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1.
Camb Q Healthc Ethics ; : 1-12, 2024 May 09.
Article in English | MEDLINE | ID: mdl-38720656

ABSTRACT

Derek Parfit's view of personal identity raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. However, rather than accepting that an unknown metaphysical 'further fact' underpins agential unity, one can accept Parfit's view but offer a different account of what it implies morally. Part II of this article argues that contractual obligations provide a moral basis for honoring advance decisions refusing life-saving and/or life-sustaining medical treatment; advance decisions have similarities to contracts, such as life insurance policies and will-contracts, that come into effect when the psychological discontinuity is through death.

2.
Heliyon ; 10(9): e30650, 2024 May 15.
Article in English | MEDLINE | ID: mdl-38756612

ABSTRACT

The European Union supports the use of technology to improve public procurement, acknowledging Building Information Modeling (BIM) as a catalyst for cost-effective public works and innovation. The purpose of this paper is to evaluate BIM implementation practices in Spanish public procurement. The methodology used in this study is a mixed research method involving a questionnaire survey and semi-structured expert interviews. The findings reveal market maturity as a barrier to BIM adoption in Spanish public procurement throughout the asset lifecycle. Selecting the right instrument for implementation proves challenging for public organizations. This study has contributed to the development of more practical and effective strategies to ensure full adoption of BIM within the public procurement sector of Spain. It proposes a framework approach for the pre-contractual phase, helping contracting authorities to make the optimal instrument selection. Two criteria are considered: the maturity of the public client and sector, and the economic value classification of tenders.

3.
Data Brief ; 54: 110412, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38698797

ABSTRACT

One-third of total government spending across the globe goes to public procurement, amounting to about 10 trillion dollars a year. Despite its vast size and crucial importance for economic and political developments, there is a lack of globally comparable data on contract awards and tenders run. To fill this gap, this article introduces the Global Public Procurement Dataset (GPPD). Using web scraping methods, we collected official public procurement data on over 72 million contracts from 42 countries between 2006 and 2021 (time period covered varies by country due to data availability constraints). To overcome the inconsistency of data publishing formats in each country, we standardized the published information to fit a common data standard. For each country, key information is collected on the buyer(s) and supplier(s), geolocation information, product classification, price information, and details of the contracting process such as contract award date or the procedure type followed. GPPD is a contract-level dataset where specific filters are calculated allowing to reduce the dataset to the successfully awarded contracts if needed. We also add several corruption risk indicators and a composite corruption risk index for each contract which allows for an objective assessment of risks and comparison across time, organizations, or countries. The data can be reused to answer research questions dealing with public procurement spending efficiency among others. Using unique organizational identification numbers or organization names allows connecting the data to company registries to study broader topics such as ownership networks.

4.
Sensors (Basel) ; 24(10)2024 May 14.
Article in English | MEDLINE | ID: mdl-38793962

ABSTRACT

This paper surveys the implementation of blockchain technology in cybersecurity in Internet of Things (IoT) networks, presenting a comprehensive framework that integrates blockchain technology with intrusion detection systems (IDS) to enhance IDS performance. This paper reviews articles from various domains, including AI, blockchain, IDS, IoT, and Industrial IoT (IIoT), to identify emerging trends and challenges in this field. An analysis of various approaches incorporating AI and blockchain demonstrates the potentiality of integrating AI and blockchain to transform IDS. This paper's structure establishes the foundation for further investigation and provides a blueprint for the development of IDS that is accessible, scalable, transparent, immutable, and decentralized. A demonstration from case studies integrating AI and blockchain shows the viability of combining the duo to enhance performance. Despite the challenges posed by resource constraints and privacy concerns, it is notable that blockchain is the key to securing IoT networks and that continued innovation in this area is necessary. Further research into lightweight cryptography, efficient consensus mechanisms, and privacy-preserving techniques is needed to realize all of the potential of blockchain-powered cybersecurity in IoT.

