Case Study

Behavioral Reinforcements Motivate People to Achieve Health Goals 2

In Collaboration With:

Novartis is a global healthcare company based in Switzerland that provides solutions to address the evolving needs of patients worldwide.


Readmission rates among patients with heart issues are too high. Yet, adherence to positive health behaviors is low, particularly when it comes to correctly taking prescribed medication, regular exercise, and eating a healthy diet. Because people are so consistently non-adherent, they often suffer from poor health.


The Center for Advanced Hindsight designed a behavioral intervention to test which strategies motivate people to stick to their health goals. Using the Pattern Health mobile app, we assessed different incentives to encourage participants from a community population to follow a multivitamin regimen, exercise daily (tracked with Fitbits), and photograph their meals. The intervention included social accountability (sharing progress on Facebook), a points system (where, depending on their behaviors and experimental condition, participants could win or lose money), and “app control” (where a subset of participants’ smartphone apps were blocked if they failed to complete their daily tasks.)


Loss aversion was an effective means of motivating participants (via losing points compared to gaining points), as was the app control punishment. The social accountability aspect was more effective when participants shared their progress with larger audiences (i.e., their entire Facebook community vs. a limited group), as well as when they only shared failures (compared to those who shared their successes). The study also demonstrated a greater acceptance of the mobile app by older populations, a valuable takeaway given that this demographic makes up the majority of patients with heart failure.

Value for Sponsor

This was a pilot for a larger scale study with Novartis, the Duke Clinical Research Institute and the Center for Advanced Hindsight. The follow-up study involves research with over 8,000 heart failure patients from over 160 hospitals across the United States. The goal of this follow-up study is to glean insights on the benefits of using a mobile app to help patients be more adherent to their health plans, thus reducing readmission rates and ultimately death. Patients begin taking part in the study once they are discharged from the hospital, so essentially the research serves as accountability in the interim time before their next physician visit.

Novartis is able to approach this digital health study using apps that have been backed by research as a result of the initial pilot. Novartis will be able to use apps to ensure medication is reliably taken, a major benefit for both the patients and the company.