MINDSPACE Strategy for Risk Optimization

In this project, the investigators will draw on the science that has provided a foundation
for behavioral economics as a guide to activation interventions. Specifically, the
investigators will use the MINDSPACE framework that was created by some of the founders of
behavioral economics. That framework details nine approaches to behavioral activation that
have particularly solid evidence bases. Two of these, salience and incentives, the
investigative team identified as most promising and practical for stroke activation.

Aims:

1. Use electronic health record data to construct Framingham stroke risk scores in both
Richard L. Roudebush Veterans Affairs Medical Center and Eskenazi Health System.

2. Conduct iterative testing with high risk stroke patients from both health systems to
refine two different stroke risk messages based on the behavioral strategies of salience
and incentives.

3. Conduct a randomized trial of four mailed stroke risk messages, comparing the impact on
patient activation of: 1) a standard stroke risk message, 2) a salience-focused stroke
risk message, 3) an incentive-focused stroke risk message, and 4) a salience plus
incentive message.

4. Compare the proportion in each messaging group that completes a stroke risk factor
relevant healthcare system visit within two months of receiving the stroke risk message.

Inclusion Criteria:

- • High risk stroke patients 18 years of age or older, as determined by calculation of
a Framingham Stroke Risk Score

- At least one primary care visit 12 months prior to study initiation with the
Richard L. Roudebush VA Medical Center (VHA) or Sidney & Lois Eskenazi (EHS)
Health System primary care clinics

Exclusion Criteria:

- • Patients with at least one primary care provider visit in the prior 12 months in
both the VA and EHS systems