Brief 'Nudge' Can Help Patients Finish Health Program

Keeping messages brief and simple is more effective when trying to encourage patients to complete a health care program, according to new research.

In a study that analyzes six years of data, a team of researchers found small “nudges” in the right direction were a simple, inexpensive, and effective way to increase completion of health care programs, leading to a 16 percent jump in the completion rate for an already fastidious audience.

“Retention and completion are critical components of the effectiveness of health care interventions in real-world conditions, so a 16 percent increase in completion is significant,” said Dr. Dolores Albarracin, a professor of psychology and business administration at the University of Illinois and one of the co-authors of the study.

She noted that most health care intervention programs — for example, 10 sessions with a counselor — are expensive to implement and deliver.

“Patients start but they often drop out, which is not beneficial and is a huge deadweight loss of resources for everyone,” she said. “That’s why increasing retention rates is vital for public health, because multi-session behavioral interventions or a series of appointments with a health care provider are more efficacious when completed.”

For the study, a randomized control trial with more than 700 eligible patients in Florida was conducted to identify a simple, effective intervention to increase the completion of an HIV-prevention counseling program delivered at the Duval County Department of Health.

The study involved two factors: One representing an instrumental message and the other an empowering message. The messages were brief videos played immediately after the counseling program.

The instrumental message reminded participants that they could discuss issues other than HIV with their counselor. The empowering message was designed to make them feel free, independent and in charge of their decision to return — a strategy that doubled enrollment in programs in other work by the same team, according to the study.

The idea was to use brief, simple marketing messages not for a commercial product, but for “health programs to get people to complete interventions that change detrimental behavior,” Albarracin said.

“These messages were designed to either empower clients as agents responsible for their own change or to highlight the instrumental outcomes of the intervention in terms of participants’ lives by addressing health concerns other than HIV, such as employment or education,” she explained.

Results indicated that the instrumental message alone produced more completion than either the empowering message alone or combined with the instrumental message.

The success of the simple, post-session message, which the researchers termed “meta-intervention,” comes down to the power of the nudge as a “gentle reminder to do something,” Albarracin said.

“The word ‘nudge’ has such a nice connotation to it because it reminds us that we need to find strategies that are simple and cost-effective,” she said. “In a health care setting, you need something that’s practical, implementable and inexpensive. This is that kind of approach.”

For people who are vulnerable or disadvantaged, repeated contact with the health care system is important, according to Albarracin.

“Contact with the public health system is often the front door to accessing a lot of other public services — mental health services, career and employment services, and other forms of social assistance,” she said. “So the public health system might design a program with health in mind, but the audience who is buying into the program has multiple goals in mind, not just health.”

Having a good job or access to other services is just as important, which is why you have to sell the benefits of the program from the perspective of the audience, not of the provider, according to Albarracin.

“Social marketing is a marriage between psychological approaches and an approach that has the consumer in mind,” she said. “Make it recipient- and patient-centered, not provider-centered. The instrumental message capitalizes on that.”

The study was published in the Journal of Consulting and Clinical Psychology. 

Source: University of Illinois
 
Photo: Keeping your message brief and simple — on the level of a gentle reminder, as opposed to constant nagging — can produce gains when trying to increase engagement with health care programs, says new research from University of Illinois professor and social psychology expert Dolores Albarracin. Credit: L. Brian Stauffe.