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

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Abstract

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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Notes

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

References

  1. Adams, J., Nettle, D.: Time perspective, personality and smoking, body mass, and physical activity: an empirical study. Br. J. Health Psychol. 14, 83–105 (2009)

    Article  PubMed  Google Scholar 

  2. Becker, G.S., Mulligan, C.B.: The endogenous determination of time preference. Q. J. Econ. 112, 729–758 (1997)

    Article  Google Scholar 

  3. Barsky, R.B., Kimball, M.S., Juster, F.T., Shapiro, M.D.: Preference parameters and behavioral heterogeneity: an experimental approach in the health and retirement study. Quart. J. Econ. 112, 537–579 (1997)

    Article  Google Scholar 

  4. Blumenthal, J.A., Sherwood, A., Gulette, E.C., Babyak, M., Waugh, R.: Exercise and weight loss reduce blood pressure in men and women with mild hypertension: effects on cardiovascular, metabolic, and hemodynamic functioning. Arch. Intern. Med. 160(13), 1947–1958 (2001)

    Article  Google Scholar 

  5. Boule, N.G., Haddad, E., Kenny, G.P., Wells, G.A., Sigal, R.J.: Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 286(10), 1218–1227 (2001)

    Article  CAS  PubMed  Google Scholar 

  6. Brandt, S., Dickinson, M.S.: Time and risk preferences and the use of asthma controller medication. Pediatrics 131, e1204–e1210 (2013)

    Article  PubMed  Google Scholar 

  7. Campbell, J.T., Ronksley, P.E., Manns, B.J., Tonelli, M., Sanmartin, C., Weaver, R.G., Hennessy, D., King-Shier, K., Campbell, T., Hemmelgarn, B.R.: The association of income with health behavior change and disease monitoring among patients with chronic disease. Plos One 9(4), e94007 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chapman, G.B., Brewer, N.T., Coups, E.J., Borwlee, S., Leventhal, H., Leventhal, E.A.: Value for the future and preventive behaviour. J. Exp. Psychol. 7, 235–250 (2001)

    CAS  Google Scholar 

  9. Christensen-Szalanski, J.J.J., Nortcraft, G.B.: Patient compliance behaviour: the effect of time on patients’ values of treatment regimens. Soc. Sci. Med. 21, 263–273 (1985)

    Article  CAS  PubMed  Google Scholar 

  10. Dardanoni, V., Wagstaff, A.: Uncertainty and the demand for medical care. J. Health Econ. 9, 23–28 (1990)

    Article  CAS  PubMed  Google Scholar 

  11. Dohmen, T., Falk, A., Huffman, D., Sunde, U., Schupp, J., Wagner, G.G.: Individual risk attitudes: measurement, determinants and behavioral consequences. J. Eur. Econ. Assoc. 9, 522–550 (2011)

    Article  Google Scholar 

  12. Elliott, R.A., Shinogle, J.A., Peele, P., Bhosle, M., Hughes, D.A.: Understanding medication compliance and persistence from an economics perspective. Value Health 11, 600–610 (2008)

    Article  PubMed  Google Scholar 

  13. Feldman, S.R., Chen, G.J., Hu, J.Y., Fleischer, A.B.: Effects of systematic asymmetric discounting on physician–patient interactions: a theoretical framework to explain poor compliance with lifestyle counselling. BMC Med. Inform. Decis. Mak. 2, 8 (2002)

    Article  PubMed  PubMed Central  Google Scholar 

  14. Fitzgerald, N., Spaccarotella, K.: Barriers to a healthy lifestyle: from individuals to public policy—an ecological perspective. J. Ext. 47, 1 (2009)

    Google Scholar 

  15. Frederick, S., Loewenstein, G., O’Donoghue, T.: Time discounting and time preference: a critical review. J. Econ. Lit. 40, 351–401 (2002)

    Article  Google Scholar 

  16. Greene: Econometric analysis. Prentice Hall (2003)

  17. Hall, P.A., Fong, G.T.: The effects of a brief time perspective intervention for increasing physical activity among young adults. Psychol. Health 18, 685–706 (2003)

    Article  Google Scholar 

  18. Jusot, F., Khlat, M.: The role of time preferences in smoking inequalities: a population-based study. Addict. Behav. 38, 2167–2173 (2013)

    Article  PubMed  Google Scholar 

  19. Kardas, P., Lewek, P., Matyjaszczyk, M.: Determinants of patient adherence: a review of systematic reviews. Front Pharmacol. 2013(4), 91 (2013)

    Google Scholar 

  20. Kenkel, D., Terza, J.V.: The effect of physician advice on alcohol consumption: count regression with an endogenous treatment effect. J. App. Econom. 16, 165–184 (2001)

    Article  Google Scholar 

  21. Khwaja, A., Silverman, D., Sloan, F.: Time preference, time discounting and smoking decisions. J. Health Econ. 26, 927–949 (2007)

    Article  PubMed  Google Scholar 

  22. Lawless, L., Drichoutis, A.C., Nayga, R.M.: Time preferences and health behaviour: a review. Agric. Food Econ. 1, 17 (2013)

