Experiments designed to nudge people towards healthier choices do not always yield the results researchers expect, delegates to the 15th International Health Economics Association congress heard on Monday.
Health insurers and public health experts around the world are exploring ways to apply behavioural economics, which draws on psychology to understand how people make decisions, to prompt people to make better choices about their health. But their interventions do not always yield the expected results.
For example, researchers from Wits found that sending a carefully crafted text message to people living with HIV who had missed clinic appointments, encouraging them to make a fresh start on a key calendar date such as Youth Day or Mandela Day, was no more effective than a simple message without the time reference.
SA has the world’s biggest HIV/Aids burden, and the world’s largest treatment programme. Despite free testing and medication, research has found that 18% to 30% of people who start antiretroviral treatment drop out, and by 2030 it is projected that only 78% of people living with HIV in SA will be on treatment. SA is therefore not on track to meet the 95-95-95 targets set by the UN Programme on HIV/Aids (UNAids).
These goals aim to ensure that by 2025 95% of people living with HIV know their status, 95% of all the people diagnosed with HIV/Aids receive antiretroviral treatment, and 95% of those on treatment achieve viral suppression, thus reducing the risk of transmitting the virus.
Researchers from Wits’ Indlela behavioural economics “nudge unit” are trying to find novel ways to prompt people who have stopped taking their antiretroviral medication to resume treatment. They teamed up with the Anova Health Institute to send text messages to people living with HIV in Limpopo who had missed a clinic visit.
Presenting their preliminary findings at the congress, Indlela researcher Caroline Govathson-Mandimika said prior research has found people are more likely to take action around a “temporal landmark”, as they see it as a new beginning. Further research is needed to understand why the references to a fresh start on Youth Day or Mandela Day did not have an impact on the study participants, she said. It was, however, encouraging that text messages did nudge people living with HIV to return to their clinics, she said.
An experiment investigating whether providing calorie labels with online food menus would prompt people to choose lower-calorie items was equally surprising, with most people seeming to ignore the information. In April 2022, England introduced calorie labelling regulations for businesses providing “out-of-home” food, which required publication of the calorie content of food along with a statement that “adults need around 2,000 calories a day”.
Research had previously found that consumers tend to underestimate the calorie content of the meals they purchase in restaurants, and that the sheer effort of counting calories may make them underestimate their consumption. So scientists designed an online takeaway menu with the calorie content of each item, and asked 1,040 participants to choose a takeaway dinner for themselves.
The participants were split into three groups, one of which received no information about calories, one received information about the calorie content of each item, and the third received information about the calorie content of each item, as well as the total calorie count for the meal they chose. Their preliminary analysis found there was no statistically significant difference between the average calories chosen by respondents in the three groups.
In fact, the only people who appeared to be influenced by the calorie information were a small subgroup who described themselves as calorie-conscious to begin with, said Laura Cornelsen, associate professor in public health at the London School of Hygiene and Tropical Medicine.
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.