Results of a randomised controlled trial comparing two different incentives to improve survey response rates

Background: Efforts to improve institutional research culture require that we understand current research cultures as experienced by our research communities. Low response rates in qualitative surveys of researcher experience may reduce their usefulness. Various incentives to improve response rates have been proposed, but it is not known whether the chance of a single, large incentive is more effective than a greater chance of a smaller incentive.Methods: We embedded a randomised controlled trial within the Edinburgh Research Culture Survey, comparing the effect on number of responses received of (1) a single reward of £1000 or (2) a reward of £50 for 1 in every 50 respondents, selected by random draw. Ethical approval was obtained from the University of Edinburgh College of Arts, Humanities, and Social Sciences Research Ethics Committee. Results: The incentive offered had no effect on the number of responses received (odds ratio 0.94 [95% CI 0.83 to 1.06]), but, having completed the survey, more participants entered the random draw in the £1000 incentive group (odds ratio 1.49 [1.16 to 1.92]). Staff were more likely to complete the survey, while students were more likely to enter the random draws. Most respondents provided answers to almost all of the survey items (IQR 171 to 172 or 175 items), and this did not differ between groups.Conclusions: In this test of different incentives to increase survey participation, we observed no difference between a moderate chance of a modest reward and a small chance of a high reward. Those conducting such surveys can select their incentive system based on other factors such as cost.

Effects of social network incentives and financial incentives on physical activity and social capital among older women: a randomized controlled trial

Background Financial incentives have been used to increase physical activity. However, the benefit of financial incentives is lost when an intervention ends. Thus, for this study, we combined social network incentives that leverage the power of peer pressure with financial incentives. Few reports have examined the impact of physical activity on social capital. Therefore, the main goal of this study was to ascertain whether a combination of two incentives could lead to more significant changes in physical activity and social capital during and after an intervention. Methods The participants were 39 older women over 65 years of age in Kumamoto, Japan. The participants were randomly divided into a financial incentive group (FI group) and a social network incentive plus financial incentive group (SNI + FI group). Both groups underwent a three-month intervention. Measurements of physical activity and social capital were performed before and after the intervention. Additionally, the effects of the incentives on physical activity and social capital maintenance were measured 6 months postintervention. The financial incentive group received a payment ranging from US$4.40 to US$6.20 per month, depending on the number of steps taken during the intervention. For the other group, we provided a social network incentive in addition to the financial incentive. The SNI + FI group walked in groups of three people to use the power of peer pressure. Results A two-way ANOVA revealed that in terms of physical activity, there was a statistically significant interaction between group and time (p = 0.017). The FI group showed no statistically significant improvement in physical activity during the observation period. In terms of the value of social capital, there was no significant interaction between group and time. Conclusion Our results suggest that social network incentives, in combination with financial incentives, are more effective for promoting physical activity than financial incentives alone among older women and that these effects can continue after an intervention. In the meantime, further studies should be conducted on the effect of physical activity on social capital. Trial registration UMIN000038080, registered on 09/22/2019 (Retrospectively registered).

Financial incentives to improve glycemic control in African American adults with type 2 diabetes: a pilot randomized controlled trial

Background Financial incentives is emerging as a viable strategy for improving clinical outcomes for adults with type 2 diabetes. However, there is limited data on optimal structure for financial incentives and whether financial incentives are effective in African Americans with type 2 diabetes. This pilot study evaluated impact of three financial incentive structures on glycemic control in this population. Methods Sixty adults with type 2 diabetes were randomized to one of three financial incentive structures: 1) single incentive (Group 1) at 3 months for Hemoglobin A1c (HbA1c) reduction, 2) two-part equal incentive (Group 2) for home testing of glucose and HbA1c reduction at 3 months, and 3) three-part equal incentive (Group 3) for home testing, attendance of weekly telephone education classes and HbA1c reduction at 3 months. The primary outcome was HbA1c reduction within each group at 3 months post-randomization. Paired t-tests were used to test differences between baseline and 3-month HbA1c within each group. Results The mean age for the sample was 57.9 years and 71.9% were women. Each incentive structure led to significant reductions in HbA1c at 3 months with the greatest reduction from baseline in the group with incentives for multiple components: Group 1 mean reduction = 1.25, Group 2 mean reduction = 1.73, Group 3 mean reduction = 1.74. Conclusion Financial incentives led to significant reductions in HbA1c from baseline within each group. Incentives for multiple components led to the greatest reductions from baseline. Structured financial incentives that reward home monitoring, attendance of telephone education sessions, and lifestyle modification to lower HbA1c are viable options for glycemic control in African Americans with type 2 diabetes. Trial registration Trial registration: NCT02722499. Registered 23 March 2016, url.

