Behavioral Science Methods Failed to Improve Medication Adherence
Researchers aimed to estimate the impact of using behavioral science principles within communication intended for hypertension medication adherence.
The use of social norms, messenger effects, and processing fluency in communication failed to improve adherence for the use of hypertension medication, according to data published in JAMA Network Open.1 With little success in the use of behavioral science methods, researchers believe more evidence is necessary to identify alternative approaches in boosting adherence.
“Hypertension substantially increases the risk of myocardial infarction and stroke, but medications that can effectively control hypertension are not always taken as prescribed; adherence rates for hypertension medications typically range from 40% to 74%,” wrote the authors. “Nonadherence is a potent contributor to preventable disability and death among middle-aged and older adults.”
Adherence is how a patient’s behavior corresponds with a health care provider’s agreed recommendation. | image credit: Phimwilai / stock.adobe.com
Health care adherence in general is defined as how a patient’s behavior corresponds with a health care provider’s agreed recommendation. Whether it’s taking medications, following a diet, or improving their lifestyle, those who do not make provider-directed changes to their behaviors are choosing to be nonadherent.2
READ MORE: How to Improve Medication Adherence Within the Pharmacy
“The complexity of adherence is increasingly recognized, leading to the development of new frameworks and approaches to define, measure, and understand the causes of nonadherence,” wrote authors of a study published in Frontiers of Pharmacology. “Rather than a binary concept, adherence is increasingly being seen as a process that happens over time and involves a wide range of individuals. With this change in conceptualization, a wider range of measurements and causes are being understood.”
With medication adherence relating so significantly with behavioral changes and habits, researchers of the current study attempted to use specific behavioral science methods to understand better, more efficient ways of bolstering adherence. To understand how these methods could impact adherence, researchers included them in mailing communications between patients and the entities that dispense their medications.
“Communication strategies using behavioral science theories may help to improve medication adherence but have not been well studied for hypertension medications, especially in mailed communications,” they continued.1 “In this study, we tested the application of these theories to hypertension medication adherence for a Medicare population aged 65 to 80 years.”
From August 18 to December 31, 2023, researchers conducted a randomized clinical trial containing 7 separate groups each undergoing various mailing interventions for improving their adherence to hypertension medication. All study participants were Medicare Advantage beneficiaries between the ages of 65 and 80. They were also all taking hypertension medication, with adherence rates of 60% to 80% prior to the study.
The final analysis included a total of 64,290 patients (mean age, 71.4 years; 54.1% women). In each group, participants were sent variations of mailing interventions, with each study arms’ intervention modified slightly compared with the other 6. And while arms 1 through 6 were all different mailing interventions for improving adherence, arm 7 was the placebo, or no-mailing, arm.
“In this large, 7-arm, open-label randomized clinical trial, there were no statistically significant differences in hypertension medication adherence between treatment and control groups,” wrote the authors.1 “Our results are similar to those of other studies indicating that summary information on medication adherence—for example, for statin medication adherence—may have null or limited effects on improving medication adherence scores.”
Many of the mailing interventions used on study participants focused on the promotion of why being medically adherent will benefit patients. As predominantly all of these behavioral science methods fell short, researchers suggested that further methods need to be explored in order to increase the number of ways to drive medication adherence. Some of those methods include improving communications, increasing communication frequency, and more.
“In this randomized clinical trial, use of social norms, messenger effects, and processing fluency in mailed communications did not significantly increase hypertension medication adherence. However, there are several promising avenues for future research,” concluded authors of the study.1 “Better design of communication materials, varying the mode of administration (eg, using a telephonic or digital intervention), or increasing outreach frequency or duration may have a stronger impact. Future research could also explore alternative methods of outreach with primary care clinicians over longer periods, with coaching support.”
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