Investigating the mechanisms behind behavioural strategies to improve medicines adherence

Lead Research Organisation: University of Nottingham
Department Name: Sch of Economics

Abstract

Medicines non-adherence is a major health policy challenge affecting almost 50% of patients with chronic disease, leading to massive wastage and sub-optimal patient outcomes (WHO, 2003). As such, there is significant demand for initiatives and tools to support and foster adherent behaviours, particularly for individuals dependent on regular long-term medication regimes to maintain or improve their health. It has even been suggested that the potential impact of improving the effectiveness of new and current adherence interventions, may be greater than any specific improvement in medical treatment (Haynes et al., 2002).
Increasing the number of individuals who consistently and correctly self-administer medicines, exactly as prescribed, requires long-term, widespread behaviour change and habit formation. As a result, there is significant scope for the application of behavioural science to inform current and new interventions designed to support patients to take their medication as prescribed.
The effectiveness of low-cost behavioural interventions to increase healthy preventative and protective health behaviours has been widely investigated to varying degrees of success. An intervention can be considered "behavioural" if it instrumentally utilises research, theory, and insights from economics and psychology on human choice, decision-making and behaviour.
Recent evidence suggests that patients who sign a commitment to take a new medication, when the new medicine is first dispensed, are significantly more likely to be adherent to their medicines. However, this result was conditional on the message, highlighting the importance of adherence, that was paired with the commitment (Jachimowicz et al., 2019).
These results suggest that behavioural interventions (or behavioural "nudges") may be a useful new tool for promoting public health initiatives, to enhance pharmacy practice and improve patient outcomes at minimal cost or effort from the perspective of pharmacy practice. However, the prospects for using such approaches more widely and effectively is currently limited by poor understanding of why some nudges work and others don't; why one nudge might work in some contexts and not others; or how nudges might impact different patient groups. Hence, in order to exploit the potential power of nudge-based tools to enhance pharmacy practice, further work is required to understand the mechanisms at work behind successful nudges.
My PhD research investigates the mechanisms behind successful nudges to improve medicines adherence. We employ a randomised controlled trial within 60 Boots community pharmacies to test four different behavioural nudge strategies against a "business as usual" control group. Our strategy allows us to investigate whether it is possible to replicate and improve upon Jachimowicz et al.'s (2019) results, and unpick potential mechanisms driving changes in patient behaviour in response to the nudges.
Alongside this project we have conducted a series of online experiments to evaluate the reliability of a standardised self-reported adherence questionnaire (the 5-item Medicines Adherence Rating Scale developed by Thompson et al. (2000)) to accurately evaluate the effect of a behavioural intervention on self-reported adherence. The online experiments allow us to detect whether certain behavioural strategies prompt subjects to over-report their adherence and estimate the size of any additional reporting bias.

Studentship Projects

Project Reference Relationship Related To Start End Student Name
ES/P000711/1 30/09/2017 29/09/2027
1928497 Studentship ES/P000711/1 30/09/2017 10/05/2022 Sarah Bowen
 
Description Mechanisms behind Nudging Adherence: A Randomised Controlled Trial (Pilot)
Amount £3,700 (GBP)
Funding ID RA1175 
Organisation Network for Intergrated Behavioural Science 
Sector Academic/University
Country United Kingdom
Start 04/2018 
End 05/2020
 
Description Nudging Self-Reports of Adherence: Replication and Intentions Follow-up
Amount £2,392 (GBP)
Organisation Network for Intergrated Behavioural Science 
Sector Academic/University
Country United Kingdom
Start 04/2019 
End 05/2020
 
Description Promoting Medicines Adherence Through Low-Cost Interventions
Amount £37,160 (GBP)
Funding ID RA1182 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 11/2019 
End 07/2021
 
Description UKRI Policy Internship Scheme
Amount £2,400 (GBP)
Organisation United Kingdom Research and Innovation 
Department Policy Internship Scheme
Sector Public
Country United Kingdom
Start  
End 12/2020
 
Description Engagement with community pharmacy UK 
Organisation Boots UK
Country United Kingdom 
Sector Private 
PI Contribution Expertise in each team member's respective field. In economics and psychology, team members provide knowledge in theory and research design and implementation. Within social pharmacy, team members provide access to community pharmacists and effective strategies to engage our external partners.
Collaborator Contribution Senior-level support/advice in developing the intervention. Facilitation of implementation (including identifying and encouraging buy-in of participating pharmacies. Support for the dissemination of findings and development of processes to translate results to practice (e.g. via RMOCs, through pharmacy networks and the NHS). Organising and chairing project steering group.
Impact Secured an ESRC Impact Acceleration Account (IAA) award to fund our randomised controlled trial to investigate the effects and mechanisms behind low-cost behavioural interventions to promote medicines adherence (a multi-disciplinary project with collaboration from psychology, economics, and social pharmacy).
Start Year 2018
 
Description Engagement with community pharmacy UK 
Organisation Royal Pharmaceutical Society of Great Britain
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Expertise in each team member's respective field. In economics and psychology, team members provide knowledge in theory and research design and implementation. Within social pharmacy, team members provide access to community pharmacists and effective strategies to engage our external partners.
Collaborator Contribution Senior-level support/advice in developing the intervention. Facilitation of implementation (including identifying and encouraging buy-in of participating pharmacies. Support for the dissemination of findings and development of processes to translate results to practice (e.g. via RMOCs, through pharmacy networks and the NHS). Organising and chairing project steering group.
Impact Secured an ESRC Impact Acceleration Account (IAA) award to fund our randomised controlled trial to investigate the effects and mechanisms behind low-cost behavioural interventions to promote medicines adherence (a multi-disciplinary project with collaboration from psychology, economics, and social pharmacy).
Start Year 2018