Effects of social network incentives and financial incentives on physical activity and social capital among older women: a randomized controlled trial

Background: Financial incentives have been used to increase physical activity. However, the benefit of financial incentives is lost when an intervention ends. Thus, for this study, we combined social network incentives that leverage the power of peer pressure with financial incentives. Few reports have examined the impact of physical activity on social capital. Therefore, the main goal of this study was to ascertain whether a combination of two incentives could lead to more significant changes in physical activity and social capital during and after an intervention.Methods: The participants were 39 older women over 65 years of age in Kumamoto, Japan. The participants were randomly divided into a financial incentive group (FI group) and a social network incentive plus financial incentive group (SNI+FI group). Both groups underwent a three-month intervention. Measurements of physical activity and social capital were performed before and after the intervention. Additionally, the effects of the incentives on physical activity and social capital maintenance were measured six months postintervention. The financial incentive group received a payment ranging from US$4.40 to US$6.20 per month, depending on the number of steps taken during the intervention. For the other group, we provided a social network incentive in addition to the financial incentive. The SNI+FI group walked in groups of three people to use the power of peer pressure.Results: A two-way ANOVA revealed that in terms of physical activity, there was a statistically significant interaction between group and time (p=0.017). The FI group showed no statistically significant improvement in physical activity during the observation period. The FI group showed no statistically significant improvement in physical activity during the observation period. In terms of the value of social capital, there was no significant interaction between group and time. Conclusion: Our results suggest that social network incentives, in combination with financial incentives, are more effective for promoting physical activity than financial incentives alone among older women and that these effects can continue after an intervention. In the meantime, further studies should be conducted on the effect of physical activity on social capital.Trial registration: UMIN000038080, registered on 09/22/2019 (Retrospectively registered).

Effects of social network incentives and financial incentives on physical activity and social capital among older women: a randomized controlled trial

Background Financial incentives have been used to increase physical activity. However, the benefit of financial incentives is lost when an intervention ends. Thus, for this study, we combined social network incentives that leverage the power of peer pressure with financial incentives. Few reports have examined the impact of physical activity on social capital. Therefore, the main goal of this study was to ascertain whether a combination of two incentives could lead to more significant changes in physical activity and social capital during and after an intervention. Methods The participants were 39 older women over 65 years of age in Kumamoto, Japan. The participants were randomly divided into a financial incentive group (FI group) and a social network incentive plus financial incentive group (SNI+FI group). Both groups underwent a three-month intervention. Measurements of physical activity and social capital were performed before and after the intervention. Additionally, the effects of the incentives on physical activity and social capital maintenance were measured six months postintervention. The financial incentive group received a payment ranging from US$4.40 to US$6.20 per month, depending on the number of steps taken during the intervention. For the other group, we provided a social network incentive in addition to the financial incentive. The SNI+FI group walked in groups of three people to use the power of peer pressure. Results A two-way ANOVA revealed that in terms of physical activity, there was a statistically significant interaction between group and time (p=0.017). The FI group showed no statistically significant improvement in physical activity during the observation period. In terms of social capital, the change in trust approached significance ( p =0.08). Conclusion Our results suggest that social network incentives, in combination with financial incentives, are more effective for promoting physical activity than financial incentives alone among older women and that these effects can continue after an intervention. In the meantime, further studies should be conducted on the effect of physical activity on social capital.

105. Null Effect of Financial Incentives or Social Media Support on Prep Adherence in a Randomized Controlled Trial of Young Men Who Have Sex with Men of Colour

Background Pre-exposure prophylaxis (PrEP) using emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) effectively reduces HIV transmission, with efficacy being dependent on adherence. We evaluated the effect of either social media-based support or financial incentives on PrEP adherence among young MSM of color in Washington, DC Methods MSM aged 18–29 were randomized 1:1:1 to standard of care (SOC) PrEP (Control group), SOC PrEP + invitation to a bidirectional Facebook group supervised by two clinicians (Social Media group), or SOC PrEP + $50 gift card at each of two follow-up visits (Financial Incentive group). Participants were asked to return at 3 and 6 months. Adherence was monitored with predefined dried blood spots (DBS) TFVdp levels with < 490, 490–979, 980–1749 and ≥1750 fmol/punch correlating with average of < 2, 2–4, 4–6, and 7 doses per week Results We enrolled 53 MSM. Average age was 22.5 years and 72% of participants were Black. At enrollment, 96% had previously heard of PrEP, 17% had ever taken PrEP but none had taken PrEP in the prior 6 months. 92% of participants reported condomless anal sex in the prior 3 months, 36% with an HIV-positive man or man of unknown HIV status (Table 1). 81% of participants returned for their 3-month visit and 70% for their 6-month visit. Mean self-reported PrEP adherence over the previous 3 months was 78% with no difference in adherence between the three groups at either visit. Based on DBS TFVdp levels, protective PrEP adherence (≥4 doses/week) was measured in 46% of the Financial Incentive group and in 57% of the Social Media group compared to in 67% of the Control group (p=0.38). Only 16% of TFVdp levels corresponded to taking PrEP 7 days a week (Figure 1). There was no change in sexual risk activity over the course of the study. 38 sexually transmitted infections were diagnosed in 26 participants (Figure 2). No participant tested positive for HIV. 3 months after study completion, 9 participants were still taking PrEP Table I. Sexual risk behaviors over the previous 3 months for study participants assessed at baseline visit, as well as 3 month and 6 month follow up visits Figure 1. PrEP Adherence. Figure 2. Number of sexually transmitted infections by specific etiology and site diagnosed Conclusion Our study showed no impact of either offering financial incentives or providing access to a supervised Facebook-based support group on PrEP adherence. Financial compensation based on level of PrEP adherence and using a more age-appropriate social media platform may have a greater impact on adherence Disclosures All Authors: No reported disclosures

