Trial Outcomes & Findings for Social Norms, Messengers, and Processing Fluency to Increase Hypertension Medication Adherence (NCT NCT06066541)

Last Updated: 2025-01-14

Results Overview

The primary outcome will be the average end-of-year adherence level in each arm (as measured by the Proportion of Days Covered metric \[PDC\]) stratified by refill cycle and adjusting for age, sex, and race.

Recruitment status

COMPLETED

Study phase

Target enrollment

65177 participants

Primary outcome timeframe

approximately 4 months

Results posted on

2025-01-14

Participant Flow

We randomized 65,177 study participants before our study launched with recruitment starting in August 2023. We recruited in two waves (on August 18, 2023 and August 24, 2023) to ensure a sufficient sample size after adjusting for dropouts due to loss of eligibility or changes in membership.

Participant milestones

Participant milestones
Measure	Baseline Mailing (Scorecard) Participants randomized to this arm will receive a scorecard from Humana reporting patients' medication adherence using a "refill score." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score."	Baseline Mailing + Dynamic Social Norms Participants randomized to this arm will receive the Arm 1 scorecard plus dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores).	Baseline Mailing + Messenger Effects Participants randomized to this arm will receive the Arm 1 scorecard, coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication.	Baseline Mailing + Processing Fluency Participants randomized to this arm will receive a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Dynamic Social Norms Participants randomized to this arm will receive the Arm 4 processing fluency scorecard plus dynamic social norms messaging. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Messenger Effects Participants randomized to this arm will receive the Arm 4 processing fluency scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	No Mailing (Usual Care) Participants randomized to this arm will not receive any mailed message.
Enrollment Wave 1 (August 18, 2023) STARTED	8571	8571	8571	8571	8571	8571	8571
Enrollment Wave 1 (August 18, 2023) COMPLETED	8464	8449	8443	8461	8446	8448	8448
Enrollment Wave 1 (August 18, 2023) NOT COMPLETED	107	122	128	110	125	123	123
Enrollment Wave 2 (August 24, 2023) STARTED	740	740	740	740	740	740	740
Enrollment Wave 2 (August 24, 2023) COMPLETED	734	731	737	732	733	729	735
Enrollment Wave 2 (August 24, 2023) NOT COMPLETED	6	9	3	8	7	11	5

Reasons for withdrawal

Reasons for withdrawal
Measure	Baseline Mailing (Scorecard) Participants randomized to this arm will receive a scorecard from Humana reporting patients' medication adherence using a "refill score." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score."	Baseline Mailing + Dynamic Social Norms Participants randomized to this arm will receive the Arm 1 scorecard plus dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores).	Baseline Mailing + Messenger Effects Participants randomized to this arm will receive the Arm 1 scorecard, coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication.	Baseline Mailing + Processing Fluency Participants randomized to this arm will receive a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Dynamic Social Norms Participants randomized to this arm will receive the Arm 4 processing fluency scorecard plus dynamic social norms messaging. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Messenger Effects Participants randomized to this arm will receive the Arm 4 processing fluency scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	No Mailing (Usual Care) Participants randomized to this arm will not receive any mailed message.
Enrollment Wave 1 (August 18, 2023) Excluded due to membership changes	107	122	128	110	125	123	123
Enrollment Wave 2 (August 24, 2023) Excluded due to membership changes	6	9	3	8	7	11	5

Baseline Characteristics

Social Norms, Messengers, and Processing Fluency to Increase Hypertension Medication Adherence

