Coupling Financial Incentives With Direct Mail in Population-Based Practice

Abstract

Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail. This study reports results of a population-based randomized controlled trial testing a direct mail, incentive-based intervention for promoting mammography uptake. The study population was composed of a random sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening. Participants ( N = 18,939) were randomized into three groups: (1) Direct Mail only, (2) Direct Mail plus Incentive, and (3) Control. Both direct mail groups received two mailers with a message about the importance of mammography; however, Mail plus Incentive mailers also offered a $25 incentive for getting a mammogram. Logistic regression analyses measured intervention effects. Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups. The use of incentives also proved to be cost-effective. Additionally, the Direct Mail only group was more likely to receive mammography than the Control group. Findings offer experimental evidence on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.

Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules among Households with Children: A Pilot Intervention Implemented through a National Cancer Program

“…We found most participants were recruited through DM, and the response rate of 1% to the DM mailing corresponded to previous DM research conducted through Minnesota’s NBCCEDP. We expected a response rate for DM not to be higher than 2% as most DM campaigns, including those implemented within the Sage population, have produced response rates between 1% and 2% [ 23 , 24 , 26 , 30 , 31 ]. The DM route associated with this SFHP pilot is capable of achieving the lowest expected response rate.…”

Economics of Multicomponent Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening: A Community Guide Systematic Review

“…The economic literature search (January 2004–January 2018) identified 8,568 articles. The body of evidence (Figure 2) included 53 studies 14–66 distributed as nine studies 14,16,17,19–23,26 for breast cancer, six studies 28–33 for cervical cancer, 33 studies 34–66 for colorectal cancer, two studies 15,25 for both breast and cervical cancers, and three studies 18,24,27 for both breast and colorectal cancers.…”

“…A total of 40 studies 14–21,24–27,29,31–33,35–38,40–42,45,46,48,50,52,54–65 were conducted in the U.S., and 13 studies 22,23,28,30,34,39,43,44,47,49,51,53,66 were conducted in other high-income countries. 13 The U.S. studies were distributed in the following geographic regions: Northeast, 15,18,24,37,38,46,50,52,58,62,63 Southeast, 17,18,26,27,55,64,65 Midwest, 14,16,25,36,42,45,54 Southwest, 19,20,29,33,35,56,59–61 and West. 21,29–32,40,41,48,57 There were non-U.S. studies from Japan 22 and Spain 23 for breast cancer; from Japan 28 and Canada 30 for cervical cancer; and from Netherlands, 34,39 France, 47,49,53 Hong Kong, 51 South Korea, 66 and Italy 43,44 for colorectal cancer.…”

“…Most of the studies were RCTs. 14–17,20–22,24,25,29–32,34–43,45–50,52–54,56–58,62,64,66 Most included cost-effectiveness analyses, reporting ICERs, 14–16,18,20–24,26,27,29–33,35–38,40,41,45,47,49,57,60,62,64–66 whereas some reported only cost estimates. 17,19,25,28,34,39,42–44,46,48,54–56,58,59,61 Only one study reported cost–benefit estimates.…”

Clinical Population Medicine: Integrating Clinical Medicine and Population Health in Practice

“…Though CPM is perhaps most apparent in the ideas presented in a leading primary care journal, we see it thriving in other areas ranging from surgery to radiology, perinatology to palliative care. [19][20][21][22] The papers in this virtual issue distinguish CPM from conventional clinical practice and the work of existing public health agencies. CPM may share methods with health services research and quality improvement, but is equally distinct from these nonclinical practices.…”