5.
Front Public Health ; 12: 1358184, 2024.
Article in English | MEDLINE | ID: mdl-38605878

ABSTRACT

The rapid development of the Hospital Information System has significantly enhanced the convenience of medical research and the management of medical information. However, the internal misuse and privacy leakage of medical big data are critical issues that need to be addressed in the process of medical research and information management. Access control serves as a method to prevent data misuse and privacy leakage. Nevertheless, traditional access control methods, limited by their single usage scenario and susceptibility to single point failures, fail to adapt to the polymorphic, real-time, and sensitive characteristics of medical big data scenarios. This paper proposes a smart contracts and risk-based access control model (SCR-BAC). This model integrates smart contracts with traditional risk-based access control and deploys risk-based access control policies in the form of smart contracts into the blockchain, thereby ensuring the protection of medical data. The model categorizes risk into historical and current risk, quantifies the historical risk based on the time decay factor and the doctor's historical behavior, and updates the doctor's composite risk value in real time. The access control policy, based on the comprehensive risk, is deployed into the blockchain in the form of a smart contract. The distributed nature of the blockchain is utilized to automatically enforce access control, thereby resolving the issue of single point failures. Simulation experiments demonstrate that the access control model proposed in this paper effectively curbs the access behavior of malicious doctors to a certain extent and imposes a limiting effect on the internal abuse and privacy leakage of medical big data.


Subject(s)
Biomedical Research , Blockchain , Big Data , Computer Simulation , Health Behavior
6.
PeerJ Comput Sci ; 10: e1933, 2024.
Article in English | MEDLINE | ID: mdl-38660154

ABSTRACT

The robust development of the blockchain distributed ledger, the Internet of Things (IoT), and fog computing-enabled connected devices and nodes has changed our lifestyle nowadays. Due to this, the increased rate of device sales and utilization increases the demand for edge computing technology with collaborative procedures. However, there is a well-established paradigm designed to optimize various distinct quality-of-service requirements, including bandwidth, latency, transmission power, delay, duty cycle, throughput, response, and edge sense, and bring computation and data storage closer to the devices and edges, along with ledger security and privacy during transmission. In this article, we present a systematic review of blockchain Hyperledger enabling fog and edge computing, which integrates as an outsourcing computation over the serverless consortium network environment. The main objective of this article is to classify recently published articles and survey reports on the current status in the domain of edge distributed computing and outsourcing computation, such as fog and edge. In addition, we proposed a blockchain-Hyperledger Sawtooth-enabled serverless edge-based distributed outsourcing computation architecture. This theoretical architecture-based solution delivers robust data security in terms of integrity, transparency, provenance, and privacy-protected preservation in the immutable storage to store the outsourcing computational ledgers. This article also highlights the changes between the proposed taxonomy and the current system based on distinct parameters, such as system security and privacy. Finally, a few open research issues and limitations with promising future directions are listed for future research work.

7.
Sensors (Basel) ; 24(7)2024 Mar 29.
Article in English | MEDLINE | ID: mdl-38610418

ABSTRACT

The technology landscape has been dynamically reshaped by the rapid growth of the Internet of Things, introducing an era where everyday objects, equipped with smart sensors and connectivity, seamlessly interact to create intelligent ecosystems. IoT devices are highly heterogeneous in terms of software and hardware, and many of them are severely constrained. This heterogeneity and potentially constrained nature creates new challenges in terms of security, privacy, and data management. This work proposes a Monitoring-as-a-Service platform for both monitoring and management purposes, offering a comprehensive solution for collecting, storing, and processing monitoring data from heterogeneous IoT networks for the support of diverse IoT-based applications. To ensure a flexible and scalable solution, we leverage the FIWARE open-source framework, also incorporating blockchain and smart contract technologies to establish a robust integrity verification mechanism for aggregated monitoring and management data. Additionally, we apply automated workflows to filter and label the collected data systematically. Moreover, we provide thorough evaluation results in terms of CPU and RAM utilization and average service latency.

