Oxytocin differentially modulates reward system responses to social and non-social incentives.

RATIONALE: Oxytocin has been shown to modulate behavior related to processing of monetary incentives and to regulate social and reproductive behavior, yet little is known about how oxytocin differentially influences neural responses to social and non-social incentives. OBJECTIVES: We aimed to evaluate the effects of oxytocin administration on behavioral and neural responses to social and monetary incentives. METHODS: Twenty-eight healthy adults (age 18-45 years) performed both monetary and social incentive tasks during blood oxygenation level dependent (BOLD) imaging. Intranasal oxytocin or placebo was administered before each scan using a double blind, randomized, cross-over design. Task performance and self-reported motivation and mood states were collected. Time-series analysis was conducted to assess the influence of oxytocin on the hemodynamic response in the ventral tegmental area and substantia nigra (VTA/SN) and nucleus accumbens (NAc). RESULTS: Oxytocin demonstrated a multifaceted effect on VTA/SN and NAc when processing reward incentives, with it increasing BOLD response in VTA/SN and decreasing BOLD response in NAc during social incentive anticipation. A reversal of this was shown with decreased BOLD responses in the VTA/SN and increased BOLD response in the NAc during monetary incentive anticipation. CONCLUSIONS: Our findings suggest a more nuanced purpose of oxytocin when evaluating reward incentive decision making. It is possible that while oxytocin does increase salience to rewards, that it is more important for cognitive control when determining short-term versus long-term benefits in rewards. Future studies should more closely examine the relationship between oxytocin and delay discounting.

Social validity of digital social incentives in the treatment of substance use disorders.

Substance use disorders (SUDs) affect millions and have substantial negative consequences for individuals and society. Social incentives that leverage social networks for reinforcement or feedback have been used to improve health behaviors such as physical activity. This study investigated the feasibility, acceptability, and usability of a novel digital social incentive system embedded into a web- and smartphone-based platform for SUD recovery. The system leveraged a preexisting care team to deliver social incentives following notifications on recovery-related goal completion and abstinence to members undergoing SUD treatment. In total, 243 notifications were sent to care-team members, resulting in 117 social incentives, nearly all of which (99.15%) were coded as positive. Treatment members and care-team members provided favorable endorsements on acceptability and usability measures. Some areas of improvement were identified, such as increasing personalization and transparency. This digital social incentive system was feasible, acceptable, and usable as an adjunct treatment component for SUD recovery.

Collaboration for new therapies: maximizing health and innovation.

Introduction: Innovative medicines and vaccines can provide direct health benefits to patients and populations by preventing, treating and curing diseases, and also drive wider socioeconomic and productivity gains. However, researching and developing them is complex and risky. Funding for life sciences R&D has different sources: public, charitable/NGO, and private sector. We believe there is consensus that all are required, although there is less understanding about their respective roles, synergies, and funding priorities. The purpose of this paper is to provide an overview of the current life sciences innovation ecosystem in Europe, highlighting challenges for funding and innovation of new therapies and our proposed options to address these. Methods: The basis of this paper stems from the reflections made by the co-authors during a webinar with title "Collaboration for new therapies: maximising funding and innovation," in March 2023, with further targeted literature reviews. Results: We identify eight challenges in the European life sciences ecosystem, some closely related, and nine options that we think might be helpful to address them. Each option on its own can have different levels of 'impact', but collectively will provide synergies among them, and thus maximize their impact. Discussion: It is critical to ascertain how the strengths of each actor can be leveraged to bring new medicines/treatments to market, quicker and more efficiently. We need a trusted environment, with strategic collaborations between the public and private sectors, and policy initiatives and incentives should be targeted to strengthen the infrastructure with the aim of fostering such optimal alliances.

Driving change: Understanding consumers' reasons influencing electric vehicle adoption from the lens of behavioural reasoning theory.

