Florian Vogt

Financial Incentives for Increasing Uptake of HPV Vaccinations: A Randomized Controlled Trial

Objective: Uptake of human papillomavirus (HPV) vaccinations by 17- to 18-year-old girls in England is below (<35%) target (80%). This trial assesses (a) the impact of financial incentives on uptake and completion of an HPV vaccination program, and (b) whether impacts are moderated by participants’ deprivation level. It also assesses the impact of incentives on decision quality to get vaccinated, as measured by attitudes toward the vaccination and knowledge of its consequences. Method: One thousand 16- to 18-year-old girls were invited to participate in an HPV vaccination program: 500 previously uninvited, and 500 unresponsive to previous invitations. Girls randomly received either a standard invitation letter or a letter including the offer of vouchers worth £45 (€56;

Using financial incentives to increase initial uptake and completion of HPV vaccinations: protocol for a randomised controlled trial

73) for undergoing 3 vaccinations. Girls attending their first vaccination appointment completed a questionnaire assessing decision quality to be vaccinated. Outcomes were uptake of the first and third vaccinations and decision quality. Results: The intervention increased uptake of the first (first-time invitees: 28.4% vs. 19.6%, odds ratio [OR] = 1.63, 95% confidence interval [CI; 1.08, 2.47]; previous nonattenders: 23.6% vs. 10.4%, OR = 2.65, 95% CI [1.61, 4.38]) and third (first-time invitees: 22.4% vs. 12%, OR = 2.15, 95% CI [1.32, 3.50]; previous nonattenders: 12.4% vs. 3%, OR = 4.28, 95% CI [1.92, 9.55]) vaccinations. Impacts were not moderated by deprivation level. Decision quality was unaffected by the intervention. Conclusions: Although the intervention increased completion of HPV vaccinations, uptake remained lower than the national target, which, in addition to cost effectiveness and acceptability issues, necessitates consideration of other ways of achieving it.

Perceived Effectiveness of Stop Smoking Interventions: Impact of Presenting Evidence Using Numbers, Visual Displays, and Different Timeframes

BackgroundHPV vaccination reduces the risk of cervical cancer. Uptake however, of the ‘catch-up’ campaign in England for 17-18 year old girls is below the 80% NHS target. The aim of this randomized controlled trial is to assess the impact of financial incentives on (a) the uptake and completion of an HPV vaccination programme and (b) the quality of the decisions to undertake the vaccination.Method/DesignOne thousand (n = 1000) 16-18 year-old girls will be invited to participate in an HPV vaccination programme: Five-hundred (n = 500) will have received a previous invitation to get vaccinated but will have failed to do so (previous non-attenders) and 500 will not have previously received an invitation (first-time invitees). Girls will be randomly selected from eligible participants who are registered with a GP in areas covered by the Birmingham East and North (BEN) and Heart of Birmingham Primary Care Trusts. The two samples of girls will be randomised to receive either a standard vaccination invitation letter or an invitation letter including the offer of vouchers worth £45 for receiving three vaccinations. Girls will also complete a questionnaire to assess the quality of their decisions to be vaccinated. The primary outcome will be uptake of the 1st and 3rd vaccinations. The secondary outcome will be the quality of the decisions to undertake the vaccination, measured by assessing attitudes towards and knowledge of the HPV vaccination.DiscussionThe key results will be: a) the effectiveness of financial incentives in increasing uptake of the 1st and 3rd vaccinations; b) the role of participants’ socio-economic status in the moderation of the impact of incentives on uptake; and c) the impact of incentives on the quality of decisions to undertake the HPV vaccinations.

Determination of the influence of home delivery of HIV therapy on virological outcomes and adherence

INTRODUCTION This study investigates the impact of visual and numerical representations of effectiveness and different lengths of follow-up upon the perceived effectiveness of stop smoking interventions. METHODS This study entails two between-subjects experiments with smokers from the general population. In Experiment 1, U.K. smokers (n = 318) viewed information about a stop smoking intervention that included (a) no effectiveness information, (b) standard numerical effectiveness information, or (c) numerical and visual absolute effectiveness information. In Experiment 2, U.K. smokers (n = 320) viewed numerical and visual absolute effectiveness information about a stop smoking intervention showing either the short-term (1-month) or the long-term (12-month) quit rate with and without intervention. Outcome measures included perceived effectiveness of stop smoking interventions and intentions to use them. RESULTS In Experiment 1, numerical and visual absolute effectiveness information compared with no effectiveness information resulted in greater perceived effectiveness (Scheffé test, p = .033, Cohens d = 0.36) and intentions to use stop smoking interventions (Scheffé test, p = .012, d = 0.43). No differences were detected between standard numerical effectiveness information and no effectiveness information. In Experiment 2, the short-term quit rate compared with long-term quit rate resulted in greater perceived effectiveness, t(318) = 3.2, p = .002, d = 0.35, but not significantly greater intentions to use stop smoking interventions, t(318) = 1.59, p = .11, d = 0.18. CONCLUSIONS Presenting numerical and visual absolute effectiveness information about the short-term effectiveness of stop smoking interventions may increase the use of stop smoking interventions.

