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April 2013

Using Hawthorne Effects to Improve Adherence in Clinical Practice: Lessons From Clinical Trials—Reply

Author Affiliations

Author Affiliations: Departments of Dermatology (Drs Gelfand, Takeshita, and Van Voorhees and Ms Wang) and Epidemiology and Biostatistics, Center for Clinical Epidemiology and Biostatistics (Dr Gelfand), Perelman School of Medicine, University of Pennsylvania, Philadelphia; The National Psoriasis Foundation, Portland, Oregon (Dr Robertson); and the Department of Dermatology, University of Utah School of Medicine, Salt Lake City (Drs Krueger and Callis Duffin).

JAMA Dermatol. 2013;149(4):490-491. doi:10.1001/jamadermatol.2013.2846

In reply

We thank Mr Davis and Dr Feldman for their insightful comments in response to our study. They addressed how the Hawthorne effect, which occurs when patients' behaviors change (such as improving adherence) when they know they are being watched in ways that may improve outcomes, could be leveraged in clinical practice. In our cross-sectional study,1 patients were evaluated at a single time point under real-world conditions (ie, routine follow-up visit) and did not know that the effectiveness of their psoriasis treatment was going to be formally assessed until the day of their regularly scheduled clinic visit. Thus, the Hawthorne effect could not have affected adherence and was unlikely to have impacted our estimates of physician-reported outcomes, but it may have influenced patient-reported outcomes.