Incentives are used to improve many health-related behaviors, but evidence is mixed for their effectiveness both during the incentivization period and, even more so, on the persistence of the behavior after incentives are withdrawn. In this paper, we present the results of a randomized controlled trial that successfully uses incentives to improve medication adherence among HIV-infected patients in Uganda over 20 months, and follows the sample for another 6 months to measure the persistence of these behavioral improvements. Our study contributes to the literature on habit formation by identifying a behavioral strategy that is associated with persistently high medication adherence after controlling for observable individual-level characteristics and the receipt of incentives. We find evidence supporting a psychological theory of habits as reflexive context-behavior associations, which suggests new ways of designing incentive-based interventions for better promoting persistent, healthier behaviors.

激励措施可用来改善许多与健康相关的行为，但其在激励期间的有效性以及激励措施取消后行为持续存在的证据却混杂在一起。在本文中，我们介绍了一项随机对照试验的结果，该试验在 20 个月内成功地利用激励措施提高乌干达 HIV 感染者的药物依从性，并跟踪样本另外 6 个月以衡量这些行为改善的持久性。我们的研究通过在控制可观察到的个人水平特征和接受激励后确定与持续高药物依从性相关的行为策略，为习惯形成的文献做出了贡献。我们发现证据支持习惯作为反射性情境行为关联的心理学理论，这提出了设计基于激励的干预措施的新方法，以更好地促进持久、更健康的行为。