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CHIBE Research

CHIBE researchers apply concepts from the field of behavioral economics to design, implement, and evaluate interventions that improve health and build knowledge about efficacy, cost and effectiveness. 

CHIBE Basic Science Core Request for Applications

The Basic Science Core aims to support laboratory or low-cost field studies that will shed light on mechanisms that can generate behavior change.  In contrast to previous large-scale field studies, which have often combined multiple mechanisms into one intervention in order to maximize impact on behavior, basic science projects supported by the Core focus on disentangling and precisely identifying the impacts of individual mechanisms.  CHIBE researchers interested in applying for project support can click here for more information.

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Using Social Forces to Improve Medication Adherence in Statin Users With Diabetes

Principal Investigators: Kevin Volpp, MD, PhD, Judd Kessler, PhD, Peter Reese, MD, MSCE

There is growing evidence of strong associations between a patient’s social environment and health behavior.  Social forces are worth harnessing as a strategy to promote health behaviors because patients usually engage with their physicians and nurses during occasional health system visits, but they interact with their social networks much more frequently. Furthermore, social forces may be particularly effective at building enduring habits for healthy behavior and might be cost effective to implement.  This study proposes to complete a randomized controlled trial of 200 subjects with diabetes and evidence of poor adherence to a statin medication (<70% medication possession ratio determined through pharmacy records). Study subjects will use GlowCaps to store their statin medication. Study subjects will identify potential Medication Adherence Partners (MAPs) who can receive information about their adherence patterns at enrollment. The primary outcome will be the percent of statin doses taken during the study as measured by the GlowCaps. The secondary outcome will be subjects’ statin MPR during the study.

Funder: Merck & Co.


Using Social Comparison to Improve Medication Adherence in Statin Users With Diabetes

Principal Investigators: Kevin Volpp, MD, PhD, Judd Kessler, PhD, Peter Reese, MD, MSCE

This study aims to investigate the association between a patient’s social environment and health behaviors. It has been well documented in non-health domains that providing agents with information about what others are doing can be an effective motivator. Leveraging this social force might be capable of encouraging patients to build habits for healthy behavior and might be cost effective to implement. This study specifically leverages feedback and information about the performance of others to influence individual behavior. An individual can be motivated to improve his performance when he knows he will be receiving feedback about that performance. Additionally, individuals may feel compelled to compete when their performance is compared to the performance of others. This study’s interventions will study the effects of feedback and information about others by varying what individuals are told about their medication adherence and how it compares to other people in the study. 

Funder: Merck & Co.


A Rapid Cycle Approach to Improving Medication Adherence Through Incentives and Remote Monitoring for Coronary Artery Disease Patients

Principal Investigators: Kevin Volpp, David Asch

The goal of this project is to improve medication adherence and health outcomes in post-discharge patients who are recovering from acute myocardial infarctions.  Such patients typically have high rates of poor medication adherence and hospital readmissions and are costly to monitor through intensive case management.  The intervention will increase medication adherence through use of wireless pill bottles, financial incentives, and social incentives. We are conducting this study in 38 states with 5 major insurer partners. The anticipated result will be improved health outcomes and lower cost.

Funder: Center for Medicare and Medicaid Innovation


Using Implementation Intentions Prompts to Enhance Influenza Vaccination Rates

Principal Investigator:  Milkman

The purpose of this study was to test the association between behavioral nudges and rate of flu shot vaccination among older employees at a large firm.  The results were published in the Proceedings of the National Academy of Sciences June 13, 2011.  The researchers found that those who received a reminder mailing and were prompted to write down the date and time they planned to get a flu shot had a 4.2 percentage point higher vaccination rate than those who just received a reminder in the mail.

Funder:  Roybal Center for Behavior Change in Health and Savings at the National Bureau of Economic Research


Behavioral Economics and Aging

Principal Investigator: Karlawish 

This line of research is examining the implications of the psychology and neurology of aging on theories of behavioral economics with attention to the clinical, ethical and policy issues.


