Making Medications Stick: Improving Medication Adherence by Highlighting the Personal Health Costs of Non-compliance

Jon M. Jachimowicz; Joe J. Gladstone; Dan  Berry; Charlotte L. Kirkdale; Tracey  Thornley; Adam  D. Galinsky

Article | Behavioural Public Policy | Forthcoming

Making Medications Stick: Improving Medication Adherence by Highlighting the Personal Health Costs of Non-compliance

by Jon M. Jachimowicz, Joe J. Gladstone, Dan Berry, Charlotte L. Kirkdale, Tracey Thornley and Adam D. Galinsky

Abstract

Poor compliance of prescription medication is an ongoing public health crisis. Nearly half of patients do not take their medication as prescribed, harming their own health while also increasing public health care costs. Despite these detrimental consequences, prior research has struggled to establish cost-effective and scalable interventions to improve adherence rates. We suggest that one reason for the limited success of prior interventions is that they make the personal health costs of non-adherence insufficiently prominent, while a higher saliency of these costs may motivate patients to adhere more. In the current research, we test whether an intervention that makes the personal health costs of non-compliance more salient for patients will increase their medication adherence. To do so, we conducted a randomized controlled trial with 16,191 patients across 278 UK pharmacies over a 9-month time period and manipulated the perceived consequences of medication non-adherence. We find that patients who received a treatment highlighting the personal health costs of non-compliance were significantly more likely to adhere to their medication than three comparison groups (odds ratio = 1.84, 95% confidence interval = 1.37–2.47). Shifting patients’ focus to the personal health costs of non-compliance may thus offer a potentially cost-effective and scalable approach to improving medication adherence.

Keywords: prescription drugs; medication adherence; personal health costs; Health; Behavior; Motivation and Incentives; Communication Strategy;

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Citation:

Jachimowicz, Jon M., Joe J. Gladstone, Dan Berry, Charlotte L. Kirkdale, Tracey Thornley, and Adam D. Galinsky. "Making Medications Stick: Improving Medication Adherence by Highlighting the Personal Health Costs of Non-compliance." Behavioural Public Policy (forthcoming): 1–21. (Pre-published online, February 27, 2019.)

Article | Behavioural Public Policy | November 2019

When and Why Defaults Influence Decisions: A Meta-analysis of Default Effects

Jon M. Jachimowicz, Shannon Duncan, Elke U. Weber and Eric J. Johnson

When people make decisions with a pre-selected choice option—a “default”—they are more likely to select that option. Because defaults are easy to implement, they constitute one of the most widely employed tools in the choice architecture toolbox. However, to decide when defaults should be used instead of other choice architecture tools, policy makers must know how effective defaults are and when and why their effectiveness varies. To answer these questions, we conduct a literature search and meta-analysis of the 58 default studies (pooled n = 73,675) that fit our criteria. While our analysis reveals a considerable influence of defaults (d = 0.68, 95% confidence interval = 0.53–0.83), we also discover substantial variation: the majority of default studies find positive effects, but several do not find a significant effect, and two even demonstrate negative effects. To explain this variability, we draw on existing theoretical frameworks to examine the drivers of disparity in effectiveness. Our analysis reveals two factors that partially account for the variability in defaults’ effectiveness. First, we find that defaults in consumer domains are more effective and in environmental domains are less effective. Second, we find that defaults are more effective when they operate through endorsement (defaults that are seen as conveying what the choice architect thinks the decision-maker should do) or endowment (defaults that are seen as reflecting the status quo). We end with a discussion of possible directions for a future research program on defaults, including potential additional moderators and implications for policy makers interested in the implementation and evaluation of defaults.

Keywords: choice architecture; defaults; default effects; Decision Making; Behavior; Analysis;

Citation:

Jachimowicz, Jon M., Shannon Duncan, Elke U. Weber, and Eric J. Johnson. "When and Why Defaults Influence Decisions: A Meta-analysis of Default Effects." Behavioural Public Policy 3, no. 2 (November 2019): 159–186. View Details

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Prior research attributes the positive effects of passion on professional success to intrapersonal characteristics. We propose that interpersonal processes are also critical because observers confer status on and support those who express passion. These interpersonal benefits of expressing passion are, however, contingent on several factors related to the expresser, perceiver, and context. Six studies, including entrepreneurial pitches from Dragons’ Den and two preregistered experiments, establish three key findings. First, observers conferred status onto and increased their support for individuals who express passion; importantly, expressing passion affected how admired—but not how accepted—someone was. Second, these effects were weaker when passion was expressed in an inappropriate manner/context and when observers disagreed with the target of expresser’s passion. Third, in competitive contexts, expressing passion became threatening and decreased the support individuals received from others. These results demonstrate that passion’s effects travel, in part, through the gravitational pull exerted by expressing passion.

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Making Medications Stick: Improving Medication Adherence by Highlighting the Personal Health Costs of Non-compliance

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