The present study attempts to explore consumer-centric reasons affecting the adoption of electric vehicles (EVs) are investigated using behavioural reasoning theory (BRT). Our study is among the first to examine consumer's EV adoption intention using BRT through the integration of the reasons "for and against" electric vehicle (EV) adoption. On data of 312 urban consumers, second order confirmatory factor analysis (CFA) revealed the existence of underlying reasons and SEM helped in testing the proposed relationships. This study also investigates the interaction effect of financial incentive policy with the consumer reasons on EV adoption. Findings revealed that "reasons for" adoption are environmental concern, perceived technology, and maintenance of knowledge and "reasons against" adoption are scepticism, price, and instrumental utility. Environmental beliefs and values influence the "reasons for" consumer intentions to approve electric vehicle adoption. Financial incentives policy was found significant in dampening the impact of reasons against adoption of electric vehicle. The study delineates the strategies for strengthening the promotion of electric vehicles.

Dynamic use of agriculture incentives to promote conservation.

A common problem in resource management concerns the offer of incentives to individuals and organizations to encourage their participation in conservation practices. For underlying acceptance rates that are not known initially, a structured process of annually offering different incentives and recording responses can guide decisions about the number of incentives to offer through time. We examined a dynamic model that includes combinations of different incentives that are offered to farmers each year, with the objective of strengthening participation in agricultural conservation. We considered 3 approaches for identifying incentive acceptance rates that measure participation, including an arbitrary rate assignment independent of incentive data; iterative averaging based on annual offers and acceptances; and Bayesian updating of expected acceptance rates with beta distributed rates and a binomial data distribution. We performed a proof-of-concept simulation that evaluated different strategies that utilize the estimated rates to offer incentives through time. The strategies we evaluated included matching offers to prior year acceptance rate estimates, possibly weighted by their precision; offering only the incentive with the largest estimated acceptance rate each year; and equally allocating offers among the incentives. We evaluated scenarios for non-stationarity in the underlying acceptance rates and considered alternatives for using offer data to deal with non-stationarity. Results indicated that the trajectory of future offers is marginally affected by variance weighting, and there is a strong influence of non-stationarity. Truncating data with a negative rate change accentuates the decline in an offer trajectory, whereas truncation with a positive rate change dampens the trajectory increase. We found that the way one handles variation in estimating acceptance rates, in particular non-stationarity, can have a substantial effect on the management of incentives, especially in the short term. The results can be generalized to allow for multiple changes in underlying rates over a project time horizon. We highlight the strong similarities between our framing of the incentives problem and the more general context of sequential experimentation, with its opportunity to improve conservation through adaptive learning.

Response Rates and Nonresponse Bias Among 20 Years of Pediatrician Surveys.

OBJECTIVES: Our objectives were to examine the following: physician survey response rates across a twenty-year period; the impact of a token incentive on response rates; whether survey nonresponse bias is present and if it is associated with response rate; and the impact of a token incentive on nonresponse bias. METHODS: We utilized data from 68 American Academy of Pediatrics (AAP) pediatrician surveys from 2000 to 2019 and an AAP administrative database, which included information for both respondents and non-respondents (target sample). Linear regression examined response rates over time. To assess nonresponse bias, a t-test or Wilcoxon rank test compared respondents and the target sample by age, gender, and U.S. Census region. Linear regression or Spearman correlation examined the association of response rate and nonresponse bias. Interrupted time series analyses tested the introduction of a $2 token incentive on both response rates and nonresponse bias. RESULTS: Overall mean survey response rate was 56.2%. Response rates declined across survey years (ß=-0.58, p<0.001). The $2 incentive generated an 8.7% response rate increase (p<0.001). The respondent groups had more female pediatricians than the target samples (62.5% vs 60.1%, p<0.001). Age nonresponse bias was associated with lower response rates (ß=-0.47, p<0.001). The $2 incentive was associated with nonresponse bias shifts toward older, away from female, and away from Northeastern respondents. CONCLUSIONS: Our study demonstrates an overall decline in pediatrician survey response rates and a meaningful impact of a token incentive on response rates and nonresponse bias, underscoring the importance of measuring nonresponse bias whenever possible.

Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation.

Aim of the study: Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding. Methods: Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs. Results: Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case's revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%). Conclusion: From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies.

Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study.

BACKGROUND: This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHealth tools, such as mobile phone surveys, provide vital health feedback, optimal incentive strategies to ensure long-term engagement remain limited. This study explores how different incentive levels affect response rates in multiple survey rounds, providing insights into effective methods for encouraging ongoing participation, especially in the context of Zambia's prepaid mobile system and multi-SIM usage, a common practice in sub-Saharan Africa. OBJECTIVE: This study aimed to assess the response rate success across multiple invitations to participate in a care experience survey using a mobile phone short codes and unstructured supplementary service data (USSD) model among individuals in an HIV care setting in the Lusaka, Zambia. METHODS: Participants were recruited from 2 study clinics-1 in a periurban setting and 1 in an urban setting. A total of 2 rounds of survey invitations were sent to study participants on a 3-month interval between November 1, 2018, and September 23, 2019. Overall, 3 incentive levels were randomly assigned by participant and survey round: (1) no incentive, (2) 2 Zambian Kwacha (ZMW; US $0.16), and (3) 5 ZMW (US $0.42). Survey response rates were analyzed using mixed-effects Poisson regression, adjusting for individual- and facility-level factors. Probability plots for survey completion were generated based on language, incentive level, and survey round. We projected the cost per additional response for different incentive levels. RESULTS: A total of 1006 participants were enrolled, with 72.3% (727/1006) from the urban HIV care facility and 62.4% (628/1006) requesting the survey in English. We sent a total of 1992 survey invitations for both rounds. Overall, survey completion across both surveys was 32.1% (637/1992), with significantly different survey completion between the first (40.5%, 95% CI 37.4-43.6%) and second (23.7%, 95% CI 21.1-26.4) invitations. Implementing a 5 ZMW (US $0.42) incentive significantly increased the adjusted prevalence ratio (aPR) for survey completion compared with those that received no incentive (aPR 1.35, 95% CI 1.11-1.63). The cost per additional response was highest at 5 ZMW, equivalent to US $0.42 (72.8 ZMW [US $5.82] per 1% increase in response). CONCLUSIONS: We observed a sharp decline of almost 50% in survey completion success from the initial invitation to follow-up survey administered 3 months later. This substantial decrease suggests that longitudinal data collection potential for a care experience survey may be limited without additional sensitization and, potentially, added survey reminders. Implementing a moderate incentive increased response rates to our health care experience survey. Tailoring survey strategies to accommodate language preferences and providing moderate incentives can optimize response rates in Zambia. TRIAL REGISTRATION: Pan African Clinical Trial Registry PACTR202101847907585; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14613.

Supplemental Nutrition Assistance Program healthy eating incentives and fruit and vegetable spending across the month.

OBJECTIVE: To estimate how incentives that encourage healthy eating among Supplemental Nutrition Assistance Program (SNAP) participants impact intra-monthly variation in fruit and vegetable spending. DESIGN: We used transaction data from three Alabama grocery stores participating in a programme that offered dollar-matching coupons for fresh produce. For each store, we calculated daily spending on fresh produce out of SNAP benefits and daily incentive coupon redemptions. We compared total daily spending on fresh produce and daily coupon redemptions on days over which SNAP benefits are distributed in Alabama with spending and redemption on days at the end of the month with no SNAP distribution. SETTING: SNAP and incentive transactions in three Alabama grocery stores. PARTICIPANTS: SNAP participants purchasing fruit and vegetables April 2023-July 2023. RESULTS: Daily spending with SNAP on produce dropped by 38% at the end of the month. Incentive coupon redemption did not significantly drop at the end of the month. The share of total SNAP spending going to fresh fruits and vegetables increased by two percentage points and the share of fresh fruits and vegetables spending coming from redemptions increased by ten percentage points at the end of the month. CONCLUSIONS: SNAP households may use incentive coupons to smooth drops in produce consumption at the end of the month. These findings also highlight trade-offs inherent in different delivery mechanisms for SNAP incentives.

