Behavioral Economics Incentives for Health Management

Study Overview
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Brief Summary
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Incentives are increasingly being used to motivate health behavior in medical studies. Small cash payments conditional on certain health and welfare promoting behaviors have shown efficacy in both real world and experimental settings. Furthermore, in incentive studies, behavioral economics has been shown to amplify behavior change beyond what is possible with simple cash payments, but little is known about how varying incentive payment design may impact health behavior. The goal of the present study is to evaluate a new incentive payment instrument, lottery insurance, to determine its impact on adherence to the target health behavior, attendance at free exercise classes provided by QueensCare Family Clinics, a safety-net medical clinic.

Official Title
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Evaluation of Behavioral Economics Patient Incentive Strategies for Health Management

Conditions
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Obesity, Type 2 Diabetes

Intervention / Treatment
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* Behavioral: Lottery Insurance
* Behavioral: Standard Lottery


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 to 64 years of age BMI between 25-40 Receiving care in QueensCare Family Clinics Exclusion Criteria: Failure to obtain exercise clearance from physician

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 64 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Lottery Insurance<br>All participants receive a one time, $10 payment for attending the first exercise class of the 12 week session. Participants in the 'Lottery Insurance' arm receive a lottery ticket valued at $20 for attending either a Monday or Tuesday exercise class. They have the option to insure their lottery ticket by attending a second exercise class during the week on either Wednesday or Thursday. If they do not attend the second class, they have a 90% chance of winning the weekly lottery. This sequence is repeated each week over the 12 week exercise session. | Behavioral: Lottery Insurance<br> <br> |
| Experimental: Standard Lottery<br>All participants receive a one time, $10 payment for attending the first exercise class of the 12 week session. Subjects in the 'Standard Lottery' arm receive a lottery ticket valued at $20 for attending either a Monday or Tuesday exercise class. They also receive the expected value of the insurance ($2) for attending a second exercise class during the week on either Wednesday or Thursday. They have a 90% chance of winning the weekly lottery. This sequence is repeated each week over the 12 week exercise session. | Behavioral: Standard Lottery<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Attendance at exercise classes | Attendance at exercise classes over the 12 week session will be analyzed across 'Lottery Insurance' and 'Standard Lottery' arms. | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body Mass Index | Change from Baseline Body Mass Index (based on Centers for Disease Control calculations) at 12 weeks (post exercise session) will be assessed. | Change from Baseline Body Mass Index at 12 weeks | 
| HbA1c | Change from Baseline glycemic control (measured as percentage glycosylated hemoglobin [HbA1c] as part of a fasting blood sample) at 12 weeks (post exercise session) will be assessed. | Change from Baseline HbA1c at 12 weeks | 
| Blood Pressure | Change from Baseline Blood Pressure at 12 weeks (post exercise session) will be assessed. | Change from Baseline Blood Pressure at 12 weeks | 
| LDL cholesterol | Change from Baseline LDL cholesterol (measured as part of a lipid panel) at 12 weeks (post exercise session) will be assessed. | Change from Baseline LDL at 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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behavioral economics, incentives, health behavior, exercise