8.
Heliyon ; 10(7): e29130, 2024 Apr 15.
Article in English | MEDLINE | ID: mdl-38601668

ABSTRACT

In response to the epochal demand for high-quality development in early childhood education in China, it is imperative and necessary to improve the competency level of early childhood educators. The study aims to investigate the relationship between psychological contracts and teacher competency, and to verify the mediating roles of job crafting and professional identity in the relationship between psychological contracts and teacher competency. This study employed validated measurement scales regarding psychological contracts, teachers' professional identity, job crafting, and teacher competency. Each of these scales has established internal consistency coefficients. Data were collected from 318 early childhood teachers in Sichuan, China. The results highlight the significant impact of psychological contracts on the prediction of teacher competency. It is worth mentioning that the psychological contracts, together with their distinct components such as normative responsibility and development responsibility, have a direct and favorable impact on teacher competency. This implies that developing the psychological contracts might be an effective technique for improving teacher competence. The individual mediation of job crafting and professional identity in the link between psychological contracts and teacher competency has been well-established. However, the combined or chain mediating influence of these factors provides a unique and valuable perspective on the phenomenon of job crafting leading to professional identity, which in turn impacts teacher competency. The study found that psychological contracts have a positive predictive effect on teacher competency, while job crafting and professional identity both have independent and chain mediating roles in the relationship between psychological contracts and teacher competency. Therefore, this study suggests a comprehensive enhancement of the psychological contracts level from aspects such as normative responsibility, interpersonal responsibility, and development responsibility. By stimulating job crafting and professional identity levels in both internal and external environments, we can improve the competency level of early childhood educators.

9.
Sensors (Basel) ; 24(6)2024 Mar 15.
Article in English | MEDLINE | ID: mdl-38544159

ABSTRACT

In contemporary data-driven economies, data has become a valuable digital asset that is eligible for trading and monetization. Peer-to-peer (P2P) marketplaces play a crucial role in establishing direct connections between data providers and consumers. However, traditional data marketplaces exhibit inadequacies. Functioning as centralized platforms, they suffer from issues such as insufficient trust, transparency, fairness, accountability, and security. Moreover, users lack consent and ownership control over their data. To address these issues, we propose DataMesh+, an innovative blockchain-powered, decentralized P2P data exchange model for self-sovereign data marketplaces. This user-centric decentralized approach leverages blockchain-based smart contracts to enable fair, transparent, reliable, and secure data trading marketplaces, empowering users to retain full sovereignty and control over their data. In this article, we describe the design and implementation of our approach, which was developed to demonstrate its feasibility. We evaluated the model's acceptability and reliability through experimental testing and validation. Furthermore, we assessed the security and performance in terms of smart contract deployment and transaction execution costs, as well as the blockchain and storage network performance.

10.
Comput Biol Med ; 173: 108347, 2024 May.
Article in English | MEDLINE | ID: mdl-38554663

ABSTRACT

Despite recent advancements in monitoring brain activity, causal relationships within the brain during responsibility identification in construction contracts remain unexplored. We aimed to understand the neural mechanisms involved in the cognitive components and their interactions related to contract text reading by delving into the brain mechanisms of contract responsibility identification. This study investigated students' brain connectivity using electroencephalography (EEG) data during a text-based contract responsibility-identification task. It employed an adaptive directed transfer function based on Granger causality to simulate directed and time-varying information flow in observed brain activity. We evaluated the EEG records of 18 participants under two reading conditions (involving or not involving contractor responsibility). During responsibility identification, the most substantial information exchange occurs in the somatosensory area of the brain. The results revealed a "top-down" cortical mechanism for responsibility identification, with the left parietal-occipital area (PO3) as the central hub promoting connectivity structures. These findings indicate that the perceptual processing of contract responsibility texts is associated with higher visual learning and memory quality. Contracts without contractor-responsibility clauses resulted in more substantial information flow output in the frontal cortex and consumed more cognitive resources. Our findings advance the understanding of cognitive processes involved in contract responsibility identification, providing a framework for investigating causal relationships within the brain and novel insights into cortical mechanisms. By identifying the neural basis of responsibility identification, stakeholders can develop effective training programs for negotiators and enhance their ability to interpret and implement construction contracts.


