Cash incentives versus defaults for HIV testing: A randomized clinical trial.
<h4>Background</h4>Tools from behavioral economics have been shown to improve health-related behaviors, but the relative efficacy and additive effects of different types of interventions are not well established. We tested the influence of small cash incentives, defaults, and both in com...
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Public Library of Science (PLoS)
2018-01-01
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| author | Juan Carlos C Montoy William H Dow Beth C Kaplan |
| author_facet | Juan Carlos C Montoy William H Dow Beth C Kaplan |
| author_sort | Juan Carlos C Montoy |
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| description | <h4>Background</h4>Tools from behavioral economics have been shown to improve health-related behaviors, but the relative efficacy and additive effects of different types of interventions are not well established. We tested the influence of small cash incentives, defaults, and both in combination on increasing patient HIV test acceptance.<h4>Methods and findings</h4>We conducted a randomized clinical trial among patients aged 13-64 receiving care in an urban emergency department. Patients were cross-randomized to $0, $1, $5, and $10 incentives, and to opt-in, active-choice, and opt-out test defaults. The primary outcome was the proportion of patients who accepted an HIV test. 4,831 of 8,715 patients accepted an HIV test (55.4%). Those offered no monetary incentive accepted 51.6% of test offers. The $1 treatment did not increase test acceptance (increase 1%; 95% confidence interval [CI] -2.0 to 3.9); the $5 and $10 treatments increased test acceptance rates by 10.5 and 15 percentage points, respectively (95% CI 7.5 to 13.4 and 11.8 to 18.1). Compared to opt-in testing, active-choice testing increased test acceptance by 11.5% (95% CI 9.0 to 14.0), and opt-out testing increased acceptance by 23.9 percentage points (95% CI 21.4 to 26.4).<h4>Conclusions</h4>Small incentives and defaults can both increase patient HIV test acceptance, though when used in combination their effects were less than additive. These tools from behavioral economics should be considered by clinicians and policymakers. How patient groups respond to monetary incentives and/or defaults deserves further investigation for this and other health behaviors. |
| format | Article |
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| institution | DOAJ |
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| language | English |
| publishDate | 2018-01-01 |
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| spelling | doaj-art-48a0d438d77d412c9f9cfc5c0a72a6be2025-08-20T02:45:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-01137e019983310.1371/journal.pone.0199833Cash incentives versus defaults for HIV testing: A randomized clinical trial.Juan Carlos C MontoyWilliam H DowBeth C Kaplan<h4>Background</h4>Tools from behavioral economics have been shown to improve health-related behaviors, but the relative efficacy and additive effects of different types of interventions are not well established. We tested the influence of small cash incentives, defaults, and both in combination on increasing patient HIV test acceptance.<h4>Methods and findings</h4>We conducted a randomized clinical trial among patients aged 13-64 receiving care in an urban emergency department. Patients were cross-randomized to $0, $1, $5, and $10 incentives, and to opt-in, active-choice, and opt-out test defaults. The primary outcome was the proportion of patients who accepted an HIV test. 4,831 of 8,715 patients accepted an HIV test (55.4%). Those offered no monetary incentive accepted 51.6% of test offers. The $1 treatment did not increase test acceptance (increase 1%; 95% confidence interval [CI] -2.0 to 3.9); the $5 and $10 treatments increased test acceptance rates by 10.5 and 15 percentage points, respectively (95% CI 7.5 to 13.4 and 11.8 to 18.1). Compared to opt-in testing, active-choice testing increased test acceptance by 11.5% (95% CI 9.0 to 14.0), and opt-out testing increased acceptance by 23.9 percentage points (95% CI 21.4 to 26.4).<h4>Conclusions</h4>Small incentives and defaults can both increase patient HIV test acceptance, though when used in combination their effects were less than additive. These tools from behavioral economics should be considered by clinicians and policymakers. How patient groups respond to monetary incentives and/or defaults deserves further investigation for this and other health behaviors.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0199833&type=printable |
| spellingShingle | Juan Carlos C Montoy William H Dow Beth C Kaplan Cash incentives versus defaults for HIV testing: A randomized clinical trial. PLoS ONE |
| title | Cash incentives versus defaults for HIV testing: A randomized clinical trial. |
| title_full | Cash incentives versus defaults for HIV testing: A randomized clinical trial. |
| title_fullStr | Cash incentives versus defaults for HIV testing: A randomized clinical trial. |
| title_full_unstemmed | Cash incentives versus defaults for HIV testing: A randomized clinical trial. |
| title_short | Cash incentives versus defaults for HIV testing: A randomized clinical trial. |
| title_sort | cash incentives versus defaults for hiv testing a randomized clinical trial |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0199833&type=printable |
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