Friends of the Behavioral Economics Club, this week we present the paper “Feasibility of implementing a behavioral economics mobile health platform for individuals with behavioral health conditions”, by Granek, B.; Evans, A.; Petit, J.; Crawford James, M.; Ma, X.; Loper, M.; Fuccillo, M. and Schmidt, R. (2020), in which authors consider the possibility of creating an app for mobile phones that is based on behavioral economics’ principles in order to help people with behavioral health problems. 

Studies have shown that 43% of people living with a behavioral health condition (or mental illness) report not taking their medications.

Approximately 40% stop taking their medication within a year of it being prescribed, and 75% stop taking it within two years. In addition, there are those who, although they do not stop taking their medications, they take them irregularly for long periods of time.

There are known risks for people when this occurs; for example, if prescribed psychotropic medications are not taken, there are 3.7 times more possibilities of experience a relapse.

That is why interventions are needed to help people with behavioral health conditions develop healthy habits and the necessary skills to effectively manage their own health care, based on following the assigned medication regimen.

There is an innovative program called “Pathway Home” that facilitates the transition of people who have spent a long period of time in psychiatric centers and their reintegration into the community.

This program is community-based and lasts for up to nine months. In addition, it is organized into four different phases, each with a set of tasks. They may include, for example, escorting the person home after discharge from the hospital, accompanying him/her to appointments, sending reminders for health care activities, and so on.

Throughout the program, people gradually become more autonomous, self-directed, and feel responsible for their own care.

Those responsible for this program, in their search for innovation and improvement of it, incorporated a mobile application, called Wellth. This app combines behavioral economics and technology to help track health activities and build healthy habits.

Behavioral economics, as we already know, takes advantage of psychology and economics to explain why people make suboptimal decisions, such as engaging in unhealthy behaviors. Behavioral economics takes into account cognitive biases, which are what would affect this decision-making process.

One of the strategies that are often used is offering people specific financial incentives that reward verifiable participation in their administration of prescription drugs, or in the different plans of their treatment.

For example, financial incentives of a few dollars a day have been used to help people with behavioral health problems stick with their medication regimen. This made them 7 times more likely to take their medications.

On the other hand, in another study mentioned in the article, financial incentives were offered to individuals with schizophrenia over the course of a year to improve the taking of an antipsychotic and the follow-up of the medication regimen was improved by 11.5%.

Authors recruited a total of 53 participants who enrolled in the program and agreed to be part of the study. In it, they had to use the Wellth app for 90 days.

Each member would receive $30 per month, that is, $90 at the end of the program. Each day, they would receive messages reminding them to record their medication by sending a photo of it. Having to submit a photo requires the participant to put their medication on hand, which helps them overcome the intention-behavior gap, and actually leads them to take their medication.

In addition, participants would receive instant reward messages, to link behavior to incentives. The message would indicate that an action is complete and would create a present value for healthy behavior, overcoming the current bias and offering an immediate reward.

Incentives would also be marked using loss aversion, a concept rooted in behavioral economics research, which suggests that the threat of loss is a more powerful motivator than the equivalent chance of winning. Participants were shown that they had $30 in their account at the beginning of each month: as long as they submitted their records with photos through the mobile app, they would avoid losing $2.

The results obtained confirmed that 35 of 53 participants (66%) showed a registration rate higher than 70%. On the other hand, 19 out of 53 (24%) showed a rate lower than or equal to 70%.

The total medication registration rate for the 53 participants was 87%.

29 of the 53 participants (54.72%) completed the 90-day program, the rest dropped out. This data is considered sufficient by the authors, given the complex needs of those living with a behavioral health illness.

Therefore, the study suggests that the use of behavioral economics in this area is not only possible but also beneficial.

However, the small number of participants and the fact that the use of economic incentives can be considered unconventional, or in some circumstances, coercive are pointed out as limitations. Authors comment that future research should work to improve these last points.

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