Skip to main content Accessibility help
×
Home

Making medications stick: improving medication adherence by highlighting the personal health costs of non-compliance

  • JON M. JACHIMOWICZ (a1), JOE J. GLADSTONE (a2), DAN BERRY (a3), CHARLOTTE L. KIRKDALE (a4), TRACEY THORNLEY (a5) and ADAM D. GALINSKY (a6)...

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Making medications stick: improving medication adherence by highlighting the personal health costs of non-compliance
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Making medications stick: improving medication adherence by highlighting the personal health costs of non-compliance
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Making medications stick: improving medication adherence by highlighting the personal health costs of non-compliance
      Available formats
      ×

Copyright

Corresponding author

*Correspondence to: Jon M. Jachimowicz, Columbia University, 116th St & 3022 Broadway, New York, NY 10027, USA. Email: jmj2183@columbia.edu
Joe J. Gladstone, University College London, Level 38, 1 Canada Square, Rm NE3, Canary Wharf, London, E14 5AB, UK. Email: j.gladstone@ucl.ac.uk

Footnotes

Hide All

Denotes equal first authorship

Footnotes

References

Hide All
Albarracín, D. and Kumkale, G. T. (2003), ‘Affect as information in persuasion: A model of affect identification and discounting’, Journal of Personality and Social Psychology, 84(3): 453469.
Apter, A. J., Reisine, S. T., Affleck, G., Barrows, E. and ZuWallack, R. L. (1998), ‘Adherence with twice-daily dosing of inhaled steroids: Socioeconomic and health-belief differences’, American Journal of Respiratory and Critical Care Medicine, 157(6 PART I): 18101817.
Barclay, T. R., Hinkin, C. H., Castellon, S. A., Mason, K. I., Reinhard, M. J., Marion, S. D. and Durvasula, R. S. (2007), ‘Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status’, Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 26(1): 40–9.
Barth, K. R., Cook, R. L., Downs, J. S., Switzer, G. E. and Fischhoff, B. (2002), ‘Social stigma and negative consequences: factors that influence college students’ decisions to seek testing for sexually transmitted infections’, Journal of American College Health, 50(4): 153159.
Beshears, J., Choi, J. J. and Madrian, B. C. (2011), ‘Self Control and Liquidity: How to Design a Commitment Contract’, Working Paper, 154.
Choudhry, N. K., Avorn, J., Glynn, R. J., Antman, E. M., Schneeweiss, S., Toscano, M. and Shrank, W. H. (2011), ‘Full Coverage for Preventive Medications after Myocardial Infarction’, New England Journal of Medicine, 365(22): 20882097.
Elliott, R. A., Boyd, M. J., Salema, N.-E., Davies, J., Barber, N., Mehta, R. L., and Craig, C. (2016), ‘Supporting adherence for people starting a new medication for a long-term condition through community pharmacies: a pragmatic randomised controlled trial of the New Medicine Service’, BMJ Quality & Safety, 25: 747758.
Fisher, R. J. (1993), ‘Social Desirability Bias and the Validity of Indirect Questioning’, Journal of Consumer Research, 20(2): 303315.
Frazier, P. A., Davis-Ali, S. H., Dahl, K. E., P.A., F., S.H., D.-A. and K.E., D. (1994), ‘Correlates of noncompliance among renal transplant recipients’, Clinical Transplantation, 8(6): 550557. Retrieved from http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L24361561%5Cnhttp://sfx.metabib.ch/sfx_locater?sid=EMBASE&issn=09020063&id=doi:&atitle=Correlates+of+noncompliance+among+renal+transplant+recipients&stitle=CLIN.+TRANSPLANT.&title=Cl
Golman, R., Hagmann, D., and Loewenstein, G. (2017), ‘Information Avoidance’, Journal of Economic Literature, 55(1): 96135.
Grant, R. W., Devita, N. G., Singer, D. E. and Meigs, J. B. (2003), ‘Polypharmacy and medication adherence in patients with type 2 diabetes’, Diabetes Care, 26(5): 14081412.
Gray, T. A., Fenerty, C., Harper, R., Spencer, A. F., Campbell, M., Henson, D. B. and Waterman, H. (2012), ‘Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: An exploratory randomised controlled trial’, Eye, 26(3): 407417.
Gulliver, A., Griffiths, K. M. and Christensen, H. (2010), ‘Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review’, BMC Psychiatry, 113.
Hallsworth, M. (2017), ‘Rethinking public health using behavioural science’, Nature Human Behaviour, 1(9): 612612.
