Sticker Charts and Behavior Change

Human beings crave recognition. Giving people positive reinforcement for their actions is a powerful way to modify their behavior. Giving them visible, tangible positive reinforcement is all the more powerful. There’s an easy way to use this feature of human psychology to get patients to use their medication well: The sticker chart.

The Lesson Of Potty Training

I am not sure when I first learned of the sticker chart as a way to modify behavior. In grade school, some teachers made use of it. But when my wife successfully used this approach to help our children achieve independence with the potty, I more fully appreciated the power of the tool that we were dealing with.

The sticker chart is a simple concept, typically used for children (but almost certainly modifiable for use in adults, too). Usually the sticker chart may involve a calendar or other matrix, and a sticker is added to a day of the calendar (or a box of the matrix) each time the child does the desired activity. The motivation a sticker chart creates is quite effective. I am only partially joking when suggesting that human research subject protection committees might find the sticker chart too coercive in its effects to use in research studies.

Physicians And Pharma Marketers Can Make Use Of Sticker Charts

In the clinic setting, using a sticker chart to encourage good adherence to treatment in children is quite easy. A few lines drawn on a sheet of paper or a pre-printed calendar can be used as the chart. Inexpensive, age-appropriate, stickers individualized to the preferences of the patient might be chosen for maximal effect. In a classically gender-based approach we might use some action-oriented, Teenage Mutant Ninja Turtle or Batman stickers for the boys and pink heart or Barbie stickers for the girls, but I am no longer tied to making such assumptions about children’s gender-based preferences. I have a vague recollection of gold or silver stars being used to influence me in my youth. The child is told they get a sticker for each time they take their medication, with or even without some tangible reward for completing a row of the chart. A system like this may have the child begging for their medication. Moreover, the resulting chart may provide a somewhat reliable record of how well the medication is being used.

Pharmaceutical marketers might consider offering physicians sticker chart materials to use for their patients. Or, pharmaceutical marketers might offer sticker chart kits directly to patients (or their parents), either in the drug package or as a separate item. The sticker chart might only be needed for the first week or two when medication is initiated, helping build a habit of good, reliable, routine medication use that will continue long after the sticker chart is discontinued—it has been many years since my kids needed the sticker charts to get them to use the potty.

 

  • Steven Feldman, M.D.

    Dr. Steven Feldman is Professor of Dermatology and Public Health Sciences at Wake Forest Baptist Medical Center. Steve studies patient adherence at North Carolina’s Wake Forest Baptist Medical Center. He is also Chief Science Officer of Causa Reseach, an adherence solutions company (www.causaresearch.com), founder of www.DrScore.com, and author of “Compartments” and “An Illustrated Dictionary of Behavioral Economics for Healthcare Professionals.”

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