Incentives for Research Participants in Personal Health Information Technology Studies

Katherine Kim, M.P.H., MBA, iN Touch Principal Investigator, San Francisco State University
Holly Logan, iN Touch Project Coordinator, San Francisco State University

I was recently asked whether we were using incentives to motivate our participants to use iN Touch. In designing our incentive strategy we combined our team’s experience with youth and the advice of the Project HealthDesign National Advisory Committee. We wanted to promote participation in research but we didn’t want incentives to be an external motivator for health goal attainment. We also wanted to minimize participants’ disappointment if they were selected for the control group.

Our strategy is to provide iPod Touches to all intervention group participants, which they will keep upon completion of the project. Control group participants are randomly selected to receive either an iPod Touch or an iPod Shuffle, but are guaranteed to receive one of these items. In addition, we offer a $10 gift card from Target or iTunes for each focus group or interview. The 13- to 18-year-olds prefer iTunes and the 18- to 24-year-olds usually select Target. We do not provide any incentives for use of the application, collection of observations of daily living (ODLs) or visits with a health coach or clinician.

We wondered how other research projects were approaching the use of incentives so we did a little research. AHRQ recently published an excellent report on the impact of consumer health informatics applications.¹ That was a good starting point. We conducted a quick review of 12 randomized clinical trials that showed a positive relationship between the use of personal health information technology and either health outcomes or intermediate outcomes. This is what we found:

Three papers didn’t report on incentives, four reported giving no incentives, and five gave incentives. Here is a summary of the five papers that reported on incentives:

• An Internet self-help application for test anxiety for college students provided a $5-10 incentive for filling out pre and post surveys.²
• An Internet weight loss intervention for African-American adolescent girls provided a subsidy for the purchase of a computer and compensation for time for completing each of four assessments (adolescents received a gift valued at ~$10, parents received $30).³
• A computer-aided behavioral weight loss program for adult women offered a pedometer and $9 per appointment.⁴
• A computer-based health information support system for HIV/AIDS patients offered an incentive for each of three surveys (no amount stated).⁵
• A comparison of computer-tailored counseling and email counseling for overweight/obese adults offered $25 for first visit, $50 for second visit and discounts on meal replacement drinks.⁶

This mini-review showed that detailed incentive strategies were inconsistently described in clinical trials of personal health information technology. We’d love to know more about what others in the field are doing and what the impact of incentives are on behavior or adoption of technology.

References

1. Gibbons MC, W. R., Samal L, Lehmann CU, Dickersin K, Lehmann HP, Aboumatar H, Finkelstein J, Shelton E, Sharma R, Bass EB. (2009). Impact of Consumer Health Informatics Applications. Evidence Report/Technology Assessment No. 188. (Prepared by Johns Hopkins University Evidence-based Practice Center under contract No. HHSA 290-2007-10061-I). Rockville, MD: Agency for Healthcare Research and Quality.

2. Orbach G, Lindsay S, Grey S. A randomized placebo-controlled trial of a self-help Internet-based intervention for test anxiety. Behav Res Ther 2007; 45(3):483-96. 134. March S, Spence SH, Donovan CL. The Efficacy of an Internet-Based Cognitive-Behavioral Therapy Intervention for Child Anxiety Disorders. Journal of Pediatric Psychology 2008.

3. Williamson DA, Walden HM, White MA et al. Two-year internet-based randomized controlled trial for weight loss in African- American girls. Obesity (Silver Spring) 2006; 14(7):1231-43.

4. Adachi Y, Sato C, Yamatsu K, Ito S, Adachi K, Yamagami T. A randomized controlled trial on the long-term effects of a 1-month behavioral weight control program assisted by computer tailored advice. Behaviour Research and Therapy 2007; 45(3):459-70.

5. Gustafson DH, Hawkins R, Boberg E et al. Impact of a patient-centered, computerbased health information/support system. American Journal of Preventitive Medicine 1999; 16(1):1-9.

6. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Archives of Internal Medicine 2006; 166(15):1620-5

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Comments

[Dave Gustafson]

We have found that we must adjust our incentives to the population we study. I think it is important to note that we have also evolved over time in our goals regarding response rate. We now feel we must get over 80% response rates from both control and experimental groups. This is in part due to the research of Chris Scott at Chestnut on impact of lower response rates on outcome. Raising our response goals has raised our incentives. In one addiction trials we are paying subjects $40 for each quarterly survey they complete and an extra $40 at the end if they complete all three. These are alcoholics who may need more incentive to respond than others.

[Kathy Kim]

Thanks for the updated information and pointing out Chris Scott's work. I agree with you that both points--a high response rate and tailoring the incentives to the population--are important.