Appa Ayesha, Miller Amanda P, Fatch Robin, Kekibiina Allen, Beesiga Brian, Adong Julian, Emenyonu Nneka, Marson Kara, Getahun Monica, Kamya Moses, Muyindike Winnie, McDonell Michael, Thirumurthy Harsha, Hahn Judith A, Chamie Gabriel, Camlin Carol S
Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
School of Public Health, San Diego State University, San Diego, California, United States of America.
PLOS Glob Public Health. 2024 Apr 24;4(4):e0002472. doi: 10.1371/journal.pgph.0002472. eCollection 2024.
Economic incentives to promote health behavior change are highly efficacious for substance use disorders as well as increased medication adherence. Knowledge about participants' experiences with and perceptions of incentives is needed to understand their mechanisms of action and optimize future incentive-based interventions. The Drinkers' Intervention to Prevent Tuberculosis (DIPT) trial enrolled people with HIV (PWH) in Uganda with latent tuberculosis and unhealthy alcohol use in a 2x2 factorial trial that incentivized recent alcohol abstinence and isoniazid (INH) adherence on monthly urine testing while on INH preventive therapy. We interviewed 32 DIPT study participants across trial arms to explore their perspectives on this intervention. Participants described 1) satisfaction with incentives of sufficient size that allowed them to purchase items that improved their quality of life, 2) multiple ways in which incentives were motivating, from gamification of "winning" through support of pre-existing desire to improve health to suggesting variable effects of extrinsic and intrinsic motivation, and 3) finding value in learning results of increased clinical monitoring. To build effective incentive programs to support both reduced substance use and increased antimicrobial adherence, we recommend carefully selecting incentive magnitude as well as harnessing both intrinsic motivation to improve health and extrinsic reward of target behavior. In addition to these participant-described strengths, incorporating results of clinical monitoring related to the incentive program that provide participants more information about their health may also contribute to health-related empowerment.
促进健康行为改变的经济激励措施对于物质使用障碍以及提高药物依从性非常有效。为了了解激励措施的作用机制并优化未来基于激励的干预措施，需要了解参与者对激励措施的体验和看法。预防结核病饮酒者干预试验（DIPT）在乌干达招募了患有潜伏性结核病且有不健康饮酒行为的艾滋病毒感染者（PWH），进行了一项2×2析因试验，该试验在接受异烟肼预防性治疗期间，通过每月尿液检测激励近期戒酒和坚持服用异烟肼（INH）。我们采访了32名来自不同试验组的DIPT研究参与者，以探讨他们对这种干预措施的看法。参与者描述了：1）对足够规模的激励措施感到满意，这些激励措施使他们能够购买改善生活质量的物品；2）激励措施具有多种激励方式，从通过支持改善健康的既有愿望实现“获胜”的游戏化，到表明外在动机和内在动机的不同影响；3）从了解增加临床监测的结果中发现价值。为了建立有效的激励计划，以支持减少物质使用和提高抗菌药物依从性，我们建议谨慎选择激励强度，并利用改善健康的内在动机和目标行为的外在奖励。除了这些参与者描述的优点外，纳入与激励计划相关的临床监测结果，为参与者提供更多关于他们健康状况的信息，也可能有助于增强与健康相关的权能。
