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A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: A Feasibility Study (Preprint)


 BACKGROUND
 Medication non-adherence is prevalent in severe mental illness and is associated with multiple negative outcomes. Mobile technology and financial incentives show promise to improve medication adherence, but studies in mental health, especially with oral medications, are lacking.
 
 
 OBJECTIVE
 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.
 
 
 METHODS
 A 10-week, single-arm longitudinal pilot study was conducted (NCT04191876). Patients earned rewards in the context of app-based adherence incentives. The reward was split into bi-weekly payments made in increments of $15, minus any $2/day penalties for missed check-ins. Time-varying effect modeling (TVEM) was used to summarize patient’s response during the study.
 
 
 RESULTS
 Twenty-five patients were enrolled in this pilot study, 72% (n=18) of them female, and 48% (n=12) white. Median age was 24 years (Q1-Q3: 20.5-30). 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 two weeks were higher than in the last eight weeks of the study. At study endpoint, app engagement remained high (N=24, Z=-3.17, p=.000) but medication adherence was not different from baseline (N=24, Z=-.59, p=.28).
 
 
 CONCLUSIONS
 Financial incentives were effectively delivered using an app and led to high engagement throughout the study and to significantly increased medication adherence during two-weeks. Leveraging behavioral economics and mobile health technology can increase medication adherence.
 
 
 CLINICALTRIAL
 NCT04191876
