Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 10, 2015; 6(5): 752-758
Published online Jun 10, 2015. doi: 10.4239/wjd.v6.i5.752
Patient attitudes about financial incentives for diabetes self-management: A survey
Katherine S Blondon
Katherine S Blondon, Division of General Internal Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland
Author contributions: Blondon KS solely contributed to this paper.
Ethics approval: By the Institutional Review Board of the University of Washington.
Informed consent: Statement available online, participants gave their online consent by accepting to participate.
Conflict-of-interest: No funding to disclose.
Data sharing: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Katherine S Blondon, MD, PhD, Division of General Internal Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland. kblondon@uw.edu
Telephone: +41-79-5534323 Fax: +41-22-3729235
Received: November 27, 2014
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
Processing time: 203 Days and 18.9 Hours
Abstract

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.

Keywords: Patient incentives; Diabetes self-management; Motivation; Weight loss; Patient engagement

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.