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PubMed1994

Effect of a monetary incentive on response to a mail survey.

We assessed the effect of a $1 incentive on response to a two-page questionnaire which was sent to 8356 female cosmetologists between 22 and 36 years old. The study population was randomly assigned to one of three groups in which a $1 incentive was enclosed with either the first or second mailing, or with none of the mailings. Ten percent of questionnaires were returned by the postal service because of an incorrect address or death of the addressee and were omitted from response calculations. Of the remaining questionnaires, 79% were completed and returned after up to three mailings. The cumulative response was highest among cosmetologists who received a $1 incentive with the first mailing, (81%; 95% confidence interval (CI), 80 to 82), intermediate among those who received $1 with the second mailing (78%, 95% CI, 77 to 79), and lowest among cosmetologists who received no incentive (74%; 95% CI, 70 to 78). Characteristics of cosmetologists who responded after having received a "41 incentive were similar to those who responded without having received an incentive. The higher costs per response incurred by the use of an incentive must be weighed against the benefit of higher response.

Adult↗

PubMed2006

Incentives for survey participation when are they "coercive"?

Monetary incentives are increasingly used to help motivate survey participation. This article summarizes several theories underlying the use of incentives and briefly reviews research demonstrating their intended and unintended effects on response rates, sample composition, response bias, and response quality. It also considers the evidence for the effectiveness of incentives in reducing nonresponse bias. Institutional review boards have begun to ask whether, and under what conditions, the use of monetary incentives to induce participation might be coercive and to question the use of such incentives in surveys of "vulnerable" populations, including surveys of injury and violence. The article reviews the ethical principles underlying the requirement for voluntary informed consent as well as current regulations and a broad theoretical and empirical literature bearing on this question, concluding that incentives are never coercive. The question of whether they exert "undue influence" in a specific situation is more difficult, but it may be the wrong question to ask. The article concludes with several recommendations designed to ensure the ethical use of incentives in surveys on violence and injury.

Bias↗

PubMed2006

Combining conditional and unconditional recruitment incentives could facilitate telephone tracing in surveys of postpartum women.

BACKGROUND AND OBJECTIVE: To compare tracing and contact rates using alternative incentives in a computer-assisted telephone interview (CATI) survey among postpartum women. METHODS: In a randomized trial of 1,061 postpartum women 18-49 years of age selected from four Iowa counties, we compared the effects of: (1) unconditional $5 telephone card incentive enclosed with the introductory letter followed by $25 incentive conditional upon successful telephone tracing, contact, and completion of CATI (Group 1, n = 530) vs. (2) $30 incentive conditional upon subject completion of CATI (Group 2, n = 531). RESULTS: Overall telephone tracing and contact rates achieved were 67.8% and 66.6%, respectively. Tracing (70.2 vs. 65.4%, P = .09) and contact (68.5 vs. 64.8%, P = .26) rates were consistently higher among subjects assigned the combination of a conditional and an unconditional incentive. The combined incentive type had a greater impact on telephone tracing success rates for subjects on whom we could not initially locate an active telephone number (16.7 vs. 7.3%, P = .07) when compared to subjects for whom we found an active telephone number at the time of mailing the introductory letter (78.9 vs. 75.9%, P = .30). CONCLUSIONS: Combining conditional and unconditional recruitment incentives can facilitate telephone tracing efforts in surveys conducted among recently postpartum women.

Data Collection↗

PubMed2006

Effects of financial incentives on the intention to consent to organ donation: a questionnaire survey.

