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Verbesserung der Adhärenz zur Lebensstiländerung von Menschen mit Diabetes

Implikationen aus Ökonomie und Verhaltensökonomie
  • Markus VomhofEmail author
Leitthema
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Zusammenfassung

Bei der Integration eines gesünderen Lebensstils in den Alltag stellt die Adhärenz für viele Menschen mit Typ-2-Diabetes eine Herausforderung dar. Anhand ökonomischer und verhaltensökonomischer Literatur wurde untersucht, wie diese verbessert werden kann. Da Lebensstilveränderungen eher akzeptiert werden, wenn sie an den Präferenzen der Teilnehmer ausgerichtet sind, ist es notwendig diese Präferenzen zu beachten, um die Adhärenz zu derartigen Lebensstilveränderungen zu verbessern. Darüber hinaus können diese durch finanzielle und nichtfinanzielle Anreize unterstützt werden. In der Verhaltensökonomie werden systematische Abweichungen von rationalem Verhalten identifiziert, die einerseits aufzeigen, welche Verzerrungen ungesundes Verhalten begünstigen, und andererseits, wie Lebensstilinterventionen effektiver gestaltet werden können. So helfen die Erkenntnisse aus der Verhaltensökonomie, Anreize effektiver und zielgerichteter einzusetzen. Auch die Berücksichtigung individueller Risiko- und Zeitpräferenzen, die Einfluss auf viele Entscheidungen im Rahmen von Therapie, Adhärenz, Selbstmanagement und Lebensstiländerung von Menschen mit Diabetes haben, kann hilfreich sein, patientenzentrierte und wirksame Lebensstilinterventionen zu entwickeln.

Schlüsselwörter

Patientenzentrierung Patienten Präferenzen Verhaltensökonomische Ansätze Anreize Risikopräferenzen 

Improving adherence to lifestyle changes in people with diabetes

Economic and behavioral economic implications

Abstract

When integrating a healthier lifestyle in everyday routine, adherence is a challenge for many people with type 2 diabetes mellitus. Based on economic and behavioral economic literature, this article analyzes how adherence can be improved. Since lifestyle changes are better accepted if they are aligned with the preferences of participants, it is necessary to consider preferences to improve adherence. Moreover, financial and non-financial incentives might be implemented to support lifestyle changes. The discipline of behavioral economics identifies systemic deviations from rationality which, on the one hand, specifies biases that foster unhealthy behavior and, on the other, advises how behavioral lifestyle interventions can be designed more effective. Thus, insights from behavioral economics can be used to make incentives more effective and tailored. Moreover, considering individual risk and time preferences, which affect many decisions regarding therapy, adherence, self-management, and lifestyle changes in people with diabetes, may help to design patient-centered and more effective behavioral interventions.

