Follow-up examinations, such as those for high blood pressure, provide doctors with the opportunity to monitor patients’ risk factors, assess treatment outcomes, and encourage medication adherence. However, in low- and middle-income countries, the demand for preventive health services is often low. Contributing factors include low salience and widespread misconceptions about the necessity of preventive care. A common belief, for instance, is that no treatment is needed in the absence of symptoms.
How this situation might be improved was the focus of a new study conducted under the supervision of Prof. Dr. Nikkil Sudharsanan, head of the Assistant Professorship for Behavioral Science for Disease Prevention and Health Care. The research team, led by research associate Caterina Favaretti, investigated whether appointment reminders that also debunk common health myths could increase the use of preventive care services. The findings were published under the title “Does bundling reminders with messages debunking misconceptions improve the demand for preventive health services? A randomized controlled trial among adults with hypertension in Punjab, India” in the international journal “Social Science & Medicine”.
Prof. Sudharsanan points out: “One major challenge for improving the use of preventive services is that people often feel healthy and don’t believe they need care. This misconception is very widespread and a major challenge for improving prevention.”
As part of a randomized controlled trial, the researchers examined whether combining traditional appointment reminders with targeted corrections of health misconceptions would increase demand for preventive services. For this purpose, 463 individuals with uncontrolled hypertension were recruited at two public clinics in Punjab, India. Participants either received standard care without any reminder (control group) or a telephone reminder that included the date and location of their next doctor’s appointment along with corrections of two widespread misconceptions about the need for regular blood pressure monitoring and medication adherence.
Favaretti explains the research context: “Many people with hypertension miss their follow-up appointments—even though these are crucial for managing a chronic condition that worsens over time if left untreated. While previous studies often cite forgetfulness or present bias as the main reasons, we focus on a different, often overlooked factor: misconceptions about the necessity of ongoing treatment. This is especially relevant in countries like India, where many people are more familiar with infectious diseases and thus assume that medical care is only needed when acute symptoms are present. As a result, some stop treatment once their blood pressure returns to a normal range, while others discontinue medication or skip follow-up visits simply because they feel fine. Our study aims to correct exactly these misconceptions.”
The results show that the reminder significantly increased follow-up attendance: 12.1 percent more participants in the intervention group attended their appointments compared to the control group. Thus, the reminder had an effect—due mainly to the increased salience of the appointment itself. However, the additional information intended to correct misconceptions had no significant impact on misconceptions. Participants’ beliefs about hypertension remained largely unchanged—most answered key questions incorrectly at follow-up, just as they had at the baseline survey.
“There are many different ways to design behavioral messages. Most approaches, however, have been developed in high-income countries and tested mainly under controlled laboratory conditions,” says Favaretti, describing a challenge of this research. “By contrast, we work in low- and middle-income countries, where such strategies are rarely tested in real-world contexts that reflect local conditions. We found that a simple message like the one we used is not enough to effectively change misconceptions.”
Overall, the study shows that personal reminder calls can already make an important contribution to increasing the use of preventive health services. At the same time, the findings highlight the persistence of misconceptions about chronic diseases such as hypertension. According to Favaretti, more advanced approaches are needed to achieve sustainable behavioral change and reduce misinformation. These could include experimenting with different ways of framing messages, offering more personalized or emotionally resonant communication, using social norms to show that consistent treatment is the norm, or involving trusted figures in the healthcare system to deliver key messages.
Contact:
Prof. Dr. Nikkil Sudharsanan
Rudolf Mößbauer Assistant Professorship for Behavioral Science for Disease Prevention and Health Care
TUM Campus im Olympiapark
Am Olympiacampus 11
80809 Munich
Tel.: +49 89 289 24990
Email: nikkil.sudharsanan(at)tum.de
Caterina Favaretti
Rudolf Mößbauer Assistant Professorship for Behavioral Science for Disease Prevention and Health Care
TUM Campus im Olympiapark
Am Olympiacampus 11
80809 Munich
Email: caterina.favaretti(at)tum.de
Text: Jasmin Schol
Photos: Pexels/Private