Legal Regulation, Financial Incentives and Professional Autonomy in the Prioritisation of Norwegian Specialist Health Services.

To study hospital physicians' awareness and perceptions of the legal and financial regulations, and their impact on professional discretion regarding equity in access to treatment and quality of care. A sample of 637 physicians in the Norwegian specialist healthcare services selected from a survey conducted by the Institute for Studies of the Medical Profession. The paper investigates how legal and financial policy instruments affect the application of professional discretion regarding the prioritisation of specialist health services. Descriptive statistics and regressions were conducted for the analyses. Compared with financial incentives, legal regulations (laws, priority rules and guidelines) were assessed to be less negative external interventions in the exercise of medical and professional judgement. The empirical analyses revealed a positive tendency in physicians' assessments of the impact of legal regulations on treatment equity and healthcare quality, but negative attitudes towards financial instruments. The variations revealed are attributable to various structural and epistemic features of the legal-bureaucratic and economic models of administration in this area of the welfare state. Legal and financial regulations are imposed to achieve certain social goals and values. The findings of this study can provide further insight for the health authorities in other countries concerning implementation of such regulations in the specialist healthcare services.

Theoretically framing views of people who smoke in understanding what might work to support smoking cessation in coastal communities: adapting the TIDieR checklist to qualitative analysis for complex intervention development.

INTRODUCTION: People living in coastal communities have some of the worst health outcomes in the UK, driven in part by high smoking rates. Deprived coastal communities include socially disadvantaged groups that struggle to access traditional stop smoking services. The study aimed to seek the views of people who smoke living in coastal communities, to assess the optimal smoking cessation intervention for this population. In addition, the Template for Intervention Description Replication (TIDieR) checklist was adapted as an analytical framework for qualitative data to inform intervention design. METHODS: Current or recent ex-smokers (n = 25) were recruited to participate in qualitative interviews from a range of community locations in a deprived English seaside town. A thematic analysis of the interview data was undertaken adapting the TIDieR framework. This analysis was triangulated with relevant literature and notes from stakeholder meetings and observations to map onto the TIDieR checklist to describe the optimal intervention. RESULTS: Barriers to quitting smoking in the target population included low motivation to quit, high anxiety/boredom, normalisation of smoking and widespread illicit tobacco use. There was broad support for combining behavioural support, e-cigarettes and financial incentives, with a strong preference for the intervention to be delivered opportunistically and locally within (non-healthcare) community settings, in a non-pressurising manner, ideally by a community worker specially trained to give stop smoking support. CONCLUSIONS: An intensive community-based smoking cessation intervention was acceptable to the target population. Adapting the TIDieR checklist as a deductive qualitative analytical framework offered a systematic approach to intervention development. Combined with other intervention development activities, this ensured that the intervention design process was transparent and the proposed intervention was well defined. It is recommended that prior to intervention development researchers speak to members of the target population who may give valuable insight into the optimal intervention.

California's Recovery Incentives Program: Implementation strategies.

INTRODUCTION: Due to the increasing role of psychostimulants in the US drug poisoning crisis, there is an increasing need to effectively implement evidence-based treatment for individuals with stimulant use disorder (StimUD). Contingency management is a behavioral strategy with robust evidence of support for the treatment of StimUD. In 2023, California initiated a large-scale effort to implement CM as a treatment for individuals with a stimulant use disorder (cocaine, methamphetamine, amphetamine) called the Recovery Incentives Program: California's Contingency Management Benefit. METHODS: The Recovery Incentives Program is being systematically implemented using the Becker et al. Science to Service Lab (SSL) implementation approach with several augmentations for this project. The SSL features three core components: didactic training, performance feedback, and external facilitation. We have augmented this approach with a readiness assessment process for sites prior to CM service launch, and an ongoing fidelity monitoring and feedback component post-launch. RESULTS: The present paper is a preliminary report describing the use of this augmented SSL strategy for CM implementation in a large-scale implementation effort. Data are presented to describe the implementation activities during the first ten months of the Recovery Incentives Program. CONCLUSION: The California Recovery Incentives Program has been systematically implemented and appears to be receiving a positive response from treatment program staff and enrolled members. Future papers and evaluation reports will continue to document member response to the Program and report on the ongoing training and implementation process.