Keywords

Patient-Centeredness Patient preferences Behavioral economics Approaches Incentives Risk preferences 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Vomhof gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden vom Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Dunkley AJ, Bodicoat DH, Greaves CJ, Russell C, Yates T, Davies MJ, Khunti K (2014) Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabetes Care 37:922–933.  https://doi.org/10.2337/dc13-2195 CrossRefPubMedGoogle Scholar
  2. 2.
    Chen L, Pei J‑H, Kuang J, Chen H‑M, Chen Z, Li Z‑W, Yang H‑Z (2015) Effect of lifestyle intervention in patients with type 2 diabetes: a meta-analysis. Metab Clin Exp 64:338–347.  https://doi.org/10.1016/j.metabol.2014.10.018 CrossRefPubMedGoogle Scholar
  3. 3.
    Zhao G, Ford ES, Li C, Mokdad AH (2008) Compliance with physical activity recommendations in US adults with diabetes. Diabet Med 25:221–227.  https://doi.org/10.1111/j.1464-5491.2007.02332.x CrossRefPubMedGoogle Scholar
  4. 4.
    Bailey CJ, Kodack M (2011) Patient adherence to medication requirements for therapy of type 2 diabetes. Int J Clin Pract 65:314–322.  https://doi.org/10.1111/j.1742-1241.2010.02544.x CrossRefPubMedGoogle Scholar
  5. 5.
    Anderson JR, Novak JR, Johnson MD, Deitz SL, Walker A, Wilcox A et al (2016) A dyadic multiple mediation model of patient and spouse stressors predicting patient dietary and exercise adherence via depression symptoms and diabetes self-efficacy. J Behav Med 39:1020–1032.  https://doi.org/10.1007/s10865-016-9796-9 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    August KJ, Sorkin DH (2010) Marital status and gender differences in managing a chronic illness: the function of health-related social control. Soc Sci Med 71:1831–1838.  https://doi.org/10.1016/j.socscimed.2010.08.022 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Abubakari A‑R, Cousins R, Thomas C, Sharma D, Naderali EK (2016) Sociodemographic and clinical predictors of self-management among people with poorly controlled type 1 and type 2 diabetes: the role of illness perceptions and self-efficacy. J Diabetes Res 2016:6708164.  https://doi.org/10.1155/2016/6708164 CrossRefPubMedGoogle Scholar
  8. 8.
    Sumlin LL, Garcia TJ, Brown SA, Winter MA, García AA, Brown A, Cuevas HE (2014) Depression and adherence to lifestyle changes in type 2 diabetes: a systematic review. Diabetes Educ 40:731–744.  https://doi.org/10.1177/0145721714538925 CrossRefPubMedGoogle Scholar
  9. 9.
    Wallace AS, Carlson JR, Malone RM, Joyner J, Dewalt DA (2010) The influence of literacy on patient-reported experiences of diabetes self-management support. Nurs Res 59:356–363.  https://doi.org/10.1097/NNR.0b013e3181ef3025 CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Náfrádi L, Nakamoto K, Schulz PJ (2017) Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control and medication adherence. PLoS ONE 12:e186458.  https://doi.org/10.1371/journal.pone.0186458 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Sloan FA, Padrón NA, Platt AC (2009) Preferences, beliefs, and self-management of diabetes. Health Serv Res 44:1068–1087.  https://doi.org/10.1111/j.1475-6773.2009.00957.x CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Ahola AJ, Groop P‑H (2013) Barriers to self-management of diabetes. Diabet Med 30:413–420.  https://doi.org/10.1111/dme.12105 CrossRefPubMedGoogle Scholar
  13. 13.