Subject(s)
Brain , Negotiating , Humans , Electroencephalography/methods , Cerebral Cortex , Brain Mapping/methods
11.
Philos Trans A Math Phys Eng Sci ; 382(2270): 20230160, 2024 Apr 15.
Article in English | MEDLINE | ID: mdl-38403054

ABSTRACT

Law is a critical tool that humans have created to assist them in managing complex social interactions. Computational Law holds the potential to significantly enhance our capacity to express and manage legal complexity, and a number of advantages can result from restating public and private legal rules in computable form. Capturing that potential depends in part on the approaches taken to automation. One set of choices involves whether to translate directly into code from existing natural language statements of laws, regulations and contracts or whether to step back, envision the basic structure underlying those statements and build a software approach that reflects that structure in a code-native manner. We argue that many advantages can flow from the second approach, and we present a specific use case of a simplified insurance policy as an example of this approach. Large language models may assist in this process, but are not yet a replacement for a code-native utility. This article is part of the theme issue 'A complexity science approach to law and governance'.

12.
AJPM Focus ; 3(2): 100190, 2024 Apr.
Article in English | MEDLINE | ID: mdl-38357553

ABSTRACT

Introduction: The majority of large public universities have exclusive pouring rights contracts with beverage companies that produce and market sugar-sweetened beverages. Pouring rights contracts contain provisions that conflict with recommendations from major public health organizations that institutions reduce sugar-sweetened beverage availability, marketing, and consumption. This study assessed the following among students at 3 public universities: student perception of pouring rights contracts (the extent to which they favored or opposed pouring rights contracts), the association between student socioeconomic characteristics and perception of pouring rights contracts, student estimates of pouring rights contract revenue, and the association between student pouring rights contract revenue estimates and perception of pouring rights contracts. To contextualize results, actual pouring rights contract revenue as a percentage of total revenues was estimated. Methods: A cross-sectional exploratory study was conducted among a convenience sample of 1,311 undergraduate sugar-sweetened beverages-consuming students recruited from 3 large and diverse public universities in Northern California. On an online questionnaire, undergraduate students indicated the extent to which they favored or opposed pouring rights contracts on a 10-point scale (oppose=1-5, favor=6-10) and provided a numeric estimate of the percentage of total university revenue they thought their university's pouring rights contract generated. Regression models were used to analyze differences in perception of pouring rights contracts by student socioeconomic characteristics and estimates of university revenues generated by pouring rights contracts. In addition, pouring rights contracts and financial reports were obtained from the 3 universities to estimate actual pouring rights contract revenue as a percentage of total revenues. Survey data were collected between August and November 2018 and analyzed in August 2022. Results: A large majority of students (81%) opposed pouring rights contracts, and the opposition did not significantly differ by student socioeconomic characteristics, including by levels of food security, need-based financial aid, participation in federal food assistance or healthcare programs, parental education, or parental income (all ps>0.14). The median student estimate for pouring rights contract revenue as a percentage of total university revenue was 10%. In contrast, the estimated actual annual revenue generated from the pouring rights contracts ranged from 0.01% to 0.04% at these schools. Revenue estimates were not significantly associated with participants' opposition or favoring of pouring rights contracts (p=0.65). Conclusions: A large majority of students opposed pouring rights contracts, and this opposition was similar regardless of student socioeconomic characteristics or student estimates of pouring rights contract revenues. Students markedly overestimated (by >100-1,000-fold) the percentage of university revenue that came from pouring rights contracts. University administration should consider student views on pouring rights contracts when deciding whether to exit or continue with pouring rights contracts.

