Promote, not information, for participation and adoption

You have groundbreaking medical devices or digital health applications and data to show improved health outcomes or lower costs. You go to the market with all the compelling facts, but the adoption rate is lower than the forecast. Does this sound familiar? If so, you are not alone.

We are prejudiced as humans

As humans, we like to think that we respond reasonably to situations, facts and information will drive preferred behaviors. However, decades of behavioral science research have confirmed that humans are irrational even when it comes to high-risk health and health care.

For example, we have bias towards the present (that's why we eat chocolate cake), we have a disgust for losses and regrets (that's why we insist on losing stocks), and our overweight low probability events while reducing the high probability (that's why we play lottery).

Utilizing behavioral science

Successful healthcare innovators use behavioral science to achieve adoption and behavioral change, instead of fighting these innate psychological tendencies with more information and assuming that more information will overcome them. The three main pillars of applying behavioral science in healthcare are:

1. Select the architecture
2. Behavioral framework
3. Principled incentives

Select architecture: Design decisions

Selection architecture refers to the design of ideas about how to propose, organization, and structural structures to guide decision makers to achieve preferred results without limiting freedom of choice.

• Default value in EHR: The default setting greatly affects physician behavior. When Penn Medicine changed prescription defaults to “universal” for common medicines, the universal prescription rate increased from the range of 25%-90% to 98.4% overnight. By making generics the default choice rather than requiring additional clicks, the system makes it easy for doctors to do things that are in the best interest of patients and the system.
• Opt out of the Remote Administrator: Make the right path simply increase engagement. Provider practice introduces remote monitoring procedures by sending letters to patients. In a set of letters, patients were asked to call to arrange an appointment to pick up the device and adhere to 13% of the device. In another group, patients were told they had planned to pick up the device at the date/time and followed 38% of the device. Three times the patient participation rate was eliminated.

Behavioral Framework: Incorporating Behavioral Science into Health Communication

The importance of building information is more important than it is said.

• Loss framework: We weigh the advantages and disadvantages. When doctors are told that in the case of “95% of patients not hospitalized”, they will receive the drug at a 6.5 mark (out of 10 marks). However, if told “5% of patients are hospitalized”, the rating dropped to 4.7 out of 10 points. The same information presented in another way has different effects on acceptability.
• Anchor point: We are influenced by the reference point. When the patient was asked to start a monthly injection, the willingness was lower, at 2.0 in 10. But if they are asked to start once first –Daily Injection, and Then Required to start onceper month Injection, the willingness increased to 7.5 out of 10 points. The initial question brought patients to new treatments.
• Social norms: The doctor is influenced by the people around him. In one example, inappropriate prescriptions for antibiotics decreased by 16.3% after a doctor received an email to compare their prescription rates with peers. Using local, social comparison drives behavioral change

Principles Incentives: Introduction to Financial Components

The design of financial factors is more important than their size.

• Loss Framework and Donations: People don't like losing what we already have. In an employer walking program, a group of participants receives a bonus of $1.40 per day, up to $42 if they meet their own step goals. Another group received a $42 reward, but if they don't match their steps to score, they have to give back $1.40 per day. At the beginning, participants often earn $42 for their daily walking goals. Economists would say that $1.40 a day is the same, but behavioral economics shows.
• Perception of value: Higher cost, full-price treatment is considered more effective. When patients receive a placebo medication of “$0.10 discount”, 61% of them will relieve pain. For those taking the “full priced $2.50” placebo medication, 85% of them will relieve pain. Both are placebos, but programs considered to be of higher value can produce better patient-reported results.

Summary

Adopting new devices and digital health tools often does not meet strategic goals, not because information or evidence is weak, but because human decision-making is unreasonable. To overcome these biases, innovators use behavioral science. Select Architecture Leverages the default design and exit design to make the preferred option the easiest path. The behavioral framework optimizes communication through technologies such as loss frameworks, anchoring and social norms. Finally, principled incentives should be incorporated into endowment and value perception. Together, these approaches establish natural human tendencies and help organizations achieve change in adoption and behavior.

Photo: Stock Finland, Getty Images

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