Changing health behaviours in rheumatology: an introduction to behavioural economics

Although the management of patients with rheumatic diseases has evolved substantially over the past 20 to 30 years, lifestyle changes (such as weight reduction, physical activity and medication adherence) remain an important and unmet challenge in improving patient outcomes. The field of behavioural economics considers the many ways that individuals behave irrationally and uses the predictability of these patterns to create opportunities to anticipate and avoid or harness these behaviours to improve patient outcomes. Existing among other motivational approaches, the concepts in behavioural economics have only been applied to health care in the past 10 to 15 years. Although few published examples have applied behavioural economic concepts in the management of patients with rheumatic diseases specifically, these concepts have been applied in other chronic diseases, and such interventions could also be applicable in rheumatology. In this Perspectives article, we introduce six principles in behavioural economics (loss aversion, framing effect, present bias, status quo bias, time inconsistency and social normalization), discuss how these concepts have been addressed in other fields and examine their potential application in rheumatology. Using physical activity as an example, we describe how these concepts could be applied to promote healthy behaviour in patients with inflammatory arthritis.