13.
Heliyon ; 10(1): e23622, 2024 Jan 15.
Article in English | MEDLINE | ID: mdl-38223731

ABSTRACT

Disruptions in the supply chains/networks result in both performance failures and a poor return on investment (ROI) of network assets. We propose that addressing this situation requires the governance of exchange relationships through contracts guided by sustainability principles. Specifically, we refer to these contracts in the supply and distribution context as "sustainable network contracts", and the overall framework as the "sustainable contracting framework (SCF)/theory". Despite the critical role of sustainable network contracts for all key stakeholders in the network, we identify a gap in the existing literature regarding the theory of sustainable network contracts. We bridge this gap by extending the extant dimensions of contracts, as described in Transaction Cost Economics and Relational Exchange Theory, to include sustainability dimensions - constituting the 'what' of theory building. To inform sustainable contracts, we propose and employ three factors: costs, benefits, and risks (CBR). We present the 'how' of the theory building, outlined in a five-step approach along with an analytical tool, to demonstrate the practical application of our framework. Additionally, we provide a rationale for adopting sustainable network contracts (the 'why' of the theory building). Our research methodology involves collecting interview-based data from senior executives (CXOs) (secondary and primary), collecting primary and secondary cost data (objective), integrating behavioral elements (subjective), and employing constrained optimization techniques to determine quantity allocation under various contract policies. Further, we map the proposed eight distinct contract types onto the CBR-space, thereby highlight the relevance of the contract types to real-world practices. This mapping considers network externalities, risks, and allows for a coordinated sustainable approach to contracting from the buyer's (retailer's) perspective. For managers, our framework would serve as an important tool that would inform the contract evaluation process, facilitate local versus global decision-making, safeguard network investments, and help align the interests of buyers and suppliers in each contracting cycle.

14.
Br J Gen Pract ; 2024 May 13.
Article in English | MEDLINE | ID: mdl-38228359

ABSTRACT

BACKGROUND: The new Scottish GP contract introduced in April 2018 aims to improve quality of care through expansion of the multidisciplinary team (MDT) to enable GPs to spend more time as expert medical generalists with patients with complex needs. AIM: To explore patients' views on the changes in general practice in Scotland since the inception of the new contract. DESIGN AND SETTING: Qualitative study with 30 patients (10 living in urban deprived areas, 10 living in urban affluent/mixed urban areas, and 10 living in remote and rural areas). METHOD: In-depth semi-structured interviews with thematic analysis. RESULTS: Patients were generally unaware of the new GP contract, attributing recent changes in general practice to the COVID-19 pandemic. Ongoing concerns included access to GP consultations (especially face-to-face ones), short consultation length with GPs, and damage to continuity of care and the GP-patient relationship. Most patients spoke positively about consultations with MDT staff but still wanted to see a known GP for health concerns that they considered potentially serious. These issues were especially concerning for patients with multiple complex problems, particularly those from deprived areas. CONCLUSION: Following the introduction of the new Scottish GP contract, patients in this study's sample were accepting of first contact care from the MDT but still wanted continuity of care and longer face-to-face consultations with GPs. These findings suggest that the expert generalist role of the GP is not being adequately supported by the new contract, especially in deprived areas, though further quantitative research is required to confirm this.

15.
Network ; : 1-19, 2024 Jan 31.
Article in English | MEDLINE | ID: mdl-38293964

ABSTRACT

This research introduces an innovative solution addressing the challenge of user authentication in cloud-based systems, emphasizing heightened security and privacy. The proposed system integrates multimodal biometrics, deep learning (Instance-based learning-based DetectNet-(IL-DN), privacy-preserving techniques, and blockchain technology. Motivated by the escalating need for robust authentication methods in the face of evolving cyber threats, the research aims to overcome the struggle between accuracy and user privacy inherent in current authentication methods. The proposed system swiftly and accurately identifies users using multimodal biometric data through IL-DN. To address privacy concerns, advanced techniques are employed to encode biometric data, ensuring user privacy. Additionally, the system utilizes blockchain technology to establish a decentralized, tamper-proof, and transparent authentication system. This is reinforced by smart contracts and an enhanced Proof of Work (PoW) mechanism. The research rigorously evaluates performance metrics, encompassing authentication accuracy, privacy preservation, security, and resource utilization, offering a comprehensive solution for secure and privacy-enhanced user authentication in cloud-based environments. This work significantly contributes to filling the existing research gap in this critical domain.