Effects of social network incentives and financial incentives on physical activity and social capital among older women: a randomized controlled trial

Background: Financial incentives have been used to increase physical activity. However, the benefit of financial incentives is lost when an intervention ends. Thus, for this study, we combined social network incentives that leverage the power of peer pressure with financial incentives. Few reports have examined the impact of physical activity on social capital. Therefore, the main goal of this study was to ascertain whether a combination of two incentives could lead to more significant changes in physical activity and social capital during and after an intervention.Methods: The participants were 39 older women over 65 years of age in Kumamoto, Japan. The participants were randomly divided into a financial incentive group (FI group) and a social network incentive plus financial incentive group (SNI+FI group). Both groups underwent a three-month intervention. Measurements of physical activity and social capital were performed before and after the intervention. Additionally, the effects of the incentives on physical activity and social capital maintenance were measured six months postintervention. The financial incentive group received a payment ranging from US$4.40 to US$6.20 per month, depending on the number of steps taken during the intervention. For the other group, we provided a social network incentive in addition to the financial incentive. The SNI+FI group walked in groups of three people to use the power of peer pressure.Results: A two-way ANOVA revealed that in terms of physical activity, there was a statistically significant interaction between group and time (p=0.017). The FI group showed no statistically significant improvement in physical activity during the observation period. The FI group showed no statistically significant improvement in physical activity during the observation period. In terms of social capital, the change in trust approached significance (p=0.08).Conclusion: Our results suggest that social network incentives, in combination with financial incentives, are more effective for promoting physical activity than financial incentives alone among older women and that these effects can continue after an intervention. In the meantime, further studies should be conducted on the effect of physical activity on social capital.

Evaluating mobile conditional cash transfers for improving immunization coverage in Pakistan

Background Despite progress in increasing immunization coverage, poor uptake of vaccines remains a challenge, particularly in LMICs. In part, this is due to the poor socio-economic status of caregivers, lack of motivation, and parental procrastination. While there is evidence that large (≥100 USD) incentives can overcome these problems, research on small incentives that are more appropriate for an LMIC setting is sparse. Our study addresses this gap by evaluating the impact of small (≤12 USD) CCTs in increasing immunization coverage for children under the age of two. Methods A 2-year program utilizing two small incentive schemes of different amounts (high: USD9; low: USD5) was implemented in Shikarpur District, Pakistan. Caregivers (with children 0-24 months) visiting any of the 33 study immunization centers were given the opportunity to enroll. All consenting parent-child pairs were randomized in one of the two incentive schemes and incentives were disbursed following each immunization visit, using mobile money. A baseline and end-line survey was conducted to evaluate changes in pre-post coverage. Results A total of 63,336 participants were enrolled between March 2016 - April 2018, of which 41,483 were randomized in the high or low incentive schemes (remaining caregivers were enrolled in the no-incentive group). Results show a 13% and 28% increase in age-appropriate coverage for Measles-1 (M1) and fully immunized children (FIC) compared to the baseline (FIC:16%, M1: 38%). There was no difference in M1 coverage between the high and low incentive schemes. Discussion Small CCTs have induced positive behavioral change and are a powerful tool for improving immunization coverage and compliance within LMICs. Key messages Small mobile conditional cash transfers (USD<12) can serve as nudges to parents and lead to behavioral shifts resulting in improved immunization outcomes for children. There was no significant difference in outcomes between high and low incentives, indicating that small mobile conditional cash transfers were equally effective in improving immunization coverage.

