Using Insights From Behavioral Economics and Social Psychology to Help Patients Manage Chronic Diseases
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Using Insights From Behavioral Economics and Social Psychology to Help Patients Manage Chronic Diseases Braden K. Mogler, BS3,4, Suzanne B. Shu, PhD1,5, Craig R. Fox, PhD1,5,6, Noah J. Goldstein, PhD1,5,6, Ronald G. Victor, MD1,7, José J. Escarce, MD, PhD1,2, and Martin F. Shapiro, MD, PhD1,2,3 1
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles, CA, USA; 3David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 4Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA; 5UCLA Anderson School of Management, Los Angeles, CA, USA; 6 Department of Psychology, UCLA, Los Angeles, CA, USA; 7Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
Despite a revolution in therapeutics, the ability to control chronic diseases remains elusive. We present here a conceptual model of the potential role of behavioral tools in chronic disease control. Clinicians implicitly accept the assumption that patients will act rationally to maximize their self-interest. However, patients may not always be the rational actors that we imagine. Major behavioral barriers to optimal health behavior include patients’ fear of threats to health, unwillingness to think about problems when risks are known or data are ambiguous, the discounting of risks that are far in the future, failure to act due to lack of motivation, insufficient confidence in the ability to overcome a health problem, and inattention due to pressures of everyday life. Financial incentives can stimulate initiation of health-promoting behaviors by reducing or eliminating financial barriers, but may not produce long-term behavior change without additional interventions. Strategies have been developed by behavioral economists and social psychologists to address each of these barriers to better decision-making. These include: labeling positive behaviors in ways consistent with patient life goals and priorities; greater focus on more immediate risks of chronic diseases; intermediate subgoals as steps to a large health goal; and implementation of specific plans as to when, where, and how an action will be taken. Such strategies hold promise for improving health behaviors and disease control, but most have not been studied in medical settings. The effectiveness of these approaches should be evaluated for their potential as tools for the clinician.
KEY WORDS: chronic disease; behavioral economics; financial incentives; social psychology. J Gen Intern Med 28(5):711–8 DOI: 10.1007/s11606-012-2261-8 © Society of General Internal Medicine 2012
Received May 7, 2012 Revised September 14, 2012 Accepted October 11, 2012 Published online November 15, 2012
INTRODUCTION
Chronic diseases affect 133 million Americans1 and often are not being managed effectively. For example, of 75 million people with hypertension in the United States, onethird go untreated and more than half do not adequately control their blood pressure.2 Efforts to improve chronic disease control have in
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