title: Financial incentives for increasing uptake of HPV vaccinations: a randomized controlled trial.
abstract: 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.
  
  
  METHODS
  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; $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.
authors.affiliation: Centre for the Study of Incentives in Health.
authors.forename: Eleni
authors.initials: E
authors.lastname: Mantzari
authors.affiliation: Institute of Pharmaceutical Science, King's College London.
authors.forename: Florian
authors.initials: F
authors.lastname: Vogt
authors.affiliation: Centre for the Study of Incentives in Health.
authors.forename: Theresa M
authors.initials: TM
authors.lastname: Marteau
mesh_terms: D000293:Adolescent; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D032541:Mass Vaccination / Q000191:economics; D009042:Motivation; D016017:Odds Ratio; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012201:Reward; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D053918:Papillomavirus Vaccines