A qualitative exploration of health-related present bias among HIV-positive adults in Uganda

ABSTRACT

Decision-making errors such as present bias (PB) can have important consequences for health behaviors, but have been largely studied in the financial domain. We conducted a mixed-method study on PB in the context of ART adherence among clinic-enrolled adults in Uganda (n = 39). Specifically, we quantified PB by asking about preferences between medication available sooner to minimize headaches versus available later to cure headaches. We describe demographic similarities among PB participants and qualitatively explored how participants reflected on their PB (or absence thereof) in the context of health. Participants reporting PB were predominantly male, single/unmarried, older, had higher levels of education and income and more advanced HIV progression. Three common reasons for more present-biased choices provided were: (1) wanting to avoid pain, (2) wanting to return to work, and (3) fear of one’s health worsening if s/he did not address their illness immediately. While PB in the financial domain often suggests that poorer individuals are more likely to prefer immediate rewards over their wealthier counterparts, our results suggest poor health is potentially a driving factor of PB. Further research is needed to build on these finding and inform how programs can frame key messages regarding ART adherence to patients displaying PB.

Trial registration: ClinicalTrials.gov identifier: NCT03494777.

KEYWORDS:

• HIV/AIDS
• Uganda
• qualitative analysis
• adherence
• present bias

Acknowledgments

We would like to thank the Mildmay staff for allowing this study to take place in their clinic and for providing administrative support. We are particularly grateful to the study participants for sharing their experiences, and to our excellent study team Peter Wabukala, Lillian Lunkuse, Stewart Walukaga, Pius Kimuli, and Philip Aroda.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

The data that support the findings of this study are qualitative transcripts and are therefore not publicly available due to their containing information that could compromise research participant privacy.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research was funded through resources and services provided by the National Institute of Mental Health (Grant: R01MH110350, PI: Linnemayr). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Clinical trial registration: ClinicalTrials.gov NCT03494777.