@Article{info:doi/10.2196/37184,
author="Guinart, Daniel
and Sobolev, Michael
and Patil, Bhagyashree
and Walsh, Megan
and Kane, John M",
title="A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study",
journal="JMIR Ment Health",
year="2022",
month="Oct",
day="12",
volume="9",
number="10",
pages="e37184",
keywords="antipsychotic; adherence; digital; mobile health; mHealth; financial incentives",
abstract="Background: Medication 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. Objective: The 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. Methods: A 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. Results: A 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). Conclusions: Financial 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 Registration: ClinicalTrials.gov NCT04191876; https://clinicaltrials.gov/ct2/show/NCT04191876 ",
issn="2368-7959",
doi="10.2196/37184",
url="https://mental.jmir.org/2022/10/e37184",
url="https://doi.org/10.2196/37184",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222818"
}