When Do Reminders Work? Memory Constraints and Medical Adherence

Abstract

An extensive literature shows that reminders can successfully change behavior. Yet, there exists substantial unexplained heterogeneity in their effectiveness, both: (i) across studies, and (ii) across individuals within a particular study. This paper investigates when and why reminders work. We develop a theoretical model that highlights three key mechanisms through which reminders may operate. To test the predictions of the model, we run a nationwide field experiment on medical adherence with over 4000 pregnant women in South Africa and document several key results. First, we find an extremely strong baseline demand for reminders. This demand increases after exposure to reminders, suggesting that individuals learn how valuable they are for freeing up memory resources. Second, stated adherence is increased by pure reminders and reminders containing a moral suasion component, but interestingly, reminders containing health information reduce adherence in our setting. Using a structural model, we show that heterogeneity in memory costs (or, equivalently, annoyance costs) is crucial for explaining the observed behavior.

Note: Funding Information: Funding was generously provided by Trygg-Hansas Forskningsfond, Sweden. The activities of CEBI are financed by the Danish National Research Foundation, Grant DNRF134

Conflict of Interests: We have no financial or commercial interest in this research.

Ethical Approval: Local ethics approval has been granted by: Pharma Ethics Ltd, Reference, No:181021588

Trial Registration: The AEA RCT Registry trial number associated with this project is AEARCTR-0004018.

Keywords: Nudging, Reminders, Memory, Attention, Medication adherence, Structural model

JEL Classification: D04, D91, C93, I12