How patient navigators view the use of financial incentives to influence study involvement, substance use, and HIV treatment

Mitchell, Shannon Gwin; Monico, Laura B.; Stitzer, Maxine L.; Matheson, Timothy; Sorensen, James L.; Feaster, Daniel J.; Schwartz, Robert P.; Metsch, Lisa R.

doi:10.1016/j.jsat.2018.07.009

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…The increase in enrollment rates among those receiving both strategies may be due in part to differences in the type of motivation targeted by each strategy. Preliminary studies have shown that motivation may be one feature by which these techniques can improve targeted behavior, like HIV health-related outcomes [ 43 , 44 ]. Indeed, a 2018 study found that incorporating financial incentives helped increase urine screening adherence when internal motivation was relatively low [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

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Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial

Greene¹,

Bernardo²,

Thompson³

et al. 2023

JMIR Form Res

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Background Nearly 1 in 3 clinical trials end prematurely due to underenrollment. Strategies to enhance recruitment are often implemented without scientific rigor to evaluate efficacy. Evidence-based, cost-effective behavioral economic strategies designed to influence decision-making may be useful to promote clinical trial enrollment. Objective This study evaluated 2 behavioral economic strategies to improve enrollment and retention rates across 4 clinical trials: information provision (IP) and contingency management (CM; ie, lottery). IP targets descriptive and injunctive norms about participating in research and CM provides participants incentives to reinforce a target behavior. Methods A sample of 212 participants was enrolled across 4 clinical trials focused on tobacco use: 2 focused on HIV and 2 focused on neuroimaging. The CM condition included a lottery: for each study visit completed, participants received 5 “draws” from a bowl containing 500 “chips” valued at US $0, US $1, US $5, or US $100. In the IP condition, text messages that targeted injunctive norms about research (eg, “Many find it a rewarding way to advance science and be part of a community”) were sent through the Way to Health platform before all study visits. Participants were randomized to 1 of 4 conditions: IP, CM, IP+CM, or standard recruitment (SR). We performed logistic regression, controlling for sex and study, with condition as a between-subject predictor. Outcomes were the percentage of participants who attended a final eligibility visit (primary), met intent-to-treat (ITT) criteria (secondary), and completed the study (secondary). Recruitment was evaluated by the percentage of participants who attended a final eligibility visit, enrollment by ITT status, and retention by the percentage of participants who completed the study. Results Rates of attending the eligibility visit and meeting ITT status were 58.9% (33/56) and 33.9% (19/56) for IP+CM; 45.5% (25/55) and 18.2% (10/55) for IP only; 41.5% (22/53) and 18.9% (10/53) for CM only; and 37.5% (18/48) and 12.5% (6/48) for SR, respectively. In the logistic regression, females were more likely to meet ITT status than males (odds ratio [OR] 2.7, 95% CI 1.2-5.7; P=.01). The IP+CM group was twice as likely to attend the final eligibility visit than the SR group (OR 2.4, 95% CI 1.1-5.2; P=.04). The IP+CM group was also significantly more likely to reach ITT status than the SR condition (OR 3.9, 95% CI 1.3-11.1; P=.01). Those who received any active intervention (IP, CM, or IP+CM) had a higher study completion rate (33/53, 63.5%) compared to those who received SR (5/12, 41.7%), but this difference was not significant (P=.26). Conclusions Combining IP and CM strategies may motivate participants to participate in research and improve recruitment and retention rates. Evidence from this study provides preliminary support for the utility of behavioral economics strategies to improve enrollment and reduce attrition in clinical trials.

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Section: Discussionmentioning

confidence: 99%

“…Preliminary studies have shown that motivation may be one feature by which these techniques can improve targeted behavior, like HIV health-related outcomes [43,44]. Indeed, a 2018 study found that incorporating financial incentives helped increase urine screening adherence when internal motivation was relatively low [43].…”

Section: Overviewmentioning

confidence: 99%

Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial

Greene¹,

Bernardo²,

Thompson³

et al. 2023

JMIR Form Res

View full text Add to dashboard Cite

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Experiences of conditional and unconditional cash transfers intended for improving health outcomes and health service use: a qualitative evidence synthesis

Yoshino

Sidney-Annerstedt

Wingfield

et al. 2023

Cochrane Database of Systematic Reviews

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Readiness to implement contingency management to promote PrEP initiation and adherence among people who inject drugs: results from a multi-site implementation survey

Pickering,

Viera,

Sung

et al. 2024

Addict Sci Clin Pract

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Background Contingency management (CM), an incentive-based intervention to encourage target behaviors, effectively promotes medication adherence. However, efforts to extend CM to HIV pre-exposure prophylaxis (PrEP) have been lacking. As part of a randomized clinical trial to promote HIV Prevention among people who inject drugs (PWID), we examined the readiness of staff in community-based organizations serving PWID to implement CM for PrEP uptake and adherence in this population. Methods From April to August 2022, we conducted a survey of staff from four community-based organizations providing HIV testing, harm reduction, and outreach services in the northeastern United States. We assessed knowledge and attitudes regarding PrEP for PWID on five-point Likert scales (e.g., Poor to Excellent, Not at all to Extremely). Using a modified version of the Contingency Management Beliefs Questionnaire, we assessed the degree to which attitudes about CM for HIV prevention influenced interest in its adoption on a scale from “1-No influence at all” to “5-Very strong influence”. We explored endorsement patterns, along with average values of individual items and subscale scores. Results Among 271 staff invitations, 123 (45.4%) responded. The majority (88.6%) of respondents reported prior PrEP awareness, with a mean self-rated knowledge of 2.98 out of 5 (SD = 1.1). Attitudes towards PrEP, including its relevance to and importance for clients (both means = 4.3), efficacy (mean = 4.5), and safety (mean = 4.2), were positive. Items related to practicality and confidence in providing PrEP-related care had relatively lower ratings. Respondents endorsed influential generalized (mean = 2.1) and training-related (mean = 2.5) CM implementation barriers less frequently than positive attitudes towards CM (mean = 3.6). Staff favored adding CM to existing services (mean = 3.8), and highly endorsed it as “useful for targeting HIV prevention with PrEP” (mean = 3.7). Conclusions Respondents generally supported the use of CM to promote HIV prevention among PWID and favored adding it to their existing services. Though respondents understood the value of both PrEP and CM to support HIV prevention activities, findings corroborate research citing relative lack of knowledge and confidence regarding PrEP management among clients, potentially detracting from implementation readiness. Trial Registration Number NCT04738825.

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How patient navigators view the use of financial incentives to influence study involvement, substance use, and HIV treatment

Abstract: NCT01612169.

Cited by 5 publications

References 19 publications

Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial

Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial

Experiences of conditional and unconditional cash transfers intended for improving health outcomes and health service use: a qualitative evidence synthesis

Readiness to implement contingency management to promote PrEP initiation and adherence among people who inject drugs: results from a multi-site implementation survey

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