Using Behavioral Science to MOVE—Not Nudge—Patients to Take Their Medications

Increased adherence to medication represents the single biggest opportunity for the pharmaceutical industry to help improve patient outcomes while also growing revenues and reducing health costs across the wider system.

Despite four decades of research and billions of dollars of investment, progress on the issue remains limited:

  • Up to 31% of patients don’t fulfil their first prescription.
  • Of those who do, 40% still fail to get a second refill.
  • Poor adherence contributes to 200,000 premature deaths per year in Europe alone.
  • 125 billion euro per year in excess healthcare services in Europe are linked to non-adherence.

Over recent years, the application of behavioral science has created fresh opportunities for innovation in a wide range of healthcare areas. When applied to non-adherence, this has been attempted primarily using cost-effective nudge techniques and a deeper understanding of the heuristics and biases thought to be behind non-adherence behaviors.

However, while a systematic review in 2018 of the effectiveness of nudging highlighted the promise of this approach in improving self-management behaviors, only one in four studies found nudges to be effective at improving disease control outcomes.

This research reflects the inherent limitations of nudging in more complex domains—such as treatment adherence—and points to the need for more holistic and strategic applications of behavioral science to unlock progress.

The key challenge we face when attempting to address non-adherence is the sheer complexity of the system in which those behaviors sit. A wide-ranging systematic review undertaken in 2013 identified a total of 771 individual factors influencing likelihood of non-adherence, clustering into socio-economic, healthcare team, system, condition, therapy, and patient-related factors.

These factors are inter-related, creating a hugely complex, dynamic system that will express itself differently across different disease and patient contexts.

Addressing the Complex Behaviors Behind Non-Adherence

The real power of behavioral science lies not in the use of one-size-fits-all nudges to trigger a specific behavior but in the application of evidence-based models that help healthcare organizations address complex business challenges with strategic and sustainable interventions.

For example, the MOVE framework was developed from a wide range of models such as COM-B and BJ Fogg’s B-MAP, along with theories such as Azjen’s Theory of Planned Behavior and the Health Belief Model, to facilitate a more holistic approach to influencing patient behavior.

MOVE helps manage the complexity of the adherence behavioral system while avoiding the over-simplification that comes with applying off-the-shelf nudges. It allows for teams to design for behavior change in a strategic and coordinated way by focusing on four key components of human behavior: Motivation, Opportunity, Values, and Efficacy.

Working with the theory behind MOVE, successful behavior change occurs when an intervention…

  • Builds Motivation: It’s something I want to do
  • Widens Opportunity: My environment makes it possible/easy to do
  • Aligns with Values: Doing it reflects who I am and what’s important to me
  • Builds Efficacy: I have the skills and ability required to do it.

Applying the MOVE framework can help brand teams, patient engagement teams, and clinical teams identify opportunities to improve adherence by uncovering insights and opportunities for innovation specific to a particular disease area/patient cohort.

  • Steven Johnson

    Steven Johnson is Director – Behavioral Science at WHY, a BCW consultancy specializing in the science and technology of behavior change. Steven has spent the last 15 years working at the intersection of behavioral insights, data science, and human-centered design. He has led insight and design on a wide range of award-winning behavior change projects, incorporating over 40 randomized controlled trials (RCTs).


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