Effects of Incentives on Adherence to a Web-Based Intervention Promoting Physical Activity: Naturalistic Study

Background Despite many advantages of web-based health behavior interventions such as wide accessibility or low costs, these interventions are often accompanied by high attrition rates, particularly in usage under real-life conditions. It would therefore be helpful to implement strategies such as the use of financial incentives to motivate program participation and increase adherence. Objective This naturalistic study examined real-life usage data of a 12-week web-based physical activity (PA) intervention (Fitness Coach) among insurants who participated in an additional incentive program (incentive group) and those who did not (nonincentive group). Users in the incentive group had the perspective of receiving €30 (about US $33) cash back at the end of the intervention. Methods Registration and real-life usage data as part of routine data management and evaluation of the Fitness Coach were analyzed between September 2016 and June 2018. Depending on the duration of use and the weekly recording of tasks, 4 adherence groups (low, occasional, strong, and complete adherence) were defined. Demographic characteristics were collected by a self-reported questionnaire at registration. We analyzed baseline predictors and moderators of complete adherence such as participation in the program, age, gender, and BMI using binary logistic regressions. Results A total of 18,613 eligible persons registered for the intervention. Of these, 15,482 users chose to participate in the incentive program (incentive group): mean age 42.4 (SD 14.4) years, mean BMI 24.5 (SD 4.0) kg/m2, median (IQR) BMI 23.8 (21.7-26.4) kg/m2; 65.12% (10,082/15,482) female; and 3131 users decided not to use the incentive program (nonincentive group): mean age 40.7 (SD 13.4) years, mean BMI 26.2 (SD 5.0) kg/m2, median BMI 25.3 (IQR 22.6-28.7) kg/m2; 72.18% (2260/3131) female. At the end of the intervention, participants in the incentive program group showed 4.8 times higher complete adherence rates than those in the nonincentive program group (39.2% vs 8.1%), also yielding significantly higher odds to complete the intervention (odds ratio [OR] 12.638) for the incentive program group. Gender significantly moderated the effect with men in the incentive group showing higher odds to be completely adherent than women overall and men in the nonincentive group (OR 1.761). Furthermore, older age and male gender were significant predictors of complete adherence for all participants, whereas BMI did not predict intervention completion. Conclusions This is the first naturalistic study in the field of web-based PA interventions that shows the potential of even small financial incentives to increase program adherence. Male users, in particular, seem to be strongly motivated by incentives to complete the intervention. Based on these findings, health care providers can use differentiated incentive systems to increase regular participation in web-based PA interventions.

Effects of Incentives on Adherence to a Web-Based Intervention Promoting Physical Activity: Naturalistic Study (Preprint)

BACKGROUND Despite many advantages of web-based health behavior interventions such as wide accessibility or low costs, these interventions are often accompanied by high attrition rates, particularly in usage under real-life conditions. It would therefore be helpful to implement strategies such as the use of financial incentives to motivate program participation and increase adherence. OBJECTIVE This naturalistic study examined real-life usage data of a 12-week web-based physical activity (PA) intervention (Fitness Coach) among insurants who participated in an additional incentive program (incentive group) and those who did not (nonincentive group). Users in the incentive group had the perspective of receiving €30 (about US $33) cash back at the end of the intervention. METHODS Registration and real-life usage data as part of routine data management and evaluation of the Fitness Coach were analyzed between September 2016 and June 2018. Depending on the duration of use and the weekly recording of tasks, 4 adherence groups (low, occasional, strong, and complete adherence) were defined. Demographic characteristics were collected by a self-reported questionnaire at registration. We analyzed baseline predictors and moderators of complete adherence such as participation in the program, age, gender, and BMI using binary logistic regressions. RESULTS A total of 18,613 eligible persons registered for the intervention. Of these, 15,482 users chose to participate in the incentive program (incentive group): mean age 42.4 (SD 14.4) years, mean BMI 24.5 (SD 4.0) kg/m², median (IQR) BMI 23.8 (21.7-26.4) kg/m²; 65.12% (10,082/15,482) female; and 3131 users decided not to use the incentive program (nonincentive group): mean age 40.7 (SD 13.4) years, mean BMI 26.2 (SD 5.0) kg/m², median BMI 25.3 (IQR 22.6-28.7) kg/m²; 72.18% (2260/3131) female. At the end of the intervention, participants in the incentive program group showed 4.8 times higher complete adherence rates than those in the nonincentive program group (39.2% vs 8.1%), also yielding significantly higher odds to complete the intervention (odds ratio [OR] 12.638) for the incentive program group. Gender significantly moderated the effect with men in the incentive group showing higher odds to be completely adherent than women overall and men in the nonincentive group (OR 1.761). Furthermore, older age and male gender were significant predictors of complete adherence for all participants, whereas BMI did not predict intervention completion. CONCLUSIONS This is the first naturalistic study in the field of web-based PA interventions that shows the potential of even small financial incentives to increase program adherence. Male users, in particular, seem to be strongly motivated by incentives to complete the intervention. Based on these findings, health care providers can use differentiated incentive systems to increase regular participation in web-based PA interventions.