INTRODUCTION: Shortage of donor organs is a serious problem for transplantation medicine. One controversial suggestion to increase the number of organ donors is financial incentives for consent. The aim of this study was to test whether different forms and amounts of financial incentives were apt to increase the consent to organ donation. MATERIALS AND METHODS: Data were collected via questionnaires in urban and rural regions of Austria and randomly assigned to settings with three different amounts of financial incentives. The questionnaire was designed by using the theory of planned behaviour of Ajzen. Parents 69 mothers and 35 fathers; ages 25 to 65 years were evaluated for intention to consent to organ donation, perceived social norm, and positive/ negative aspects of organ donation without and with various financial incentives. RESULTS: The intention to consent to organ donation dropped highly significantly (Z = -7.556 P = .000) from the basic condition (M = 1.13; confidence interval [CIs] 0.78 to 1.51) to the condition with financial incentives (M = -1.58; CI, 1.96 to -1.15). No influence of the amount of financial incentive was observed. Highly significant differences were measured between both conditions for the social norm (Z = -5.638; P < .000) and the attitude toward organ donation (Z = -1.962; P < .05; Z = -2.104; P < .035). CONCLUSIONS: Financial incentives led to decreased consents and elicited strong rejections and negative reactions of the participants. Taking money for consent to organ donation seems to be a strict taboo for most people in Austrian society.

Adult↗

PubMed1999

Monetary versus nonmonetary incentives for TB skin test reading among drug users.

BACKGROUND: In a prior study, we reported that monetary incentives were effective in increasing return for tuberculosis (TB) skin test reading. The purpose of this study was to compare the effects of monetary versus nonmonetary incentives and a theory-based educational intervention on return for TB skin test reading in a sample of newly recruited active injection and crack cocaine users, and to determine the prevalence of TB infection in this sample. METHODS: Active injection drug and/or crack cocaine users (n = 1,078), recruited using street outreach techniques, were skin tested for TB. They were randomly assigned to 1 of 5 experimental treatment conditions: $10 cash, grocery store coupons, bus tokens/fast-food coupons, motivational education, or usual encouragement to return. Nonmonetary incentives had a $10 value, and all incentives were provided at return for skin test reading. RESULTS: Ninety-five percent of those who received $10 returned for skin test reading compared to 86% of those who received grocery store coupons and 83% of those who received either bus tokens or fast-food coupons. In contrast, only 47% of those who received the educational session and only 49% of those who received usual encouragement returned for skin test reading. The prevalence of a positive tuberculin test was 21%, and was similar for crack cocaine and injection drug users. CONCLUSIONS: Nonmonetary and monetary incentives dramatically increased the return rate for TB skin test reading among drug users who are at high risk of TB infection. Nonmonetary incentives were somewhat less effective than monetary incentives.

Adolescent↗

PubMed2003

Irritable bowel syndrome: are incentives useful for improving survey response rates?

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders. There continues to be a need for community-based research into this condition. Unfortunately, response rates in community-based IBS surveys have typically been very low. In this study, we explore the use of incentives and multiple-response options as a means of increasing survey response rates. The study was conducted in three phases. In an initial phase, no incentive was offered; in the second phase, a 5.00 Canadian dollars incentive was offered; and in the third phase, a 20.00 Canadian dollars incentive was offered. Response rates were higher in the incentive groups: Individual response rates were 57.9%, 72.7%, and 84.7% in the three phases, respectively. A slightly higher estimate of IBS prevalence was obtained in the no incentive group. Selection bias is a possible explanation for this difference. A decision about whether to use incentives must be based on the specific goals of the study.

Adolescent↗

PubMed2004

Fall protection incentives in the construction industry: literature review and field study.

Safety literature confirms that incentives such as money or sunglasses seem to improve safety conditions over the short run. However, no studies could be found which tested the effect of incentives on fall protection for a period longer than a few days. In our research we found that after 6 months, the use of non-material incentives significantly improved on-time delivery and completion rates of a special inspection form (both p <.005). In addition, a questionnaire with embedded critical questions showed that even though workers said that they preferred material incentives, we conclude that their behavior was changed by the treatment (incentives). We further conclude that the use of natural reinforcers seems to influence worker behaviors and perception of management's commitment to safety over the long run, even though workers still say that they prefer tangible rewards. Future work should replicate these findings and explore why workers respond to natural incentives but express a preference for material incentives.

Accidental Falls↗

PubMed1980

The effect of monetary incentive on amount and rate of free recall in older and younger adults.

