TY  - JOUR
AU  - Guinart, Daniel
AU  - Sobolev, Michael
AU  - Patil, Bhagyashree
AU  - Walsh, Megan
AU  - Kane, John M
PY  - 2022
DA  - 2022/10/12
TI  - A Digital Intervention Using Daily Financial Incentives to Increase Medication Adherence in Severe Mental Illness: Single-Arm Longitudinal Pilot Study
JO  - JMIR Ment Health
SP  - e37184
VL  - 9
IS  - 10
KW  - antipsychotic
KW  - adherence
KW  - digital
KW  - mobile health
KW  - mHealth
KW  - financial incentives
AB  - 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 
SN  - 2368-7959
UR  - https://mental.jmir.org/2022/10/e37184
UR  - https://doi.org/10.2196/37184
UR  - http://www.ncbi.nlm.nih.gov/pubmed/36222818
DO  - 10.2196/37184
ID  - info:doi/10.2196/37184
ER  -