RightFit
Not yet recruitingNot applicable

Tracking Income Dynamics and Everyday Health Study

The Effects of Economic Scarcity on Health Behaviors in Older Adults With Chronic Disease

Who can join

As published by the study on ClinicalTrials.gov. "Not stated" means the study hasn't said — ask the study team.

Age
50 Years and older
Sex
All sexes
Healthy volunteers
Not accepted
Compensation
Not stated

Other requirements are listed under Eligibility below. Only the study team can confirm whether you can join.

What to expect

No one can promise a trial will help you personally — that is what the research is trying to find out.

What participation involves

  • Time periods mentioned: 4 months
  • Procedures mentioned: Pills

Only what the study's summary and detailed description on ClinicalTrials.gov say. Time periods may describe the whole study or a part of it — ask the study team what applies to you.

Show the study's own words
  • "Daily medication adherence will be measured objectively for four months with wireless electronic pill bottle caps (CleverCaps)."
Compensation
Not stated
  • Study-related exams and procedures are typically provided at no cost. This is how many trials work in general — confirm the details for this study with the study team.
  • Participants are monitored closely by the research team throughout the study.
  • Some participants may receive access to an investigational treatment, which is still being studied.
  • Your participation helps researchers learn whether this approach could help future patients.

About this study

In plain language

This study tests whether having less money affects taking daily medicine and using health and financial services. It is for adults age 50 or older who get SNAP food benefits and have certain long-term health conditions. Researchers will track medicine use for four months and compare responses to service offers before and after SNAP benefits arrive.

Among adults with chronic illnesses like hypertension, diabetes, or HIV, adherence to daily oral medications is essential but often below 50%. Why do medication adherence and preventive health service engagement remain stubbornly low? Scarcity theory offers a novel explanation in the context of poverty. It posits that economic hardship imposes a cognitive burden that shifts attention from long-term goals to immediate needs, reduces future orientation (the relative value placed on immediate vs. future outcomes), and limits mental bandwidth (the cognitive resources needed for decisions), thus undermining behaviors like daily medication adherence and service engagement. To address these gaps, the study's objective is to rigorously test whether and how economic scarcity affects medication adherence and preventive service uptake among older adults with chronic disease, leveraging the naturally occurring monthly fluctuation in scarcity created by the Supplemental Nutrition Assistance Program (SNAP) benefit cycle as a natural experiment. There are three aims: 1. Daily medication adherence will be measured objectively for four months with wireless electronic pill bottle caps (CleverCaps). The investigators will test whether, when, and by how much adherence changes as scarcity fluctuates during the SNAP benefit cycle. 2. The investigators will conduct two easily implementable RCTs to test whether scarcity affects participants' engagement with beneficial services requiring navigation of administrative burdens. In one trial, participants will be randomized to receive an invitation during either a high- or low- scarcity period (i.e., before vs. after SNAP receipt) to a personalized preventive health review that identifies gaps in US Preventive Services Task Force Grade A/B recommendations. In the second, participants will be invited to free financial counseling provided by the City of Philadelphia during a high- or low-scarcity period. The investigators hypothesize invitation response rates will be \>15% higher during low-scarcity periods. 3. Potential mechanisms that link scarcity with health behaviors will be examined by randomizing timing of validated measures of mental bandwidth and future orientation during a period of high- or low-scarcity (i.e., before vs. after SNAP receipt). The investigators hypothesize that there will be differences in several measures between participants who are randomly assessed during high- vs. low-scarcity periods (i.e. before vs. after SNAP receipt). Impact: Demonstrating that scarcity helps to explain low medication adherence and beneficial health-related service uptake can inform patient-centered adherence interventions, clinical care-delivery approaches, health-system strategies, and public health approaches to improve these health behaviors and promote healthy aging.

Compensation is read from the study's own description and may be missing — always confirm with the study team.

Eligibility

Who can join

  • You are age 50 or older.
  • You get SNAP food benefits.
  • You live in Philadelphia, Bucks, Montgomery, Chester, or Delaware County and do not plan to leave in the next four months.
  • You have high blood pressure, diabetes, high cholesterol, or HIV without a severely weakened immune system.
  • You are prescribed medicine taken by mouth once a day for one of these conditions.
  • You report missing at least two doses of that medicine in the past 30 days.

Who can't join

  • You do not meet all the requirements listed above.
  • You cannot give consent to join the study.
  • You do not speak English.
  • The lead researchers decide you have problems with memory or thinking.
  • You get cash aid through Temporary Assistance for Needy Families (TANF).
  • Your daily medicine gives quick relief from symptoms, creating a strong reason to take it.
  • Your daily medicine commonly causes short-term side effects, such as low blood sugar from some diabetes medicines.

Simplified for readability. The official criteria below are what the study team uses.

Official eligibility criteria

Inclusion Criteria: * Age ≥50 years * SNAP beneficiary * Resident of Philadelphia, Bucks, Montgomery, Chester, or Delaware County (all with the same SNAP disbursement schedule) without plans to leave in the next 4 months * Diagnosis of hypertension, diabetes mellitus, hypercholesterolemia, or HIV (without advanced immunosuppression) * Prescribed a once-daily oral medication for the qualifying condition * Self-report missing ≥2 doses of this medication over the prior 30 days (i.e., \<94% adherence) Exclusion Criteria: * Does not meet all of the inclusion criteria * Unable to provide consent * Non-English speaker * Cognitive impairment, per PIs discretion * Receives cash assistance through the Temporary Assistance for Needy Families (TANF) program * Daily medication produces immediate symptomatic relief and thus provide a strong and immediate incentive to be adherent. Daily medication has common short-term side effects (e.g., sulfonylureas, which can cause hypoglycemia).

Study sites (1)

PA