In a single-trial, free-recall experiment, older and younger adults received either 0, 5, or 50 cents for each word recalled from a 24-word list. Each subject served in each of the incentive conditions. It was hypothesized that monetary incentive would increase the degree of task involvement for older subjects and result in a noticeable reduction in the magnitude of age-related performance differences. In accord with previous investigations, incentive was expected to have no effect on the performance of younger subjects. The results showed that overall recall was not facilitated by incentive, but there was an increase in the rate of recall when incentive was available. This effect of incentive was the same for older and younger subjects, and performance deficits observed for the older subjects were not reduced by incentive. Age differences in recall were largely confined to the first 30 seconds of the recall period, suggesting that age-related differences in willingness or ability to engage in extended memory search were not the source of age-related performance differences. In addition, performance declined steadily across each successive list learned for the older learners, a result we interpreted in terms of susceptibility to interference from prior-list learning.

Adolescent↗

PubMed1993

Randomized trial of use of a monetary incentive and a reminder card to increase the response rate to a mailed health survey.

Insufficient response rates are a frequent problem in mailed epidemiologic health surveys. As part of a health survey of 1,235 young adults conducted from November 1992 through January 1993 in Geneva, Switzerland, a randomized factorial trial was carried out to assess the contributions of two tactics to increase response rates. The first incentive was the promise of sending 10 Swiss francs (7 US dollars) to respondents; the second was a red postcard, mailed 2 days after the questionnaire, which reminded potential participants to complete the questionnaire. The most effective strategy according to interim analysis was to be selected for follow-up mailings. Two weeks after the first mailing, response rates were 65% for those who had received both incentives, 57% for those who had been offered the money reward only, 54% for recipients of the reminder card, and 48% for those who had received neither incentive (p based on chi 2 (3 df) test < 0.001). The relative hazards of responding were 1.34 (95% confidence interval 1.15-1.55) for the money reward and 1.22 (95% confidence interval 1.05-1.41) for the reminder card. Follow-up mailings to all nonrespondents included both incentives. At the end of data collection, 1,007 persons (82%) had returned the questionnaire. The final response rates were 83, 84, 82, and 78% in the four groups, respectively (p = 0.29). Both the promise of a monetary reward and a reminder postcard considerably improved early response rates. The use of both incentives in follow-up mailings brought final response rates above 80%, except for those who had received no initial incentive. Testing various combinations of incentives in the early stages of a mailed health survey may be a generally useful strategy.

Adult↗

PubMedDate not supplied

Recruiting patients from a sexually transmitted disease clinic to sexual risk reduction workshops: are monetary incentives necessary?

Most patients attending urban STD clinics can benefit from workshops designed to promote sexual health and reduce sexual risk behaviors. However, many patients do not attend such workshops when invited. The purpose of this study was to evaluate the effects of providing a financial incentive on attendance at a sexual risk reduction workshop tailored to patients at an urban STD clinic. A quasi-experimental design with two conditions (incentive vs no incentive) was implemented sequentially with 107 STD clinic patients (58 men, 49 women; 69% African American; mean age = 27 years) reporting risky sexual behavior. Attendance at a subsequent sexual risk reduction workshop served as the key outcome. Results indicated that participants who were provided with a $30 cash incentive were more likely to attend the risk reduction workshop (38%) than participants who were not offered an incentive (9%), chi (1, N = 107) = 12.88, p < .001. Additional analyses confirmed that incentive (AOR = 7.59, p < .001) predicted attendance even after controlling for other significant predictors, namely, employment status (AOR = 3.04, p < .05) and age (AOR = 1.07, p < .05). We conclude that financial incentives are an effective way to increase attendance at sexual risk reduction workshops for at-risk urban populations.

Adult↗

PubMed2005

Increasing response rates in a survey of Medicaid enrollees: the effect of a prepaid monetary incentive and mixed modes (mail and telephone).

