Can loss aversion be applied to health situations?

Brojerdian, N, Dagnall, N, Fatoye, F and Goodwin, P (2019) Can loss aversion be applied to health situations? In: Physiotherapy UK Conference 2018, 19 October 2018 - 20 October 2018, Birmingham, UK.

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Abstract

Purpose: Musculoskeletal (MSK) conditions are a major source of long-term pain, psychological distress, disability and productivity loss. Physiotherapy is the mainstream management strategy for MSK conditions. The outcome of physiotherapy modalities often depends on patient adherence to treatment. For patients to adhere, they need to perceive that non-adherence results in a loss of function and or health. According to the behavioural economic concept of loss aversion (LA), loss has a greater impact on decision-making choices than equivalent gain. To date, research on adherence has focused on external processes, such as patient-clinician rapport with little attention to internal processes such as how individuals weigh gain and loss associated with adherence or non-adherence. It is unknown whether the concept of LA applies to health. The aim of this study was to determine proof of concept of whether LA influences health decisions including the two most common MSK conditions (back and neck pain). Methods: 61 Participants (N = 29 males, N = 32 females, mean age 36.38, range 19-54 years) were recruited from Manchester Metropolitan University. Stage (1) Participants completed five LA scenarios (back and neck pain, headache, breathlessness and flu). Each scenario contained five questions indicating increases in loss and gain in pain or health status. Based on the level of gain and loss, participants decided whether to play a game that could result in hypothetical loss or a gain. Stage (2) Participants completed the risk propensity scale (RPS) and Unipolar Response Scale (URS) to investigate risk inclination and the impact of magnitude of loss on their health-related behaviour. Comparison analysis looked at previous experience of the health conditions and gender differences in LA. Correlation analysis examined relationships between RPS, RPS health item and each of the five health conditions. ANOVA was used to investigate differences between loss and gain across health conditions and URS. Significance was set at 0.05. Results: LA was demonstrated in four out of the five health conditions but not at small magnitudes of loss. No associations were found between participants’ general risk-taking attitude and LA towards the health conditions. There was a strong association between neck and back pain (r = 0.75, p ≤ 0.001) and participants’ LA behaviour. A weak negative correlation between health item of RPS, neck (r = −0.24) and back (r = −0.22) pain was also found. There were no gender differences in participants’ LA attitudes. Conclusion(s): LA was demonstrated in participants’ decision-making in the health situations, apart from breathlessness consistent with the concept of LA, as the amount of pain or poor health status (loss) increased participants were less likely to take risks with their health. Further research is required to develop the concept clinically, and to determine whether application of the concept of LA can improve adherence to treatment. Implications: Establishing patient's attitude towards health-related loss may enable clinicians to individualise treatment, enhance patient adherence and improve their health outcomes. Funding acknowledgements: Unfunded.