The application of behavioral economic theory to an app designed to improve health maintenance behaviors (Preprint)

UNSTRUCTURED Chronic diseases are the leading cause of morbidity, mortality, and health care spending in the United States, yet adherence to prescribed medications and engagement in stress-reduction behaviors and low-level exercise remain persistently low. According to the Centers for Disease Control and Prevention, less than 25% of adults met the 2018 Physical Activity Guidelines for Americans [1]. Despite advances in pharmacologic therapies, only approximately 50% of adults with chronic conditions take medications as prescribed [2]. Chronic psychological stress further exacerbates disease progression and poor outcomes [3]. In addition, higher levels of regular physical activity are associated with lower rates of many chronic illnesses, such as obesity, diabetes, hypertension and cardiovascular disease [4]. Mobile health (mHealth) applications offer a scalable approach to supporting patient self-management, but sustained engagement and adherence remain key challenges. Behavioral economics provides a useful framework for addressing these challenges by leveraging principles such as loss aversion, present bias, reference points, and the strategic use of incentives [5]. This viewpoint synthesizes evidence across behavioral economics, medication adherence, mindfulness practice, and the importance of daily physical activity to inform the design of integrated mHealth applications. Incentive-based interventions, when structured appropriately, can meaningfully improve medication adherence and sustain behavior change beyond active intervention periods [6-7]. Randomized controlled trials of mindfulness-based mHealth interventions demonstrate meaningful improvements in stress, anxiety, quality of life, and related health outcomes, with evidence of dose–response effects tied to consistent practice [8-9]. Gamified and incentive-based approaches further enhance engagement in ongoing behaviors such as daily physical activity and mindfulness practice [10-11]. An mHealth application that leverages these principles to incentivize and monitor medication adherence, physical activity, and mindfulness practice has the potential to significantly improve patient health.