Hardin, G. (1968), ‘The tragedy of the commons’, Nature, 162: 12431248.
Haynes, R. B., Ackloo, E., Sahota, N., McDonald, H. P. and Yao, X. (2008), ‘Interventions for enhancing medication adherence (Review)’, Cochrane Database of Systematic Review, 2.
Haynes, R. B., Taylor, D. W., Sackett, D. L., Gibson, E. S., Bernholz, C. D. and Mukherjee, J. (1980), ‘Can simple clinical measurements detect patient noncompliance?’, Hypertension, 2(6): 757764.
Haynes, R., Taylor, D. and Sackett, D. (1979), Compliance in Health Care, Baltimore, MD: Johns Hopkins University Press.
Hertz, R., Unger, A. and Lustik, M. (2005), ‘Adherence with pharmacotherapy for type 2 diabetes: a retrospective cohort study of adults with employer-sponsored health insurance’, Clinical Therapeutics, 27(7): 10641073.
Hinkin, C. H., Hardy, D. J., Mason, K., Castellon, S.a, Durvasula, R. S., Lam, M. N. and Stefaniak, M. (2004), ‘Medication Adherence in HIV-infected adults: effect of patient age, cognitive status and substance abuse’, Aids, 18: 1925.
Hungin, A. P., Rubin, G. and O'Flanagan, H. (1999), ‘Factors influencing compliance in long-term proton pump inhibitor therapy in general practice’, British Journal of General Practice, 49(0960-1643): 463464.
Kahneman, D., Knetsch, J. L. and Thaler, R. H. (1991), ‘Anomalies: The Endowment Effect, Loss Aversion, and Status Quo Bias’, Journal of Economic Perspectives, 5(1): 193206.
Kahneman, D. and Tversky, A. (1979), ‘Prospect Theory: An Analysis of Decision under Risk’, Econometrica, 47(2): 263292.
Karlsson, N., Loewenstein, G. and Seppi, D. (2009), ‘The ostrich effect: Selective attention to information’, Journal of Risk and Uncertainty, 38(2): 95115.
Kettle, K. L. and Häubl, G. (2011), ‘The Signature Effect: Signing Influences Consumption-Related Behavior by Priming Self-Identity’, Journal of Consumer Research, 38(3): 474489.
Knapton, S. (2015), ‘NHS drugs to be stamped ‘Funded by the Taxpayer’ to reduce waste’, The Telegraph.
Krousel-Wood, M., Hyre, A., Muntner, P. and Morisky, D. (2005), ‘Methods to improve medication adherence in patients with hypertension: current status and future directions’, Curr Opin Cardiol, 20: 296300.
Kyngas, H. and Lahdenpera, T. (1999), ‘Compliance of patients with hypertension and associated factors’, Journal of Advanced Nursing, 29(4): 832839.
Lertmaharit, S., Kamol-Ratankul, P., Sawert, H., Jittimanee, S. and Wangmanee, S. (2005), ‘Factors associated with compliance among tuberculosis patients in Thailand’, Journal of the Medical Association of Thailand, 88.
Lim, T. O., Ngah, B. A., Rahman, R. A., Suppiah, A., Ismail, F., Chako, P. and Na, H. H. (1992), ‘The mentakab hypertension study project. Part V - Drug compliance in hypertensive patients’, Singapore Medical Journal, 33(1): 6366.
Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A. and Pescosolido, B. A. (1999), ‘Public conceptions of mental illness: Labels, causes, dangerousness, and social distance’, American Journal of Public Health, 89(9): 13281333.
Matz, S. C., Gladstone, J. J. and Stillwell, D. (2017), ‘In a world of big data, small effects can still matter: A reply to Boyce, Daly, Hounkpatin, and Wood (2017)’, Psychological Science, 28: 547550.
Milkman, K. L., Beshears, J., Choi, J. J., Laibson, D. and Madrian, B. C. (2011), ‘Using implementation intentions prompts to enhance influenza vaccination rates’, Proceedings of the National Academy of Sciences of the United States of America, 108(26): 10415–20.
Morgan, O. and Baker, A. (2006), ‘Measuring deprivation in England and Wales using 2001 Carstairs scores’, Health Statistics Quarterly / Office for National Statistics, (31): 2833.
Morisky, D. E., Green, L. W. and Levine, D. M. (1986), ‘Concurrent and predictive validity of a self-reported measure of medication adherence’, Medical Care, 24(1): 6774.
Nichols, A. L. and Maner, J. K. (2008), ‘The good-subject effect: investigating participant demand characteristics’, The Journal of General Psychology, 135(2): 151165.
Nieuwlaat, R., Wilczynski, N., Navarro, T., Hobson, N., Jeffery, R., Keepanasseril, A. and Haynes, R. B. (2014), ‘Interventions for enhancing medication adherence’, The Cochrane Database of Systematic Reviews, 11(11): CD000011.
Osterberg, L. and Blaschke, T. (2005), ‘Adherence to medication’, New England Journal of Medicine, 353(5): 487497.