    Ostermann J, Brown DS, de Bekker-Grob EW, Mühlbacher AC, Reed SD (2017) Preferences for health interventions: improving uptake, adherence, and efficiency. Patient 10:511–514.  https://doi.org/10.1007/s40271-017-0251-y CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Scholl I, Zill JM, Härter M, Dirmaier J (2014) An integrative model of patient-centeredness—a systematic review and concept analysis. PLoS ONE 9:e107828.  https://doi.org/10.1371/journal.pone.0107828 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Soekhai V, de Bekker-Grob EW, Ellis AR, Vass CM (2019) Discrete choice experiments in health economics: past, present and future. Pharmacoeconomics 37:201–226.  https://doi.org/10.1007/s40273-018-0734-2 CrossRefPubMedGoogle Scholar
  16. 16.
    de Bekker-Grob EW, Ryan M, Gerard K (2012) Discrete choice experiments in health economics: a review of the literature. Health Econ 21:145–172.  https://doi.org/10.1002/hec.1697 CrossRefPubMedGoogle Scholar
  17. 17.
    Clark MD, Determann D, Petrou S, Moro D, de Bekker-Grob EW (2014) Discrete choice experiments in health economics: a review of the literature. Pharmacoeconomics 32:883–902.  https://doi.org/10.1007/s40273-014-0170-x CrossRefPubMedGoogle Scholar
  18. 18.
    Bridges JFP, Hauber AB, Marshall D, Lloyd A, Prosser LA, Regier DA et al (2011) Conjoint analysis applications in health—a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force. Value Health 14:403–413.  https://doi.org/10.1016/j.jval.2010.11.013 CrossRefPubMedGoogle Scholar
  19. 19.
    Rydén A, Chen S, Flood E, Romero B, Grandy S (2017) Discrete choice experiment attribute selection using a multinational interview study: treatment features important to patients with type 2 diabetes mellitus. Patient 10:475–487.  https://doi.org/10.1007/s40271-017-0225-0 CrossRefPubMedGoogle Scholar
  20. 20.
    Janssen EM, Segal JB, Bridges JFP (2016) A framework for instrument development of a choice experiment: an application to type 2 diabetes. Patient 9:465–479.  https://doi.org/10.1007/s40271-016-0170-3 CrossRefPubMedGoogle Scholar
  21. 21.
    Joy SM, Little E, Maruthur NM, Purnell TS, Bridges JFP (2013) Patient preferences for the treatment of type 2 diabetes: a scoping review. Pharmacoeconomics 31:877–892.  https://doi.org/10.1007/s40273-013-0089-7 CrossRefPubMedGoogle Scholar
  22. 22.
    Purnell TS, Joy S, Little E, Bridges JFP, Maruthur N (2014) Patient preferences for noninsulin diabetes medications: a systematic review. Diabetes Care 37:2055–2062.  https://doi.org/10.2337/dc13-2527 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    von Arx L‑B, Kjeer T (2014) The patient perspective of diabetes care: a systematic review of stated preference research. Patient 7:283–300.  https://doi.org/10.1007/s40271-014-0057-0 CrossRefGoogle Scholar
  24. 24.
    Veldwijk J, Lambooij MS, van Gils PF, Struijs JN, Smit HA, de Wit GA (2013) Type 2 diabetes patients’ preferences and willingness to pay for lifestyle programs: a discrete choice experiment. BMC Public Health 13:1099.  https://doi.org/10.1186/1471-2458-13-1099 CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Whitty JA, Fraenkel L, Saigal CS, Groothuis-Oudshoorn CGM, Regier DA, Marshall DA (2017) Assessment of individual patient preferences to inform clinical practice. Patient 10:519–521.  https://doi.org/10.1007/s40271-017-0254-8 CrossRefPubMedGoogle Scholar
  26. 26.
    Barte JCM, Wendel-Vos GCW (2017) A systematic review of financial incentives for physical activity: the effects on physical activity and related outcomes. Behav Med 43:79–90.  https://doi.org/10.1080/08964289.2015.1074880 CrossRefPubMedGoogle Scholar
  27. 27.
    Mitchell MS, Goodman JM, Alter DA, John LK, Oh PI, Pakosh MT, Faulkner GE (2013) Financial incentives for exercise adherence in adults: systematic review and meta-analysis. Am J Prev Med 45:658–667.  https://doi.org/10.1016/j.amepre.2013.06.017 CrossRefPubMedGoogle Scholar
  28. 28.
