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The role of time and risk preferences in adherence to physician advice on health behavior change

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Changing physical activity and dietary behavior in chronic disease patients is associated with significant health benefits but is difficult to achieve. An often-used strategy is for the physician or other health professional to encourage behavior changes by providing advice on the health consequences of such behaviors. However, adherence to advice on health behavior change varies across individuals. This paper uses data from a population-based cross-sectional survey of 1849 individuals with chronic disease to explore whether differences in individuals’ time and risk preferences can help explain differences in adherence. Health behaviors are viewed as investments in health capital within the Grossman model. Physician advice plays a role in the model in that it improves the understanding of the future health consequences of investments. It can be hypothesized that the effect of advice on health behavior will depend on an individuals’ time and risk preference. Within the survey, which measured a variety of health-related behaviors and outcomes, including receipt and compliance with advice on dietary and physical activity changes, time preferences were measured using financial planning horizon, and risk preferences were measured through a commonly used question which asked respondents to indicate their willingness to take risks on a ten-point scale. Results suggest that time preferences play a role in adherence to physical activity advice. While time preferences also play a role in adherence to dietary advice, this effect is only apparent for males. Risk preferences do not seem to be associated with adherence. The results suggest that increasing the salience of more immediate benefits of health behavior change may improve adherence.

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  1. In the remainder of the paper, the term physician advice includes advice from physician or any other health professional.


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The Interdisciplinary Chronic Disease Collaboration (ICDC) is funded through the Alberta Heritage Foundation for Medical Research (AHFMR) Inter-disciplinary Team Grants Program. AHFMR is now Alberta Innovates-Health Solutions (AI-HS). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. The Chief Scientist Office of the Scottish Government Health and Social Care Directorates funds HERU. The views expressed in this paper are those of the authors only and not those of the funding bodies.

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Correspondence to Marjon van der Pol.


Appendix 1. Survey questions

Adherence questions

The next questions are about things that a doctor or other health professional may have suggested to help manage your ^CONDITION, and the things that people might do as a result of being diagnosed.

Has a doctor or other health professional ever suggested/recommended: eating certain foods such as fruits and vegetables, fish or lean meats, foods high in fiber or foods low in fat to help manage your chronic disease?

  • Yes

  • No

Did you ever change type of foods you eat, for example choosing more fruits and vegetables, fish or lean meats, foods high in fiber or foods low in fat to help manage your chronic condition?

  • Yes

  • No

Are you still doing this:

  • All of the time

  • Most of the time

  • Some of the time

  • None of the time

Has a doctor or other health professional ever suggested/recommended: that you exercise or participate in physical activities to help manage your chronic condition?

  • Yes

  • No

Did you ever exercise or participate in physical activities to help manage your chronic condition?

  • Yes

  • No.

Are you still doing this.

  • All of the time.

  • Most of the time.

  • Some of the time.

  • None of the time.

Planning horizon

In planning your saving and spending, which of the following time periods is most important to you?

  • The next week.

  • The next few months.

  • The next year.

  • The next 2–4 years.

  • The next 5–10 years.

  • More than 10 years ahead.


Are you generally a person who is fully prepared to take risks, or do you try to avoid taking risks?

On a scale ranging from 1 (Unwilling to take risks) to 10 (Fully prepared to take risks), where would you place yourself?

  • 1: Unwilling to take risks.

  • 2

  • 3

  • 4

  • 5

  • 6

  • 7

  • 8

  • 9

  • 10: Fully prepared to take risks.

Appendix 2

See Table 7.

Table 7 Regression results for time and risk preferences

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van der Pol, M., Hennessy, D. & Manns, B. The role of time and risk preferences in adherence to physician advice on health behavior change. Eur J Health Econ 18, 373–386 (2017).

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