Strategies to reduce attrition in randomised trials

Brueton, Valerie; Rait, Greta; Tierney, Jayne; Meredith, Sarah; Darbyshire, Julie; Harding, Seeromanie; Stenning, SP; Nazareth, Irwin

doi:10.1002/14651858.mr000032

Cited by 13 publications

(14 citation statements)

References 39 publications

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“…This was important as CPIT participants and others who had participated in incentive schemes were generally more positive about incentives and their delivery processes than those with no experience of incentive interventions. This is encouraging as incentives can reduce attrition in intervention trials 216 and, once engaged, voucher incentive interventions for smoking cessation in pregnancy are both effective and acceptable to participants.…”

Section: Strengths and Limitationsmentioning

confidence: 98%

“…These findings are consistent with a recent Cochrane review which found that incentives have a small effect on attrition in research studies. 216 Costs varied in terms of what was reported (e.g. cost per participant or cost of implementing the entire intervention), what was provided (e.g.…”

Section: Incentives For Initiating and Continuing Smoking Cessationmentioning

confidence: 99%

“…Food and drink 286,287 or an ironing service 287 can increase participation in education or support group programmes and incentives can increase recruitment and participation in research trials. 216 Gifts focusing on maternal well-being were valued for their communication of achievement and recognition of the effort required to 'be a good mother', when the odds might be stacked against this. Gifts can also be considered a cultural norm in the context of pregnancy and parenting magazines, websites, proactive e-mails and texts to shared mailing lists and NHS 'bounty bags', where small gifts and discounts are widely provided to advertise products and services.…”

Section: Primary Qualitative Study Investigating Perspectives On Incementioning

confidence: 99%

“…A contingent incentive for attending a breastfeeding session to collect outcome data would be supported by the evidence from the review (see Chapter 3) and would be more acceptable than available alternatives, such as photography or professional verification (see Chapter 6). Incentives for participation are known to reduce attrition in trials, 216 and participants considered gaming less likely for a free breast pump than shopping vouchers (see Chapter 6).…”

Section: Monitoring and Outcome Measurementmentioning

confidence: 99%

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Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Morgan

Hoddinott

Thomson

et al. 2015

Health Technology Assessment

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BackgroundSmoking in pregnancy and/or not breastfeeding have considerable negative health outcomes for mother and baby.AimTo understand incentive mechanisms of action for smoking cessation in pregnancy and breastfeeding, develop a taxonomy and identify promising, acceptable and feasible interventions to inform trial design.DesignEvidence syntheses, primary qualitative survey, and discrete choice experiment (DCE) research using multidisciplinary, mixed methods. Two mother-and-baby groups in disadvantaged areas collaborated throughout.SettingUK.ParticipantsThe qualitative study included 88 pregnant women/recent mothers/partners, 53 service providers, 24 experts/decision-makers and 63 conference attendees. The surveys included 1144 members of the general public and 497 health professionals. The DCE study included 320 women with a history of smoking.Methods(1) Evidence syntheses: incentive effectiveness (including meta-analysis and effect size estimates), delivery processes, barriers to and facilitators of smoking cessation in pregnancy and/or breastfeeding, scoping review of incentives for lifestyle behaviours; (2) qualitative research: grounded theory to understand incentive mechanisms of action and a framework approach for trial design; (3) survey: multivariable ordered logit models; (4) DCE: conditional logit regression and the log-likelihood ratio test.ResultsOut of 1469 smoking cessation and 5408 breastfeeding multicomponent studies identified, 23 smoking cessation and 19 breastfeeding studies were included in the review. Vouchers contingent on biochemically proven smoking cessation in pregnancy were effective, with a relative risk of 2.58 (95% confidence interval 1.63 to 4.07) compared with non-contingent incentives for participation (four studies, 344 participants). Effects continued until 3 months post partum. Inconclusive effects were found for breastfeeding incentives compared with no/smaller incentives (13 studies) but provider commitment contracts for breastfeeding show promise. Intervention intensity is a possible confounder. The acceptability of seven promising incentives was mixed. Women (for vouchers) and those with a lower level of education (except for breastfeeding incentives) were more likely to disagree. Those aged ≤ 44 years and ethnic minority groups were more likely to agree. Agreement was greatest for a free breast pump and least for vouchers for breastfeeding. Universal incentives were preferred to those targeting low-income women. Initial daily text/telephone support, a quitting pal, vouchers for > £20.00 per month and values up to £80.00 increase the likelihood of smoking cessation. Doctors disagreed with provider incentives. A ‘ladder’ logic model emerged through data synthesis and had face validity with service users. It combined an incentive typology and behaviour change taxonomy. Autonomy and well-being matter. Personal difficulties, emotions, socialising and attitudes of others are challenges to climbing a metaphorical ‘ladder’ towards smoking cessation and breastfeeding. Incentive interventions provide opportunity ‘rungs’ to help, including regular skilled flexible support, a pal, setting goals, monitoring and outcome verification. Individually tailored and non-judgemental continuity of care can bolster women’s capabilities to succeed. Rigid, prescriptive interventions placing the onus on women to behave ‘healthily’ risk them feeling pressurised and failing. To avoid ‘losing face’, women may disengage.LimitationsIncluded studies were heterogeneous and of variable quality, limiting the assessment of incentive effectiveness. No cost-effectiveness data were reported. In surveys, selection bias and confounding are possible. The validity and utility of the ladder logic model requires evaluation with more diverse samples of the target population.ConclusionsIncentives provided with other tailored components show promise but reach is a concern. Formal evaluation is recommended. Collaborative service-user involvement is important.Study registrationThis study is registered as PROSPERO CRD42012001980.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Strengths and Limitationsmentioning

confidence: 98%

Section: Incentives For Initiating and Continuing Smoking Cessationmentioning

confidence: 99%

Section: Primary Qualitative Study Investigating Perspectives On Incementioning

confidence: 99%

Section: Monitoring and Outcome Measurementmentioning

confidence: 99%

See 2 more Smart Citations

Benefits of Incentives for Breastfeeding and Smoking cessation in pregnancy (BIBS): a mixed-methods study to inform trial design

Morgan

Hoddinott

Thomson

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

show abstract

“…As a result, both the intervention and "control" groups in studies had to be treated as multiple intervention groups (because both received incentives). Incentives for participation have evidence of effectiveness for attrition in studies 46 and are likely to interact with nonincentive components of the intervention, such as additional breastfeeding support. Assessment of effectiveness was also limited by inadequate comparator (nonincentivized) groups.…”

Section: Discussionmentioning

confidence: 99%

Incentives to Promote Breastfeeding: A Systematic Review

et al. 2015

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BACKGROUND AND OBJECTIVES: Few women in industrialized countries achieve the World Health Organization's recommendation to breastfeed exclusively for 6 months. Governments are increasingly seeking new interventions to address this problem, including the use of incentives. The goal of this study was to assess the evidence regarding the effectiveness of incentive interventions, delivered within or outside of health care settings, to individuals and/or their families seeking to increase and sustain breastfeeding in the first 6 months after birth.

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