financial incentives

Grand Rounds January 16, 2026: Financial Incentives to Promote Diverse Participation in Alzheimer’s Disease Research (Mireille Jacobson, PhD)

Posted on by Sophia Ramirez

Speaker

Mireille Jacobson, PhD
Professor, University of Southern California Davis
School of Gerontology and Schaeffer Institute

Keywords

Incentives; Financial incentives; Alzheimer’s Disease; Participation; Dementia

Key Points

  • There are nearly 6 million people living with Alzheimer’s Disease and related dementias (AD/ADRD) in the United States, a number projected to double by 2060. Despite the feact that the highest rates of AD/ADRD are found in Black and Hispanic populations, diversity in Alzheimer’s Trials is limited; between 2000 and 2019, 90% of completed trials had 75% – 100% non-Hispanic White participants.
  • The Alzehimer’s Prevention Webstudy (APT Webstudy) is a remote registry in which participants, aged 50 and older, take quarterly memory assessments. The research team sought to assess whether financial incentives could increase diversity in the APT webstudy. 45,000 patients were invited to enroll; the first ~15,000 (Arm 1) were invited via message only, Arm 2 was offered a $25 incentive, and Arm 3 was offered the chance to win $2,500.
  • The study team found that the $25 guaranteed incentives increased enrollment the most, but messages alone were the most cost-effective. 29% of new enrollees were Black or Hispanic patients, an improvement over the APT Webstudy baseline of 5.4%. However, the study team concluded, more needs to be done to enroll people of diverse backgrounds specifically.

Discussion Themes

Attendees considered the ethical implications of the $25 and whether it qualified as coercive when offered to low-income communities. Dr. Jacobson believed that $25 was not enough to be coercive in the context of a low-risk registry study, but that the ethics might differ in a clinical trial involving medication risks.

While higher amounts might increase participation, Dr. Jacobson suggested that messaging frequency may be a more critical factor than increasing the dollar amount.

Grand Rounds October 18, 2024: Rigorous Testing of Behavior Change Interventions: Lessons from the BE ACTIVE Randomized Clinical Trial (Alexander Fanaroff, MD, MHS)

Posted on by Sophia Ramirez

Speaker

Alexander Fanaroff, MD, MHS
Assistant Professor of Medicine
Perelman School of Medicine
University of Pennsylvania

Keywords

Gamification; Financial Incentives; Physical Activity; Behavioral Economics

Key Points

  • Observational studies have found an inverse association between steps per day and risk for all-cause mortality and cardiovascular events. Though national surveys indicate the vast majority of people believe that exercise has many health benefits, many don’t exercise.
  • Behavioral economics seeks to explain why people make the decisions they do using concepts from economics and psychology. Dr. Fanaroff discussed how known biases in decision making – immediacy bias, status quo bias, and the endowment effect – create a disconnect between the “planner” self and the “doer” self. This framework can be used to understand why people don’t exercise, even when they know they should.
  • Another barrier that the research team identified was that existing guidelines from the American College of Cardiology and American Heart Association lack specificity and strong supporting evidence. Dr. Fanaroff ultimately introduced an alternative recommendation based on their findings.
  • The research team sought to leverage our existing biases in order to facilitate a sustained increase in physical activity. In a randomized controlled trial, they compared the effectiveness of gamification, financial incentives, and a combination of the two on increasing physical activity over a 12-month intervention period and a 6-month follow-up period.
  • After noting a discrepancy between the proportion of Black patients in the target population and participant population, the research team adjusted their recruitment strategy until they had a representative group. While direct-to-patient recruitment avoids biases related to who physicians invite to clinical trials, it may introduce biases related to who trusts researchers enough to join a study.
  • The research team found that gamification and financial incentives were roughly equally effective, leading to about 500 more steps per day than the control group. The combination arm saw the biggest improvement, with about 850 more steps per day than the control group. In practice, gamification is the more scalable and inexpensive of the interventions.
  • If stakeholders are to pay for an intervention like this, large scale clinical trials are needed to show improvements in patient-centered outcomes or clinical events.

Discussion Themes

Pharmaceutical interventions are not expected to be effective once treatment has ceased. If a behavioral intervention is shown to be effective during the period in which it’s administered, should it be held to a standard of long-term sustainability?

Patients set their own step count goals according to their baseline when the trial started.

The components of the intervention guided by behavioral economic theory, i.e. the immediacy of the innovation, the loss (rather than gain) of cash and/or points, and the support partners, differentiates it from the gamification built in to many wearables and fitness trackers.