Petty, R. E. and Cacioppo, J. T. (2012), The elaboration likelihood model of persuasion, Springer Science & Business Media.
Petty, R. E., Cacioppo, J. T. and Goldman, R. (1981), ‘Personal involvement as a determinant of argument-based persuasion’, Journal of Personality and Social Psychology, 41(5): 847855.
Pope, D. G. and Schweitzer, M. E. (2011), ‘Is tiger woods loss averse? Persistent bias in the face of experience, competition, and high stakes’, American Economic Review, 101(1): 129157.
Randall, D. M. and Fernandes, M. F. (1991), ‘The social desirability response bias in ethics research’, Journal of Business Ethics, 10(11): 805817.
Rogers, T., Milkman, K. L., John, L. K. and Norton, M. I. (2015), ‘Beyond good intentions: Prompting people to make plans improves follow-through on important tasks’, Behavioral Science and Policy, 1(2): 3341.
Rogers, T., Milkman, K. L. and Volpp, K. G. (2014), ‘Commitment devices: using initiatives to change behavior’, JAMA, 311(20): 20652066.
Scannell, L. and Gifford, R. (2013), ‘Personally Relevant Climate Change: The Role of Place Attachment and Local Versus Global Message Framing in Engagement’, Environment and Behavior, 45(1): 6085.
Senior, V., Marteau, T. M. and Weinman, J. (2004), ‘Self-reported adherence to cholesterol-lowering medication in patients with familial hypercholesterolaemia: The role of illness perceptions’, Cardiovascular Drugs and Therapy, 18(6): 475481.
Shea, S., Misra, D., Ehrlich, M. H., Field, L. and Francis, C. K. (1992), ‘Correlates of nonadherence to hypertension treatment in an inner-city minority population’, American Journal of Public Health, 82(12): 16071612.
Shi, L., Liu, J., Fonseca, V., Walker, P., Kalsekar, A. and Pawaskar, M. (2010), ‘Correlation between adherence rates measured by MEMS and self-reported questionnaires: a meta-analysis’, Health and Quality of Life Uutcomes, 8(99): 17.
Shu, L. L., Mazar, N., Gino, F., Ariely, D. and Bazerman, M. H. (2012), ‘Signing at the beginning makes ethics salient and decreases dishonest self-reports in comparison to signing at the end’, Proceedings of the National Academy of Sciences of the United States of America, 109(38): 15197–200.
Sinaiko, A. D. and Rosenthal, M. B. (2011), ‘Increased Price Transparency in Health Care — Challenges and Potential Effects’, New England Journal of Medicine, 364(10): 891894.
Solomon, D. H., Iversen, M. D., Avorn, J., Gleeson, T., Brookhart, M. A., Patrick, A. R. and Katz, J. N. (2012), ‘Osteoporosis telephonic intervention to improve medication regimen adherence: a large, pragmatic, randomized controlled trial’, Archives of Internal Medicine, 172(6): 477–83.
Sorrentino, R. M., Bobocel, D. R., Gitta, M. Z. and Olson, J. M. (1988), ‘Uncertainty orientation and persuasion: Individual differences in the effects of personal relevance on social judgments’, Journal of Personality and Social Psychology, 55(3): 357371.
Steiner, J. F. and Prochazka, A. V. (1997), ‘The assessment of refill compliance using pharmacy records: Methods, validity, and applications’, Journal of Clinical Epidemiology, 50(1): 105116.
Viller, F., Guillemin, F., Briancon, S., Moum, T., Suurmeijer, T. and van den Heuvel, W. (1999), ‘Compliance to drug treatment of patients with rheumatoid arthritis: a 3 year longitudinal study’, Journal of Rheumatology, 26(10): 2114–22.
Viswanathan, M., Golin, C., Jones, C., Ashok, M., Blalock, S., Wines, R. and Lohr, K. (2012), ‘Interventions to improve adherence to self-administered medications for chronic diseases in the United States: A systematic review’, Annals of Internal Medicine, 157(11): 785795.
Vlasnik, J. J., Aliotta, S. L. and DeLor, B. (2005), ‘Medication adherence: Factors influencing compliance with prescribed medication plans’, Case Manager, 16(2): 4751.
Volpp, K. G., Troxel, A. B., Mehta, S. J., Norton, L., Zhu, J., Lim, R. and Asch, D. A. (2017), ‘Effect of Electronic Reminders, Financial Incentives, and Social Support on Outcomes After Myocardial Infarction: The HeartStrong Randomized Clinical Trial’, JAMA Internal Medicine, 19104: 19.
Waltz, E. (2016), ‘Drugs go wireless’, Nature Biotechnology, 34(1): 1518.
Type Description Title
WORD
Supplementary materials

Jachimowicz et al. supplementary material
Figure S1 and Table S1

 Word (90 KB)
90 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed