Consistent also with PT, gain- or loss-framing of health information influenced decision making, and risk-free behaviors may be promoted [20].

In addition to the framing effect, alterations in the expected pattern of loss aversion have also been studied. Regarding PT in the psychological field, its application in substance addictions stands out for its inherent risky decision making. [21]. According to PT, low levels of loss aversion increase the likelihood of engaging in addictive behaviors. Drug users have been found to show lower loss aversion than non-users [21]. All of this can be taken into account by healthcare personnel to understand the resistance and ambivalence in the decision-making processes in consumer patients.

Given its long-standing interest and applicability, the aim of this study is to conduct a bibliometric and systematic review of the PT literature in health settings within the psychology categories of Web of Science (WoS), in order to provide an overview of the usefulness, applicability and limitations of the theory within this scientific discipline. This will allow the creation of a new resource pool from which replications of previous studies, scientifically argued critiques, or even new experiments or theories can emerge, leading to more critical and informed scientific developments. It may also help psychology and health professionals to understand human cognitive issues and promote good health.

#### **2. Materials and Methods**

A systematic and bibliometric review of the scientific literature of Prospect Theory [2,3] in the main WoS database was conducted. A protocol was registered in PROSPERO, with identification code CRD42022348325. The search was conducted in September 2022 following PRISMA 2020 statement for systematic reviews [22]. SPSS 22 statistical package, R package Bibliometrix [23] and WoS analysis were used for the bibliometric review.

#### *2.1. Information Sources and Search Strategy*

A search was performed in the Web of Science database (Core Collection) with the search term "prospect theory" and "health". Other databases were not consulted due to the number of studies identified and the objective of exploring the WoS psychology categories.

#### *2.2. Eligibility Criteria and Selection Process*

In the systematic search, the inclusion criteria were (a) containing the term "prospect theory" and "health" in topic, (b) being a scientific article, (c) being included in one of the psychological WoS categories: "behavioral sciences", "neurosciences", "psychology", "psychology applied", "psychology biological", "psychology clinical", "psychology educational", "psychology experimental", "psychology mathematical", "psychology multidisciplinary", "developmental psychology", "psychology psychoanalysis", or "psychology social", and (d) being written in English or Spanish.

The exclusion criteria consisted o" (a)'addressing other topics (n = 80), (b) articles on other theories (n = 20), and (c) articles that were book chapters (n = 7). The selection and screening process is shown in Figure 1.

**Figure 1.** Flowchart of the selection and screening process of the systematic review articles according to the PRISMA method.

The selection process was performed by two investigators independently and then combined to reach a consensus. A third investigator supervised the results to confirm the quality of their work.

## *2.3. Data Extraction*

After the selection and analysis process, the final sample contained 37 articles.

For the bibliometric review, the following variables were considered: year of publication, number of authors, distribution by country and continent, university affiliations, areas of research in psychology according to WoS, scientific journals, and key concepts. To perform the keyword co-occurrence networks), not all the terms were included, eliminating isolated nodes. For the systematic review, the following variables were considered: authors, year of publication, type of study, and main objective. For the empirical studies, we also extracted information on the sample, the methodology, the existence of a control group, and the main results and limitations. The bibliometric data extraction process was carried out using the WoS indicators, while data extraction for the systematic review was performed in the same way as the study selection process.