Payments to Physicians

Principal Investigator: Abrams 

There is concern in the medical community that payments to physicians by pharmaceutical companies may distort prescribing behavior, whether through a conscious or unconscious mechanism. By combining a proprietary dataset covering 80 million individual prescriptions with payment data collected by state agencies the goal of this research is to produce the first empirical estimates of the relationship between pharma payments and prescription choice.

Funder: LDI CHIBE Pilot Project


Financial Incentives in Surveys of Healthcare Providers: Lotteries versus Guaranteed Payments

Principal Investigators: Halpern / Volpp 

Co-investigator:  Asch

This study will evaluate the relative efficacy of guaranteed payments (either up-front or conditional on response) vs. lotteries (in which respondents are entered into a random drawing for a larger reward) in increasing healthcare provider response to surveys. This study comprises 3 independent randomized trials of actuarially equivalent payments and lotteries.

Funded by: Greenwall Foundation and University of Pennsylvania, LDI CHIBE Pilot Project


Behavioral Economics of Privacy

Principal Investigators: Loewenstein / Acquisti / John 

Dominant theories proposed by economists and psychologists assume that people have stable, coherent, attitudes toward privacy, but this research has found that people are extremely inconsistent in their concern about privacy. A large number of field and laboratory studies have found that people are often protective of their privacy in situations in which there is no need to be, and even more often not concerned about privacy or even motivated to reveal information in situations in which caution would be warranted.


A Randomized Trial of Behavioral Economic Interventions to Reduce CVD Risk

Principal Investigators: Asch / Volpp 

Co-investigators:  Barg, Bellamy, Berger, Gaziano, Glick, Graf, Jones, Lafata, Loewenstein, Metlay, Rosenthal, Shea, Stewart, Troxel, Weiner, Weinstein

This project aims to test whether financial incentives and/or choice architecture improve the uptake of comparative effectiveness research findings related to reducing cardiovascular disease risk among physicians and patients.

Funded by: National Institutes of Health / National Institute on Aging


Developing Interactive Technologies to Improve Research and Health Behavior

Principal Investigators: Asch / Volpp

Co-investigators:  Bellamy, Halpern, Glanz, Goldberg, Groeneveld, Karlawish, Kimmel, Kuna, Loewenstein, Rozin, Shea, Troxel, Zauberman

David A. Asch, MD, MBA and Kevin G. Volpp, MD, PhD are developing IT infrastructure that will deploy clinical and behavioral research studies to advance the science at the intersection of behavioral economics and health.  The project is called Way to Health. For more information see: waytohealth.org

Funded by: National Institutes of Health / National Institute on Aging


Behavioral Economic Approaches to Dietary Control

Principal Investigators: Loewenstein / Volpp / Asch

George Loewenstein, PhD is leading a team in pilot studies to explore different ways of encouraging consumption of healthier food items by framing caloric content using various formats.

 Funded by: Aramark


The Role of Behavioral Economic Incentive Design and Demographic Characteristics in Financial-Incentive Based Approaches to Changing Health Behaviors

Prinicpal Investigators: Nancy Haff, Mitesh Patel, Kevin Volpp

Financial incentives are increasingly being used to promote health behavior change.  The role of participant demographic characteristics and incentive structure has not been well studied.  In this meta-analysis, participant-level data was pooled from previously published studies using financial incentives to promote health behavior change and associations between the effectiveness of financial incentives, demographic characteristics, and incentive structure were evaluated.


Using Smartphones to Track Health Data: A Qualitative Analysis

Principal Investigator: Mitesh Patel

Smartphones and wearable devices are increasingly being used by individuals to track health data such as physical activity.  In this study, over 1000 participants who used a smartphone to track step counts for three months were asked to report their perceptions on using these devices to track health data.

