Tracking Income Dynamics and Everyday Health Study

Conditions

• HIV
• Hypercholerolemia
• Hypertension
• Type 2 Diabetes

Eligibility Criteria

Sex

ALL

Age

50 Years - N/A

Healthy Volunteers

Not accepted

Interventions

• Preventative health review invitation early in SNAP cycle — OTHER
  Participant will receive preventative health review invitation early in the SNAP cycle (low scarcity period)
• Financial counseling invitation early in the SNAP cycle — OTHER
  The participant will receive an invitation to a financial counseling servce early in the SNAP cycle (low scarcity period).
• Aim 3 follow-up call early in the SNAP period — OTHER
  Participant will complete aim 3 follow-up call early in the SNAP cycle (low scarcity period).
• Preventative health review invitation late in SNAP cycle — OTHER
  Participant will receive preventative health review invitation late in the SNAP cycle (high scarcity period)
• Financial counseling invitation late in the SNAP cycle — OTHER
  The participant will receive an invitation to a financial counseling servce late in the SNAP cycle (high scarcity period).
• Aim 3 follow-up call late in the SNAP cycle — OTHER
  Participant will complete aim 3 follow-up call late in the SNAP cycle (high scarcity period).

Study Details

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.

Key Dates

First listed

Oct 7, 2026

Start date

Mar 1, 2027

Status verified

Oct 2026

Primary completion

Jul 1, 2029

Completion

Jul 1, 2029

Study Design

Enrollment

400 participants (estimated)

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

HEALTH_SERVICES_RESEARCH

Arms

• Experimental: Early preventative health review, early financial counseling invitation, early aim 3 follow-up call
• Experimental: Early preventative health review, early financial counseling invitation, late aim 3 follow-up call
• Experimental: Early preventative health review, late financial counseling invitation, late aim 3 follow-up call
• Experimental: Early preventative health review, late financial counseling invitation, early aim 3 follow-up call
• Experimental: Late preventative health review, early financial counseling invitation, early aim 3 follow-up call
• Experimental: Late preventative health review, late financial counseling invitation, early aim 3 follow-up call
• Experimental: Late preventative health review, late financial counseling invitation, late aim 3 follow-up call
• Experimental: Late preventative health review, early financial counseling invitation, late aim 3 follow-up call

Primary Outcome Measure

Daily medication adherence [ Time Frame: Full 4-month participant enrollment period ]

Locations (1)

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