The Healthy Nudge
September 2019
Welcome to The Healthy Nudge . Each month, we'll get you up to speed on the latest developments in policy-relevant health behavioral economics research at CHIBE. Want more frequent updates? Follow us on Twitter @PennCHIBE and visit our website .
How to gamify physical activity
A new study in JAMA Internal Medicine found that a remotely monitored, behaviorally designed gamification intervention over 6 months increased physical activity the most when it was designed to promote competition (920 step-per-day increase relative to control). In addition to the competition arm, the researchers also looked at support and collaboration arms, which led to 600+ step-per-day increases. In the follow-up period, competition was the only arm still significantly greater than control with a 569 step-per-day increase. "Gamification and wearable devices are used commonly in workplace wellness programs and by digital health applications, but there is an opportunity to improve their impact on health behaviors by better incorporating behavioral insights and social incentives," lead study author Mitesh Patel, MD, MBA, MS , said in a press release . Read the CNN story here .
Could texts help increase colonoscopy show rates?
A new study published in Health Education & Behavior found that patients enrolled in a bidirectional, automated text message navigation program had significantly higher colonoscopy show rates ( 90 %) as compared with patients receiving usual care ( 62 %). “Automated text messaging and new insights from behavioral science offer opportunities to effectively and efficiently engage with patients before important health prevention activities,” Shivan Mehta, MD, MBA , said in a press release . Read the Forbes article , " Can Texting Patients Who Are Scheduled For Colonoscopy Reduce 'No-Shows'? " or watch Dr. Mehta's video interview with JAMA Network Open Live .
Testing financial incentive structures on step counts
“Is it more effective to disburse fixed total financial incentives at a constant, increasing, or decreasing rate to encourage physical activity?” This was the question posed by a recent study published in JAMA Network Open by CHIBE affiliates Chethan Bachireddy, MD ; Leslie John, PhD ; and Katherine Milkman, PhD . The study found that financial incentives for daily step counts were more effective during a payment period when they were offered at a constant rate than at an increasing or decreasing rate. However, shortly after the incentives were removed, physical activity in all arms tapered. Read the Inverse coverage here .
CHIBE Profile: Tamar Klaiman, PhD, MPH
Tamar Klaiman, PhD, MPH, is Senior Qualitative Research Scientist at CHIBE and the Palliative and Advanced Illness Research Center (PAIR).
What projects are you currently involved in at CHIBE?
I am primarily working on the CHF Empower Program where we are learning about patients’ and providers’ experiences in a study funded by the National Institutes of Health that tests ways to reduce hospital readmissions for Penn Medicine heart failure patients using remote monitoring devices to track weights and diuretic adherence. I am also supporting a number of proposals in progress that will include qualitative components. I also lead workshops and trainings for staff focused on how to conduct effective qualitative research.

What is the value of doing qualitative research?
In a nutshell, quantitative research answers the question “what is happening?” while qualitative answers the question, “why is it happening?” Qualitative work can help us understand why an intervention works (or doesn’t work) and for whom – and under what circumstances. Qualitative research also allows researchers to design interventions that are as effective as possible in their population of interest.

What do you find most rewarding about your work?
The most rewarding part of my work is when study participants feel that their contributions are valued by researchers. I also love when investigators learn something new or see things differently because of what participants felt about projects in which they are participants. I have seen projects transformed by the insights of participants, and I believe that understanding their perspectives makes research more robust and actionable.  
CHIBE In the News
Way to Health, 10 Years On
The Way to Health platform, which uses behavioral economics-based interventions to improve patient outcomes, is celebrating its 10-year anniversary. Read this Penn Medicine blogpost about its genesis, growth, and future directions, and hear from David Asch, MD, MBA; Kevin Volpp, MD, PhD; Mohan Balachandran, MS; Christianne Sevinc, MPH; and Laurie Norton, MA .
Mitesh Patel Wins BX Award for Outstanding Practitioner
Congratulations to Mitesh Patel, MD, MBA, MS , part of CHIBE’s leadership team and Director of the Penn Medicine Nudge Unit , who received the BX Award for Outstanding Practitioner of the Year on September 5 in London. This award is given to one person across all industries internationally. According to The Behavioural Insights Team website, this award is given to an individual who has made an outstanding contribution to the field of behavioral science and policy. Read his nomination here on our blog .
