Motivational messaging for medicine
- Magdel Louw
Behavioural Linguistics is a new advanced area in healthcare that's especially critical to medication compliance and adherence.
In today’s world, where self-care is such a burning issue, and we are encouraged to take better care of our own bodies and minds, we often need a nudge in the right direction to find ways to help us make better medical and health decisions.
As these decisions are not always easy, and, especially where we need to take daily regimens of a variety of drugs, we often opt for the easy way out, not taking our medication at all, where the benefits of taking it should be obvious.
“My research is all about how we make decisions. What makes us choose one thing over another? And how can language play a role in influencing these behaviours? At the core of my research is how the link between behavioural economics, psychology and linguistics can play an important role in shaping our decision making.”
This fascinating field of study boils down to how information is delivered to us through language and communication. Many other elements come into play too, such as what the message is, when it is sent and who the messenger is. “They all play a significant role in whether the person receiving the message both engages with the information and acts on it.”
Behavioural Science in message framing is regularly tested and used globally, from getting people to eat better and exercise more, to saving money for retirement and taking out certain insurance products. “Post-pandemic, we saw the importance of taking a behavioural approach to health: starting with washing our hands, through to mask-wearing and then getting our vaccines,” Crymble points out.
Enter Behavioural Linguistics, a new advanced area in healthcare that’s especially critical to medication compliance and adherence and which alleviates the need for preachy, know-it-all messaging that triggers our naturally rebellious behaviour.
Good behavioural messaging boosts medication adherence
Conservative estimates put the cost of people not taking their prescribed medicine, how and when they should, at more than $300 billion every year. Someone is considered “non-adherent” when they take less than 80% of medication prescribed to them, for example for diabetes, hypertension or high cholesterol.
And the implications are huge. People who don’t manage their health conditions compromise themselves financially and their quality of life. In putting strain on healthcare resources, the broader economy is affected too.
“One of the biggest behavioural blocks for people is the disconnect between the present and the future version of themselves – known as the ‘present bias’. Research on neuroimaging of the brain goes as far as suggesting we perceive a future version of ourselves in the same way as we think of a stranger. This makes it difficult for us to act in ways that are in our best future interests, especially if the action impacts us in the ‘now’, such as experiencing negative side effects,” Crymble explains.
A nudge in a nutshell
Fortunately, behavioural science research shows that a way to improve medication adherence is to deliver the right nudge to the right patient, at the right time and in the right way.
Professors Richard Thaler, Nobel Prize laureate, and Cass Sunstein, American economist, support this very concept in Nudge: Improving Decisions about Health, Wealth, and Happiness: “A nudge is any aspect of the choice architecture that alters people’s behaviour in a predictable way without forbidding any options or significantly changing their economic incentives. To count as a mere nudge, the intervention must be easy and cheap to avoid. Nudges are not mandates. Putting fruit at eye level counts as a nudge. Banning junk food does not”.
Part of Crymble’s PhD using behavioural linguistic theory was to develop a new communications framework to test how messages can be more effective across various industries. Right now, they are applying this specifically to test medication adherence messaging.
Their research helps patients develop better health awareness and education in today’s technical, often intimidating, world. All people need is a small, friendly push, or “nudge” and so they are finding ways to encourage patients to take their medication in the right dose at the right time, and to make sure patients prioritise doctor appointments and health checks and collect and fulfil repeat medication scripts on time, she says.
“Interestingly, these patterns of behaviour apply across demographics and often transcend languages, genders, ages, cultures, and other variable factors. This is particularly helpful in a country as diverse as South Africa, where there are large numbers of people needing life-saving chronic medication.”
Messages are tested across multiple communication platforms including SMS, in-app notifications (for patients with smartphones), print material and direct mailers - sent both to the patients themselves and to healthcare professionals. “A first in the country, we are also working with an innovative new company which prints ‘nudgey’ messages directly onto pill packs which are personalised to the individual patient,” she highlights.
“In the end, crafting content in ways that are intrinsically linked to how people think and act means you are more likely to ultimately persuade them, which is crucial in helping to increase medication adherence,” Crymble says.
“However, this discipline is heavily rooted in ethical action. People have full freedom of choice in what they decide to do and nothing is coerced, forced, banned, or used for ill-intent. Instead, the choice architecture we rely on is set up in ways to help nudge people in the direction that is in their best interests: to help reduce morbidity and mortality as a result of medicine non-adherence.”
The test for what really works
Crymble explains that five principles were developed for this research to test effectiveness and gain insight into the close link between language, decision-making and behaviour:
- Incentives that motivate an individual to do something. Whether intrinsic (motivated internally by our sense of personal satisfaction) or extrinsic (motivated through getting a reward). Incentives are very effective in encouraging behavioural change. For example, testing the difference between receiving a free item or discount, and recognition messaging for being “a health superhero”.
- The messenger effect for when we send messages through someone who is trusted, it boosts credibility and makes the message more persuasive. For medication adherence, this can be a doctor or pharmacist. They’re even testing pre-loaded messages from the patient (to themselves!) as well as messages from loved ones.
- Social proofing as we are social beings heavily influenced by what those around us do and say, and often do what others do to fit in and ‘follow the herd’. Are patients more likely to fill scripts and take their medication correctly when told that “others like them” or “most South Africans” are doing this preferred behaviour?
- Framing because how a message is positioned and structured, matters. You can highlight either the positive (gain) or negative (loss) aspects of the same decision. This is the difference between using a gain-frame message like “those who take their diabetes medication correctly can add five years to their life”, versus the loss-frame message of “those who don’t take their diabetes medication correctly can lose five years of their life”.
- Timely reminders and cues which are simple methods to getting someone to act on time. This is a powerful tool for motivation and behavioural change. Language like “your medication is packed and ready”, “your meds are waiting for you” and “reserved for you” helps increase medication adherence.
- Magdel Louw is a freelance writer.
- This article first appeared in Curiosity, a research magazine produced by Wits Communications and the Research Office.
- Read more in the 16th issue, themed: #Drugs, where we highlight the diversity, scope, and multi-dimensional nature of drug-related research at Wits University.