Funder: NIH Institute on Aging

 

Tags: Mitesh Patel

Team-Based Approaches for Physical Activity to Compare Social Norms Feedback With and Without Forgiveness: A Randomized, Controlled Trial

Principal Investigators: Mitesh Patel, David Asch, Kevin Volpp

Increased physical activity has been found to be associated with lower rates of all-cause mortality, cardiovascular disease, type 2 diabetes, hypertension, and stroke.  Yet, more than 50% of adults in the United States do not meet the national guidelines for minimum levels of physical activity to achieve health benefits.  This randomized, controlled trial enrolled teams of four members each who were given the goal of walking at least 7,000 steps per day.  Each team received different types of social norms feedback on their performance and outcomes were compared for groups that received feedback that accounted for all seven days of the week or forgave the two lowest days of activity, counting only 5 of 7 days per week.

Funder: NIH Institute on Aging


 


Team-Based Approaches for Physical Activity Using Financial Incentives and Social Norms Feedback: A Randomized, Controlled Trial

Principal Investigators: Mitesh Patel, David Asch, Kevin Volpp

Increased physical activity has been found to be associated with lower rates of all-cause mortality, cardiovascular disease, type 2 diabetes, hypertension, and stroke.  Yet, more than 50% of adults in the United States do not meet the national guidelines for minimum levels of physical activity to achieve health benefits.  This randomized, controlled trial enrolled teams of four members each who were given the goal of walking at least 7,000 steps per day.  Each team received different types of social norms feedback on their performance and outcomes were compared with and without financial incentives.

Funder: NIH Institute on Aging

 


CDC Prevention Research Center

Directors: Karen Glanz, PhD, MPH; Kevin Volpp, MD, PhD

A five-year, $4,350,000 grant from the Centers for Disease Control and Prevention has established a Prevention Research Center (PRC) at the University of Pennsylvania. The PRC, one of 26 in the nation, will conduct innovative public health and disease management research aimed at preventing chronic disease and reducing health disparities in Southeastern Pennsylvania. This will be the first PRC in Philadelphia.

Among other initiatives, the PRC will conduct a workplace weight loss study to evaluate environmental change strategies and incentives for decreasing obesity and preventing cardiovascular disease in employees of the City of Philadelphia, Independence Blue Cross, and the Southeastern Pennsylvania Transportation Authority (SEPTA).


Process Versus Outcomes Incentives for Lipid Management

Principal Investigators: Peter Reese, Kevin Volpp

Financial incentives have been shown to be effective at improving patient health behaviors including medication adherence in a wide variety of contexts. The delivery of such incentives has been enhanced by the recent development of new wireless technologies that facilitate the measurement of daily medication adherence and the provision of incentives in an automated fashion. However, the relative effectiveness of incentives based on process (e.g. statin adherence) versus outcome (e.g. improvements in LDL cholesterol) is unknown.This is a randomized controlled trial to evaluate the relative effectiveness and cost-effectiveness of improving cholesterol levels among participants who are at high risk of CVD and who have elevated LDL cholesterol levels by testing process versus outcomes financial incentives. 

Funder: National Heart, Lung and Blood Institute


Donor Registration Trial

Principal Investigator: Peter Reese

This Roybal pilot is a randomized, controlled trial to compare the effects of four interventions on the rate of organ donor registration by members of the general public who visit the DMV website for business unrelated to organ donor registration.

Funded by: Roybal P30 Pilot


A Pilot Intervention of an MI-Informed SMS Intervention For Poorly Controlled Type II Diabetes

Principal Investigators: Judith Long, Ilona Lorincz

This project will develop and pilot a three month randomized control trial (RCT) of a Motivational Interviewing (MI)‐informed SMS intervention tailored to patient level of activation in a population of patients with poorly controlled type II diabetes. The pilot will inform the development of a larger RCT, powered to detect a change in glycemic control.

Funded By: Roybal P30 Pilot


Retail pharmacy vouchers to promote Tdap vaccination for adults living with infants

Principal Investigators: Alison Buttenheim, Kristen Feemster

The goal of this study is to assess the feasibility, acceptability, and impact of vouchers and a high-salience celebrity PSA  on uptake of Tdap vaccination for adult caregivers of infants.

Funder: Robert Wood Johnson Foundation Health & Society Scholars Program Research Grants in Population Health and Leonard Davis Institute Health Services Research Pilot Grant