Does incentivising pill-taking ‘crowd out’ risk-information processing? Evidence from a web-based experiment

The aim of this study was to evaluate whether the change in the mode of supply of HIV medicines to a homecare model was associated with any change in adherence and patient outcomes. We conducted a retrospective analysis of medical records of 100 patients who received supplies from a clinic-based hospital HIV pharmacy and 100 patients who were started on home delivery over a three-month period and were followed up over six months. Data on patient demographics, type of HIV drug regimen, HIV viral load, CD4% and adherence status were analysed. The mode of delivery had no significant effect on CD4% (p > 0.05), HIV viral load status (p > 0.05) or adherence status (p > 0.05). There was a significant increase in CD4% over time for both groups (p < 0.01). This study suggests that expanding home delivery as a model of care in London HIV clinics is safe and does not affect adherence and patient outcomes as indicated by HIV viral load and CD4%.

Crediting treatments for good outcomes that would have happened anyway: the impact of baseline risk on treatment perceptions.

The use of financial incentives for changing health-related behaviours raises concerns regarding their potential to undermine the processing of risks associated with incentivised behaviours. Uncertainty remains about the validity of such concerns. This web-based experiment assessed the impact of financial incentives on i) willingness to take a pill with side-effects; ii) the time spent viewing risk-information and iii) risk-information processing, assessed by perceived-risk of taking the pill and knowledge of its side-effects. It further assesses whether effects are moderated by limiting cognitive capacity. Two-hundred and seventy-five UK-based university staff and students were recruited online under the pretext of being screened for a fictitious drug-trial. Participants were randomised to the offer of different compensation levels for taking a fictitious pill (£0; £25; £1000) and the presence or absence of a cognitive load task (presentation of five digits for later recall). Willingness to take the pill increased with the offer of £1000 (84% vs. 67%; OR 3.66, CI 95% 1.27–10.6), but not with the offer of £25 (79% vs. 67%; OR 1.68, CI 95% 0.71–4.01). Risk-information processing was unaffected by the offer of incentives. The time spent viewing the risk-information was affected by the offer of incentives, an effect moderated by cognitive load: Without load, time increased with the value of incentives (£1000: M = 304.4sec vs. £0: M = 37.8sec, p < 0.001; £25: M = 66.6sec vs. £0: M = 37.8sec, p < 0.001). Under load, time decreased with the offer of incentives (£1000: M = 48.9sec vs. £0: M = 132.7sec, p < 0.001; £25: M = 60.9sec vs. £0: M = 132.7sec, p < 0.001), but did not differ between the two incentivised groups (p = 1.00). This study finds no evidence to suggest incentives “crowd out” risk-information processing. On the contrary, incentives appear to signal risk, an effect, however, which disappears under cognitive load. Although these findings require replication, they highlight the need to maximise cognitive capacity when presenting information about incentivised health-related behaviours.

General practitioners’ and family physicians’ negative beliefs and attitudes towards discussing smoking cessation with patients: a systematic review

Background. In some patient populations, many would experience good outcomes even if untreated (described as a small baseline risk). It appears that treatments for populations with small baseline risks are perceived as more effective than those for populations with large baseline risks: in essence, treatments are credited for good outcomes that would have happened anyway. Previous research failed to control for differences in treatment effects. Objective. To evaluate if the baseline risk of developing an acute condition influences the perceived effectiveness of preventive treatments besides the genuine treatment effect. Methods. In study 1 (n = 1100) and study 2 (n = 336), general population samples were shown information that systematically differed in size of treatment effect (absolute and relative risk reduction) and the size of the baseline risk of developing a condition. In study 3, medical students (n = 110) were shown treatments that systematically differed in the size of the baseline risk of developing a condition and the type of condition to be prevented (i.e., migraines, heart disease, and pancreatic cancer). Measures included the perceived effectiveness of treatments, intentions to use these treatments, and numeracy. Results. The baseline risk of developing an acute condition influenced the perceived effectiveness of treatments (study 1: F 1,1043 = 66.17, P < 0.001; study 2: F 1,329 = 16.574, P < 0.001; study 3: F 1,98 =14.31, P < 0.001) and, in turn, intention to use the treatment (study 1: F 1,1045 = 7.12, P = 0.008). It caused treatments to be judged as unduly ineffective when the baseline risk was large and vice versa. The influence was independent of treatment effect and was not moderated by numeracy. Conclusions. Treatments for populations with a small baseline risk of developing the condition are perceived as more effective than those for populations with a large baseline risk.