Feasibility of implementing a behavioral economics mobile health platform for individuals with behavioral health conditions

Granek, Barry; Evans, Aja; Petit, Jorge R.; James, Mary Crawford; Ma, Youjie; Loper, Margaret L.; Fuccillo, M. K.; Schmidt, Rudy

doi:10.1007/s12553-020-00492-9

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…There is significant research showing that contingency management improves treatment outcomes in the context of health concerns like substance use, medication and treatment adherence, and a range of health risk behaviors [70][71][72]. Some recent studies have shown that these types of incentives also increase digital intervention adherence for health behaviors [73,74]. Applications of contingency management specific to engagement with DMHIs are limited, but early results are promising.…”

Section: Intervention-level Engagement Considerationsmentioning

confidence: 99%

The Engagement Problem: a Review of Engagement with Digital Mental Health Interventions and Recommendations for a Path Forward

Lipschitz,

Pike,

Hogan

et al. 2023

Curr Treat Options Psych

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Purpose of the review Digital mental health interventions (DMHIs) are an effective and accessible means of addressing the unprecedented levels of mental illness worldwide. Currently, however, patient engagement with DMHIs in real-world settings is often insufficient to see a clinical benefit. In order to realize the potential of DMHIs, there is a need to better understand what drives patient engagement. Recent findings We discuss takeaways from the existing literature related to patient engagement with DMHIs and highlight gaps to be addressed through further research. Findings suggest that engagement is influenced by patient-, intervention-, and system-level factors. At the patient level, variables such as sex, education, personality traits, race, ethnicity, age, and symptom severity appear to be associated with engagement. At the intervention level, integrating human support, gamification, financial incentives, and persuasive technology features may improve engagement. Finally, although system-level factors have not been widely explored, the existing evidence suggests that achieving engagement will require addressing organizational and social barriers and drawing on the field of implementation science. Summary Future research clarifying the patient-, intervention-, and system-level factors that drive engagement will be essential. Additionally, to facilitate an improved understanding of DMHI engagement, we propose the following: (a) widespread adoption of a minimum necessary 5-element engagement reporting framework, (b) broader application of alternative clinical trial designs, and (c) directed efforts to build upon an initial parsimonious conceptual model of DMHI engagement.

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Section: Intervention-level Engagement Considerationsmentioning

confidence: 99%

The Engagement Problem: a Review of Engagement with Digital Mental Health Interventions and Recommendations for a Path Forward

Lipschitz,

Pike,

Hogan

et al. 2023

Curr Treat Options Psych

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“…Of the 53 enrolled users, 54.72% completed the full 90-day program and 66% completed over 70% of the possible task check-ins via the app. Two-thirds of participants indicated MI increased their tendency to take their medication and adhere to their care plan ( Granek et al, 2021 ). Similarly, in a naturalistic study of a 12-week digital fitness program, users who received MI for completing the program via their health plan were more than 12× more likely to complete the program than those who received no incentives ( Wurst et al, 2020 ).…”

Section: Monetary Incentives In Digital Interventions: Some Preliminary Evidencementioning

confidence: 99%

Engagement in Digital Mental Health Interventions: Can Monetary Incentives Help?

Boucher¹,

Ward²,

Mounts³

et al. 2021

Front. Psychol.

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Digital mental health interventions (DMHI) are scalable and cost-effective strategies for increasing access to mental health care; however, dropout rates associated with digital interventions are high, particularly for open-access digital interventions. While some studies have focused on predictors of dropout from digital mental health programs, few studies have focused on engagement features that might improve engagement. In this perspective article, we discuss whether monetary incentives (MI) are one avenue to increasing user engagement in DMHI. We begin by reviewing the literature on the effects of MI for behavior change in health domains (e.g., dietary behaviors, substance use, and medication adherence). Then, drawing on a pilot study we conducted to test the effects of different levels of MI on usage and improvement in subjective well-being among users of a DMHI (Happify), we discuss the potential applications of MI for DMHI, the potential drawbacks of financial incentives in this context, and open questions for future research.

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“…Of 125,369 health maintenance reminders sent for Medicare wellness visits, 77% (96,839) were nudge health maintenance reminders (ie, using behavioral economics-based language). Of 125,369 Medicare wellness visits health maintenance reminder portal messages sent, 60.2% (75,407) led to an appointment being scheduled, with 12.2% (15,342)…”

Section: Sample Characteristicsmentioning

confidence: 99%

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study (Preprint)

Liang¹,

Stults²,

Jones³

et al. 2021

Preprint

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BACKGROUND Behavioral economics has been an increasingly utilized method in healthcare to “nudge” behavior change through the use of techniques such as choice architecture and framing of words. Patient portals are a key tool for facilitating patient engagement in their health, and deployment of interventions via patient portals have been effective in improving utilization of preventive health services. Our integrated healthcare system was one of the first to employ behavioral economics in health maintenance reminder (HMR) messages sent through the online patient portal to improve patient engagement and preventive service use. OBJECTIVE We examined the impacts of behavioral economics-based nudge HMRs on online scheduling uptake and appointment completion for two preventive services, Medicare wellness visits (MWV) and pap smears. METHODS This was a retrospective observational study using electronic health record data from an integrated healthcare system in Northern California. Nudge HMRs with behavioral economics-based language were implemented in November 2017 to all sites for MWV and selected sites in February 2018 for pap smears. We analyzed 125,369 HMRs for MWV, and 585,358 HMRs for pap smears sent between January 2017 and February 2020. The primary outcomes were online scheduling and appointment completion. The predictor was the receipt of a nudge HMR. We used segmented regression with interrupted time series design to assess the immediate and gradual effect of the nudge for MWV. For Pap smear, we used logistic regression models to assess the association of the nudge HMR on study outcomes, adjusting for the propensity to receive a nudge HMR. RESULTS Rates of online scheduling were higher for nudge HMRs recipients than control HMRs (13.0% nudge vs. 9.7% control for MWV; 1.4% nudge vs. 0.6% control for pap smears; p<0.001 for all comparisons). Rates of appointment completion were higher in nudge HMRs for pap smears (21.4% nudge vs. 15.3% control, p<0.001) but comparable for MWV between the two groups (51.5% nudge vs. 51.8% control, p=0.30). Regression results suggest a marginally gradual effect of nudge on online scheduling for the overall MWV sample (at a monthly rate of 0.26%, p=0.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, p=0.04). For pap smears, nudge HMRs were positively associated with online scheduling (propensity adjusted odds ratio [OR] 1.68; 95% confidence interval [CI] 1.50–1.88 overall sample; propensity adjusted OR 1.65 [1.45–1.87] among scheduled appointments) and appointment completion (propensity adjusted OR 1.07 [1.04–1.10]). CONCLUSIONS Nudge for health, a behavioral economics-based approach to providing HMRs, improves patient online scheduling for Medicare wellness visits and pap smears. Our study demonstrates that a simple approach of framing and modifying language in an electronic message can have a significant and long-term impact on patient engagement and access to care. CLINICALTRIAL No

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Feasibility of implementing a behavioral economics mobile health platform for individuals with behavioral health conditions

Cited by 7 publications

References 17 publications

The Engagement Problem: a Review of Engagement with Digital Mental Health Interventions and Recommendations for a Path Forward

The Engagement Problem: a Review of Engagement with Digital Mental Health Interventions and Recommendations for a Path Forward

Engagement in Digital Mental Health Interventions: Can Monetary Incentives Help?

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study (Preprint)

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