Effectiveness and Ethics of Incentives for Research Participation

Halpern, Scott D.; Chowdhury, Minhaz; Bayes, Brian; Cooney, Elizabeth; Hitsman, Brian; Schnoll, Robert A.; Lubitz, Su Fen; Reyes, Celine; Patel, Mitesh S.; Greysen, S. Ryan; Mercede, Ashley; Reale, Catherine; Barg, Frances K.; Volpp, Kevin G.; Karlawish, Jason; Stephens‐Shields, Alisa J.

doi:10.1001/jamainternmed.2021.5450

Cited by 36 publications

(36 citation statements)

References 52 publications

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“…Our findings are also important because worries about unintended consequences of payments reach well beyond vaccination 43 . Financial incentives intended to motivate healthy and prosocial behaviours have been considered in many contexts, for instance, to motivate blood 1 , 44 , 45 and organ donation 46 , to curtail smoking 3 , 4 , 47 , to encourage exercising and healthy eating 10 , 11 , 48 , to boost medication adherence 49 , to foster clinical trial participation 50 , 51 and to increase uptake of preventive measures, such as cancer screening 2 , 52 . Our findings and methods inform the large and long-standing academic literature discussing the potential negative consequences of financial incentives for behaviour change more generally.…”

Section: Mainmentioning

confidence: 99%

Financial incentives for vaccination do not have negative unintended consequences

Schneider

Campos‐Mercade

Meier

et al. 2023

Nature

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Financial incentives to encourage healthy and prosocial behaviours often trigger initial behavioural change1–11, but a large academic literature warns against using them12–16. Critics warn that financial incentives can crowd out prosocial motivations and reduce perceived safety and trust, thereby reducing healthy behaviours when no payments are offered and eroding morals more generally17–24. Here we report findings from a large-scale, pre-registered study in Sweden that causally measures the unintended consequences of offering financial incentives for taking the first dose of a COVID-19 vaccine. We use a unique combination of random exposure to financial incentives, population-wide administrative vaccination records and rich survey data. We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety. In a complementary study, we find that informing US residents about the existence of state incentive programmes also has no negative consequences. Our findings inform not only the academic debate on financial incentives for behaviour change but also policy-makers who consider using financial incentives to change behaviour.

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Section: Mainmentioning

confidence: 99%

Financial incentives for vaccination do not have negative unintended consequences

Schneider

Campos‐Mercade

Meier

et al. 2023

Nature

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“…Participants in this qualitative study recognized that they were enrolled in research, despite the fact that that the research coordinator did not consistently use the term “research” in the recruitment discussion. Overall, RETAIN found low rates of possible and likely therapeutic misconceptions, which did not differ by incentive groups 15 …”

Section: Discussionmentioning

confidence: 82%

“…Overall, RETAIN found low rates of possible and likely therapeutic misconceptions, which did not differ by incentive groups. 15 A commonly cited concern is that incentives for participation in research create unjust inducementsthat is, they preferentially encourage enrollment among people of lower socioeconomic status, thereby resulting in an uneven distribution of research risks and burdens over the population. 16 Several participants in this qualitative study volunteered information about their socioeconomic status, noting, for example, that they were "low income" or had "financial problems. "…”

Section: E R H E R Hmentioning

confidence: 99%

Participants’ Perspectives on Payment for Research Participation: A Qualitative Study