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure	Baseline Mailing (Scorecard) n=9198 Participants Participants randomized to this arm will receive a scorecard from Humana reporting patients' medication adherence using a "refill score." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score."	Baseline Mailing + Dynamic Social Norms n=9180 Participants Participants randomized to this arm will receive the Arm 1 scorecard plus dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores).	Baseline Mailing + Messenger Effects n=9180 Participants Participants randomized to this arm will receive the Arm 1 scorecard, coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication.	Baseline Mailing + Processing Fluency n=9193 Participants Participants randomized to this arm will receive a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Dynamic Social Norms n=9179 Participants Participants randomized to this arm will receive the Arm 4 processing fluency scorecard plus dynamic social norms messaging. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Messenger Effects n=9177 Participants Participants randomized to this arm will receive the Arm 4 processing fluency scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	No Mailing (Usual Care) n=9183 Participants Participants randomized to this arm will not receive any mailed message.	Total n=64290 Participants Total of all reporting groups
Race/Ethnicity, Customized Other	778 Participants n=5 Participants	820 Participants n=7 Participants	808 Participants n=5 Participants	814 Participants n=4 Participants	842 Participants n=21 Participants	845 Participants n=8 Participants	829 Participants n=8 Participants	5736 Participants n=24 Participants
Race/Ethnicity, Customized Unknown	309 Participants n=5 Participants	306 Participants n=7 Participants	325 Participants n=5 Participants	324 Participants n=4 Participants	320 Participants n=21 Participants	289 Participants n=8 Participants	307 Participants n=8 Participants	2180 Participants n=24 Participants
Age, Continuous	71.36 years STANDARD_DEVIATION 4.11 • n=5 Participants	71.44 years STANDARD_DEVIATION 4.09 • n=7 Participants	71.44 years STANDARD_DEVIATION 4.09 • n=5 Participants	71.33 years STANDARD_DEVIATION 4.07 • n=4 Participants	71.49 years STANDARD_DEVIATION 4.10 • n=21 Participants	71.44 years STANDARD_DEVIATION 4.07 • n=8 Participants	71.50 years STANDARD_DEVIATION 4.07 • n=8 Participants	71.4 years STANDARD_DEVIATION 4.10 • n=24 Participants
Sex: Female, Male Female	4881 Participants n=5 Participants	5005 Participants n=7 Participants	5041 Participants n=5 Participants	4938 Participants n=4 Participants	5040 Participants n=21 Participants	4967 Participants n=8 Participants	4939 Participants n=8 Participants	34811 Participants n=24 Participants
Sex: Female, Male Male	4317 Participants n=5 Participants	4175 Participants n=7 Participants	4139 Participants n=5 Participants	4255 Participants n=4 Participants	4139 Participants n=21 Participants	4210 Participants n=8 Participants	4244 Participants n=8 Participants	29479 Participants n=24 Participants
Race/Ethnicity, Customized White	5882 Participants n=5 Participants	5914 Participants n=7 Participants	5822 Participants n=5 Participants	5837 Participants n=4 Participants	5903 Participants n=21 Participants	5900 Participants n=8 Participants	5879 Participants n=8 Participants	41137 Participants n=24 Participants
Race/Ethnicity, Customized Black	2229 Participants n=5 Participants	2140 Participants n=7 Participants	2225 Participants n=5 Participants	2218 Participants n=4 Participants	2114 Participants n=21 Participants	2143 Participants n=8 Participants	2168 Participants n=8 Participants	15237 Participants n=24 Participants
Refill cycle 30-day refill cycle	1965 Participants n=5 Participants	1962 Participants n=7 Participants	1961 Participants n=5 Participants	1977 Participants n=4 Participants	1974 Participants n=21 Participants	1972 Participants n=8 Participants	1975 Participants n=8 Participants	13786 Participants n=24 Participants
Refill cycle 90-day refill cycle	7233 Participants n=5 Participants	7218 Participants n=7 Participants	7219 Participants n=5 Participants	7216 Participants n=4 Participants	7205 Participants n=21 Participants	7205 Participants n=8 Participants	7208 Participants n=8 Participants	50504 Participants n=24 Participants
Low-Income Subsidy (LIS)/Dual Eligibility Status Low-Income Subsidy (LIS) Only	497 Participants n=5 Participants	518 Participants n=7 Participants	536 Participants n=5 Participants	514 Participants n=4 Participants	524 Participants n=21 Participants	567 Participants n=8 Participants	566 Participants n=8 Participants	3722 Participants n=24 Participants
Low-Income Subsidy (LIS)/Dual Eligibility Status Medicaid Eligible only	9 Participants n=5 Participants	7 Participants n=7 Participants	10 Participants n=5 Participants	12 Participants n=4 Participants	16 Participants n=21 Participants	8 Participants n=8 Participants	10 Participants n=8 Participants	72 Participants n=24 Participants
Low-Income Subsidy (LIS)/Dual Eligibility Status LIS and Dual Eligible	2407 Participants n=5 Participants	2364 Participants n=7 Participants	2289 Participants n=5 Participants	2396 Participants n=4 Participants	2330 Participants n=21 Participants	2294 Participants n=8 Participants	2296 Participants n=8 Participants	16376 Participants n=24 Participants
Low-Income Subsidy (LIS)/Dual Eligibility Status No LIS/Dual Eligibility	6285 Participants n=5 Participants	6291 Participants n=7 Participants	6345 Participants n=5 Participants	6271 Participants n=4 Participants	6309 Participants n=21 Participants	6308 Participants n=8 Participants	6311 Participants n=8 Participants	44120 Participants n=24 Participants
Hypertension proportion of days covered (PDC) as of selection	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=5 Participants	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=7 Participants	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=5 Participants	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=4 Participants	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=21 Participants	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=8 Participants	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=8 Participants	0.77 proportion of days covered (PDC) STANDARD_DEVIATION 0.06 • n=24 Participants
Hypertension PDC ≥ 80% as of selection	3690 Participants n=5 Participants	3615 Participants n=7 Participants	3705 Participants n=5 Participants	3720 Participants n=4 Participants	3690 Participants n=21 Participants	3650 Participants n=8 Participants	3722 Participants n=8 Participants	25792 Participants n=24 Participants

