Behavioral Economics to improve Antihypertensive Therapy Adherence (BETA) - PROJECT SUMMARY
Hypertension is one of the most prevalent cardiovascular disease risk factors, with over 45% of the United States
population having elevated blood pressure. Decades of research have demonstrated that controlling blood
pressure can reduce the risk of serious adverse cardiovascular events including stroke, myocardial infarction,
and heart failure. A key component of successfully obtaining control of hypertension is the use of medications to
lower blood pressure. Unfortunately, more than 50% of Americans demonstrate medication non-adherence, a
statistic that directly contributes to suboptimal blood pressure control and, therefore, excess preventable
cardiovascular events. Strong data indicates that linking the taking of medications to daily routines (‘anchoring’)
increases adherence, however, existing interventions built on this information have failed to create successful,
long term improvements in medication adherence. This study aims to leverage behavioral economic insights to
improve medication adherence to antihypertensive medications. Specifically, we propose to complement linking
medication taking to a daily routine with two added components to make it easier for participants to stick to their
anchoring plan: increasing information salience through frequent text messages and providing intermittent
rewards for pill-taking according to the anchoring plan. This study will be implemented in a pilot randomized
controlled trial (RCT) in a high-volume clinical practice to establish feasibility, acceptability, and preliminary
efficacy. The specific aims include 1) a formative phase to develop the intervention and evaluate its feasibility
and acceptability via focus groups with key stakeholders; 2) a RCT of 60 hypertensive patients in which a control
group (n=20) is provided education on anchoring medication taking to a daily routine, and two intervention
groups, one (n=20) who receives anchoring education and daily text message reminders and another (n=20)
which receives anchoring education, text messages, and financial incentives for adherence in accordance with
their anchoring plan; and 3) data collection in preparation for a future R01 application, including focus group
discussions with key stakeholders (patients, providers [Physicians, Nurses, Advanced Care Practitioners,
Pharmacists] and clinic staff) and exit focus groups with study participants regarding ways to improve the
intervention. The main hypothesis is: the intervention is effective by anchoring pill-taking to an existing routine,
tested by comparing the pooled (Message group + Incentive group) vs. the Control group. The secondary
hypothesis is: adding incentives to the text messages is more effective for routinizing pill-taking (testing outcomes
in the Incentive group vs. Message group). Outcomes from this study have the potential to greatly enhance our
understanding of the barriers and facilitators of medication adherence among hypertensive patients and
potentially provide evidence for a low-cost and scalable intervention to improve medication adherence in clinical
practice.