Relationship between participation in projects of incentives to promote walking and healthy aging among the older population: A four-year longitudinal study.

OBJECTIVE: This study aimed to evaluate the association between the Yokohama Walking Point Program, which promotes walking through feedback on step counts and incentives, and the extension of healthy life expectancy. METHODS: A total of 4298 individuals aged over 65 years who responded to the 2013 and 2016 surveys and who were not certified as needing long-term care in 2016 were included in this study. The participants were categorized into "non-participation," "participation without uploading," and "participation with uploading" groups based on their involvement and uploading of pedometer data. The objective variable was the occurrence of long-term care certification and deaths over the subsequent four years. A modified Poisson regression model was applied, adjusting for 15 variables before project initiation. RESULTS: A total of 440 participants (10.2 %) were included in the "participation with uploading" group and 206 (4.8 %) in the "participation without uploading" group. Compared with "non-participation," the risk ratio was 0.77 (95 % confidence interval (CI): 0.59-0.99) for "participation with uploading" and 1.02 (95 % CI: 0.75-1.38) for "participation without uploading". In the sensitivity analysis censoring death as an inapplicable outcome and considering functional decline, participation with uploading showed a risk ratio of 0.79 (95 % CI: 0.60-1.04) for the likelihood of functional decline. CONCLUSIONS: The use of pedometers and health point programs based on walking activity is associated with enhancing the health of older individuals participating in the program, representing a population-centric strategy targeting all citizens.

Financial incentives to increase engagement across the hepatitis C care cascade among people at risk of or diagnosed with hepatitis C: A systematic review.

BACKGROUND: Reversing declining rates of people initiating and completing hepatitis C (HCV) treatment, observed in many countries, is needed to achieve global HCV elimination goals. Providing financial incentives to increase HCV testing and treatment uptake among people at-risk of or living with HCV infection could be an effective intervention. We conducted a systematic review to assess evidence regarding the effectiveness of financial incentives to improve engagement and progression through the HCV care cascade. METHODS: We searched MEDLINE, PubMed and EMBASE for studies published from January 2013 to January 2023 that evaluated financial incentives offered to people living with and at-risk of HCV to increase HCV antibody and or RNA testing, linkage to care, treatment initiation, treatment adherence, treatment completion, and sustained viral load (SVR) testing. Open-label randomised controlled trials (RCTs), controlled non-randomised studies, cohort or observation studies and mixed-methods studies were included, whereas literature reviews, case series and studies which did not report data were excluded. RESULTS: We identified 1,278 studies, with 21 included after full-text screening (14,913 participants); three randomised controlled trials and 18 non-randomised studies. Studies evaluated incentives aimed at improving test uptake (n = 11), engagement in care (n = 13), treatment initiation (n = 8), adherence (n = 3), completion (n = 3) and attainment of SVR (n = 5). Findings provided inconclusive evidence for the effectiveness of incentives in improving engagement in the HCV cascade of care. Determining incentive effectiveness to improve care cascade engagement was limited by low quality study designs, heterogeneity in type (cash or voucher), value (US$5 to $600) and cascade stage being incentivised. No randomised controlled trials assessed the effectiveness of incentives to promote HCV testing, and none showed an impact on treatment uptake. In non-randomised studies (observational comparative), some evidence suggested that incentives promoted HCV testing, but evidence of their role in promoting linkage to care, HCV treatment adherence and treatment completion were mixed. CONCLUSION: Currently, there lacks high-quality evidence evaluating whether financial incentives improve HCV testing and treatment outcomes. Future research should seek to standardise methodologies, compare incentive types and values to enhance engagement in HCV care, and determine factors that support incentives effectiveness.