PRIMARY outcome

Timeframe: approximately 4 months

Outcome measures

Outcome measures
Measure	Baseline Mailing (Scorecard) n=9198 Participants Participants randomized to this arm will receive a scorecard from Humana reporting patients' medication adherence using a "refill score." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score."	Baseline Mailing + Dynamic Social Norms n=9180 Participants Participants randomized to this arm will receive the Arm 1 scorecard plus dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores).	Baseline Mailing + Messenger Effects n=9180 Participants Participants randomized to this arm will receive the Arm 1 scorecard, coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication.	Baseline Mailing + Processing Fluency n=9193 Participants Participants randomized to this arm will receive a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Dynamic Social Norms n=9179 Participants Participants randomized to this arm will receive the Arm 4 processing fluency scorecard plus dynamic social norms messaging. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Messenger Effects n=9177 Participants Participants randomized to this arm will receive the Arm 4 processing fluency scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	No Mailing (Usual Care) n=9183 Participants Participants randomized to this arm will not receive any mailed message.
Average End-of-year Adherence Level	0.81 proportion of days covered Standard Deviation 0.12	0.81 proportion of days covered Standard Deviation 0.12	0.81 proportion of days covered Standard Deviation 0.12	0.81 proportion of days covered Standard Deviation 0.12	0.81 proportion of days covered Standard Deviation 0.12	0.81 proportion of days covered Standard Deviation 0.12	0.81 proportion of days covered Standard Deviation 0.12

SECONDARY outcome

Timeframe: approximately 4 months

As measured by the Proportion of Days Covered metric \[PDC\]

Outcome measures

Outcome measures
Measure	Baseline Mailing (Scorecard) n=9198 Participants Participants randomized to this arm will receive a scorecard from Humana reporting patients' medication adherence using a "refill score." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score."	Baseline Mailing + Dynamic Social Norms n=9180 Participants Participants randomized to this arm will receive the Arm 1 scorecard plus dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores).	Baseline Mailing + Messenger Effects n=9180 Participants Participants randomized to this arm will receive the Arm 1 scorecard, coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Scorecard: Participants will be mailed a scorecard from Humana reporting patients' medication adherence using a "refill score." Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication.	Baseline Mailing + Processing Fluency n=9193 Participants Participants randomized to this arm will receive a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring." Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Dynamic Social Norms n=9179 Participants Participants randomized to this arm will receive the Arm 4 processing fluency scorecard plus dynamic social norms messaging. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Social norms: Participants will be mailed a dynamic social norms messaging (noting the proportion of Humana members improving their medication refill scores). Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	Processing Fluency + Messenger Effects n=9177 Participants Participants randomized to this arm will receive the Arm 4 processing fluency scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Two messages will be sent during the intervention: The first message will contain the baseline refill score. The second message will note any changes in the refill score. Messenger effects: Participants will be mailed a scorecard coming from the trusted messenger of a Humana-identified pharmacist taking the same medication. Processing fluency: Participants will be mailed a modified scorecard increasing processing fluency through a visual metaphor of "closing the ring."	No Mailing (Usual Care) n=9183 Participants Participants randomized to this arm will not receive any mailed message.
Proportion of Participants With End-of-year PDC≥80%	6518 Participants	6590 Participants	6467 Participants	6515 Participants	6558 Participants	6598 Participants	6587 Participants

Deaths: 0 deaths

Serious adverse events

Adverse event data not reported

Other adverse events

Adverse event data not reported

Additional Information

Niteesh Choudhry, MD, PhD

Brigham and Women's Hospital

Phone: 617-278-0930

Email: [email protected]

Results disclosure agreements

Principal investigator is a sponsor employee
Publication restrictions are in place