A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study
BackgroundMedication nonadherence is prevalent in severe mental illness and is associated with multiple negative outcomes. Mobile technology and financial incentives show promise to improve medication adherence; however, studies in mental health, especially with oral medicati...
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| Format: | Article |
| Language: | English |
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JMIR Publications
2022-10-01
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| Series: | JMIR Mental Health |
| Online Access: | https://mental.jmir.org/2022/10/e37184 |
| _version_ | 1797734634441670656 |
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| author | Daniel Guinart Michael Sobolev Bhagyashree Patil Megan Walsh John M Kane |
| author_facet | Daniel Guinart Michael Sobolev Bhagyashree Patil Megan Walsh John M Kane |
| author_sort | Daniel Guinart |
| collection | DOAJ |
| description |
BackgroundMedication nonadherence is prevalent in severe mental illness and is associated with multiple negative outcomes. Mobile technology and financial incentives show promise to improve medication adherence; however, studies in mental health, especially with oral medications, are lacking.
ObjectiveThe aim of this paper is to assess the feasibility and effectiveness of offering financial incentives through a mobile app based on behavioral economics principles to improve medication adherence in severe mental illness.
MethodsA 10-week, single-arm longitudinal pilot study was conducted. Patients earned rewards in the context of app-based adherence incentives. The reward was split into biweekly payments made in increments of US $15, minus any US $2 per day penalties for missed check-ins. Time-varying effect modeling was used to summarize the patients’ response during the study.
ResultsA total of 25 patients were enrolled in this pilot study, of which 72% (n=18) were female, and 48% (n=12) were of a White racial background. Median age was 24 (Q1-Q3: 20.5-30) years. Participants were more frequently diagnosed with schizophrenia and related disorders (n=9, 36%), followed by major depressive disorder (n=8, 32%). App engagement and medication adherence in the first 2 weeks were higher than in the last 8 weeks of the study. At study endpoint, app engagement remained high (n=24, Z=–3.17; P<.001), but medication adherence was not different from baseline (n=24, Z=–0.59; P=.28).
ConclusionsFinancial incentives were effectively delivered using an app and led to high engagement throughout the study and a significantly increased medication adherence for 2 weeks. Leveraging behavioral economics and mobile health technology can increase medication adherence in the short term.
Trial RegistrationClinicalTrials.gov NCT04191876; https://clinicaltrials.gov/ct2/show/NCT04191876 |
| first_indexed | 2024-03-12T12:47:12Z |
| format | Article |
| id | doaj.art-365f990054a04af0b3d8078edff06bcf |
| institution | Directory Open Access Journal |
| issn | 2368-7959 |
| language | English |
| last_indexed | 2024-03-12T12:47:12Z |
| publishDate | 2022-10-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Mental Health |
| spelling | doaj.art-365f990054a04af0b3d8078edff06bcf2023-08-28T23:15:19ZengJMIR PublicationsJMIR Mental Health2368-79592022-10-01910e3718410.2196/37184A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot StudyDaniel Guinarthttps://orcid.org/0000-0001-5078-6716Michael Sobolevhttps://orcid.org/0000-0002-8931-7682Bhagyashree Patilhttps://orcid.org/0000-0003-1031-5869Megan Walshhttps://orcid.org/0000-0002-3091-2145John M Kanehttps://orcid.org/0000-0002-2628-9442 BackgroundMedication nonadherence is prevalent in severe mental illness and is associated with multiple negative outcomes. Mobile technology and financial incentives show promise to improve medication adherence; however, studies in mental health, especially with oral medications, are lacking. ObjectiveThe aim of this paper is to assess the feasibility and effectiveness of offering financial incentives through a mobile app based on behavioral economics principles to improve medication adherence in severe mental illness. MethodsA 10-week, single-arm longitudinal pilot study was conducted. Patients earned rewards in the context of app-based adherence incentives. The reward was split into biweekly payments made in increments of US $15, minus any US $2 per day penalties for missed check-ins. Time-varying effect modeling was used to summarize the patients’ response during the study. ResultsA total of 25 patients were enrolled in this pilot study, of which 72% (n=18) were female, and 48% (n=12) were of a White racial background. Median age was 24 (Q1-Q3: 20.5-30) years. Participants were more frequently diagnosed with schizophrenia and related disorders (n=9, 36%), followed by major depressive disorder (n=8, 32%). App engagement and medication adherence in the first 2 weeks were higher than in the last 8 weeks of the study. At study endpoint, app engagement remained high (n=24, Z=–3.17; P<.001), but medication adherence was not different from baseline (n=24, Z=–0.59; P=.28). ConclusionsFinancial incentives were effectively delivered using an app and led to high engagement throughout the study and a significantly increased medication adherence for 2 weeks. Leveraging behavioral economics and mobile health technology can increase medication adherence in the short term. Trial RegistrationClinicalTrials.gov NCT04191876; https://clinicaltrials.gov/ct2/show/NCT04191876https://mental.jmir.org/2022/10/e37184 |
| spellingShingle | Daniel Guinart Michael Sobolev Bhagyashree Patil Megan Walsh John M Kane A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study JMIR Mental Health |
| title | A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study |
| title_full | A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study |
| title_fullStr | A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study |
| title_full_unstemmed | A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study |
| title_short | A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study |
| title_sort | digital intervention using daily financial incentives to increase medication adherence in severe mental illness single arm longitudinal pilot study |
| url | https://mental.jmir.org/2022/10/e37184 |
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