OBJECTIVES: We sought to evaluate the effect of pairing a mixed-mode mail and telephone methodology with a prepaid US 2.00 dollars cash incentive on response rates in a survey of Medicaid enrollees stratified by race and ethnicity. RESEARCH DESIGN: Sampling was conducted in 2 stages. The first stage consisted of a simple random sample (SRS) of Medicaid enrollees. In the second stage, American Indian, African American, Latino, Hmong, and Somali enrollees were randomly sampled. A total of 8412 enrollees were assigned randomly to receive a mail survey with no incentive or a US 2.00 dollars bill. RESULTS: The response rate within the SRS after the mail portion was 54% in the incentive group and 45% in the nonincentive group. Response rates increased considerably with telephone follow-ups. The incentive SRS response rate increased to 69%, and the nonincentive response rate increased to 64%. Differences between incentive conditions are more pronounced after the first mailing (P < 0.01); almost all differences remained significant (P < 0.05) after the completion of the mail mode. The inclusion of the US 2.00 dollars incentive had similar effects on response rates and cost across the different racial and ethnic strata, except for Latino enrollees. CONCLUSIONS: A mixed-mode mail and telephone methodology is effective for increasing response rates in a Medicaid population overall and within different racial and ethnic groupings. The effectiveness of this strategy can be enhanced, in terms of response rate and cost, by including a US 2.00 dollars prepaid incentive.

Ethnicity↗

PubMed2007

The effects of anorexic drugs on free-fed rats responding under a second-order FI15-min (FR10:S) schedule for high incentive foods.

Many similarities exist between the overconsumption of food, which results in obesity, and drug addiction. The present study investigated the effects of anorectic drugs on responding maintained by high incentive, but nutritionally unnecessary, food reinforcers using an FI15(fixed-ratio 10:S) schedule of reinforcement, similar to that used in studies on the incentive properties of drugs of abuse. Rats were trained to respond on a lever to gain access to two high incentive foods--chocolate chip cookies and cheese. Under the FI15(FR10:S) schedule, every 10th response (fixed-ratio 10) delivered a tone and light conditioned stimulus. The first ratio completed 15 min after the start of the session produced the conditioned stimulus and opened a door to give access to a piece of cookie. After 5 min to consume the high incentive food, a second 15-min interval was started, terminating in access to a second reinforcer, cheese. Once trained, the rats were given free access to laboratory chow in the home cage. They continued to work for the high incentive foods for a period of over 1 year, showing a pattern of responding appropriate to an FI(fixed-ratio) schedule. Naloxone (1.0 mg/kg), fenfluramine (1 and 2 mg/kg), D-amphetamine (0.25 and 0.5 mg/kg), and rimonabant (3 mg/kg) significantly reduced responding, especially in the second interval. In contrast, complete removal of the high incentive food from the test procedure did not immediately reduce the rate of responding, tending to increase it in the second of the intervals. Apparently, the drugs did not reduce responding by reducing the experienced magnitude of the high incentive food, but more probably by reducing the animals' motivation.

Animals↗

PubMed2004

Incentives for children in research.

PURPOSE: To describe the challenges of using incentives for children in research. ORGANIZING FRAMEWORK: A discussion of incentives in the context of recruitment for research, including a review of the literature, a description of the types of incentives used with children and their families, factors influencing choice of incentives and ethical considerations. Recommendations to guide decisions about incentives are proposed. CONCLUSIONS: Since the 1997 mandate from the U.S. National Institutes of Health that investigators provide justification for excluding children, researchers have become more willing to include children. Whether all parts of the research process pertain to children without careful consideration and adaptation is unclear. One area lacking clarity is the use of incentives to encourage participation in research. The issue of incentives for children or parents should be considered early in the design of the research proposal, with attention to developmental age, ethical considerations, purpose of the research, and burden to the child and family.

Adolescent↗

PubMedDate not supplied

Incentives and barriers that influence clinical computerization in Hong Kong: a population-based physician survey.

OBJECTIVE: Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation. DESIGN AND MEASUREMENTS: A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation. RESULTS: Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better-quality care were ranked highest as potential incentives to computerize. Cost vs. noncost, physician-related vs. patient-related, and monetary vs. nonmonetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and "push" vs "pull" factors accounted for the incentive variables. Four clusters were identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts toward computerization. Those who found the potential interference with communication important also believed that the promise of improved care from computerization to be a significant incentive. CONCLUSION: This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that may be employed to accelerate uptake of computer systems.

Attitude of Health Personnel↗

PubMed1992

Postthoracotomy respiratory muscle mechanics during incentive spirometry using respiratory inductance plethysmography.

