de Buisonjé David, Van der Geer Jessica, Keesman Mike, Van der Vaart Roos, Reijnders Thomas, Wentzel Jobke, Kemps Hareld, Kraaijenhagen Roderik, Janssen Veronica, Evers Andrea
Health, Medical and Neuropsychology Unit, Leiden University, Leiden, Netherlands.
Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands.
JMIR Cardio. 2021 Aug 30;5(2):e27867. doi: 10.2196/27867.
A promising new approach to support lifestyle changes in patients with cardiovascular disease (CVD) is the use of financial incentives. Although financial incentives have proven to be effective, their implementation remains controversial, and ethical objections have been raised. It is unknown whether health care professionals (HCPs) involved in CVD care find it acceptable to provide financial incentives to patients with CVD as support for lifestyle change.
This study aims to investigate HCPs' perspectives on using financial incentives to support healthy living for patients with CVD. More specifically, we aim to provide insight into attitudes toward using financial incentives as well as obstacles and facilitators of implementing financial incentives in current CVD care.
A total of 16 semistructured, in-depth, face-to-face interviews were conducted with Dutch HCPs involved in supporting patients with CVD with lifestyle changes. The topics discussed were attitudes toward an incentive system, obstacles to using an incentive system, and possible solutions to facilitate the use of an incentive system.
HCPs perceived an incentive system for healthy living for patients with CVD as possibly effective and showed generally high acceptance. However, there were concerns related to focusing too much on the extrinsic aspects of lifestyle change, disengagement when rewards are insignificant, paternalization and threatening autonomy, and low digital literacy in the target group. According to HCPs, solutions to mitigate these concerns included emphasizing intrinsic aspects of healthy living while giving extrinsic rewards, integrating social aspects to increase engagement, supporting autonomy by allowing freedom of choice in rewards, and aiming for a target group that can work with the necessary technology.
This study mapped perspectives of Dutch HCPs and showed that attitudes are predominantly positive, provided that contextual factors, design, and target groups are accurately considered. Concerns about digital literacy in the target group are novel findings that warrant further investigation. Follow-up research is needed to validate these insights among patients with CVD.
一种支持心血管疾病（CVD）患者改变生活方式的新方法颇具前景，即使用经济激励措施。尽管经济激励措施已被证明是有效的，但其实施仍存在争议，并且引发了伦理方面的反对意见。目前尚不清楚参与心血管疾病护理的医护人员（HCPs）是否认为向心血管疾病患者提供经济激励以支持其生活方式改变是可以接受的。
本研究旨在调查医护人员对于使用经济激励措施来支持心血管疾病患者健康生活的看法。更具体地说，我们旨在深入了解对使用经济激励措施的态度以及在当前心血管疾病护理中实施经济激励措施的障碍和促进因素。
对参与支持心血管疾病患者改变生活方式的荷兰医护人员进行了总共16次半结构化、深入的面对面访谈。讨论的主题包括对激励系统的态度、使用激励系统的障碍以及促进激励系统使用的可能解决方案。
医护人员认为针对心血管疾病患者的健康生活激励系统可能有效，并普遍表示高度接受。然而，也存在一些担忧，包括过于关注生活方式改变的外在方面、奖励微不足道时的参与度下降、家长式作风和威胁自主性，以及目标群体的数字素养较低。据医护人员称，减轻这些担忧的解决方案包括在给予外在奖励的同时强调健康生活的内在方面、融入社会因素以提高参与度、通过允许在奖励方面有选择自由来支持自主性，以及针对能够使用必要技术的目标群体。
本研究梳理了荷兰医护人员的观点，表明只要准确考虑背景因素、设计和目标群体，态度主要是积极的。对目标群体数字素养的担忧是新发现，值得进一步研究。需要进行后续研究以在心血管疾病患者中验证这些见解。