Online Graduate Credit Course in Health Care Innovation: Translating Ideas Into Outcomes
October 22 – December 9, 2019
Translating Ideas Into Outcomes
This course, taught by a CHIBE-affiliated faculty member, is designed for those who want to engage in applying state-of-the-art innovation methodology to make a meaningful difference for patients, providers, and health care organizations. Learn more and sign up on the Medical Ethics & Health Policy Online Education website .
New Publications
Olivier Aubert, Peter P. Reese, Benoit Audry, Yassine Bouatou, Marc Raynaud, Denis Viglietti, Christophe Legendre, Denis Glotz, Jean-Phillipe Empana, Xavier Jouven, Carmen Lefaucheur, Christian Jacquelinet, Alexandre Loupy. Disparities in Acceptance of Deceased Donor Kidneys Between the United States and France and Estimated Effects of Increased US Acceptance. JAMA Internal Medicine
Wei Chang, Primrose Matambanadzo, Albert Takaruza, Karin Hatzold, Frances M. Cowan, Euphemia Sibanda, Harsha Thirumurthy. Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe. JAMA Network Open.  
Amol S. Navathe, Claire Dinh, Sarah E Dykstra, Rachel M Werner, Joshua M Liao. Overlap between Medicare’s Voluntary Bundled Payment and Accountable Care Organization Programs. Journal of Hospital Medicine. 
Shivan J. Mehta, Vikranth Induru, David Santos, Catherine Reitz, Timothy McAuliffe, Charles Orellana, Kevin G. Volpp, David A. Asch, Chyke A. Doubeni. Effect of Sequential or Active Choice for Colorectal Cancer Screening Outreach. JAMA Network Open.
Chén C. Kenyon, Kavya G. Sundar, Siobhan M. Gruschow, William O. Quarshie, Chris Feudtner, Tyra C. Bryant-Stephens, Victoria A. Miller. Tailored Medication Adherence Incentives for High-Risk Children with Asthma: A Pilot Study. Journal of Asthma
Robert E Burke, Chelsea Leonard, Marcie Lee, Roman Ayele, Ethan Cumbler, Rebecca Allyn, Ryan Greysen. Cognitive Biases Influence Decision-Making Regarding Post-acute Care in a Skilled Nursing Facility. Journal of Hospital Medicine.
Matthew J. Stotts, Justin A. Grischkan, Vandana Khungar. Improving Cirrhosis Care: The Potential For Telemedicine And Mobile Health Technologies . World Journal of Gastroenterology.
Rebecca E. Stewart, Nathaniel Williams, Y. Vivian Byeon, Alison Buttenheim, Sriram Sridharan, Kelly Zentgraf, David T. Jones, Katelin Hoskins, Molly Candon, Rinad S. Beidas. The Clinician Crowdsourcing Challenge: Using Participatory Design to Seed Implementation Strategies. Implementation Science.
Douglas L. Hill, Jennifer K. Walter, Julia E. Szymczak, Concetta DiDomenico, Shefali Parikh, Chris Feudtner. Seven Types of Uncertainty when Clinicians Care for Pediatric Patients with Advanced Cancer. Journal of Pain and Symptom Management. 
Chethan Bachireddy, Andrew Joung, Leslie K. John, Francesca Gino, Bradford Tuckfield, Luca Foschini, Katherine L. Milkman. Effect of Different Financial Incentive Structures on Promoting Physical Activity Among Adults. JAMA Network Open.
Christopher Manz, Katharine Rendle, Justin Bekelman. Mind The Gap: How Vulnerable Patients Fall Through The Cracks Of Cancer Quality Metrics. BMJ Quality & Safety.
Dustin C. Krutsinger, Kuldeep N. Yadav. Elizabeth Cooney, Steven Brooks, Scott D. Halpern, Katherine R. Courtright. A Pilot Randomized Trial of Five Financial Incentive Strategies To Increase Study Enrollment And Retention Rates. Contemporary Clinical Trials Communications.  
Megan H. Noe, Daniel B. Shin, Jalpa A. Doshi, David J. Margolis, Joel M. Gelfand. Prescribing Patterns Associated With Biologic Therapies for Psoriasis from a United States Medical Records Database. Journal of Drugs in Dermatology.  
The Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania conducts behavioral economics research aimed at reducing the disease burden from major U.S. public health problems. Originally founded within the Leonard Davis Institute of Health Economics , our mission is to inform health policy, improve health care delivery, and increase healthy behavior.