Social Pressure

On a daily basis, we are faced with the problem of diagnosing patients’ skin conditions and prescribing appropriate treatments. On top of that, we also face the problem of how to get patients to use the treatment well. Getting people to do things is not easy. Physicians are not the only ones faced with that problem.  

In the recent election, voter turnout was a high priority. Like adherence to medicine, getting people to vote can be a tall order. Gerber et al¹ studied social pressure as a way to induce greater political participation. Turnout was substantially higher among those who received mailings that promised to publicize whether they voted to their household or to their neighbors. 

In this final issue of 2020, we highlight the National Eczema Association’s latest mobile app for our patients with eczema (page 28). This app helps patients with atopic dermatitis track their skin, itch, and pain symptoms, among others, and it even has a function that can remind patients to apply their prescribed care regimen. There is potential in mobile apps for patient self-monitoring and treatment adherence, and the literature is starting to explore their impact for a number of therapeutic areas.^2-4

Tools such as mobile apps may help our patients, but in order for these interventions to work, patients need to use them. One of the tools we have to encourage better adherence may be to invoke social pressure. It could be an office visit with us shortly after starting therapy or perhaps, as Gerber and colleagues¹ found, planned disclosure of medication use to family or friends. The disclosure functionality could even be built into an app. Humans are social beings; we should not underestimate the power and influence of social pressure. 

Steven R. Feldman, MD, PhD
Chief Medical Editor

References
1. Gerber AS, Green DP, Larimer CW. Social pressure and voter turnout: evidence from a large-scale field experiment. Am Polit Sc Rev. 2008;102(1):33-48. doi:10.1017/S000305540808009X
2. Mosnaim GS, Stempel DA, Gonzalez C, et al. The impact of patient self-monitoring via electronic medication monitor and mobile app plus remote clinician feedback on adherence to inhaled corticosteroids: a randomized controlled trial. J Allergy Clin Immunol Pract. Published online November 16, 2020. doi:10.1016/j.jaip.2020.10.064
3. Wiecek E, Torres-Robles A, Cutler RL, Benrimoj SI, Garcia-Cardenas V. Impact of a multicomponent digital therapeutic mobile app on medication adherence in patients with chronic conditions: retrospective analysis. J Med Internet Res. 2020;22(8):e17834. doi:10.2196/17834
4. Svendsen MT, Andersen F, Andersen KH, et al. A smartphone application supporting patients with psoriasis improves adherence to topical treatment: a randomized controlled trial. Br J Dermatol. 2018;179(5):1062-1071. doi:10.1111/bjd.16667