Published online Jun 10, 2015. doi: 10.4239/wjd.v6.i5.752
Peer-review started: November 28, 2014
First decision: January 20, 2015
Revised: March 3, 2015
Accepted: April 1, 2015
Article in press: April 7, 2015
Published online: June 10, 2015
AIM: To study the acceptability of incentives for behavior changes in individuals with diabetes, comparing financial incentives to self-rewards and non-financial incentives.
METHODS: A national online survey of United States adults with diabetes was conducted in March 2013 (n = 153). This survey was designed for this study, with iterative testing and modifications in a pilot population. We measured the demographics of individuals, their interest in incentives, as well as the perceived challenge of diabetes self-management tasks, and expectations of incentives to improve diabetes self-management (financial, non-financial and self-rewards). Using an ordered logistic regression model, we assessed the association between a 32-point score of the perceived challenge of the self-management tasks and the three types of rewards.
RESULTS: Ninety-six percent of individuals were interested in financial incentives, 60% in non-financial incentives and 72% in self-rewards. Patients were less likely to use financial incentives when they perceived the behavior to be more challenging (odds ratio of using financial incentives of 0.82 (95%CI: 0.72-0.93) for each point of the behavior score). While the effectiveness of incentives may vary according to the perceived level of challenge of each behavior, participants did not expect to need large amounts to motivate them to modify their behavior. The expected average amounts needed to motivate a 5 lb weight loss in our population and to maintain this weight change for a year was $258 (interquartile range of $10-100) and $713 (interquartile range of $25-250) for a 15 lb weight loss. The difference in mean amount estimates for 5 lb and 15 lb weight loss was significant (P < 0.001).
CONCLUSION: Individuals with diabetes are willing to consider financial incentives to improve diabetes self-management. Future studies are needed to explore incentive programs and their effectiveness for diabetes.
Core tip: Patient incentives have shown potential in modifying behaviors such as smoking cessation or weight loss. This online survey for individuals with diabetes explores their attitude towards incentives (financial, non-financial and self-rewards) for diabetes self-management. Although nearly all participants showed positive expectations about financial incentives, they favored financial incentives for less challenging behaviors, and non-financial incentives for more challenging behaviors. This survey also enquired about expected amount of incentives, in particular for a 5 lb weight loss, maintained over a year.