    Tambor M, Pavlova M, Golinowska S, Arsenijevic J, Groot W (2016) Financial incentives for a healthy life style and disease prevention among older people: a systematic literature review. Bmc Health Serv Res 16(Suppl 5):426.  https://doi.org/10.1186/s12913-016-1517-0 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Strohacker K, Galarraga O, Williams DM (2014) The impact of incentives on exercise behavior: a systematic review of randomized controlled trials. Ann Behav Med 48:92–99.  https://doi.org/10.1007/s12160-013-9577-4 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Patel MS, Asch DA, Rosin R, Small DS, Bellamy SL, Eberbach K et al (2016) Individual versus team-based financial incentives to increase physical activity: a randomized, controlled trial. J Gen Intern Med 31:746–754.  https://doi.org/10.1007/s11606-016-3627-0 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sumida Y, Yoshikawa T, Tanaka S, Taketani H, Kanemasa K, Nishimura T et al (2014) The ‘donations for decreased ALT (D4D)’ prosocial behavior incentive scheme for NAFLD patients. J Public Health 36:629–634.  https://doi.org/10.1093/pubmed/fdt098 CrossRefGoogle Scholar
  32. 32.
    Wanders JOP, Veldwijk J, de Wit GA, Hart HE, van Gils PF, Lambooij MS (2014) The effect of out-of-pocket costs and financial rewards in a discrete choice experiment: an application to lifestyle programs. BMC Public Health 14:870.  https://doi.org/10.1186/1471-2458-14-870 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Moller AC, Buscemi J, McFadden HG, Hedeker D, Spring B (2014) Financial motivation undermines potential enjoyment in an intensive diet and activity intervention. J Behav Med 37:819–827.  https://doi.org/10.1007/s10865-013-9542-5 CrossRefPubMedGoogle Scholar
  34. 34.
    Moller AC, McFadden HG, Hedeker D, Spring B (2012) Financial motivation undermines maintenance in an intensive diet and activity intervention. J Obes 2012:740519.  https://doi.org/10.1155/2012/740519 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Gneezy U, Meier S, Rey-Biel P (2011) When and why incentives (don’t) work to modify behavior. J Econ Perspect 25:191–209.  https://doi.org/10.1257/jep.25.4.191 CrossRefGoogle Scholar
  36. 36.
    Thaler RH (2018) From cashews to nudges: The evolution of behavioral economics. Am Econ Rev 108:1265–1287CrossRefGoogle Scholar
  37. 37.
    Thorgeirsson T, Kawachi I (2013) Behavioral economics: merging psychology and economics for lifestyle interventions. Am J Prev Med 44:185–189.  https://doi.org/10.1016/j.amepre.2012.10.008 CrossRefPubMedGoogle Scholar
  38. 38.
    Gigerenzer G, Gaissmaier W (2011) Heuristic decision making. Annu Rev Psychol 62:451–482CrossRefGoogle Scholar
  39. 39.
    Marewski JN, Gigerenzer G (2012) Heuristic decision making in medicine. Dialogues Clin Neurosci 14:77–89PubMedPubMedCentralGoogle Scholar
  40. 40.
    Tversky A, Kahneman D (1974) Judgment under uncertainty: heuristics and biases. Science 185:1124–1131.  https://doi.org/10.1126/science.185.4157.1124 CrossRefPubMedGoogle Scholar
  41. 41.
    Kairies-Schwarz N, Kokot J, Vomhof M, Weßling J (2017) Health insurance choice and risk preferences under cumulative prospect theory: An experiment. J Econ Behav Organ 137:374–397CrossRefGoogle Scholar
  42. 42.
    Loewenstein G, Brennan T, Volpp KG (2007) Asymmetric paternalism to improve health behaviors. JAMA 298:2415–2417.  https://doi.org/10.1001/jama.298.20.2415 CrossRefPubMedGoogle Scholar
  43. 43.
    Loewenstein G, Asch DA, Friedman JY, Melichar LA, Volpp KG (2012) Can behavioural economics make us healthier? BMJ 344:e3482.  https://doi.org/10.1136/bmj.e3482 CrossRefPubMedGoogle Scholar
  44. 44.
    Williams AM, Liu PJ, Muir KW, Waxman EL (2018) Behavioral economics and diabetic eye exams. Prev Med 112:76–87.  https://doi.org/10.1016/j.ypmed.2018.04.006 CrossRefPubMedGoogle Scholar
  45. 45.
    Samuelson W, Zeckhauser R (1988) Status quo bias in decision making. J Risk Uncertain.  https://doi.org/10.1007/BF00055564 CrossRefGoogle Scholar