Transitioning from gridlock to sustainability: advancing transport strategies for eco-friendly solutions in high-income countries.

The study aims to comprehend sustainable behaviors in high-income nations, where human-environment interactions are crucial. Increased transportation needs in industrialized countries highlight the importance of environmental challenges affecting human well-being. Railway passenger carrier, automobile energy efficiency, technology breakthroughs, financial incentives, and public-private partnerships (PPPs) affect congestion and sustainability, which the study analyses for sound policy inferences in a panel of 28 high-income nations from 2000 to 2022. The panel ARDL estimates reveal that railway passenger carrier increases carbon emissions in the short run while it improves them over time, highlighting the importance of urban planning. Environmental pollution, energy use, transportation behavior (including PPPs), and technical innovation have an inverse connection, demonstrating the efficacy of energy-efficient transport methods, research and development, and renewable energy sources. However, economic incentives highly correspond with carbon-intensive habits, emphasizing the need for high-income countries to phase them out.

A Framework for the Design of Risk-Adjustment Models in Health Care Provider Payment Systems.

Prospective payments for health care providers require adequate risk adjustment (RA) to address systematic variation in patients' health care needs. However, the design of RA for provider payment involves many choices and difficult trade-offs between incentives for risk selection, incentives for cost control, and feasibility. Despite a growing literature, a comprehensive framework of these choices and trade-offs is lacking. This article aims to develop such a framework. Using literature review and expert consultation, we identify key design choices for RA in the context of provider payment and subsequently categorize these choices along two dimensions: (a) the choice of risk adjusters and (b) the choice of payment weights. For each design choice, we provide an overview of options, trade-offs, and key references. By making design choices and associated trade-offs explicit, our framework facilitates customizing RA design to provider payment systems, given the objectives and other characteristics of the context of interest.

Differential effects of social versus monetary incentives on inhibitory control under acute inflammation.

While the impact of chronic, low-grade inflammation on cognitive functioning is documented in the context of neurodegenerative disease, less is known about the association between acute increases in inflammation and cognitive functioning in daily life. This study investigated how changes in interleukin-6 (IL-6) levels were associated with performance on an inhibitory control task, the go/no-go task. We further examined whether the opportunity to earn different incentive types (social or monetary) and magnitudes (high or low) was associated with differential performance on the task, depending on IL-6 levels. Using a within-participant design, individuals completed an incentivized go/no-go task before and after receiving the annual influenza vaccine. Multilevel logistic regressions were performed on the trial-level data (Nobs = 30,528). For no-go trials, we did not find significant associations between IL and 6 reactivity between the sessions and changes in trial accuracy. For go trials, we found significant differences in the associations between IL and 6 reactivity and changes in accuracy from session 1 to session 2 as a function of the incentive condition. Notably, greater IL-6 reactivity was consistently associated with fewer omission errors (i.e., greater accuracy on go trials) on high-magnitude social incentives (i.e., viewing a picture of a close-other picture) when compared to both low-magnitude social and high-magnitude monetary incentives. Together, these results suggest that mild fluctuations in inflammation might alter the valuation of an incentive, and possibly a shift toward devoting greater attentional resources when a large social incentive is on the line. Overall, this study sheds light on how everyday, low-grade fluctuations in inflammation may influence cognitive abilities essential for daily life and effective inhibitory control.

Caregiver-reported barriers to engagement in a paediatric fresh fruit and vegetable prescription programme.

