Every day we receive, interpret and process all kinds of digital messages and signals. Now, I’m not just talking about text messages or funny emails. I’m talking about the thousands of messages and signals we receive from advertisers, through reading the news, listening to the radio, from various media sources and from professionals, our colleagues, friends and family. Upon receiving these messages we make a choice about what to do with the newly attained information. Our cognitive process of decision making is triggered, resulting in a specific course of action – a choice based on knowledge, underlying biases, establishment of objectives, previous experiences and decision outcomes, a developed sense of morality, commitment, cost, and the list goes on based on the type of decision being made. Often a predefined action plan is already in place and an automatic response is applied, other times a new message is registered and a new plan of action is formulated. But in the world of health, we are competing with messages professionally engineered to drive us to make bad lifestyle choices.

So what does this have to do with patient non-adherence?

The act of taking medication is a choice – regardless of the disease or expected result from a treatment course. Once out of the Dr.’s office, the patient must make the conscious decision to go to the pharmacy and fill their prescription, to take the medication, to modify their lifestyle if required and to maintain this level of involvement in their health. Cutting through the barrage of conflicting information can often times lead us to ignore what we know and make a decision that isn’t in our best interest.

Looking at chronic diseases like Diabetes, COPD and Hypertension, there’s a specific kind of lifestyle that comes hand in hand with having any of these illnesses, including diet and exercise, requiring vigilant maintenance of this lifestyle to ensure optimal health outcomes.

Just looking at Type II Diabetes, we know that 98% of the 347 million people worldwide who have diabetes (WHO diabetes stats 2011) are NOT compliant with the required lifestyle, including not taking their medications, resulting in a $300 billion a year problem in the US alone. Several factors can be attributed to this phenomenon including forgetfulness, level of patient engagement, cognitive status, and health literacy – these factors can also be said of the aforementioned conditions.

One of the barriers to adherence that has thus far gone unmentioned, is the influence of those professionally engineered messages driving our bad habits and choices. Media, food manufacturers, restaurants, store owners – are not looking out for the health and well being of its consumers, their goal is to sell their wares and make a profit. It’s up to us as informed consumers to make a choice – we can choose the sugary cola after seeing an appealing advertisement or we can reach for a cup of water. We can order the bacon and eggs and fried potatoes for breakfast or we choose fruit, oatmeal and/or yogurt.

When designing an adherence intervention, it’s just as important to provide patients with the knowledge they need to make better health decisions as it is to remind them to take their medications. As a developer of message content, I incorporate healthy lifestyle messaging into all of our programs – teaching patients about what to avoid when at the grocery store, food alternatives for meal preparation, healthy recipe options, and how to include physical activity into their everyday lives. Our algorithms adjusts and segments the messages patients receive to accommodate the information they need at a specific time. In an ideal world, information might affect decisions directly but behavioral economics and the competing interests within the brain actually determine the outcomes. So to all, please consider this a call to arms to defend against the messages driving us to make bad lifestyle decisions!