Uncovering a behavioral strategy for establishing new habits: Evidence from incentives for medication adherence in Uganda

Incentives are used to improve many health-related behaviors, but evidence is mixed for their effectiveness both during the incentivization period and, even more so, on the persis-tence of the behavior after incentives are withdrawn. In this paper, we present the results of a randomized controlled trial that successfully uses incentives to improve medication adherence among HIV-infected patients in Uganda over 20 months, and follows the sam-ple for another 6 months to measure the persistence of these behavioral improvements. Our study contributes to the literature on habit formation by identifying a behavioral strat-egy that is associated with persistently high medication adherence after controlling for observable individual-level characteristics and the receipt of incentives. We find evidence supporting a psychological theory of habits as reflexive context-behavior associations, which suggests new ways of designing incentive-based interventions for better promoting persistent, healthier behaviors. (c) 2021 Elsevier B.V. All rights reserved.

Automated summary

This study presents the results of a randomized controlled trial using incentives to improve medication adherence among HIV-infected patients in Uganda. It identifies a behavioral strategy associated with persistently high medication adherence, independent of individual characteristics and incentives, supporting a psychological theory of habits as reflexive context-behavior associations.