‘Nudges’ an inexpensive, effective way to increase completion of health promotion programs
CHAMPAIGN, Ill. — Keeping messages brief and simple can produce gains when trying to encourage patients to complete a health care program, says research co-written by a University of Illinois expert in social psychology.
In a forthcoming 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 Dolores Albarracin, a professor of psychology and of business administration at Illinois and one of the co-authors of the study. "Most health care intervention programs" – 10 sessions with a counselor, for example – "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.
"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."
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 paper. Completion of the three-session counseling was determined by recording attendance.
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."
Results indicated that the instrumental message alone produced more completion than either the empowering message alone or combined with the instrumental message.
The overall gains in completion as a result of the instrumental message were 16 percent, indicating success in the intended facilitation of counseling completion, according to the paper.
The efficacy 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 quite important, Albarracin said.
"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 paper will be published by the Journal of Consulting and Clinical Psychology. Albarracin's co-authors are Marta R. Durantini of the University of Illinois; Dr. Kristina Wilson of the Duval County (Florida) Department of Health; William C. Livingood of the University of Florida; and Aashna Sunderrajan of the University of Illinois. Wilson was the site manager for the six years of the study.
The research was funded by the National Institutes of Health.
Editor's notes: To contact Dolores Albarracin, call 217-244-7019; email [email protected]
The paper "A Meta-Intervention to Increase Completion of an HIV-Prevention Intervention: Results From a Randomized Controlled Trial in the State of Florida" is available online.