CAN GAMES
HELP YOU GET
BETTER?
Experimental
Evidence
from
Pakistan
Umar Taj
Supervised by Prof. Daniel Read & Prof. Ivo Vlaev
Behavioural Science Group, Warwick Business School
Problem
On average, 50% of
The estimated annual
the patients do not
cost to UK
take their medication
Government of non
as prescribed.
adherence, resulting in
wasted medicine, readmissions etc.
(Horne et al., 2005)
Research Focus
Symptoms disappearing
Symptoms
Disease
Why is Adherence necessary?
Contagious
Relapse
Drug Resistance
(CDC, 1999), (Volmink & Garner, 2006)
Interventions to improve adherence
There have been three recent systematic reviews
on interventions for medication adherence with
mixed results.
The interventions reviewed were generally effective
and the adherence rate increased by 4% to 11%
among different interventions.
(Haynes et al., 2002; Roter et al., 1998; Peterson et al., 2003)
There is an increasing recognition that design of behaviour change
interventions should follow the same cycle as development of drugs.
theory
modelling
exploratory
trial
RCT
theory
modelling
exploratory
trial
RCT
Used Morisky’s Medication Adherence Scale (MMAS-4)
to determine the extent of adherence among the
Pakistani population.
A national survey of 1,892 adult men and women.
All interviews were face to face.
MMAS - 4
60%
Do you ever forget to take your antibiotic medication when
you were completing the antibiotic course?
50%
Are you careless at times about taking your antibitoic
medication?
56%
Sometimes, if you feel worse when you take the antibiotics,
then do you stop taking it or not?
39%
When you feel better, do you sometimes stop taking the
antibiotics or not?
MMAS - 4
Hi
Med
Low
9%
52%
39%
(0)
(1-2)
(3-4)
theory
modelling
exploratory
trial
RCT
Used Theoretical Domains Framework (TDF) to
identify barriers to medication adherence and
develop theory-informed interventions.
Show behaviour change scorecard.
Dashboard
theory
modelling
exploratory
trial
RCT
Model patient behaviour and test interventions
in controlled lab setting
Recall
Symptoms disappearing
Symptoms
Disease
(Kessler & Roth, 2012)
Extract key features in
the Natural Setting:
Disease
Symptoms
Pill
Cost
Partial adherence . . .
Model them in the Lab
Setting . . .
Experiment (concept)
ENTER CODE
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Experiment design (major)
Enter code 14 times in total, once at the start of
every minute, screen becomes clear after 4
attempts
There is a chance of screen getting blurred again if
code not entered – relapse
Earning based on game score so there is a pull to
focus on the game once the screen is clear
A code counter that shows how many codes have
been used up, similar to a pill pack
elongated
reminder
symptoms
incentive
commitment
Pakistan Lab Experiments
Pakistan’s first
Behavioural
Science Lab
General Public
General Public
Results
Sample visual display of results
Pakistan Interviewers (no
cost)
50%
71%
50%
71%
79%
Condition 1 (no cost): 14
minute experiment
14%
50%
79%
71%
14%
Condition 3 (no cost):
giving reminder
0%
0%
36%
7%
Condition 4 (no cost):
progress bar
21%
0%
64%
0%
0%
Condition 5 (no cost):
incentive
71%
7%
0%
Full display of results
Adherence Rate
+23%
+8%
44%
Baseline (n=104)
**Incentive
condition
(n=106)
+10%
+2%
**Reminder
Commitment
condition (n=97) sticker condition
(n=101)
**Elongated
disease
condition
(n=100)
cheap
what if
quick
easy on
ethics
Thank You!
What is Adherence?
“
The extent to which the patient’s
behaviour matches agreed
recommendations from the
”
prescriber
(Horne et al., 2005)
“
Increasing the effectiveness of adherence
interventions may have a far greater impact on the
health of the population than any improvement in
”
specific medical treatments
(Horne et al., 2005, WHO,2003)
Experiment design (practice)
3 steps:
Participants given time to practice 2048 game
Asked to watch the instruction video*
Play the modified game
*Show the links for all three steps
For instruction video, carried out a national
survey (n=1,686) to understand the
communication that takes place between
doctor and patient when prescribing
antibiotic.
These instructions were mimicked in the
instruction video of the experiment.
Doctor-Patient Communication
94%
Did the doctor tell you what medicine to take?
84%
Did the doctor tell you how often to take the medicine
every day?
82%
Did the doctor tell you how long you should take the
medicine for?
67%
Did the doctor inform you about consequences of not
completing the course?