Vouchers to Increase Uptake of Already Free Eye Care

Study Overview
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Brief Summary
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This study was intended to test if reframing an offer for a free follow-up eye examination could increase uptake within ongoing community-based screening program for low-income and minority populations in Baltimore City. This study evaluated the effect of offering participants a physical voucher they were told was redeemable for free follow-up, relative to simply telling participants that the follow-up appointment would be free of charge. The investigators assessed two forms of vouchers, one with estimated value information, and one without. The underlying hypothesis was that reframing these already free offers would increase uptake by increasing perceived offer value and increasing a sense of regret from not taking advantage of a good deal.

Official Title
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Providing Vouchers Redeemable for Already Free Eye Exams To Increase Uptake Among a Low-Income Minority Population: A Randomized Trial

Conditions
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Glaucoma, Eye Diseases

Intervention / Treatment
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* Behavioral: Voucher Without Value Information
* Behavioral: Voucher With Value Information


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Referred for follow-up at a Screening to Prevent Glaucoma (SToP) study screening event (overarching observational study from which trial sample was drawn). SToP participants were referred for follow-up for any of the following conditions: (1) VA worse than 20/40 in at least 1 eye despite autorefraction; (2) signs of retinal abnormalities on fundus photography; (3) uninterpretable fundus photography; (4) cup-to-disc ratio (CDR) greater than or equal to 0.9, and/or CDR between 0.7 and 0.9 with visual field defects or history of glaucoma; and (5) IOP of 23 mm Hg or greater. Exclusion Criteria: SToP participants who were not referred at the time of screening but later contacted after review of fundus photography SToP participants who were referred for follow-up but stated at the time of counseling that they were already under the care of an eye doctor

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

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
Interventional Model Description: Cluster randomized study: screening events (clusters) randomized to one of three interventions, outcomes from individuals within clusters tracked.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: No Voucher<br>Individuals being referred from screening events randomized to no intervention received the standard approach to offering free follow-up examinations (patient education, standard counseling, appointment information packet, reminder phone calls). | |
| Experimental: Voucher Without Value Information<br>In addition to receiving the standard approach above, individuals being referred from screening events randomized to Voucher Without Value Information received a personal voucher. | Behavioral: Voucher Without Value Information<br>* Patients being referred for follow-up received standard materials, counseling, and reminders as in the 'no information' group and were provided with a physical voucher they were told is redeemable for free follow-up appointment at Johns Hopkins Hospital. The voucher included the patient's name, the screener's name, and an expiration date 90 days from the date of screening. These participants were told: I am going to give you this voucher for a completely free appointment and a free pair of glasses if you need them. So, with this voucher, both the exam and the glasses will be completely free.<br>|
| Experimental: Voucher With Value Information<br>In addition to receiving the standard approach above, individuals being referred from screening events randomized to Voucher With Value Information received a personal voucher, which differed from the voucher in the second arm since it included a statement of value. | Behavioral: Voucher With Value Information<br>* Patients being referred for follow-up received standard materials, counseling, and reminders as in the 'no information' group and were provided with a physical voucher they were told is redeemable for free follow-up appointment at Johns Hopkins Hospital, which would normally cost $250. The voucher included the patient's name, the screener's name, an expiration date 90 days from the date of screening, and a statement about the $250 voucher value. These participants were told: I am going to give you this voucher for a completely free appointment and a free pair of glasses if you need them. These services normally cost about $250, but with this voucher, both the exam and the glasses will be completely free.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Uptake of follow-up appointment | The primary endpoint was attending a follow-up appointment, either on the initially scheduled or on a rescheduled date within 90 days of the date of screening. Individuals who did not meet this endpoint either stated that they were not interested in follow-up at the screening event itself, cancelled or did not show for their appointments on 3 occasions, stated that they were not interested in follow-up when study staff attempted to reschedule, or did not show for an appointment and could not be reached for rescheduling after 3 attempts. | Within 90 days of the date of screening | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Uptake of initial appointment | Binary indicator for completion of the initially scheduled appointment. | Within 90 days of the date of screening | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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voucher, information, health behavior