16.
Br J Gen Pract ; 2024 Jan 31.
Article in English | MEDLINE | ID: mdl-38296357

ABSTRACT

BACKGROUND: There is little evidence and no agreement on what constitutes full-time working for general practitioners (GPs). This is essential for workforce planning, resource allocation and accurately describing GP activity. AIM: To clarify the definition of full-time working for general practitioners, how this has changed over time and whether these changes are explained by GP demographics. DESIGN AND SETTING: Repeated cross-sectional national surveys between 2010 and 2021. METHOD: Comparison of three measures of working time commitments (hours and sessions per week and hours per session) plus a measure of workload intensity across survey years. Multiple regression to adjust the changes over time for age, sex, ethnicity, contract type, area deprivation, and rurality. Unadjusted hours and sessions per week were compared to definitions of full-time working. RESULTS: Average hours and sessions per week reduced from 40.5 (95% CI: 38.5, 42.5) to 38.0 (36.3, 39.6) and 7.3 (7.2, 7.3) to 6.2 (6.2, 6.3) respectively between 2010 and 2021. In 2021, 54.6% of GPs worked at least 37.5 hours per week and 9.5% worked at least 9 sessions. Hours per session increased from 5.7 (5.7, 5.7) to 6.2 (6.2, 6.3) between 2010 and 2021. Partners worked more hours, sessions and hours per session. Adjustments increased the increase in hours per session from 0.54 to 0.61. CONCLUSION: At the current average duration of sessions, six sessions per week aligns with the NHS definition of full-time hours. However, hours per week is a more consistent way to define full-time work for GPs.

17.
Med Health Care Philos ; 27(1): 15-30, 2024 Mar.
Article in English | MEDLINE | ID: mdl-37851211

ABSTRACT

In this paper, I assess the role responsibility argument that claims suicidal agents have obligations to specific people not to kill themselves due to their roles. Since the plausibility of the role responsibility argument is clearest in the parent-child relationship, I assess parental obligations. I defend a view that says that normative roles, such as those of a parent, are contractual and voluntary. I then suggest that the normative parameters for some roles preclude permissible suicide because the role-related contract includes a promise to provide continuing care and emotional support. I propose that as we have established criteria for morally acceptable reasons for cancelling, voiding, or amending a contract, we can apply these to the role responsibility argument to establish grounds for releasing a parent from his role-related and contractual obligations. Failure to fulfil one's contractual roles may not be blameworthy, depending upon the circumstances. I propose the factors determining culpability in failure to fulfil one's role-related obligations are: intention, voluntariness, diminished responsibility, mental capacity, and foreseeability.


Subject(s)
Moral Obligations , Suicide , Humans , Suicidal Ideation , Parents , Dissent and Disputes , Social Responsibility
18.
J Prev (2022) ; 45(1): 107-121, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38017294

ABSTRACT

BACKGROUND: Health status, type of contract, education and age might affect labour force participation (LFP). We investigated possible factors associated with LFP among European countries. METHODS: European Union Statistics on Income and Living Conditions (EU-SILC) data of 149,798 individuals were used and the odds ratios were calculated in logistic regression analyses. RESULTS: LFP rates were higher among those in good health. Self-perceived poor health frequencies were higher in people with temporary contracts than in those with permanent contracts in Bulgaria, Finland, and Hungary, while they were lower in Republic of Serbia. Multivariate analyses revealed that having temporary contract, poor health, oldest age group, and lower educational level were associated with lower probability of being in paid employment in the total study population. Poor health was stronger driver of lower LFP than temporary contracts in Austria, Hungary, Iceland, Netherlands. Temporary contracts were stronger driver of lower LFP than poor health in Greece, Spain, Finland, Portugal, Serbia, Slovenia and total study population. CONCLUSION: Both poor health and temporary contracts were associated with lower LFP. The magnitude of these associations varied among countries. Worker's health status differed by type of contract in Bulgaria, Hungary, Finland and Serbia.


