Small changes, or nudges, having a big impact on people’s behavior is one that everyone in the behavioral economic community supports and heralds as the latest great idea. However, this great idea isn’t working for everyone. In particular, nudges don’t seem to be making much headway in medication compliance.
When a patient doesn’t take their medicine properly, doctors call it “noncompliance.” Noncompliance could mean anything from not filling prescriptions to not finishing the prescribed amount of medication to not “taking as directed by their physician.”
The term sounds benign, but the consequences are anything but. Per an article in the NY Times a few weeks ago about a review published in The New England Journal of Medicine back in 2005, as many as two-thirds of hospital admissions related to medication problems were the result of “noncompliance.” Moreover, these admissions cost approximately $100 billion a year. What is worse, some experts assert that 100,000 deaths occur annually due to noncompliance!
If ever there were a time when changing a behavior is a matter of life or death, noncompliance with medication could be it. To this point, nothing anyone has tried in the healthcare industry to correct patient behavior has worked—at least not in a significant or widespread way.
Looking to change that, researchers recently turned to concepts touted in Behavioral Economics to get people to take their medicine. Behavioral Economics is the study of how people’s psychology affects their behavior as customers, which, as my regular readers know, is irrational behavior for the most part. The researchers were using “nudges” to help patients adhere to their medication requirements. In fact, per the NY Times article, they tried a multitude of them, including financial incentives and social support among others.
But they didn’t work. It turns out that nudging didn’t seem to make a difference in medication noncompliance. It appears that some behaviors respond better to nudging than others.
When Nudges Work, They Work Well
This brief 2-minute video shares some of the ways Nudges do work:
In each of the video’s examples, you can see how nudging works best when it works with our natural instincts. For example, the shirt example talks about how stores persuade us to buy more shirts than we need. We are already going to buy shirts. The nudge presents us a bargain too good to pass up, so we buy more shirts than we would have. This nudge wouldn’t work, however, if you weren’t on the market for shirts.
Researcher David Halpern has some suggestions that help make a nudge work to change behavior. He suggests that the nudge should be:
These types of nudges can influence people’s desire to do something. A good example is in personalizing a text from a job center that booked interviews for candidates. They were having a problem getting candidates to turn up for their interviews, i.e., one in ten would attend. The candidate would receive a notification via text that they had been booked for an interview. Halpern and his team worked with the messaging to include the candidate’s name and the job center employee’s name along with a short personal message. They improved the attendance rate from 10% to 27% just by this little nudge.
If you want to watch Halpern’s presentation, here you go:
Too Soon to Call
It is too early for the medical community to give up on the idea of nudging the patients to adhere to the medication protocol as recommended by the doctors. While there haven’t been significant results using nudges in patient noncompliance correction as of yet, the failure could be because of other, undiscovered factors that influence the patient. It could also be something outside the parameters of the analysis that affected patient behavior.
Sometimes a great idea works great for everyone all the time. Sliced bread is a good example. Another example could be indoor plumbing. Other times, a great idea works great, but not for everyone. Presidential Twitter accounts come to mind as an example here. However, in most cases, the idea is still a good one, even if it doesn’t work for everyone all the time. Nudges are one of these ideas.
If there is one thing we have learned on changing people’s behavior, it’s that it is never a simple answer or a one-size-fits-all solution. The idea is to keep on trying and hopefully find a way to nudge patients out of noncompliance.
Do you have a method to ‘nudge’ your customers? Share your ideas below.
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