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Medication Adherence describes the extent to which a patient’s behavior corresponds with the clinician’s recommendations.

Non-adherence poses a challenge to Patient Support Programs, as patients often fail to adjust their lifestyle to their new condition. This can have a significant impact on patients’ well-being, the overall success of the treatment and healthcare outcomes.

There’s been a lot of focus and no little amount of effort put into addressing medication non-adherence that often yield some initial results [1], but failed to sustain these results over time [2].

Taking a behavioral approach to medication adherence is not new. However, due to the complexity of the programs, the short-term nature of the interventions and high running costs, they did not lead to improvements in the long-run [3].

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Digitally enhanced Patient Support Programs have changed some of these parameters and limitations. Programs can leverage digital tools to focus on strategies that enable and support their patients in establishing and maintaining healthy adherence habits for long-term medications.

We take a deeper look at adherence, the traditional approach at addressing unintentional non-adherence and how digitally enhanced patient support programs can apply a behavioral lens to address the challenges posed by unintentional non-adherence.

The Challenge of Addressing Medication Non-Adherence

The task of improving treatment adherence is not an easy one.
Even the most motivated patients often forget to take their medication. Traditional solutions often rely on time-based reminders.

While time-based reminders seem to be effective for short-term regimes [1], their effectiveness (and salience) decreases with time [2] as they inhibit habit formation. This makes them less reliable as a memory aid for long-term medications.

For chronic conditions, patients who incorporate taking their medication into their daily routines are less likely to forget to take their medication, compared to those relying on time-based reminders.

One reason medication adherence is a challenge is that of the “intention-action gap”.

This refers to the difference between what people say they would like to do or even plan to do, and what they actually do [4]. For example, a patient may genuinely intend to form a new habit of exercising regularly, but ultimately fail to do so over time.

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This gulf between intentions and actions can be explained by the influence of habits and routines on people’s daily lives. Almost half (around 45%) of the activities and tasks people undertake in their day are habitual [5].

Once a habit is established, it is generally difficult to change the behavior. It’s a lot easier to change a behavior once, as opposed to changing a behavior and sustaining that change over time.

Thinking Behaviorally about Medication Adherence

Habits play a central part in people’s lives, as well as being an effective device for changing patient behavior.

Habits are learned patterns of behavior that become associated with a particular trigger or cue (e.g. a location or another routine such as having breakfast in the morning). When the behavior is regularly and frequently performed in a sequence [2, 6, 7], it is much more likely to become habitual.

There are three core characteristics habitual behaviors tend to have:
1. The task should be easy [8];
2. It should be associated with an existing routine/task [9, 10]; and
3. Completing the task should provide positive reinforcement [8].

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Taking medication is an excellent example of a task that has strong potential to become habitual.

This is because patients tend to learn to associate taking their medications with a specific location, another routine or a particular time of the day.

Habits can be set up by linking the desired behavior to cues in the environment. The more stable the environment is, the better it acts as a trigger for the habit to occur (environmental cues remind us to perform the habit).

In the habit formation process, timing can be very important. It is much easier to set up new healthy habits or break existing unhealthy ones whenever there is a natural change in environment and pre-existing routines.

Building Healthy Habits

People who consistently act in healthy ways in daily life generally do so out of habit, rather than due to their willpower or stronger convictions [10, 12].

Digitally enhanced Patient Support Programs (PSPs) can guide patients through the habit formation process by providing information on how to set up new habits and by giving personalized feedback on patients’ performance (as well as actionable recommendations for improvement).

There are six key strategies that patient support programs should leverage in order to help patients build healthy habits:

  1. Ensure there’s a stable, supportive environment
  2. Leverage the context, such as existing routines
  3. Make the desired behavior easy to do
  4. Develop cues in the environment and rewards
  5. Practice and repeat the new behavior
  6. Build meaning and motivation around the new behavior
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Breaking Existing Bad Habits

Confronted with a new diagnosis, patients often have to adjust their lifestyles.

This doesn’t just involve building new healthier habits, but it also often involves breaking some existing bad habits (e.g. smoking, unhealthy diet, etc).

Patient support programs should assist patients in neutralizing context and cues that automatically trigger the bad habit.

There are three main strategies for reducing the impact of existing cues on bad habits:

  1. Eliminate or disrupt exposure to familiar cues
  2. Alter and reengineer triggers in an existing environment
  3. Consciously and vigilantly monitor temptations to relapse into bad behavior
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Medication Adherence – Don’t Remind Me

For patients with a chronic condition on long-term treatments, incorporating medication into their daily routines will mean they are less likely to forget to take their medication compared to those relying on time-based reminders.

Remembering to take medication is a prospective memory task that relies on cues. These cues can prompt effective habit formation when patients are encouraged to pair the cue with an existing habit or routine in their daily lives.

We have highlighted a range of behavioral strategies that can be leveraged by digitally enhanced Patient Support Programs to effectively support patients in making and breaking habits to enable them to adhere to their medication and wider treatment recommendations.

Download the full whitepaper and get access to:

  • A detailed explanation of each behavioral strategy to help build health habits, and break existing bad habits
  • Leveraging behavioral strategies in digitally enhanced patient support programs
  • Why personalization is key to successful behavioral interventions
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References

1. Judah, G., Gardner, B., & Aunger, R. (2013). Forming a flossing habit: an exploratory study of the psychological determinants of habit formation. British journal of health psychology, 18(2), 338-353.
2. Tobias, R. (2009). Changing behavior by memory aids: a social psychological model of prospective memory and habit development tested with dynamic field data. Psychological review, 116(2), 408.
3. Haynes, R. B., Ackloo, E., Sahota, N., McDonald, H. P., & Yao, X. (2008). Interventions for enhancing medication adherence. The Cochrane Library.
4. Sheeran, P. (2002). Intention—behavior relations: a conceptual and empirical review. European review of social psychology, 12(1), 1-36.
5. Rhodes, R. E., & Bruijn, G. J. (2013). How big is the physical activity intention–behaviour gap? A meta‐analysis using the action control framework. British journal of health psychology, 18(2), 296-309.
6. Aarts, H., & Dijksterhuis, A. (2000). Habits as knowledge structures: Automaticity in goal-directed behavior. Journal of personality and social psychology, 78(1), 53.
7. Wood, W., & Neal, D. T. (2007). A new look at habits and the habit-goal interface. Psychological review, 114(4), 843.
8. Lally, P., & Gardner, B. (2013). Promoting habit formation. Health Psychology Review, 7(sup1), S137-S158.
9. Kahneman, D. (2003). Maps of bounded rationality: Psychology for behavioral economics. American economic review, 93(5), 1449-1475.
10. Adriaanse, M. A., Kroese, F. M., Gillebaart, M., & De Ridder, D. T. (2014). Effortless inhibition: Habit mediates the relation between self-control and unhealthy snack consumption. Frontiers in psychology, 5, 444.
11. Lally, P., Van Jaarsveld, C. H., Potts, H. W., & Wardle, J. (2010). How are habits formed: Modelling habit formation in the real world. European journal of social psychology, 40(6), 998-1009.
12. Galla, B. M., & Duckworth, A. L. (2015). More than resisting temptation: Beneficial habits mediate the relationship between self-control and positive life outcomes. Journal of Personality and Social Psychology, 109(3), 508.

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