  46. 46.
    Story GW, Vlaev I, Seymour B, Darzi A, Dolan RJ (2014) Does temporal discounting explain unhealthy behavior? A systematic review and reinforcement learning perspective. Front Behav Neurosci 8:76.  https://doi.org/10.3389/fnbeh.2014.00076 CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Lawless L, Drichoutis AC, Nayga RM (2013) Time preferences and health behaviour: a review. Agric Food Econ 1:1–19.  https://doi.org/10.1186/2193-7532-1-17 CrossRefGoogle Scholar
  48. 48.
    Barlow P, Reeves A, McKee M, Galea G, Stuckler D (2016) Unhealthy diets, obesity and time discounting: a systematic literature review and network analysis. Obes Rev 17:810–819.  https://doi.org/10.1111/obr.12431 CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Hunter RF, Tang J, Hutchinson G, Chilton S, Holmes D, Kee F (2018) Association between time preference, present-bias and physical activity: implications for designing behavior change interventions. BMC Public Health 18:1388.  https://doi.org/10.1186/s12889-018-6305-9 CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Karl FM, Holle R, Schwettmann L, Peters A, Laxy M (2018) Time preference, outcome expectancy, and self-management in patients with type 2 diabetes. Patient Prefer Adherence 12:1937–1945.  https://doi.org/10.2147/PPA.S175045 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Mørkbak MR, Gyrd-Hansen D, Kjær T (2017) Can present biasedness explain early onset of diabetes and subsequent disease progression? Exploring causal inference by linking survey and register data. Soc Sci Med 186:34–42.  https://doi.org/10.1016/j.socscimed.2017.05.050 CrossRefPubMedGoogle Scholar
  52. 52.
    Simon-Tuval T, Shmueli A, Harman-Boehm I (2016) Adherence to self-care behaviors among patients with type 2 diabetes—the role of risk preferences. Value Health 19:844–851.  https://doi.org/10.1016/j.jval.2016.04.003 CrossRefPubMedGoogle Scholar
  53. 53.
    Rouyard T, Attema A, Baskerville R, Leal J, Gray A (2018) Risk attitudes of people with ‘manageable’ chronic disease: an analysis under prospect theory. Soc Sci Med 214:144–153.  https://doi.org/10.1016/j.socscimed.2018.08.007 CrossRefPubMedGoogle Scholar
  54. 54.
    Quaife M, Terris-Prestholt F, Di Tanna GL, Vickerman P (2018) How well do discrete choice experiments predict health choices? A systematic review and meta-analysis of external validity. Eur J Health Econ 19:1053–1066.  https://doi.org/10.1007/s10198-018-0954-6 CrossRefPubMedGoogle Scholar
  55. 55.
    Ferecatu A, Önçüler A (2016) Heterogeneous risk and time preferences. J Risk Uncertain 53:1–28CrossRefGoogle Scholar
  56. 56.
    Bleichrodt H, Gao Y, Rohde KIM (2016) A measurement of decreasing impatience for health and money. J Risk Uncertain 52:212–231CrossRefGoogle Scholar
  57. 57.
    Andersen S, Harrison GW, Igel Lau M, Rutström EE (2014) Discounting behavior: a reconsideration. Eur Econ Rev 71:15–33CrossRefGoogle Scholar
  58. 58.
    Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M et al (2012) Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 35:1364–1379.  https://doi.org/10.2337/dc12-0413 CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M et al (2015) Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 38:140–149.  https://doi.org/10.2337/dc14-2441 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Institut für Versorgungsforschung und Gesundheitsökonomie, Deutsches Diabetes-Zentrum (DDZ)Leibniz-Zentrum für Diabetes-Forschung an der Heinrich Heine Universität DüsseldorfDüsseldorfDeutschland
  2. 2.Institut für Versorgungsforschung und Gesundheitsökonomie, Medizinische FakultätHeinrich Heine Universität DüsseldorfDüsseldorfDeutschland

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