Uncovering a Behavioral Strategy for Establishing New Habits : Evidence from Incentives for Medication Adherence in Uganda

Incentives are used to improve many health-related behaviors, but evidence is mixed for their effectiveness both during the incentivization period and, even more so, on the persistence of healthier habits after incentives are withdrawn. In this paper, we present the results of a randomized controlled trial that successfully uses incentives to improve medication adherence among HIV-infected patients in Uganda over 20 months, and follows the sample for another 6 months to measure the persistence of these behavioral improvements. Our study contributes to the literature on habit formation by identifying a behavioral strategy that is associated with persistently high medication adherence and independent of observable individual-level characteristics and the receipt of incentives. We reject the prevailing economic theory of habit formation in favor of a psychological definition of habits as reflexive context-behavior associations, and these findings help outline an expanded set of intervention design parameters for better promoting persistent, healthier behaviors