Paediatric fruit and vegetable prescription programmes hold promise in improving food security and dietary patterns among youth. However, programme success is largely dependent upon caregiver and family engagement. The current study sought to gain a better understanding of environmental barriers to engagement in a paediatric fruit and vegetable prescription programme in one low-income, urban community (Flint, Michigan, USA). Following the implementation of a paediatric fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers explored caregivers' understanding of the fruit and vegetable prescription programme, barriers to programme engagement, and recommendations for improvement. Telephone interviews were transcribed for textual analysis. Researchers used thematic analysis to examine qualitative data, determine patterns across transcripts, and develop emerging themes. Researchers concluded interviews when data saturation was reached. The majority of participants were female (94%), African American (66%), and residents of Flint (72%). Five recurrent themes emerged: (1) nutrition security; (2) prescription distribution; (3) prescription redemption; (4) educational supports; and (5) programme modifications. Although caregivers indicated that the prescription programme addressed household food insecurity, environmental barriers to engagement were apparent. Caregivers provided suggestions, such as partnering with large grocery stores and developing digital prescriptions, to address programme engagement challenges. Fundamental to the success of fruit and vegetable prescription programmes is the understanding of barriers to engagement from the perspective of participants. This study explores challenges with one paediatric fruit and vegetable prescription programme and provides actionable solutions, from the viewpoint of caregivers, to address these challenges.

Financial incentives in the management of diabetes: a systematic review.

METHODS: Web of Science, Cochrane library and PubMed were systematically searched up to January 2024 to identify studies examining the impact of financial incentives on diabetes management in patients. Studies were evaluated based on the robustness of their methodology, participant numbers, and quality scores. The Cochrane risk-of-bias tool was applied for randomized controlled trials, while the Newcastle-Ottawa Scale was used for non-randomized controlled trials to assess study quality. Due to the heterogeneity of the included studies, a narrative synthesis approach was utilized. RESULTS: In the study, we included 12 published research studies. Five studies investigated the influence of financial incentives on patient behavior, all demonstrating a significant positive impact on behaviors such as blood glucose monitoring, medication adherence, and physical activity. 10 studies analyzed the impact of financial incentives on HbA1c levels in diabetes patients. Among them, 5 studies reported that financial incentives could improve HbA1c levels through longitudinal historical comparisons. The other 5 studies did not find significant improvements compared to the control group. Three studies explored long-term effects, two studies targeting the adolescent population had no impact, and one study targeting adults had a positive impact. CONCLUSIONS: In summary, this review found that financial incentives can positively influence patient behavior and enhance compliance, but their impact on HbA1c levels is inconsistent. Financial incentives may help adult patients maintain behavior even after the withdrawal of incentives.

Examining the impact of low magnitude incentives in contingency management protocols: Non-engagement in Petry et al. 2004.

INTRODUCTION/METHOD: Current federal regulations limit the use of incentives in contingency management (CM) interventions to a nominal total value (i.e., up to $75/patient/year in aggregate of federal funds). This limit represents a striking divergence from the magnitudes used in evidence-based CM protocols. In the present report, we re-analyze data from the Petry et al. (2004) study, which was designed to test the efficacy of two different magnitude CM protocols ($80 and $240 in 2004 dollars) relative to usual intensive outpatient services for treatment-seeking patients with cocaine use. Petry et al. (2004) found that the $240 condition [~$405 in 2024 dollars], but not the $80 condition [~$135 in 2024 dollars], improved abstinence outcomes relative to usual care. The lower-cost $80 condition is the closest condition to the current federal $75 limit that permits a head-to-head comparison of magnitudes. A re-analysis offers an opportunity to examine the impact of low magnitude protocols in more detail, specifically in terms of non-engagement with treatment (defined as absence of negative samples and thus not encountering incentives for abstinence). RESULTS: We found moderate to large effects favoring the $240 condition over both usual care (ds ranging 0.33 to 0.97) and the $80 condition (ds ranging 0.39 to 0.83) across various thresholds of non-engagement with the incentives/reinforcers for abstinence. Importantly, the $80 condition evidenced higher (worse) rates of non-engagement compared to the usual care condition (i.e., small and negative effect sizes ranging -0.30 to 0.14), though not reaching statistical significance. CONCLUSIONS: These results suggest that CM protocols designed to stay within the federal limitation of $75 should be discouraged, and evidence-based protocols should be recommended along with the regulatory reforms necessary to support their implementation.