    Article  Google Scholar 

  23. Lazaro, A., Barberan, R., Rubio, E.: Private and social time preferences for health and money: an empirical estimation. Health Econ. 10, 351–356 (2001)

    Article  CAS  PubMed  Google Scholar 

  24. Lichtenstein, A.H., Appel, L.J., Brands, M., Carnethon, M., Daniels, S.: Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation 114(1), 82–96 (2006)

    Article  PubMed  Google Scholar 

  25. Loureiro, M.L., Nayga, R.M.: Physician’s advice affects adoption of desirable dietary behaviors. Rev. Agric. Econ. 29, 318–330 (2007)

    Article  Google Scholar 

  26. Manuel, D.G., Perez, R., Bennett, C., Rosella, L., Taljaard, M., et al.: Seven more years: the impact of smoking, alcohol, diet, physical activity and stress on health and life expectancy in Ontario. Institute for Clinical Evaluative Sciences and Public Health Ontario, Toronto (2012)

    Google Scholar 

  27. Manuel, D.G.: The burden of unhealthy living in Ontario: the impact of smoking, alcohol, diet, physical inactivity and stress on life expectancy. Healthc. Q. 16(1), 16–18 (2013)

    PubMed  Google Scholar 

  28. Manuel, D.G., Perez, R., Bennett, C., Rosella, L., Choi, B.: 900,000 days in hospital: the annual impact of smoking, alcohol, diet, and physical activity on hospital use in Ontario. Institute for Clinical Evaluative Sciences, Toronto (2014)

    Google Scholar 

  29. Manuel, D.G., Tuna, M., Perez, R., Tanuseputro, P., Hennessy, D., Bennett, C., Rosella, L., Sanmarin, C., van Walraven, C., Tu, J.V.: Predicting stroke based on health behaviours: development of the Stroke population risk tool (SPoRT). PLoS One 10(12), e0143342 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  30. Pfeifer, C.: A note on smoking behavior and health risk taking. Nord. J. Health Econ. (2012)

  31. Picone, G., Sloan, F., Taylor, D.: Effects of risk and time preference and expected longevity on demand for medical tests. J. Risk Uncertain. 28, 39–53 (2004)

    Article  Google Scholar 

  32. Reach, G.: A novel conceptual framework for understanding the mechanism of adherence to long term therapies. Patients Preferences Adherence 2, 7–19 (2008)

    Google Scholar 

  33. Rosella, L.C., Manuel, D.G., Burchill, C., et al.: A population-based risk algorithm for the development of diabetes: development and validation of the diabetes population risk tool (DPoRT). J. Epidemiol. Community Health 65, 613–620 (2011)

    Article  PubMed  Google Scholar 

  34. Samwick, A.A.: Discount heterogeneity and social security reform. J. Dev. Econ. 57, 117–146 (1998)

    Article  Google Scholar 

  35. Story, G., Vlaev, I., Seymour, B., Darzi, A., Dolan, R.J.: Does temporal discounting explain unhealthy behaviour? A systematic review and reinforcement learning perspective. Front. Behav. Neurosci. 76 (2014)

  36. Taljaard, M., Tuna, M., Bennett, C., Perez, R., Rosella, L., Tu, J.V., Sanmartin, Hennessy, D., Tanuseputro, P., Lebenbaum, M., Manuel, D.: Cardiovascular Disease Population Risk Tool (CVDPoRT): predictive algorithm for assessing CVD risk in the community setting. A study protocol. BMJ Open 4(10), e006701 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  37. Weaver, R.G., Manns, B.J., Tonelli, M., Sanmartin, C., Campbell, D.J.T., Ronksley, P.E., Lewanczuk, R., Braun, T.C., Hennessy, D., Hemmelgarn, B.: Access to primary care and other health care use among western Canadians with chronic conditions: a population-based survey. Can. Med. Assoc. J. Open 2(1), E27 (2014)

    Google Scholar 

  38. Weinstein, N.D.: Perceived probability, perceived severity, and health- protective behavior. Health Psychol. 19, 65–74 (2000)

    Article  CAS  PubMed  Google Scholar 

  39. WHO (2003) Adherence to long-term therapies: evidence for action. http://apps.who.int/medicinedocs/en/d/Js4883e/

  40. Yeung, C.W., Thomas, S.: Income imputation for the Canadian community health survey. Statistics Canada, Ottawa (2012)

    Google Scholar 

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK

    Marjon van der Pol

  2. Health Analysis Division, Statistics Canada, Ottawa, Canada

    Deirdre Hennessy

  3. University of Calgary, Calgary, Canada

    Braden Manns

Authors
  1. Marjon van der Pol
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  2. Deirdre Hennessy
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  3. Braden Manns
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Corresponding author

Correspondence to Marjon van der Pol.

Appendices

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.

Risk

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
Full size table

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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). https://doi.org/10.1007/s10198-016-0800-7

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  • DOI: https://doi.org/10.1007/s10198-016-0800-7

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