We undertook this study to characterize the postthoracotomy compartmental displacement and respiratory mechanical changes occurring during and after the performance of the incentive spirometry maneuver. We also evaluated the effect of recumbency angle on compartmental recruitment. Sixteen patients were randomized to perform incentive spirometry either at 30 degrees or 60 degrees recumbency angle. They were studied using respiratory inductance plethysmography to measure tidal volume, respiratory frequency, inspiratory time, rib cage motion/tidal volume ratio, inspiratory duty cycle, and inspiratory flow. Patients were studied before surgery and on postoperative days 1 and 3. Statistical analysis was accomplished using multiple measures ANOVA with post-hoc Student's t-tests when appropriate. Preoperative incentive spirometry augmented VT by increasing both VT/TI and TI. Postoperatively, the incentive recruitment of VT was reduced, a result of a decrease in TI and TI/TTOT; VT/TI was unchanged. There was postoperative decrease of AB and AB/VT during incentive spirometry, greatest in the 60 degrees group. Our results characterize the nature of the respiratory recruitment afforded by incentive spirometry, before and after thoracotomy. We also found evidence of postthoracotomy diaphragmatic derecruitment during incentive spirometry exacerbated by a high recumbency angle.

Female↗

PubMed2003

The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines.

BACKGROUND: This study tested the effects of two organizational support processes, the provision of financial incentives for superior clinical performance and the availability of a patient (smoker) registry and proactive telephone support system for smoking cessation, on provider adherence to accepted practice guidelines and associated patient outcomes. METHODS: Forty clinics of a large multispecialty medical group practice providing primary care services were randomly allocated to study conditions. Fifteen clinics each were assigned to the experimental conditions "control" (distribution of printed versions of smoking cessation guidelines) and "incentive" (financial incentive pay-out for reaching preset clinical performance targets). Ten clinics were randomized to receive financial incentives combined with access to a centralized patient registry and intervention system ("registry"). Main outcome measures were adherence to smoking cessation clinical practice guidelines and patients' smoking cessation behaviors. RESULTS: Patients' tobacco use status was statistically significant (P < 0.01) more frequently identified in clinics with the opportunity for incentives and access to a registry than in clinics in the control condition. Patients visiting registry clinics accessed counseling programs statistically significantly more often (P < 0.001) than patients receiving care in the control condition. Other endpoints did not statistically significantly differ between the experimental conditions. CONCLUSIONS: The impact of financial incentives and a patient registry/intervention system in improving smoking cessation clinical practices and patient behaviors was mixed. Additional research is needed to identify conditions under which such organizational support processes result in significant health care quality improvement and warrant the investment.

Ambulatory Care Facilities↗

PubMedDate not supplied

External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases.

CONTEXT: Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. OBJECTIVES: To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). DESIGN, SETTING, AND PARTICIPANTS: One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. MAIN OUTCOME MEASURES: Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use. RESULTS: Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives-public recognition and better contracts for health care quality-was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P =.007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50% reported no clinical IT capability. CONCLUSIONS: The use of CMPs varies greatly among POs, but it is low on average. Government and private purchasers of health care may increase CMP use by providing external incentives for improvement of health care quality to POs and by assisting them in improving their clinical IT capability.

Asthma↗

PubMed1990

Incentives and their influence on appointment compliance in a teenage family-planning clinic.

The purpose of this study was to ascertain whether or not the family-planning compliance patterns of indigent adolescents could be influenced by various types of incentives. From February 1988 through January 1989, 534 postpartum inner city teenagers, aged 12-19, who delivered at a large city-county public hospital, participated. Teens were randomly assigned to two treatment groups that either offered a coupon for milk for the infant or a gift for the teenage mother if they returned for their postpartum visit 4-6 weeks after delivery. A third group, which used no incentive for appointment keeping, acted as a control. Although overall compliance was low, a significant relationship was found between type of program incentive and compliance outcome. The program using milk coupons as an incentive had the best compliance rate. This incentive appeared to be most effective with black adolescents. Such incentive programs, although not without controversy, offer a potential way to enhance postpartum contraceptive appointment-keeping compliance in a high-risk population.

Adolescent↗