JMIR Publications

ABSTRACT

Background:

The principles of behavioral economics (BE) suggest that there are many potential ways to develop meaningful health care partnerships with patients. Crowdsourced experimental surveys may help efficiently assess the time and cost needed for different options.

Objective:

The goals of this study were (1) to assess the feasibility of using crowdsourced surveys to evaluate BE interventions for patient partnerships, and (2) to assess the impact of two BE-based intervention designs, psychological rewards and loss of framing, on simulated medication reconciliation behaviors in a simulated primary care setting.

Methods:

We conducted between-subject survey experiments on a crowdsourcing platform (Amazon Mechanical Turk) to assess the design of behavioral interventions. Interventions were aimed at improving a targeted behavior that pertains to bringing medicines to primary care office visits. The baseline and three simulated interventions were compared in simulated primary care office visit scenarios. Interventions were monetary compensation, status effect as a psychological reward, and loss frame as a modification of the status effect. Willingness to bring medicines was measured on a 5-point Likert scale. A reverse coding question was included to assess response intentionality.

Results:

A total of 569 study participants were recruited. There were 132 in the baseline group, 187 in the monetary compensation group, 149 in the psychological reward group, and 101 in the loss framing group. All three interventions increased participants’ willingness to bring medicines significantly when compared to the baseline scenario. The monetary compensation intervention caused an increase of 13.06% (P<.001), psychological rewards increased willingness by 6.53% (P=.025), and a loss frame on the psychological rewards increased willingness by 16.80% (P<.001). Responses to the reverse coding question were consistent with the willingness questions.

Conclusions:

In primary care, bringing medications to office visits is a frequently advocated patient partnership behavior that is nonetheless not widely adopted. Crowdsourcing platforms such as MTurk support efforts to efficiently and rapidly reach large groups of individuals to assess the efficacy of behavioral interventions. We found that crowdsourced survey-based experiments with simulated monetary compensation resulted in valid simulated behavioral responses. Simulated psychological status design, especially with a loss framing design, had a significant impact on the targeted behavior. It should thus be considered an effective behavioral intervention design to enhance patient engagement in primary care. These results support the use of crowdsourcing platforms to augment and complement traditional approaches to learning about behavioral economics for patient engagement.