Behavioral Economics: A Promising New Way to Improve Adherence

By | March 12, 2014

Behavioral economics describes and predicts how common biases influence our decision-making. An understanding of these biases opens up promising new ways to improve adherence. Read on to find out more.

Patient motivation is a key factor for improving adherence. My last post presented reasons for including Motivational Interviewing into any adherence improvement plan; to boost patients’ internal motivation to adhere. Now here’s another way to approach the motivation issue. An approach that combines behavioral economics with elements of gaming to engage and motivate patients.

Behavioral economics describes how common biases influence our decision-making. Understanding these biases opens new opportunities to improve adherence.The Value of Behavioral Economics to Adherence

Truth be told, we all make irrational decisions. It’s the way humans are built. When we’re deciding between options, we unconsciously combine logic with emotions, feelings, and past experiences to make our choice.

From studying the mistakes people make, behavioral economics concludes we’re predictably irrational in our decision-making. We show common and consistent biases in the ways we select and analyze information.

Here are a few examples of such biases (there are many, many more!). People tend to:

  • Overestimate small probabilities (overestimation bias)
  • Favor short-term gains over longer-term rewards (present bias)
  • Prefer avoiding loss over acquiring gain (loss aversion bias)
  • Favor information that’s most readily available (salience bias)
  • Opt for a supplied choice when decisions are complex (default bias)
  • Continue to do something, rather than change to something else (status quo bias)
  • Follow others in their decisions (herding bias)

From a deep understanding of the bias factors that influence our decisions, behavioral economics goes one stage further. It offers a systematic way to think about incentivizing behavior change. An approach that offers strong promise for improving adherence.

Here’s a great example! Follow this link and read the short case study on pages 43-44. Warfarin non-adherence was reduced dramatically using a combination of the first three biases described above (ie, overestimation, present, and loss aversion biases). This case study also uses gaming to enhance patient engagement and make it fun!

5 Reasons Behavioral Economics Offers Promise for Adherence

Behavioral economics is a newcomer to adherence, so there’s little data in the public domain. However, the two studies mentioned directly below were positive. Also, anecdotal reports from other programs are equally encouraging. Here are 5 reasons behavioral economics approaches could make big impacts on adherence.

1.   They appear to work!

The warfarin program cited earlier in this post reduced non-adherence from 36% to 3%-4% (see here, pages 43-44).  

Another 3-arm study examined adherence to weight loss interventions. Arm #1 received lottery-based incentives (overestimation bias), arm #2 had deposit contracts (loss aversion bias), while arm #3 received just information and advice (control group – no incentives). Further details can be found here, page 44. Here’s a summary of study results:

“Only 7% of participants in the control group achieved their weight loss goals, while 71% of those in the lottery incentive group and a very impressive 100% of those in the deposit contract group achieved their weight loss goals.

2.   They’re fun!

It’s no fun having a chronic condition. Nor is it fun taking treatments on a daily basis. There is nothing inherently positive about these things. For many people, taking medication is a dreaded act (see here). Behavioral economics provides immediate rewards, gaming, and social contact. All of which bring fun and motivation to the act of adherence. 

3.   They strengthen perceived value

Along with rewards for taking their medication and refilling prescriptions, patients also get rewards for taking educational quizzes. These quizzes are designed to help patients get smarter about their disease. They also help patients better appreciate the value of medications and the value of adherence.

4.   They minimally consume HCPs’ time

HCPs are overworked nowadays. They lack the time to invest in counseling patients to improve their adherence. HCPs need solutions that can relieve the pressure on them. Which is what behavioral economics approaches can provide. As an example, take a look here for the benefits that one company provides to physicians.

5.   They’re broadly applicable

Because of the way they are constructed, there are very few inherent restrictions on the patient types for which behavioral economics approaches are applicable. They can be effective irrespective of reason(s) for non-adherence.

Behavioral economics: What are your thoughts about its role in adherence?