Largent

Eriksen

Barg

et al. 2022

Ethics & Human Research

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Difficulty enrolling participants in randomized clinical trials (RCTs) is a recognized barrier to evaluating health interventions. 1 To overcome this barrier, many investigators offer payment to participants. Though widespread, this practice remains ethically contentious. 2 It has largely been debated on conceptual grounds, and concerns include that payment might unduly influence or coerce potential participants, undermining their informed consent, or result in the disproportionate enrollment of low-income or otherwise disenfranchised individuals. 3 Prior studies have assessed how offers of payment affect willingness to participate in hypothetical RCTs. 4 By contrast, the recently published Randomized Evaluation of Trial Acceptance by Incentive (RETAIN) study tested the extent to which incentives improve recruitment or exert unintended influences on patients' decisions to enroll in actual RCTs. 5 As a complement to RETAIN's quantitative analyses, we conducted a quali-tative study to explore participants' own experiences and perspectives in greater detail. In this article, we report the results of that qualitative study, which included two components: discourse analysis of recruitment conversations between study coordinators and potential participants and semistructured interviews with participants. STUDY METHODSR ETAIN has been described in detail elsewhere. 6 In brief, two RCTs of incentives were embedded in two parent RCTs-one evaluating an ambulation intervention (national clinical trial number NCT03321279) and one comparing smoking cessation interventions (NCT02378714). The University of Pennsylvania institutional review board (IRB) approved RETAIN and waived the regulatory requirement for obtaining participants' informed consent. Here, we report the results of a qualitative study that was embedded into the ABSTRACT Investigators commonly offer payments to research participants to promote recruitment and retention. Yet the ethics of offering monetary incentives to research participants continues to be debated. Prior conceptual work has addressed some of these concerns; there is, however, also a need for empirical evidence to understand the effects of payment on participants. Here, we report the results of a qualitative study comprising (1) discourse analysis of recruitment conversations between study coordinators and potential participants for an actual clinical trial and (2) semistructured interviews with participants addressing the effects of an incentive on their decision-making. Many participants reported that money had been a motivation for enrolling in the clinical trial but did not use reasoning that suggested undue influence or unjust inducement. These findings add to a growing body of literature suggesting that payment is an ethically acceptable tool for promoting recruitment and retention in clinical trials.

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“…These approaches have been variably successful in survey based and clinical trial research across age groups and populations. Of these methods studied, financial or monetary incentives are seen by participants as both ethical and necessary for long term retention ( 20 , 21 ). In the limited data on retention methods for remote and randomized clinical trials, one meta-analysis of digital health studies with large remote samples found that providing a monetary incentive resulted in better overall retention than providing no monetary incentive, where no monetary incentive resulted in retention rates as low as 10% ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Participant retention in a fully remote trial of digital psychotherapy: Comparison of incentive types

Fillipo

Pullmann

Hull³

et al. 2022

Front. Digit. Health

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Numerous studies have found that long term retention is very low in remote clinical studies (>4 weeks) and to date there is limited information on the best methods to ensure retention. The ability to retain participants in the completion of key assessments periods is critical to all clinical research, and to date little is known as to what methods are best to encourage participant retention. To study incentive-based retention methods we randomized 215 US adults (18+ years) who agreed to participate in a sequential, multiple assignment randomized trial to either high monetary incentive (HMI, $125 USD) and combined low monetary incentive ($75 USD) plus alternative incentive (LMAI). Participants were asked to complete daily and weekly surveys for a total of 12 weeks, which included a tailoring assessment around week 5 to determine who should be stepped up and rerandomized to one of two augmentation conditions. Key assessment points were weeks 5 and 12. There was no difference in participant retention at week 5 (tailoring event), with approximately 75% of the sample completing the week-5 survey. By week 10, the HMI condition retained approximately 70% of the sample, compared to 60% of the LMAI group. By week 12, all differences were attenuated. Differences in completed measures were not significant between groups. At the end of the study, participants were asked the impressions of the incentive condition they were assigned and asked for suggestions for improving engagement. There were no significant differences between conditions on ratings of the fairness of compensation, study satisfaction, or study burden, but study burden, intrinsic motivation and incentive fairness did influence participation. Men were also more likely to drop out of the study than women. Qualitative analysis from both groups found the following engagement suggestions: desire for feedback on survey responses and an interest in automated sharing of individual survey responses with study therapists to assist in treatment. Participants in the LMAI arm indicated that the alternative incentives were engaging and motivating. In sum, while we were able to increase engagement above what is typical for such study, more research is needed to truly improve long term retention in remote trials.

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Effectiveness and Ethics of Incentives for Research Participation

Cited by 36 publications

References 52 publications

Financial incentives for vaccination do not have negative unintended consequences

Financial incentives for vaccination do not have negative unintended consequences

Participants’ Perspectives on Payment for Research Participation: A Qualitative Study

Participant retention in a fully remote trial of digital psychotherapy: Comparison of incentive types

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