JMIR Publications

ABSTRACT

Chronic diseases are the leading cause of morbidity, mortality, and health care spending in the United States, yet adherence to prescribed medications and engagement in stress-reduction behaviors and low-level exercise remain persistently low. According to the Centers for Disease Control and Prevention, less than 25% of adults met the 2018 Physical Activity Guidelines for Americans [1]. Despite advances in pharmacologic therapies, only approximately 50% of adults with chronic conditions take medications as prescribed [2]. Chronic psychological stress further exacerbates disease progression and poor outcomes [3]. In addition, higher levels of regular physical activity are associated with lower rates of many chronic illnesses, such as obesity, diabetes, hypertension and cardiovascular disease [4]. Mobile health (mHealth) applications offer a scalable approach to supporting patient self-management, but sustained engagement and adherence remain key challenges. Behavioral economics provides a useful framework for addressing these challenges by leveraging principles such as loss aversion, present bias, reference points, and the strategic use of incentives [5]. This viewpoint synthesizes evidence across behavioral economics, medication adherence, mindfulness practice, and the importance of daily physical activity to inform the design of integrated mHealth applications. Incentive-based interventions, when structured appropriately, can meaningfully improve medication adherence and sustain behavior change beyond active intervention periods [6-7]. Randomized controlled trials of mindfulness-based mHealth interventions demonstrate meaningful improvements in stress, anxiety, quality of life, and related health outcomes, with evidence of dose–response effects tied to consistent practice [8-9]. Gamified and incentive-based approaches further enhance engagement in ongoing behaviors such as daily physical activity and mindfulness practice [10-11]. An mHealth application that leverages these principles to incentivize and monitor medication adherence, physical activity, and mindfulness practice has the potential to significantly improve patient health.