Subject(s)
Employment , Health Status , Humans , Contracts , Educational Status , Serbia
19.
Expert Rev Pharmacoecon Outcomes Res ; 24(2): 293-301, 2024 Feb.
Article in English | MEDLINE | ID: mdl-37883069

ABSTRACT

OBJECTIVE: To understand the use of alternative payment models to address the reimbursement challenges of cell and gene therapies (CGT) in the U.S.A.. METHODS: A literature search focused on CGT reimbursement in the U.S. market was conducted to identify information gaps and inform survey development. U.S. developers (n = 100) and payers (n = 195) were invited to complete an online survey between June and August 2022. RESULTS: The overall response rate was 16%; payer respondents represented 98 plans covering 338 million lives. Most developers (81%) and payers (84%) had implemented or were planning to implement at least one alternative payment model. Payers pursued these models to 'reduce product performance uncertainties' (81%), 'align therapy costs with benefits' (58%), and 'manage actuarial uncertainty' (54%). Developers aimed to 'streamline patient access' (92%) and 'mitigate budget impact' (77%). Common perceived barriers included increased administrative burden (developers 79% and payers 67%), defining performance measures (developers 71%, payers 83%) and addressing patient mobility (developers 71% and payers 63%). Both parties expressed a willingness to use real-world evidence for contract adjudication. CONCLUSION: Although limited by the number of participants, this survey indicates early discussions coupled with understanding motivations are essential for developing contracts that appeal to both parties and ensure patient access.

20.
Psychol Sport Exerc ; 70: 102532, 2024 Jan.
Article in English | MEDLINE | ID: mdl-37678644

ABSTRACT

BACKGROUND: Financial incentives are a promising tool to help people increase their physical activity, but they are expensive to provide. Deposit contracts are a type of financial incentive in which participants pledge their own money. However, low uptake is a crucial obstacle to the large-scale implementation of deposit contracts. Therefore, we investigated whether (1) matching the deposit 1:1 (doubling what is deposited) and (2) allowing for customizable deposit amounts increased the uptake and short term effectiveness of a deposit contract for physical activity. METHODS: In this randomized controlled trial, 137 healthy students (age M = 21.6 years) downloaded a smartphone app that provided them with a tailored step goal and then randomized them to one of four experimental conditions. The deposit contract required either a €10 fixed deposit or a customizable deposit with any amount between €1 and €20 upfront. Furthermore, the deposit was either not matched or 1:1 matched (doubled) with a reward provided by the experiment. During 20 intervention days, daily feedback on goal progress and incentive earnings was provided by the app. We investigated effects on the uptake (measured as agreeing to participate and paying the deposit) and effectiveness of behavioral adoption (measured as participant days goal achieved). FINDINGS: Overall, the uptake of deposit contracts was 83.2%, and participants (n = 113) achieved 14.9 out of 20 daily step goals. A binary logistic regression showed that uptake odds were 4.08 times higher when a deposit was matched (p = .010) compared to when it was not matched. Furthermore, uptake odds were 3.53 times higher when a deposit was customizable (p = .022) compared to when it was fixed. Two-way ANCOVA showed that matching (p = .752) and customization (p = .143) did not impact intervention effectiveness. However, we did find a marginally significant interaction effect of deposit matching X deposit customization (p = .063, ηp2 = 0.032). Customization decreased effectiveness when deposits were not matched (p = .033, ηp2 = 0.089), but had no effect when deposits were matched (p = .776, ηp2 = 0.001). CONCLUSIONS: We provide the first experimental evidence that both matching and customization increase the uptake of a deposit contract for physical activity. We recommend considering both matching and customization to overcome lack of uptake, with a preference for customization since matching a deposit imposes significant additional costs. However, since we found indications that customizable deposits might reduce effectiveness (when the deposits are not matched), we urge for more research on the effectiveness of customizable deposit contracts. Finally, future research should investigate which participant characteristics are predictive of deposit contract uptake and effectiveness. PRE-REGISTRATION: OSF Registries, https://osf.io/cgq48.


Subject(s)
Daucus carota , Motivation , Humans , Young Adult , Exercise , Income , Reward
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