Are reminders better than financial incentives?

When patients are taking prescribed medicines to manage their health, it is vital that they follow a consistent schedule.

However, failure to take medication as directed remains a widespread issue.

This 'medical non-adherence' has significant consequences for public health and healthcare systems around the globe.

The UK National Institute for Clinical Excellence (NICE) warns that up to half of medicines prescribed for long-term conditions are not take as intended.

Many patients struggle with adherence because of forgetfulness, side effects, or a lack of motivation, especially as symptoms lessen.

When they miss doses or discontinue their treatment prematurely, it often leads to poor health results. This in turn can lead to increased hospitalisations and higher healthcare costs.

Poor medication management causes approximately 5,700 deaths in the UK every year. It also costs the NHS in excess of £930 million annually.

That figure rises to $125 billion a year for non-adherence across Europe. And it could cost an estimated $290 billion every year in the US.

It is clear that improving adherence is essential, not only for patient wellbeing, but also to reduce the pressure on healthcare workers and manage healthcare resources efficiently.

How to use behavioural science in health research

A recent study I conducted sought to understand which interventions might work best for improving adherence.

Working with my Warwick Business School colleagues Umar Taj, Daniel Read, and Ivo Vlaev, we used a novel gamified approach.

We simulated real-life behaviour in a controlled, laboratory setting to test how four interventions might influence patients’ medication routines.

These interventions were reminders, incentives, commitment devices, and extended symptom duration.

The study highlights the potential of reminders as a low-cost, high-impact strategy for improving patient health outcomes.

Games motivate users into engaging in an activity with a higher intensity and duration. Game elements are activities, behaviours, and mechanisms that designers incorporate into a specific context to create a gameful experience.

Introducing gaming elements into a nongaming context has the potential to transform routine tasks into more enjoyable and motivating experiences.

The concept of "gamification" has gained traction in health research. Gamification can encourage engagement and sustained attention, qualities that are beneficial in health contexts where routine behaviours, like taking medication, need reinforcement.

Nudging patients to follow treatment recommendations

Using a modified version of the popular video game “2048,” we created a simulation where players had to enter a code at regular intervals to maintain their “health” status. This is similar to taking regular doses of medication.

If they skipped entries, the screen would blur, representing a relapse or worsening symptoms.

The game environment allowed us to experiment with different "nudges," in a cost-effective and controlled setting. The allowed us to see what might effectively boost adherence in real-life situations.

We found that reminders improved adherence rates by 23 per cent. Simply prompting participants to act at the designated time was highly effective by countering forgetfulness. This is a major reason for non-adherence in real life.

However, financial rewards did not notably improve adherence. While incentives can sometimes motivate behaviour, they may not be as effective for routine tasks like medication adherence.

For these everyday behaviours, habit formation and intrinsic motivation play a larger role.

Similarly, commitment devices and extended symptom duration didn’t lead to a significant improvement in adherence. That suggests that other strategies might be more suitable to help patients improve their behaviour.

Why sending reminders improves medical adherence

The success of reminders over incentives may stem from the nature of adherence itself. Many people miss medications simply because they forget, especially when they begin to feel better.

Reminders serve as immediate prompts to recall and act, countering forgetfulness without altering the underlying motivation to adhere.

Incentives may be beneficial in some contexts. However, they may not be as effective in situations where routine and habit are more critical than external rewards.

Moreover, financial incentives can have a paradoxical effect. Individuals may view the act of taking medication as less meaningful. Or they may feel that they are doing it solely for the reward, rather than as a personal responsibility.

In the healthcare context, this effect is particularly concerning. It suggests that an over-reliance on rewards could inadvertently diminish people’s long-term commitment to managing their health independently.

Small changes have a major impact for patients with chronic diseases

Improving medication adherence can significantly enhance outcomes for patients with chronic conditions and optimise healthcare resources.

This is particularly significant as aging populations are living with a growing number of complex health conditions.

But changing that behaviour requires a deep understanding of individuals' actions and the factors that influence them.

Using gamification has the potential to bridge the gap between prescription and practice. This can promote better health outcomes for all.

Reminders are a simple and often cost-effective intervention. They are an accessible way to offer patients help t say on track with their medication regime.

As such, they have proved to be a powerful tool in supporting adherence.

For policymakers and healthcare providers facing that could be just the prescription they need.

Implementing reminder systems could offer them a straightforward yet transformative step to influence adherence and improve public health.

Further reading:

Three ways nudging can improve health outcomes

The Consistency Trap: How to make better decisions

Why do systems create problems then nudge us to fix them?

How to prevent profits from tainting behavioural nudges

Aikaterini Grimani is Assistant Professor of Behavioural Science at Warwick Business School.

Learn to uses behavioural nudges more effectively in your organisation with the four day course Behavioural Science in the Real World at WBS at the Shard.

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