Friends of the Behavioral Economics Club, this week we present the paper “The Role of Behavioral Economics in Improving Cardiovascular Health Behaviors and Outcomes”, by Hare, A. J.; Patel, M. S.; Volpp, K. and Adusumalli, S. (2021), in which authors carry out a revision of the behavioral economics’ tools that can be applied in order to improve the behaviors and outcomes of cardiovascular health.
Despite the extensive study and knowledge of the lifestyle factors required for the onset and worsening of cardiovascular diseases, as well as evidence-based therapies to fight them, these diseases continue to be the main cause of mortality around the world, and especially in the United States, context of this study.
Traditional economic theory is based on the idea that people are rational, self-controlled, selfish, and always optimistic.
If this was the case, one might ask: why are cardiovascular diseases still so prevalent when they can be largely prevented and therapies have shown good efficacy in their prevention and treatment?
Behavioral economics offers a more nuanced understanding of human behavior, and why individuals often make decisions that may not be consistent with their long-term well-being.
For example, regarding patients, behavioral economics can help us understand why adherence to positive diets, exercise regimens, and medication routines may be more difficult than traditional economic theory suggests.
Regarding clinicians, it could help explain why targeted therapy prescription rates are demonstrably suboptimal across clinics.
Although insights from behavioral economics can be used in a variety of clinical settings, they are particularly relevant to cardiovascular care.
Factors that act against adherence, such as time costs, are clear, observable and immediate; but the benefits, such as reducing the long-term risk of adverse outcomes, are immeasurable and generally slow to be seen.
Therefore, this lack of feedback and obtaining immediate rewards is reflected in the prolonged and asymptomatic accumulation of many cardiovascular conditions.
For this reason, cardiovascular health represents an opportunity to encourage patients to better align their short-term behaviors, such as physical exercise, with their long-term health goals.
Therefore, authors carry out this review of previous literature, highlighting the existing applications of behavioral economics to improve cardiovascular health.
For example, regarding physical activity, there are previous studies. In one mentioned in the article, an experiment in which patients who received an activity bracelet and cash financial incentives had more minutes of moderate physical activity compared to the control group was conducted.
But the same did not happen with participants who received only the activity bracelet, or the activity bracelet and financial incentives for charities. This showed evidence that financial incentives can be effective when received directly.
Beyond the realm of financial incentives, peer comparisons have also been examined in a paper mentioned in the article, in which subjects received team step counting feedback compared to other participants. An increasement of physical activity close to 50% was observed.
Behavioral economics techniques have also proven to be effective in motivating patients to lose weight.
For example, a 2008 study showed that providing financial incentives significantly increased weight loss among participants.
Smoking is also a habit that carries the risk of cardiovascular disease.
A study showed that financial incentives added to free smoking cessation aids resulted in higher rates of continued abstinence from smoking than electronic cigarettes.
On the other hand, adherence to cardiovascular medicines presents another opportunity to take advantage of the principles of behavioral economics.
In 2019, in a paper cited in the article, it was shown that the provision of financial vouchers to offset medicine copayments resulted in an adjusted 2.3% increase in adherence.
Authors also point out the usefulness of artificial intelligence in the matter.
Artificial intelligence has resurfaced in the medical community as successful use cases have begun to be integrated into both general care and cardiology.
Currently, the most common applications of artificial intelligence in health include risk prediction algorithms, image interpretation and complex phenotyping of diseases.
AI could be used to behaviorally phenotype clinicians or patients using the influences they are most sensitive to, and design personalized interventions to achieve behavior change.
On the other hand, AI could be leveraged to predict the optimal time and context for a behavioral intervention.
Authors note that future interventions using behavioral economics could incorporate lessons from non-health industries, as well as the power of AI, to tailor interventions to the right people, in the right context, and with the right information.
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