Uncovering a behavioral strategy for establishing new habits: Evidence from incentives for medication adherence in Uganda

Chad Stecher, Barbara Mukasa, Sebastian Linnemayr, Chad Stecher, Barbara Mukasa, Sebastian Linnemayr

Abstract

Incentives are used to improve many health-related behaviors, but evidence is mixed for their effectiveness both during the incentivization period and, even more so, on the persistence of the behavior after incentives are withdrawn. In this paper, we present the results of a randomized controlled trial that successfully uses incentives to improve medication adherence among HIV-infected patients in Uganda over 20 months, and follows the sample for another 6 months to measure the persistence of these behavioral improvements. Our study contributes to the literature on habit formation by identifying a behavioral strategy that is associated with persistently high medication adherence after controlling for observable individual-level characteristics and the receipt of incentives. We find evidence supporting a psychological theory of habits as reflexive context-behavior associations, which suggests new ways of designing incentive-based interventions for better promoting persistent, healthier behaviors.

Trial registration: ClinicalTrials.gov NCT02503072.

Keywords: HIV; Habit formation; Incentives; Medication adherence.

Copyright © 2021 Elsevier B.V. All rights reserved.

Figures

Figure 1.
Figure 1.
Positive Impact of Incentives on Monthly and Cumulative Mean Adherence During the 20-Month Intervention
Figure 2.
Figure 2.
Positive Impact of Incentives on the Percent of Participants with at Least 90% Cumulative Mean Adherence Over the 20-Month Intervention
Figure 3.
Figure 3.
Impact of Incentives on Monthly and Cumulative Mean Adherence Over the 20-Month Intervention and 6 Months Post-Intervention
Figure 4.
Figure 4.
Impact of Incentives on the Percent of Participants with at Least 90% Cumulative Mean Adherence Over the 20-Month Intervention and 6 Months Post-Intervention
Figure 5.
Figure 5.
Percentage Point Change in Mean Monthly Adherence During the 6 Months Post-Intervention
Figure 6.
Figure 6.
Monthly Mean Adherence Over the 20-Month Intervention and 6 Months post-Intervention Between Participants With and Without Time-Based Cues
Figure 7.
Figure 7.
Monthly Number of 48 Hours or Longer Pill Interruptions Over Full 26 Months Between Participants With and Without Time-Based Cues
Figure 8.
Figure 8.
Percent of Participants of Using Time-Based Cues Across All Three Study Groups
Figure 9.
Figure 9.
Intrinsic Motivation Measured for Each Study Group at Four Periods During the 20-Month Intervention

Source: PubMed

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